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Improving Primary Care Pharmaceutical Use

4. Administrative/Managerial Strategies

Chowdhury

(1996)

Asia

RCT

MDs

24 H facilities (8 per study group)

ARI

Visit to disseminate and discuss ARI STG (E1), with Rx audit and review (E2)

% receiving AB for ARI

ΔE1 = 85.9%75.7% = -10.2%

ΔE2 = 91.8%67.8% = -24.0%

ΔC = 89.3%81.5% = -7.8%

Kafle

(1995a)

Asia

RCT

Dispensers

9 districts (3 districts/gp with total of 12 health posts and 9 subposts per gp)

Quality of dispensing

1.5 day multi-method training program for dispensers (E1) supplemented by 2 on-site supervisory visits over 3 mos. by district H officer using simple supervisory tool (E2)

Av. dispensing time (seconds)

% adequately labelled

% patients knowing correct drug administration

ΔE1 = 7158 = -18.3%

ΔE2 = 6477 = +20.3%

ΔC = 7860 = -23.1%

All groups = 0% pre and post

ΔE1 = 50.9%67.8% = +16.9%

ΔE2 = 69.2%60.2% = -9.0%

ΔC = 64.2%48.4% = -15.8%

Kafle

(1995b)

Asia

RCT

Parameds

6 districts (3 districts/gp with total of 12 health posts and 9 subposts per gp)

Rxg for all conditions

2 on-site supervisory visits over 3 months by district health officers specially trained to use simple supervisory tool

% AB use

% inj. use

% according to std. Tx schedule

ΔE = 57.7%45.2% = -12.5%

ΔC = 54.2%48.6% = -5.6%

ΔE = 20.0%14.7% =  -5.3%

ΔC = 12.2%16.5% = +4.3%

ΔE = 26.9%40.5% = +13.6%

ΔC = 29.9%23.1% = -6.8%

Loevinsohn

(1995)

Asia

PP&C

Midwives

10 provinces (4 E with 49 facilities, 6 C with 63 facilities)

Task performance

2-day training for Municipal H officers, dist. & provin. supervisors on use of Integrated Supervisory Checklist

Performance

(Max: 60 pts)

% know correct dose & interval of vitamin A

ΔE = 26.037.3 = +43.5%

ΔC = 27.031.9 = +18.1%

ΔE = 32.6%61.2% = +28.6%

ΔC = 39.7%69.8% = +30.1%

Sunartono

(1995)

Asia

TS

(repeat meas.)

MDs & parameds

29 H centers & 109 subcenters

Rxg for all conditions, especially injection use

Develop and implement process for monthly self-monitoring of Rxg practice indicators

# drugs Rxd

% AB use

% inj. use

Δ = 4.23.1 = -26%

Δ = 63%31% = -32%

Δ = 76%20% = -56%

-42-

Improving Primary Care Pharmaceutical UseApril, 1997

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