Promoting rational drug use in the community Investigating drug use patterns and identifying...

Promoting rational drug use in th e community

Investigating drug use pattern s and identifying problems

Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO

2

Objectives

Help you understand when research is needed in the development of interventions

Define what questions you need to ask Identify key quantitative and qualitative

methods Reflect on limitations of available

sources of data on drug use problems


3

Why study drug use

People often use medicines without heal th worker advice

People have their own experiences with medicines which shape their drug use pr

actices People obtain medicines from informal c

ommunity sources


4

Extent to which health worker ad vice is sought

7 1755Thailand: % of episodes (rural) ((((: 8 % 1 4 1 1 (

(((((( ((((((), 2 0 % 4 2 2 ()

- 56 48Pakistan: % in NGO PHC area, % in ()

42 43Ghana: % in urban, % in rural

Sources: Le Grand A, Sringernyuang L (1989); Hardon A (1991); Hardon AP (1987); Rasmussen ZA et al (1996); Wondergem PW, Senah KA, Glover EK (1989)


5

Trends in medicine use Overall, modernmedicinesusedi n ar ound 50%of i l l ness epi sodes t

-reated in self care Whenheal t h wor ker s advi se, near l y al ways

medicines are prescribed - Around50 60per cent of pat i ent s do not compl

y with prescribed regime


6

Town

Clinics (2%)

Hospital (1%)

Doctors (7%)

Drugstores (35%)

Household stocks andfree-clinics (8%)

Neighbourhoodstores (40%)

Neighbours andrelatives (5%)

Neighbourhood

MEDICINES (n=1324)

Community drug distribution

Source: Hardon A (1991). Confronting ill health: medicines, self-care and the poor in Manila


7

Framework for developing interventions:

When is research needed?


8

Step 1 Describedrug use and identify

problems

Step 4Select and

developintervention

Step 5 Pretest

intervention

I mprove intervention

I mprove inte

rvention

Step 3 Analyseproblems and identify

solutions

I mprove a

nalysis

Step 7Monitor and

evaluateintervention

Step 2 Prioritiseproblems

Step 6 I mplementintervention

Steps in an effective communication intervention


9

Step1 : descri be

((( (( (((((((( ( ((( ((((( (( (((((((( (((( ((( ((((((( (

(((((((( (((( (((((( (( (((( (((((– - By reviewing a wide range of existin

- g secondary data sources, and– Collecting new data with key qualitat

ive and quantitative methods


10

2 2 22222222222

Develop criteria for prioritisation (((((((( ((((( ((((((((/

((((( (( (((((((((((((( ((((((((()/


11

3Step : analyse and focus

(((((((( (((-((((((((

-Select and analyse core problems

((((((( (((((((( (((((((((


12

2 2222222 2222 222222 222

- Pre testing (Step 5) Evaluation and monitoring (Step 7)


13

Activity 1: Inventory of drug use problems

Appoint a facilitator and rapporteur The facilitator asks participants to share the drug

use problems they identified prior to course The rapporteur tries to group them in a logical way The facilitator asks group members to discuss

which problems are most important. Select five! The group discusses a brief description of the 5

problems


14

Questions: individual/communitylevel What are common health problems? Ho

w treated? Appropriate? What medicines are commonly used? W

hat for? Appropriate? What are perceived drug use problems? What are important sources of drugs? What are perceived advantages and disa

dvantages of each source?


15

Questions: continued individual/community What are important sources of advice on t

reatment of common illnesses? Where do people get information on medi

cines? Is the information adequate in their view? Would they value access to more informat

ion on drugs?


16

Questions: Health institution level How appropriate are prescribing practices?

What are the main problems? To what extent do health workers and phar

macy staff provide adequate drug information?

What other health IEC activities take place? Do they contain messages on RDU? Which?

What do health workers and pharmacy sta ff consider to be problems in drug use by co

nsumers?


17

Questions: National level

What are key messages in drug advertis ements directed towards consumers?

