Improving Primary Care Pharmaceutical Use
have proven to be effective in shaping practice, and they also fit well within the socio-cultural context of health professionals, internalizing the impetus for improvement within the group. Group process approaches offer particular promise as one strategy that might be effective in the private sector. More work needs to be done to understand which problems can be successfully addressed using group process, how to best integrate audit and feedback systems, and how to motivate groups to undertake self-improvement.
Routine has demonstrated consistently large impacts on practice. This approach should be tested more widely, and if successful, integrated into operating public health systems. More work needs to be done to expand the variety of prescribing and dispensing behaviors addressed, to extend the number and usability of indicators available to measure these behaviors, and to understand the sustainability of changes.
While our knowledge of which interventions are most effective is still limited, it would be useful for program managers to in the design and implementation of national programs in order to strengthen and better evaluate their impacts on quality use of medicines.
!Pharmaceutical quality improvement programs should be implemented based on careful quantitative and qualitative assessment of problems, and good evidence of success for particular intervention approaches. Programs can waste scarce resources on poorly defined or intractable problems, or on ineffective approaches. To facilitate stronger programs, WHO should support an international resource center that collects and organizes data on intervention design, implementation, and efficacy.
As in most policy-relevant fields, there needs to be greater understanding about how to transform effective interventions into national programs. Good models appear in this review in the series of increasingly larger-scale interventions on ARI and diarrhea in Mexico (Guiscafré 1996) and the approach to the implementation of national standard treatment guidelines in Uganda (Kafuko 1996). Additional case studies of this type are needed to provide models for how to transform research to action in other health