Improving Primary Care Pharmaceutical Use
Drugs Program (Kafuko 1996) tested three strategies for disseminating new standard treatment guidelines to health facilities in six districts: (1) simple dissemination of the STG booklet during a visit to collect data to measure the WHO drug use indicators; (2) the STG manual plus follow-up feedback of baseline performance data and targeted training on identified problems; (3) the manual, feedback, and training, plus additional monthly supervisory visits for six months. Across all 16 indicators tested, simple dissemination had no effect; targeted on-site training had consistent positive effects on performance, and supervision sometimes resulted in additional improvement. The behaviors where supervision seemed to make a difference were those that were easier to observe during a supervisory visit, such as consulting and dispensing times, or adequacy of drug labeling.
One district in Indonesia developed a noteworthy variation on the supervisory concept when they implemented a self-monitoring system in which health center staff sampled their own prescription records on a monthly basis, and then used the data to track three simple drug use indicators.(Sunartono 1995) District staff were involved initially in training and motivating local staff to collect and analyze the data, and then later in reviewing the monthly reports. Over an 18-month period, injection use declined by 56%, antibiotic use by 32%, and the number of drugs per prescription by 26%. Another intervention involving monthly audit and personal feedback regarding antibiotic prescribing in a district hospital in Africa resulted in reductions of 28.6% in antibiotic use after three months, but as the monthly feedback sessions became less frequent, antibiotic prescribing rates returned to nearly baseline levels after one year.(van der Hoek 1996)