PharmcLink

Non-adherence to drug refill is reported to be at over 28.9% among diabetes patients in Uganda and remain suboptimal among hypertension and multimorbidity patients [1]. The trend is similar for other refill patients. Literature further indictes a higher rate of non-compliance with medications in patients with Diabetes and Hypertension in developed countries [2]. The Annals review report in the USA estimated that nonadherence to medication leads to 125,000 deaths and as many as 10% of hospitalizations every year at a cost of at least $100 billion possibly as high as $289 billion. Furthermore, the manual refill patient’s information management in over 90% of pharmacies in Uganda is tedious, time consuming and error prone for the pharmacist as most pharmacies have a manual register where patient details and prescriptions are written. Missing of the refill is usually caused by the patients forgetting the refill date as the manual filling system cannot remind them, ignorance of the consequences of non-adherence as there is no continuous communication between pharmacies / drug shops and patients, finding medicines missing at the time of collection as pharmacies do not have a direct link between daily/monthly/weekly expected patients and available drugs. Once patients leave the hospital or lab, they are usually sent to a pharmacy to buy the drugs, however there is always no link between the hospital and the pharmacy/drug; hence there is always no follow-up from the doctors if the patients have received the drugs and hence some patients get lost on the way (lost to contact after referral) as reported in several reports [3].

[1] Kalyango, J. N., Owino, E., & Nambuya, A. P. (2008). Non-adherence to diabetes treatment at Mulago Hospital in Uganda: prevalence and associated factors. African health sciences, 8(2).

[2] Allaham, K. K., Feyasa, M. B., Govender, R. D., Musa, A. M. A., AlKaabi, A. J., ElBarazi, I., ... & Khan, M. A. (2022). Medication Adherence Among Patients with Multimorbidity in the United Arab Emirates. Patient preference and adherence, 16, 1187.

[3] Choun, K., Achanta, S., Naik, B., Tripathy, J. P., Thai, S., Lorent, N., ... & Zachariah, R. (2017). Using mobile phones to ensure that referred tuberculosis patients reach their treatment facilities: a call that makes a difference. BMC Health Services Research, 17(1), 1-7.

PharmcLink improves patient adherence through SMS reminders, app notifications, access to personal prescriptions, and drug orders; linking pharmacies to hospitals and streamlining pharmacy workflow management minimizing supply chain inefficiencies through linking drugs availability to patients; access to patient prescriptions; and empowering pharmacies to set up online pharmacies. The platform has been developed with a team of end users including patients, clinicians and pharmacists part of the design process and to date, there is no platform offering the integrated functionalities provided by our platform. PharmcLink is a 3-in-one digital health tool with a pharmacy management system, a digital pharmacy marketplace where patients can order drugs from the nearest pharmacy; and interoperability with different hospital information management systems. The pharmacy management system tracks drug inventory, dispensing/sales, refills; and patients’ referrals from hospitals to pharmacies. These referrals to the pharmacies are informed by real-time prices of drugs from the nearest pharmacies and distance from the patient’s address or patient choice. The digital pharmacy marketplace is a one-stop centre for drugs from authentic pharmacies. To date, patients are provided with the medication written on paper from hospital to pharmacy, but this is risky as some patients lose this information; or never get these medications. For those refill patients who reach the pharmacy, their prescriptions are usually written in a book or requested to make a photocopy so that they leave it at the pharmacy, but there is no tracking and it is hard to get their details when they return. Pharmacists have a pivotal role in primary health care since they are custodians of the drugs for any patient, but to date, their potential in strengthening the health care system through data collection is not well utilized. We are introducing a new way of measuring primary health care performance improvement in low- and middle-income countries based on medication adherence monitoring and enforcement of refill patients; referral monitoring of patients from the hospital to the pharmacy, communication between patients and prescribers; and access to drugs and personal prescriptions. The developed platform can provide insights leading to investigation of the causes of non-adherence among refill patients, loss to follow-up patients from hospitals to pharmacies, and reasons why a particular pharmacy /drug shop is preferred over the others. These insights can be used to inform decision-makers about strengthening primary health care. The primary data is captured by the pharmacists who are key in primary health care but have always been ignored; and the clinicians (prescribers) in the hospitals. The platform also extracts data insights from the platform data for decision support using machine learning algorithms.

