RESEARCH

 PROPOSAL  
 
BACHELOR  THESIS  MEDICATION  SAFETY  
ON  BEHALF  OF  THE  GIMS  FOUNDATION  
 
by  Chuck  van  de  Cappelle  and  Negina  Nangrahary  
 
 
INTRODUCTION  
 
Background  
The  health  risk  through  the  use  of  medicines  is  a  problem  that  not  everyone  is  familiar  
with.  It  is  not  fully  clear  how  different  countries  in  the  world  think  about  this  topic,  and  
what  they  do  about  it.  The  term  medication  safety  is  a  broad  term,  and  is  interpreted  
differently  by  various  countries.    
 
The   Global   Initiative   on   Medication   Safety   Foundation   (GIMS)   drafted   its   own  
definition   for   the   term   medication   safety:   “Minimize   health   risks   originated   by   the  
global  use  of  medicine”.  
 
GIMS   was   founded   in   2014   and   is   supported   by   the   board   of   Farmacie   Mondiaal  
Foundation.   GIMS   wants   to   initiate   and   create   a   higher   level   of   (awareness   of)  
medication   safety.   To   minimize   the   health   risks   originated   by   the   global   use   of  
medicine,   GIMS   aims   at   creating   awareness   and   responsibility   in   the   medical   chain,  
health   care   governance   and   patients   worldwide.   GIMS   focuses   on   supporting  
responsible   parties   in   the   medical   chain   and   health   care   governance   to   improve   the  
level  of  professionalism  of  the  processes  and  structures  of  prescribing  and  dispensing  
of  medicine  and  guidance  of  patients  in  how  to  use  medicine.  
 
Problem  statement  
The  main  goal  of  this  bachelor  thesis  is  to  gain  insight  in  the  degree  of  awareness  of  
professionals   and   concerned   directors   (in   the   medical   chain   in   different   countries)  
regarding  the  health  risks  through  the  use  of  medicines  (medication  safety).  
 
The  secondary  goal  is  to  gain  insight  in  the  process  of  prescribing,  dispensing  and  the  
guiding   of   patients   with   the   use   of   medicines   in   the   different   countries.   It   will   be  
studied   how   this   process   and   the   sub   processes   are   structured,   and   how   the   data   is  
processed,  coupled  and/or  automated/digitized.  We  look  which  ICT  systems  are  used  
in  the  medical  chain.  The  conditions  that  determine  the  parameters  are  also  important  
(economy,   3G/4G   coverage,   internet   infrastructure,   culture,   religion,   governments,  
availability  of  medicines)  
 
APPROACH  
 
Regions  and  countries  
Two   students   will   each   work   on   separate   bachelor   theses.   These   theses   differ   from  
each  other  in  the  target  countries  that  are  being  studied.  The  countries  are:      
 o Europe:   The   Netherlands,   Germany,   United   Kingdom,   Belgium,   France,  
Switzerland,  Sweden,  Poland,  Portugal,  Greece  
o Asia:  Afghanistan,  Iran,  Israel,  United  Arab  Emirates,  Laos,  Japan  
o Africa:  Egypt,  Ghana,  Kenya,  Rwanda,  South  Africa  
o North  America:  United  States  of  America,  Canada    
o South  America:  Suriname,  Argentina  
o Australia:  Australia  
 
Chuck   van   de   Cappelle   will   study:   United   Kingdom,   Belgium,   Portugal,   Poland,  
Switzerland,   Iran,   Israel,   United   Arab   Emirates,   Rwanda,   Kenya,   United   States   of  
America,  Argentina,  Australia  
 
Negina   Nangrahary   will   study:   The   Netherlands,   Germany,   France,   Sweden,   Greece,  
Afghanistan,  Laos,  Japan,  Egypt,  Ghana,  South  Africa,  Canada,  Suriname  
 
In  the  African  countries,  it  is  important  that  in  terms  of  medication  the  focus  will  be  on  
HIV,  malaria  and  tuberculosis.  Since  they  are  dominating  diseases  in  those  countries.    
 
Literature  study  and  interviews  
Each   country   will   be   studied   through   a   literature   study   and   by   interviewing  
professionals  in  the  countries.  
 
For  each  country  a  literature  study  will  be  done  on  what  is  already  known  about  the  
health   risks   of   using   medicines   in   that   country.   Therefore,   this   bachelor   thesis   has   a  
scientific   nature.     The   interviews   take   place   after   the   literature   study   is   finished.   The  
student  will  try  to  make  contact  with  pharmacists,  professional  associations,  insurance  
companies,  governments  and  the  WHO.  
 
The  professionals  will  be  interviewed  on  the  basis  of  a  questionnaire.  The  students  will  
do   this   by   a   dynamic   approach,   in   which   the   questionnaire   can   be   adjusted   on   the  
basis  of  later  insights.  
 
Neutral  point  of  view  
Culture,   religion   and   governmental   power   are   sensitive   issues   and   can   have   a   major  
impact  on  the  national  and/or  local  process  of  prescribing,  dispensing  and  the  use  of  
medicines.  
 
GIMS   is   a   non-­‐governmental,   non-­‐political   and   non-­‐religious   organization.   GIMS   will  
adopt   a   neutral   position   at   all   times.   The   students   should   also   take   a   neutral   stand  
during  the  whole  bachelor  thesis.    
 
FINAL  PRODUCT  
 
The  bachelor  thesis  will  result  in  two  final  products:  a  project  report  and  an  overview  
of  the  main  results  of  the  studied  countries.  The  project  report  will  be  a  text  document  
containing   the   approach,   literature   study,   results,   conclusions   and   advices.   How   the  
overview  document  will  be  is  not  clear  yet.  
 
