Improving Primary Care Pharmaceutical Use
validity in study design will then be compared. We will identify the intervention strategies that appear to be most successful in improving drug prescribing and other related outcomes, and estimate the level of their impact. Finally, we will identify important gaps in current experience in testing interventions to improve use of medicines, and suggest what studies are needed and which evaluation methodologies seem to be most appropriate in developing county settings. While the insights gained from this review are primarily relevant to developing countries, lessons may also exist for developed country health systems.
To assess the experience from developing countries on improving the use of medicines in primary care, we undertook a systematic inventory of published and unpublished intervention trials that met the following inclusion criteria: studies had to be from developing countries, broadly defined as countries in Asia, Africa, and Latin America not on the OECD list of industrialized countries; studies had to describe the results of a planned intervention or a clearly delineated policy targeting drug use in a primary care setting; and the studies needed to present clear accounts of methods and measure impacts in terms of defined outcomes. Descriptive studies were not included.
Primary care settings were defined to include public and private sector health facilities, private medical practices, and community-based settings where trained health providers delivered pharmaceutical care. Free-standing private pharmacies and drug stores were excluded from this review, although pharmacies in health facilities were included. Primary care providers therefore included physicians working in primary care settings, including hospital outpatient departments; paramedics such as nurses, clinical officers, public sector pharmacists, or dispensers; and trained community health workers. Interventions directed at improving the basic training of primary care providers were also included.
We first screened the archives and computerized databases of INRUD and WHO/DAP for relevant journal articles, research proposals, theses, reports, and newsletters describing interventions, completed or in progress. We