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Improving Primary Care Pharmaceutical Use

Forsberg

(1993)

Asia

PP-C

Community, parameds, MDs

4 hosps, 3 Rural H Units, HH surveys

Diarrhea

National CDD Program (impact on diarrhea treatment costs)

HH drug cost/case

Hosp drug cost/case IP

Hosp drug cost/case OP

RHU drug cost/case

Δ = $-0.77$0.50 = -$0.27

Δ = $1.52$1.86 = +$0.34

Δ = $0.70$0.61 = -$0.09

Δ = $0.51$0.06 = -$0.45

Mehnaz

(1995)

Asia

PO-C

CHWs

1 village, 16 CHWs (7 teachers, 9 students)

ARI

10-day multi-method training workshop on ARI mgmt, case finding, home Tx, referral, field supervision

% pneum cases correctly classified

% receiving correct Tx

80.5%

25.6%

Pandey

(1989)

Asia

PP-C

CHWs, community

~1000 under-five children

ARI

Pilot ARI case mgmt program (H education, immunization, AB Tx for pneumonia)

ARI <5 mortality rate  (/1000)

All cause <5 mortality rate (/1000)

Δ = 20.36.3 = -69.0%

Δ= 64.838.8 = -40.1%

Roesin

(1990)

Asia

PP-C

CHWs, MDs, parameds, community

CHWs, H prof. (& mothers)

ARI

Pilot ARI case mgmt program (CHW case recognition, home AB Tx, community ed)

ARI <5 mortality rate (/1000)

Δ = 11.94.0 = -49.6%

3. Group Process Strategies

Agyepong

(1996)

Africa

RCT

Mds, parameds

30 urban PHC facilities (15 E, 15 C)

Malaria; ARI diarrhea; hypertension

Develop consensus Tx norms in workshops with staff of each H facility facilitated by experts

% AB use

% injection  use

% generic Rxg

ΔE = 53.4%61.7% = +8.3%

ΔC = 43.4%61.0% = +17.6%

ΔE = 45.4%41.7% = -3.7%

ΔC = 43.4%46.8% = +5.4%

ΔE =75.2%84.0% = +8.8%

ΔC = 83.5%82.1% = -1.4%

-40-

Improving Primary Care Pharmaceutical UseApril, 1997

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