The  products  will  be  written  in  English,  and  be  published  on  the  website  of  GIMS.    
APPENDIX  1:  LITERATURE  STUDY  
 
For  each  country  a  literature  study  will  be  done  on  the  awareness  of  the  health  risks  
when  using  medicines  (medication  safety)  in  that  country.    
 
The  search  for  studies  on  the  topic  of  medication  safety  will  be  done  at  organisations,  
foundations,   governments,   universities   and   other   sources.   Besides   the   search   for  
studies,   we   will   ask   respondents   in   the   interviews   if   they   are   aware   of   studies   in   the  
field  of  medication  safety  in  their  country.  
 
The  following  questions  will  be  studied  for  each  country:  
o What  is  the  general  awareness  on  medication  safety?  
o What   studies   have   already   been   conducted   in   the   field   of   medication   safety?  
And  what  are  the  results  of  these  studies?  
o How  is  the  health  care  structured  in  the  concerning  country?  
o What   laws   and   regulations   does   the   government   set   in   terms   of   medication  
safety?  
o Which   guidelines   do   professional   organisations   have   in   terms   of   medication  
safety?  
 
APPENDIX  2:  INTERVIEWS  
 
The  professionals  will  be  interviewed  on  the  basis  of  a  questionnaire.  This  is  done  by  a  
dynamic   approach,   in   which   the   questionnaire   can   be   adjusted   on   the   basis   of   later  
insights.   It   is   important   that   the   students   take   an   open,   neutral   stand   to   the  
respondents.  The  students  should  not  judge  during  the  interview.    
 
The  questionnaire  is  given  below.  The  questions  are  written  in  general.  In  the  African  
countries,  it  is  important  that  in  terms  of  medication  the  focus  will  be  on  HIV,  malaria  
and  tuberculosis.    
   
QUESTIONNAIRE  
   
Diagnosis  and  prescribing    
1. Where  does  a  patient  go  when  he  doesn’t  feel  well?  
2. Who  makes  the  diagnosis?  
3. What  happens  after  the  patient  has  been  diagnosed?  
4. Who  is  allowed  to  prescribe  medicine?  
5. How  are  medicines  prescribed?    
I. Digital  or  by  paper?  
6. What  happens  after  a  medicine  is  prescribed?  
7. Who  are  allowed  to  sell  medicine?  
 
Processes  in  the  pharmacy  
8. What   is   the   process   from   a   prescription   that   enters   the   pharmacy   to  
medication  dispensing  by  the  responsible  person?    
I. What  kind  of  ICT-­‐systems  are  used  in  this  process?  
II. What  are  the  ICT-­‐systems  used  for?    
9. Are  there  any  checks  done  on  a  prescription?    
I. Who  does  those  checks?    
II. What  kind  of  checks  are  done?    
III. In  what  extent  are  you  familiar  with  the  terms:  drug  interaction;  dosage  
control;  double  medication  and  contraindications.  
10. Are  there  certain  medicines  that  need  extra  vigilance?  
11. Do  patients  always  need  to  go  to  the  same  pharmacy?  Or  are  they  always  going  
to  different  pharmacies?  
12. Is  the  prescription  included  in  a  patient  medical  record?    
I. Is  this  done  in  a  paper  file  or  a  digital  file?    
II. What  kind  of  ICT-­‐system  is  used  for  this  patient  medical  record?  
13. What  happens  when  a  medicine  is  dispensed  to  a  patient  for  the  first  time?  
14. In  what  extent  is  an  explanation  given  on  how  the  medicine  should  be  used?  
15. In   what   extent   is   the   importance   of   patient   compliance   explained   to   the  
patient?    
I. How  is  the  compliance  of  the  patient  checked  afterwards?  
 
 
 
Availability  of  medicines  
16. What  is  the  state  of  the  availability  of  medicines?  
17. In  what  extent  does  the  availability  of  medicines  affect  the  medication  safety?  
 
Contact  with  other  professionals  
18. In  what  extent  do  you  have  contact  with  other  health  care  professionals?  
I. What  kind  of  contact  is  this?  
19. What  happens  when  the  pharmacist  does  not  agree  with  the  prescription?  
I. Is   the   pharmacist   allowed   to   change   a   prescription   by   himself   or   does   he  
need  approval  from  a  doctor?  
20. Do  pharmacists  and  general  practitioners  have  a  joint  system?    
I. What  kind  of  system  is  this?  
21. In   what   extent   are   other   pharmacists   in   your   country   allowed   to   look   into   a  
patients  medication  overview?    
I. Is  there  a  joint  system  between  pharmacies?  
II. What  kind  of  system  is  this?  
 
The  pharmacy  and  pharmacist  
22. What  education  is  required  to  become  a  pharmacist?  
23. Are  there  pharmacies  that  belong  to  a  pharmacy  chain?  
24. Who   owns   the   pharmacies   in   your   country   in   general?   The   pharmacist,   a  
pharmacy  chain,  a  company,  the  government  or  a  combination  of  those?  
 
Medication  safety  
25. Can  you  explain  what  you  think  medication  safety  is?  
26. What  do  you  think  of  the  level  of  medication  safety  in  your  pharmacy?  
27. Do  you  see  opportunities  to  improve  the  medication  safety  in  your  pharmacy?  
28. In  what  extent  do  you  have  the  will  to  improve  the  medication  safety?  
29. Do   you   know   any   studies   that   have   been   done   on   the   topic   of   medication  
safety  in  your  country?  
 
End  of  the  interview  
30. How  have  you  experienced  the  interview?  
31. Is  it  good  if  I  have  the  possibility  to  contact  you  later  with  new  insights?  
32. Do  you  want  to  have  your  name  in  the  final  project  report?  
33. Do  you  want  to  receive  the  final  project  report  of  this  bachelor  thesis  when  it  is  
finished?