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Improving Primary Care Pharmaceutical Use

Habiyambere

(1992)

Africa

PO&C

Parameds, managers

H facilities (EDP, Non-EDP, NGO)

Rxg for all conds, drug availability, cost

Essential Drugs Program: Drug supply, STGs, training,  cost recovery

Rxs according to STG

AOvermedication@

Avg. # ED available

E=32%, NE=28%, NGO=32%

E=48%, NE=47%, NGO=29%

E=39, NE=27, NGO=59

Schleimann

(1990)

Asia

PP-C

MDs

90 patients (45 prescribers) pre, 87 (44) post

Dx, Rxg for all conditions

Essential Drugs Project: Drug supply, MD training, cost recovery

% with proper history

% with accurate Tx

% with sufficient Tx

Δ = 43%79% = +36%

Δ = 57%76% = +19%

Δ = 38%60% = +22%

Walker

(1990)

Asia

PO&C

Parameds

26 H units (19 E with EDP; 7 C without EDP)

Rxg for all conditions

Essential Drugs Program:  Kit supply system for 30 drugs, STGs plus 1-wk training

# items Rxd / % AB /  % injection

E = 1.5 / 45% 25%

C = 2.4 / 67% 58%

WHO

(1991)

Asia

PO&C

MDs, parameds

16 H units (10 E with EDP, 6 C without EDP)

Rxg for all conditions

Essential Drugs Program: Drug supply, training

# drus Rxd / % AB / % injection

E = 1.55 / 28.7% / 18.0%

C = 2.10 / 62.7% / 49.2%

Abbreviations

Design:PP=pre-post;  PO=post only; &C=with comparison group; -C=without comparison; RCT=randomized control trial; TS=time series (at least 4 data points in series)

Description:C=Control group; E= Experimental group ; H=health; HCs=health centers, health posts, etc;  Rx=prescription; Rxg=prescribing; Tx=treatment; Dx=diagnosis; ED=essential drugs; EDP=essential drugs program;  STG=standard treatment guideline; parameds=nurses, clinical officers, medical assistants, etc.; CHWs= community health workers, lady home visitors, OPD=outpatient department; ARI=acute respiratory infection

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Improving Primary Care Pharmaceutical UseApril, 1997

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