Government pharmacies in public hospitals, hospitals to link patients to pharmacies, Pharmacies/drug shops for refill management, dispensing and inventory, telemedicine connect patients and pharmacies; individuals for reminders and drug ordering.

The platform will specially help refill patients especially those with Hypertension, Coronary heart diseases, Diabetes and Hyperlipidemia. The platform is helping those refill patients with rare diseases including cystic fibrosis, generalized lipodystrophy, homozygous familial hypercholesterolemia, urea cycle disorders and phenylketonuria. Finally, the platform is also very useful to multimorbidity patients who usually have multiple medications for the different diseases. Refill patients are usually senior citizens (older population) who are usually helped by care takers (usually children) to pick the drugs; and this increases chances of missing the refill dates when these care takers are not around. SMS reminders; and calls from their pharmacies can increase adherence, tracking referrals from hospitals to pharmacies; and providing platform for online ordering will help these patients adhere to medications. Furthermore, simplified search for referral patients at any pharmacy will ensure that each patient gets the right patient drugs as per their subscriptions.

We are a digital health company with an ultimate aim of digitizing health care in Uganda through developing integrated systems that are HL7 data compliant and communicating with others. We have expertise in building similar platforms including a COVID-19 patient information management system in partnership with WHO and an oncology digital system in partnership with USAID. We have worked with over 20 pharmacies in Uganda developing tools to improve pharmacy management and interactions with patients. We are a company that develops solutions to solve community challenges with the end users’ part of the design process. The company has some of its members as a beneficially of the refilling functionality as the platform constant reminds her of her next refill date; and she does not need to carry her patient drugs. We have head offices in western Uganda reaching some of the remote areas in Uganda; and also in central Uganda with the highest population of refill patients.

We are seeking an investment worth $100,000; where $20,000 to upgrade the cloud hosting facility for increasing data safe storage, $10,000 for SMS credit to send reminders to refill patients, $ 21,000 for marketing in and outside Uganda, $ 24,000 to set up extra offices; and $ 25,000 for ICT infrastructure to support platform upgrades including local AI development and building local data science models. These funds will help us overcome these which are currently our barriers to scaling.

Tools like DHIS2 and OpenMRS support hospital information management and ministry of health, but do not connect to different pharmacies which are the end points for any patient. No platform in Uganda is empowering pharmacies to go online, creating a network of e-pharmacies; and bridging the gap of following up patients from hospitals/prescribers to pharmacies.

PharmCLink is based on HL7 medical standard making it able to communicate with other hospital information management software including our own hospital information management software in use in Uganda. This will enable patients’ prescriptions from these hospitals be routed to any pharmacy based on proximity to the patient, pricing, public rating; prescribers’ judgement or patient’s choice. The platform also sends encrypted messages as reminders to the patients; and also, these are helping increase drug adherence. A pharmacy using PharmcLink can create its own online shop; and PharmcLink is based on software as a service architecture. PharmcLink is going to change how patients access their patients’ drugs, and strengthen primary health care through a leveraged ground communication platform among the pharmacists, prescribers and patients.Some of the available softwares like the refill management software, pharmacy management software in use in other countries like India, may not work in the localised setting because of the differences in clinical walkthrough, Internet connectivity challenges and interoperability with locally developed systems. Our platform has been developed with several pharmacists, medical officers, patients and policy makers in Uganda.

