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Improving Primary Care Pharmaceutical Use

van der Hoek

(1996)

Africa

TS

parameds

staff at 1 district hospital

Rxg for all conditions

policy requiring Rx for ABs from CO or MD, monthly audit, personal feedback

AB tabs Rxd (at 3 mo.)

AB tabs Rxd (at 12 mo.)

Δ = 21K15K = -28.6%

Δ = 21K20K = -4.8%

Elder

(1992)

Asia

PO&C

CHWs (& mothers)

3 E villages with 15 CHWs and 3 C villages with 16 CHWs

Diarrhea

Provide counseling cards to guide CHWs and mothers through Dx and Tx (Regular diarrhea case mgmt training for both E & C gps)

% diagnostic steps / % counseling steps correct

% mothers prepare ORS correctly

E = 81.7% / 89.7%

C = 30.5% / 25.6%

E = 97.0%

C = 74.0%

Mabadeje

(1991)

Africa

PP-C

MDs

staff at 1 teaching hosp

Rxg for all outpatients

Introduction of hospital EDL accompanied by informational workshops

% Rxd as generics

% inappro combinations

Δ = 30.1%29.3% = -0.8%

Δ = 15.1%14.8% = -0.3%

5. Essential Drugs / Drug Supply Programs

ZEDAP

(1995)

Africa

TS

(repeat meas.)

MDs, parameds

67 H facilities (4 cent hosps, 7 prov hosps, 17 dist hosps, 39 HCs)

Rxg for all conds, supply, store mgmt

Essential Drugs Program: annual survey (NB #=s measure change since 1991, the end of the period of active program implementation)

# drugs Rxd

ABs as % of drugs

% following STG for gonorrhea

Δ =1.301.65 = +26.9%

Δ = 29%27% = -2%

Δ = 83%42% = -41%

Chalker

(1995)

Asia

PO&C

Parameds

2 districts, 22 H posts (11 E with program, 11 C without program)

Rxg for all conditions

Drug Supply Project: Supplementary drug supply and partial drug cost recovery via a fxed Rx charge

# items Rxd / cost per Rx / % AB / % injection

% receiving adequate AB dose

E = 2.5 / $0.43 / 60% / 24%

C = 1.7 / $0.20 / 37% / 8%

E = 58.3%

C = 22.0%

Christensen

(1990)

Africa

PP-C

MDs, parameds, H managers

22 H units

Rxg for all conditions

Essential Drugs Program: Implement drug supply, vertical training of staff on mgmt. of limited number of diseases, monitoring system

# drugs Rxd

% AB use

% inj. use

% according to STG

Δ = 1.981.84 = -7.0%

Δ = 53.5%50.2% = -3.3%

Δ = 50.1%41.3% = -8.8%

Δ = 88.2%95.9% = +7.7%

-43-

Improving Primary Care Pharmaceutical UseApril, 1997

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