E-drug: Patient Observed Sterile Treatment (POST)
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[Please see David's specific request further down in this posting. HH]
Patient Observed Sterile Treatment (Post): A Proposal to Empower
Patients to Monitor and Ensure Safe Health Care[1]
D. Gisselquist, E. Friedman, J.J. Potterat, S.F. Minkin, S. Brody
For injections and other simple invasive medical procedures,
practices can be identified and promoted that allow patients (and
parents of young patients) to see that equipment is sterile and that
injected substances are not contaminated. For example, to be sure
that an injection is safe, a patient could ask to see the provider
remove a new auto-disable (AD) syringe from a sealed package and
take the vaccine or medicine from a single-dose vial. An acronym for
all such transparent practices could be POST, for Patient Observed
Sterile Treatment.
For some procedures, such as infusions, dental care, and vaginal
exams, the POST solutions are not so obvious. Local research may
be required to determine acceptability and reliability of some
practices. Some POST practices might have a cost, and the
distribution of costs between consumer and provider may differ from
one setting to another. For many procedures, cost differences are
minimal, and costs may be lower for some safe practices; for
example, taking oral or no medication instead of injections for many
common symptoms.
Defining and implementing POST practices can begin at any level. A
church, for example, may organize meetings between members and
local healthcare providers to discuss and endorse POST practices.
With a shift to POST practices, healthcare consumers aware of risks
of unsterile care can take an active role in monitoring and promoting
safe care.
QUESTION FOR E-DRUG READERS: If POST practices are to be
achieved with vaccinations and other injections, single-dose vials may
be essential. This brings up the issue of the cost difference per dose
between single-dose vs. multi-dose vials. For example, from
UNICEF's website we can see that one dose of hepatitis B vaccine
from a single-dose vial is US$0.24 more expensive than from a
10-dose vial[2]. Many experts say that single-dose vials are too
expensive. So here is the question: If UNICEF and other large buyers
of vaccines for African and Asian developing countries put in large
orders for single-dose vials, what can we expect would be the price
difference per dose between single- vs. multi-dose vials for measles,
hepatitis, and other common vaccines? (To achieve POST in vaccine
injections, are there options other than to shift publicly-funded vaccine
programs to multi-dose vials? For example, vaccine programs could
make both single and multi-dose vials available and allow patients
who prefer single-dose vials to pay the difference. Another option
may be to redesign multidose vials so they will not allow
contamination when withdrawing single doses; is that possible?)
References:
1. Gisselquist D, Friedman E, Potterat JJ, Minkin SF, Brody S. Four
Policies to reduce HIV transmission through unsterile health care. Int
J STD AIDS 2003; 14: 717-722.
2. UNICEF. 2003 vaccine projections: quantities and pricing.
Available from:
www.supply.unicef.dk/health/2003_Vaccine_Projection%20.pdf
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