At Digital Health Uganda, we utilize the design thinking approach to design and develop solutions for our end-users. We invest time in developing an understanding of the people for whom we're designing the products or services helping us observe and develop empathy with them. Our vision is to be the leading and reliable Digital Health solutions provider of choice in the African region by 2050 thereby improving wellness and wellbeing on the continent; and our mission is to streamline and automate a hospital, Pharmacy, clinical data and disease management along the continuum of patient care. With our product PharmcLink, our goal is to be the leading digital pharmacy platform provider of choice in the East African region by 2030 thereby bringing safe and affordable drugs closer to the people. This will be archived through our public platform that can be used to order drugs from the nearest certified pharmacies or drug shops. Our second goal is to be the most trusted digital health link among hospitals, pharmacies and patients in the East African Region by 2030 thereby reducing patient loss to follow-up; and increasing adherence to medications. This will be archived through our platform that provides digital pharmacy management including refill patient management, drug inventory and dispensing; and our hospital information management system that communicates with registered pharmacies and labs.

Next year we want to scale PharmcLink to atleast1 million public users; 20 pharmacies; and 10 hospitals in year 1. We shall profile and map authentic and registered pharmacies and drug shops in Uganda; and put this information on a public portal. Once we obtain accredited pharmacies/drug shops from the ministry of health, we shall map them and register them on the platform for the public to have access to the nearest pharmacy around them. These pharmacies once registered can create accounts and set up online pharmacies. We have already developed, tested, and piloted this fully-fledged platform based on feedback and are now ready to scale and market it to the public after over 3 years of moving back and forth with requirements. 

In the next 5 years, we shall connect with pharmaceutical companies and drug manufacturers so that pharmacies can able to make drug orders and track these orders through the platform.

The number of refill patients returning to pick up their patient drugs is an indication of a possibility of increasing medication adherence. In the future we shall conduct a cross-sectional study to ascertain if a return to pick drugs is influenced/triggered by the SMS. However, from similar studies, SMS have proven to be a contributing factor to adherence to patient follow-ups. Patient throughput at pharmacies using PharmcLink as refill patients details and prescriptions can easily be located and patients are assured of receiving the correct drugs; drug availability at pharmacies as pharmacies have records of required drugs for refill patients for a given period visa vie the available stock. This ensures continuous availability of drugs and lastly tracking of patient referrals from hospitals/prescribers to pharmacies.

Goals:

Goal 1: To be the most trusted digital health link among hospitals, pharmacies and patients in the East African Region by 2030.

Goal 2: To be the leading digital pharmacy platform provider of choice in the East African region by 2030

Objectives

To increase adherence to medications by refill patients through streamlining the refill patient’s information management. This will help us archive goal one.

 To reduce patient loss to follow up from hospitals/prescribers to pharmacies through an integrated digital communication link between the pharmacies and the prescribers (hospitals/Labs/Clinics). This will help us archive goal one.

To bring safe and affordable drugs from authentic providers (pharmacies and drug shops) closer to the people. This will help us archive goal two.

Activities

• Scale PharmcLink in pharmacies
• Scale PharmcLink in hospitals
• Launch ePharmacy to the public
• Profile and map pharmacies and drug shops in Uganda.
• Train end users
• Advertise PharmcLink

Outputs

• PharmCLink scaled up in over 20 pharmacies; and 10 hospitals in Uganda.
• PharmCLink public portal launched to the public.
• A public repository of authentic and approved pharmacies and drug shops in Uganda.
• A training module or help link on the platform availed to the public and all PharmCLink users.
• Massive advertisement using Google Ads on different websites

Outcomes

• Increased knowledge and adoption of PharmcLink platform in Uganda.
• Increased information about approved and authentic pharmacies and drug shops in Uganda availed to the public.
• Registration of mature, safe and appropriate medical technologies/companies in Uganda.

Impact

Increased medical adherence by refill patients leading to better health outcomes as this has been reported in several studies [1,2].

Increased patient follow-up for refill patients leading to increased adherence to refill schedules [1].

Reduced loss to follow-up of patients from hospitals to pharmacies leading to increased adherence

Increased access to safe and affordable drugs from authentic pharmacies and drug shops by the public.

