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CITATION: Presented at the International Conference on Improving Use of - page 27 / 51

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Improving Primary Care Pharmaceutical Use

in public practice are usually unavailable; possibilities include pharmacy-based data collection and use of the insurance databases which are growing in importance in many countries.

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We need much more information on the impacts of national essential drugs programs, and more broadly, on the implementation of national drug policies.  The Zimbabwe strategy of regular surveys to monitor program impacts should be a model for all programs.  To better understand program impacts, countries should explore strategies like phased implementation (e.g., implementing changes one region at a time, or separating planned program changes in time to allow separate evaluation of impacts) and more planned use of time series in sentinel areas.

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More needs to be known about whether, and under what circumstances, interventions directed at prescribers and dispensers result in better patient outcomes.  With the exception of reduced mortality due to the ARI and diarrhea community case management interventions, we know little about whether patient clinical outcomes improve when drug prescribing becomes more effective.  It would also be useful to know how improved communication by prescribers and dispensers effects intermediate patient variables such as knowledge about illness and therapy, satisfaction with treatment, and eventual compliance with recommended therapy.

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Except for a few exceptions, (Santoso 1996, Guiscafré 1996), little attention has been paid to assessing the costeffectiveness of interventions.  Cost-effectiveness data are needed both to select among different possible strategies for improving the same drug use problems, and also to justify carrying out these interventions in comparison to other types of activity within the health system.  Simple standardized approaches need to be developed for collecting costing data during interventions, and for selecting the most feasible and relevant effectiveness measures.

CONCLUSIONS AND RECOMMENDATIONS

This review provides encouraging evidence about growth during the last decade in the frequency and quality of interventions to improve use of medicines, and also about the efficacy of some of the strategies tested.  

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