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Rationale, Aims and Objectives: Asia-Pacific carries a high burden of respiratory-related mortality. Timely referral and detection of tuberculosis cases optimizes patient and public health outcomes. Registered private pharmacies in Cambodia participate in a National Tuberculosis Referral Program to refer clients with cough suggestive of tuberculosis to public sector clinics for diagnosis and care. The objective of this study was to investigate clinical intentions of pharmacy staff when presented with a hypothetical case of a client with prolonged cough suggestive of tuberculosis., Method: A random sample of 180 pharmacies was selected. Trained interviewers administered a hypothetical case scenario to trained pharmacy staff. Participants provided 'yes'/'no' responses to five clinical actions presented in the scenario. Actions were not mutually exclusive. Data were tabulated and compared using chi-square tests or Fisher's exact tests., Results: Overall, 156 (92%) participants would have referred the symptomatic client in the case scenario. Participants who would have referred the client were less likely to sell a cough medicine (42% vs. 100%, P < 0.001) and less likely to sell an antibiotic (19% vs. 79%, P < 0.001) than those who would not have referred the client., Conclusion: Involving pharmacies in a Referral Program may have introduced concepts of appropriate clinical care when responding to clients presenting with cough suggestive of tuberculosis. However, results showed enhancing clinical competence among all referral programme participants particularly among non-referring pharmacies and those making concurrent sales of cough-related products would optimize pharmacy-initiated referral. Further research into actual clinical practices at Referral Program pharmacies would be justified., (© 2015 John Wiley & Sons, Ltd.)

Rationale, Aims and Objectives: Cambodia is one of the 22 countries with a high burden of tuberculosis (TB). People often first seek treatment for cough and other TB symptoms through private pharmacies. The National Tuberculosis Programme trained willing private sector pharmacies to refer TB symptomatic clients to their closest public sector clinic for diagnosis and treatment. The study objective was to investigate factors associated with referral of TB symptomatic clients from pharmacies to public sector clinics in Phnom Penh, Cambodia., Method: Face-to-face structured interviews were conducted with staff from a stratified random sample of 180 private pharmacies in Phnom Penh in 2012. Trained interviewers were Khmer speakers. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with self-reported referral during the previous 3 months., Results: Fifty (29.6%) pharmacies reported that they had referred 125 clients (range 1-10) to public sector clinics during the previous 3 months. In total, 164 (96.5%) pharmacies reported that they always referred all TB symptomatic clients to DOTS (directly observed treatment, short course) clinics. More than 6-year participation in the programme (OR 5.23, 95% CI 1.93-14.18) and willingness to always continue referring (OR 12.24, 95% CI 11.61-93.10) were associated with referral of one or more clients in the previous 3 months. Referral to the client's closest clinic was negatively associated with referral (OR 0.45, 95% CI 0.23-0.99)., Conclusion: Pharmacies' ongoing commitment to the Referral Programme was strongly associated with referral. Increased advocacy among the high number of non-referring pharmacies may improve programme performance. Factors negatively associated with referral may need investigation., (© 2015 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.)

Intensifying detection of tuberculosis (TB) symptomatic patients is a priority for Cambodia's National Tuberculosis Program, in a country where two-thirds of the population has latent TB infection. In 2005, the National Tuberculosis Program initiated a public-private mix (PPM) collaborative program with external and local stakeholders to identify and refer persons with TB symptoms from private sector pharmacies to public sector clinics for diagnosis and treatment. This qualitative study conducted in-depth interviews with organizational stakeholders to assess their perceptions of PPM program collaboration and its sustainability in the long term. Results showed that stakeholders perceived that collaboration and efficient management had contributed to positive program performance. However, stakeholders expressed anxiety over program sustainability should external resources be reduced. Recent developments in pharmacy undergraduate education and recognition of pharmacy providers' contribution to public health interventions may challenge PPM stakeholders to shift the paradigm from dependence on external agencies to confidence in local expertise and infrastructure., (© 2013 APJPH.)

Setting: Since 2005, private pharmacies linked to the National Tuberculosis Programme (NTP) and the Municipal Health Department in Phnom Penh have referred tuberculosis (TB) symptomatic patients to public sector TB clinics., Objective: To investigate the attitudes and practices of pharmacy-initiated referral service providers in Phnom Penh from 2005 to 2010., Methods: In a qualitative study, participants were purposively selected from the register of pharmacy owners providing referral services. Discussions were conducted in Khmer by trained facilitators. Participants discussed topics relating to their experiences and participation in the referral programme., Results: In January 2011, 54 pharmacy owners participated in six focus group discussions held in Phnom Penh. Interpreted data showed consistency of message across all topics. The emergent themes-altruism, pragmatism and professionalism-underpinned owner commitment to programme goals. Issues associated with patient counselling, fear of infection and quality of care in public sector clinics were of concern to participants. Owners believed ongoing professional support, improved public sector patient care and media campaigns would strengthen their role., Conclusion: Pharmacy outlets provide further options for NTPs engaging with private sector providers. Recognising private provider needs and aspirations may be an essential component of public/private mix programmes to meet public health goals.