[1] Kalyango, J. N., Owino, E., & Nambuya, A. P. (2008). Non-adherence to diabetes treatment at Mulago Hospital in Uganda: prevalence and associated factors. African health sciences, 8(2).

[2] Allaham, K. K., Feyasa, M. B., Govender, R. D., Musa, A. M. A., AlKaabi, A. J., ElBarazi, I., ... & Khan, M. A. (2022). Medication Adherence Among Patients with Multimorbidity in the United Arab Emirates. Patient preference and adherence, 16, 1187.

Our technology is driven by 4 core technologies i.e. data science, SMS technology, AI and SMS messages are utilized to remind refill patients of their next refill date. These are sent to any phone number and any type of phone including cellular phones. PharmcLink is a 3-in-one digital health tool with the pharmacy management system, an ePharmacy web platform; and an API that connects to proprietary, open source or our own hospital information management system. The pharmacy management system tracks drug inventory, dispensing/sales and patient refills. The drug inventory uses a data-driven inventory optimizing algorithm to guide pharmacy owners when to stock based on previous consumptions and upcoming refill patients’ appointments. The public uses ePharmacy to locate the nearest pharmacies and patients’ referrals from hospitals guided by real-time prices of drugs from the nearest pharmacies. The hospital information management system also uses geo coordinates, price information and ratings to locate the nearest approved and authentic pharmacy to refer to a patient. However, this AI model can always be overridden by the prescriber or patient’s choice. PharmCLink also has a custom-developed API that helps it communicate with other systems that were developed using open standards like HL7.

The primary health care is collected by the health Workers in any hospital using a hospital or patients information management system. With consent from patients, this data (patient name and prescription) is shared with the connected pharmacies. This is to reduce loss to follow-up since they know where these patients will go and pick drugs with a confirmation notice from pharmacy to hospital. The primary data is also collected by Pharmacists in pharmacies for those pharmacies not connected to any hospital. This will ensure that it is easy to follow up on these patients for refill schedules, and also easy to look up their patient drugs when they return. This will save time going through a book to find patient drugs.

We are a team of 6 composed of 3 males and 3 females. The company is fully registered in Uganda with a recruitment policy (human resource), sexual harassment policy; and diversity, equity, and inclusivee policy. The human resource policy and manual clearly stipulates a fair pay mechanism, working hours and communication strategy within and outside the organization. The hiring policy gives equal opportunities to every one irrespective of gender, religion, culture and race. We shall ensure that the team is periodically trained, and well equipped to take PharmCLink to the next level.

Our key customers are pharmacies. We are providing their software as a service. The pharmacy management system tracks drug inventory, dispensing/sales and patient refills. The drug inventory uses a data-driven inventory optimizing algorithm to guide pharmacy owners when to stock based on previous consumptions and upcoming refill patients’ appointments. PharmCLink also has a custom-developed API that helps it communicate with other hospital or patient information management systems that were developed using open standards like HL7. The other users are the public who use ePharmacy to locate the nearest pharmacies and patients’ referrals from hospitals guided by real-time prices of drugs from the nearest pharmacies.

We shall sustain the project through subscriptions from pharmacies using the pharmacy management system. We shall also get service commissions from pharmacies using the ePharmacy module where the public can order drugs of choice from the pharmacy. We shall also obtain commission from the transportation agents (Boda Bodas) that we shall link with Pharmacies to deliver the ordered drugs to the clients. We also expect the ePharmacy platform of PharmCLink to generate a lot of traffic hence we shall generate revenue through running ads as a way of sustaining the hosting costs.

To date, we have 8 pharmacies using PharmCLink, especially the patient's refill information management. These are on a subscription and funds raised per month can support hosting fees and maintenance fees. We also have a hospital information management system that compliments PharmCLink. We intend to generate more revenue from Google Ads in the public digital pharmacy marketplace.