Download The effect of an educational activity on the practices of drugstore

The effect of two educational activities on the
practices of drugstore sellers in the
Philippines
Rainier M Galang
Executive Director
National Drug Information Center
Manila, Philippines
Background
 Drugstore sellers in the Philippines
* In privately-owned drugstores
* No formal training in pharmacy
* Sought by consumers for advice
* Dispense drugs without supervision
from pharmacist
 Privately-owned drugstores
* Largest source of drugs nationwide
Objectives
 To determine the prevalence of three
undesired practices of drugstore sellers
 To evaluate the effect of two educational
interventions on these practices
The practices were
 Incomplete dispensing [outright filling of
erroneous
single
prescription
of
rifampicin for tuberculosis (TB)];
 Dispensing
amoxicillin
without
prescription for a child with acute
respiratory tract infection (ARI) and;
 Recommending antibiotics where they
may not be needed for an adult with flu
symptoms.
Methods
Study design : Non-randomized comparative,
pre-post intervention study
Interventions
1. Moderated interactive group discussion
(IGD):
 Involving drugstore sellers and mothers
 Discussed rational treatment of tuberculosis,
acute respiratory tract infection and flu (as
well as of wounds)
 Leaflets distributed
Methods
Interventions
2. Drugstore visit (DSV):
(Drugstores not represented at IGDs)
 5-10 minute visit from research team
 Main educational messages were conveyed
verbally
 Leaflets distributed
Outcome Measures
3 dispensing practices
-Before intervention
post- intervention
and 1-month
-Collected through trained surrogate
clients
Results
 Study population : 271 drug stores
85 in the IGD intervention group
52 in the DSV group
134 in the control group
(average 2 to 3 sellers per drugstore).
 Drugstore sellers
Almost all female
20-29 year age group
Age range: 14-75 years
Only 90 sellers [10.2% ] were pharmacists of
which 50 were drugstore owners
 Intervention and control groups comparable
Results
Baseline practices
(For all groups)
 99.3% of drugstores filled erroneous single
prescriptions of rifampicin for TB
 83.4% dispensed amoxicillin without a prescription
for ARI
 73.4% recommended antibiotics for flu symptoms
Results
Post-intervention practices
 Filling erroneous prescription for TB:
No change in all 3 groups
 Dispensing amoxicillin:
IGD group: reduced 23.1% , p=0.001
DSV group: reduced 11.0%, p=0.1317
Control group: increased 18.7% , p=0.0018
 Recommending antibiotics for flu symptoms:
IGD group: reduced 17.3%, p=0.0046
DSV group: reduced 2.1%, p=0.7389
Control group: reduced 7.3%, p=0.2207
Results
Multiple logistic regression analysis (MLRA)
Pre-intervention practice had significant effect
on post- intervention practice in the IGD group
 Dispensing amoxicillin
[OR=0.27, (95% CI: 0.12-0.61)]
 Recommending antibiotic for flu
[OR=12.54, (95%CI:6.2-25.3)]
Figure. Comparison of pre- and post-intervention practices of
drug sellers
(IGD group: n = 85, DSV group: n = 52, Control group: n = 134)
Fills erroneous single prescription of rifampicin for
tuberculosis
100
100
100
98.5
99.3
100
75
75
%
100
50
91.8
88.5
70.6
90.3
78.8
76.1
Post
Pre
50
25
25
0
0
Pre
Post
Pre
IGD
Post
DSV
Pre
Post
Pre
Control
Post
IGD
Recommends antibiotic for an adult with flu
symptoms
100
88.2
72.9
75
%
%
100
Dispenses amoxicillin without prescription for a child
with ARI
82.7
80.8
60.4
56
Pre
Post
50
25
0
Pre
Post
IGD
Pre
Post
DSV
Control
Pre
DSV
Post
Control
Note:
IGD = Interactive group discussion
DSV = Drug store visit
ARI = Acute respiratory tract infection
Conclusions
 Filling erroneous single prescriptions of
rifampicin was not significantly changed in
all groups.
 Dispensing amoxicillin without prescription
for a child with ARI
was significantly
decreased in the IGD intervention group.
 Recommending antibiotics for flu symptoms
was significantly decreased in the IGD
intervention group.
Conclusions
The drug seller profile
 No training on dispensing (Only 90 of the 855
sellers [in 271 drugstores in the study] were trained
pharmacists)
 Young female
 With little formal schooling
Recommendations
 Drugstore sellers education
 Enforcement of minimum standards of practice
THANK YOU
Research team:
IC Sia, RM Galang, O Mendoza, JA Reyes,
AMA Bernardo, D Estrada, C Quiroga, A Santiago
National Drug Information Center
&
Drug Use Study Group, University of the Philippines
Manila
Supported by Applied Research on Child Health project
(ARCH)