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CITATION: Presented at the International Conference on Improving Use of - page 28 / 51





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Improving Primary Care Pharmaceutical Use

From these successes, we should take heart.  However, we must also take heed - there are a great number of problems in a wide variety of settings about which we can say nothing, since that have yet to be targeted in any interventions.  Much remains to be done.  Based on the findings of our review, we enumerate the following key recommendations for designing, implementing, and disseminating successful interventions.

Recommendations for intervention design

!Researchers should establish a set of minimum standards for evaluating interventions, which would include: (1) an acceptable study design (RCT, pre-post with appropriate comparison, or time series with at least 6 data points pre and 6 data points post); (2) adequate sample size, which, if facilities are the units of analysis, should be at least 10 per group; (3) reliable and consistent outcome measures.   More work needs to be done to establish standards in these areas, in a similar way that standards were established for cross-sectional drug use studies. (WHO 1993)


Regular drug use surveys using indicators should be conducted in national essential drugs programs, and the World Bank and other donors should require such surveys in all pharmaceutical assistance projects.   These surveys would be invaluable in tracking long-term progress in performance, evaluating the impact of program changes, and identifying specific practices and geographic areas in need of targeted interventions.


Cost information should be routinely collected as a component of all intervention studies in order to permit analyses of the relative cost-effectiveness of different strategies.  To permit valid and reliable comparisons across studies and across environments, standardized approaches to collecting costing data need to be developed and disseminated.

Recommendations for strengthening implementation

!Ministries of health, professional organizations, and other institutions involved in quality improvement should structure in-service education programs using strategies that have been proven effective: combining multiple training modalities instead of traditional lecture approaches, skills-orientation, repeated sessions, single health problem focus, targeting health providers with the worst practices, and taking place at the work site when possible.


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