What medicines are sold most in the cou ntry. For what? Appropriate?

Does the government have a NDP? Is it i mplemented? What is done to promote R

DU? To regulate drug promotion?


18

Activity 1, Step 2Review of existing data sources The trainer gives each group a matrix

on which the four selected problems can be written.

For each problem, review what sources of data on the problem exist.

What are limitations of these sources What additional research is needed?


19

PROBLEM SOURCE OFDATA/EVIDENCE

LIMITATIONS OFEXISTING DATA

ADDITIONALRESEARCHNEEDED

Matrix for review of existing data sources


20

Limitations of existing data sources Limited data on drug use by consumers

-- more known about drug prescribing and supply

Surveys are common sources of dataBut: often focus on specific health problems --> difficult to generalise

Data often limited geographically


21

Limitations of existing data sources continued

Few attempts to ask consumers what their problems are?

Few studies assess existing drug information channels and messages

Few analyse problems: why do they occur?


22

Additional quantitative research needed To describe variety of drug use

practices and how often they occur. To quantify where people go for

medicines and where for advice To give representative data, which can

be generalised


23

Additional qualitative data needed To gain insight in problems as defined

by various stakeholders To find out what people think about

existing source of information on drugs To find out what drug information they

need To understand why problems occur


24

Key quantitative methods

Weekly illness recalls = what people do in common health problems

Inventory of medicines in household cabinets and/or informal shops selling medicines in communities = popular medicines


25

Key qualitative methods

Focus group discussions

Key informant interviews with variety of stakeholders


26

Research methods: Individual level/community Surveys Inventory drug sh

ops/medicine cabi((((

common health problems

drug use practices most popular med

(((((( sources of treatm

(((( sources of info on

drugs/therapy


27

Research methods: Individual/Co mmunity level continued

((( ((((((((( ((terviews

((((( ((((( ((((ussi ons

common health pro blems and their trea

tment perceived drug use

problems sources of drug info

rmation and therap-y advice

perceived adequac y of drug informati

on and treatment advice

need for more info ?


28

Research methods: Health institutions

review of records structured

observations of patient-health worker consultation

key informant interviews

simulated client visits pharmacies

exit interviews

drug prescription practices

perceived drug use problems

provision of drug information in health centres and pharmacies

existing IEC activities in the field of health

Messages on RDU


29

Research methods: National level content analysis

of advertisements directed to consumers

sales statistics key informant

interviews

key messages on medicines in drug promotion

most commonly sold drugs

implementation NDP, regulation of drug promotion, activities to promote RDU


30

Focus groups Used widely in marketing research Efficient way to collect information on a

wide range of behaviours/ideas Interactions stimulate people to give

their views But, best combined with individual

interviews -- some things may not be shared in a group

Analysis can be difficult


31

Focus groups: how to

Homogeneous groups in terms of age, sex, and/or socioeconomic status/ethnicity

6-10 participants Skilled facilitator Neutral venue At least two discussions per category of

respondents Avoid uninvited onlookers


32

Focus group content Limit topics to four-five Ensure natural progression from one

topic to another Ensure natural progression from general

topic to specific aspects Start with questions -- summarize into

topics Be flexible -- follow the flow of the

discussion but make sure the topics are covered


33

How to analyse FGDs Best to record on tape (ask for consent) But, keep notes as well: non-verbal

observations and who said what Make extended notes Capture exact words/local terms Analyse according to the topics/questions

asked and unexpected themes/issues that emerge.

Avoid quantifying-qualitative information


34

Activity 3: FGD on everyday medicine use You are divided into four groups:

younger women; middle-aged women; young men;middle-aged men

Focus is on every-day medicine use Review the FGD guide: change/adapt Select facilitator and rapporteur Conduct FGD: one hour Reflect on how it went Write extended notes on the results

Promoting rational drug use in the community Investigating drug use patterns and identifying...

Documents

Transcript of Promoting rational drug use in the community Investigating drug use patterns and identifying...