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The Role of Dispensers in Promoting Rational Drug Use 2

The Role of Dispensers in theThe Role of Dispensers in theRational Use of Drugs: ObjectivesRational Use of Drugs: Objectives

Identify who can be a dispenserIdentify who can be a dispenser

Identify factors that influence dispensingIdentify factors that influence dispensing

Describe methods to enhanceDescribe methods to enhance

dispenser/patient communicationsdispenser/patient communications

Identify ways to influence a dispenser'sIdentify ways to influence a dispenser'sbehaviorbehavior

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Case ReportCase Report

A 20 yr. female student suffering fromtonsilitis, seen by a doctor in a 600-bedhospital OPD. She obtained a drug fromthe hospital pharmacy, and took as

instructed. She felt very weak after takingthe drug, 3 days later she got severelycomatose and was admitted to the samehospital.She took chlorpropamide 250 mg

4 times a day. The OPD doctor claimed thathe prescribed chloromycetine 4x250 mgdaily for her tonsilitis. The patienteventually died 2 weeks after hospitaladmission.

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The Role of Dispensers in Promoting Rational Drug Use 4

Who are Dispensers?Who are Dispensers?

Pharmacists, pharmacy techniciansPharmacists, pharmacy technicians

Pharmacy assistantsPharmacy assistants

Nurses, nurse aidsNurses, nurse aids

DoctorsDoctors

Drug sellersDrug sellers

Shop keepersShop keepers Taxi drivers etc.Taxi drivers etc.

Family membersFamily members

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Prescriber and DispenserPrescriber and Dispenser

In the real world of drug use (rational andIn the real world of drug use (rational andirrational)irrational)

A PRESCRIBER IS:A PRESCRIBER IS:Anyone with a recommendation for treatment.Anyone with a recommendation for treatment.

A DISPENSER IS:A DISPENSER IS:Anyone that give out the treatment.Anyone that give out the treatment.

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What Does A Dispenser Need?What Does A Dispenser Need?

Knowledge/sourceKnowledge/source

of information:of information:

Skills:Skills:

Others:Others:

drug informationdrug information

product informationproduct information

consultationconsultation

communication skillcommunication skill

promotional/marketing techniquespromotional/marketing techniques

supplysupply

dispensing equipment dispenser-dispensing equipment dispenser-

prescriber relationshipprescriber relationship

status/role in the health care systemstatus/role in the health care system

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The Dispensing ProcessThe Dispensing Process

Receive PrescriptionReceive Prescription

Interpret PrescriptionInterpret Prescription

Retrieve Medication/IngredientsRetrieve Medication/Ingredients

Prepare and ProcessPrepare and Process

Communicate with PatientCommunicate with Patient

Assure Patient's UnderstandingAssure Patient's Understanding Monitor Compliance by PatientMonitor Compliance by Patient

Keep RecordsKeep Records

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Potential Error/ProblemsPotential Error/Problems

Wrong interpretation of prescription (or diagnosis)Wrong interpretation of prescription (or diagnosis)

Retrieval of the wrong drug from stockRetrieval of the wrong drug from stock

Wrong dosagesWrong dosages

Inadequate packaging/labelingInadequate packaging/labeling

Inaccurate counting, compoundingInaccurate counting, compounding

Inadequate or nonexistent labelingInadequate or nonexistent labeling

No knowledge of proper drug complianceNo knowledge of proper drug compliance

Insufficient knowledge of the disease processInsufficient knowledge of the disease process

Insufficient time to talk with patients about their drugsInsufficient time to talk with patients about their drugs

Inability to communicate to patients about therapyInability to communicate to patients about therapy

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Assessing Dispensing ConditionsAssessing Dispensing Conditions

Dispensing point conditionsDispensing point conditions

Dispensing time? Communication time?Dispensing time? Communication time?

How often do errors occur?How often do errors occur? Who is responsible for dispensing?Who is responsible for dispensing?

Dispensing training in country?Dispensing training in country?

Salaries and wages for dispensers?Salaries and wages for dispensers?

Dispensing packaging?Dispensing packaging?

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Roles of Prescriber/ Physician inRoles of Prescriber/ Physician inPromoting Rational Drug UsePromoting Rational Drug Use

DiagnosisDiagnosis

PrescribingPrescribing

Drug InformationDrug Information

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Roles of Pharmacist Dispenser inRoles of Pharmacist Dispenser inEnsuring Rational Drug UseEnsuring Rational Drug Use

Drug ProcurementDrug Procurement Drug DistributionDrug Distribution

Drug PrescribingDrug Prescribing

Drug InformationDrug Information Additional roles:Additional roles:

Communication withCommunication with

physicianphysician

Treatment guidelinesTreatment guidelines

Research on prescribingResearch on prescribing

and utilizationand utilization

Consumer educationConsumer education

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Improving Patient ComplianceImproving Patient Compliancewith Therapywith Therapy

Dispenser - patientDispenser - patientcommunicationcommunication

Packaging for patientPackaging for patient

useuse LabelingLabeling

Written informationWritten information

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Dispenser-PatientDispenser-PatientCommunicationCommunication

DispensersDispenserscommunicate withcommunicate with

patients how topatients how to

take drugstake drugs EnsuringEnsuring

understanding isunderstanding is

very importantvery important

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Packaging for Patient UsePackaging for Patient Use

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LabelingLabeling

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Dispensing Public or PrivateDispensing Public or PrivateSectorSector

Public SectorPublic SectorCheap but long delays and and frequentCheap but long delays and and frequent

stock-outsstock-outs

Generic DrugsGeneric Drugs

Private SectorPrivate Sector

Expensive but convenientExpensive but convenientBrand name drugsBrand name drugs

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InterventionsInterventions

GhanaGhana Poster InterventionPoster Intervention

UgandaUganda

Field TrainingField Training Kenya and IndonesiaKenya and Indonesia

Private DrugPrivate Drug

SellersSellers

PhilippinesPhilippines

Discussions withDiscussions with

the drug sellingthe drug selling

storekeepersstorekeepers

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ConclusionConclusion

Dispensing is a critical part of drug use.Dispensing is a critical part of drug use.

Dispensing is often neglected in trainingDispensing is often neglected in training

and EDP programs.and EDP programs.

Interventions exist to improve dispensing.Interventions exist to improve dispensing.

Patients benefit from better dispensing.Patients benefit from better dispensing.

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Sample Package InsertSample Package Insert