Improving Primary Care Pharmaceutical Use
CCM intervention measured changes in child mortality that resulted from improvements in case recognition and appropriate therapy. Four of the 5 diarrhea interventions also collected outcome data on the incidence or duration of diarrhea in the community. Except for these CCM studies, none of the other interventions attempted to measure actual changes in patient health resulting from interventions to improve quality of pharmaceutical care. Patient outcomes like improvements in knowledge about illness or drugs, changes in satisfaction, or changes in care seeking behavior have been rarely unstudied.
The overall rate of success of interventions in substantially improving at least one targeted outcome has been reassuringly high (Figure 3). There were 35 studies, containing 42 separate interventions, for which reliable data were available to evaluate impacts; one study was excluded because results appeared to be due primarily to changes in the control group.(Kafle 1995a) Authors in these 35 studies reported at least one large impact (>25% improvement in a targeted outcome relative to controls) in 42.8% and moderate impacts (10-25% improvement) in 35.7% of the 42 interventions; only 21.4% of interventions had very low or no impact (<10% improvement). The 30 interventions that targeted a prescribing practice as their principal outcome (as opposed to child mortality) demonstrated a median improvement relative to controls of 18.4% (25th percentile = 9.3%, 75th percentile = 28.6%). For the 7 CCM interventions targeting child mortality as the major outcome, the median relative reduction in mortality was 28.3% (25th percentile = 24.4%, 75th percentile = 55.0%).