Effectiveness of a multi-component intervention on dispensing practices at private pharmacies in Vietnam and Thailand - a randomized controlled trial
Effectiveness of a multi-component intervention on dispensing practices at private pharmacies in Vietnam and Thailand - a randomized controlled trial
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DOI：
10.1016/j.socscimed.2004.04.019
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发表时间：
2005-01-01
影响因子：
5.4
通讯作者：
Tomson, G
中科院分区：
文献类型：
--
作者：
Chalker, J;Ratanawijitrasin, S;Tomson, G
私人药房是许多社区医疗保健的第一线，通常在没有医疗监督的情况下销售小剂量抗生素和类固醇等处方药。目的是研究对河内和曼谷药品销售商配药行为进行多方面干预的有效性。该研究是一项随机对照试验，涉及 68 家河内和 78 家曼谷药店，随机选择并分配进行干预和控制。通过在基线和每次干预后一个月或更长时间，对每家药房每次配药实践进行五次模拟客户访问来评估行为。依次实施三项为期三个月的干预措施，中间间隔四个月：通过当地检查员来访来执行法规，以强调纯处方药立法的重要性；教育，在河内面对面进行，并在曼谷由一大群人进行；干预措施在河内取得了显着改善，减少了非法类固醇的配发（29% vs. 62%）和低剂量抗生素（69% vs. 90%），通过同行评审维持（17% vs. 57% 类固醇和 71% vs. 95% 抗生素），并且减少了不问问题和不提供建议的配药员（11% vs. 11%）。 30% 类固醇和 51% vs. 81% 抗生素）。曼谷唯一显着的改善是监管干预后非法配发类固醇的数量减少（25% vs. 44%）。在曼谷，在同行评审后，自愿参加同行评审的小组中，没有提出任何问题，也没有对低剂量抗生素请求提出建议的人较少（58% 比 81%）。多成分干预可以对改变配药者的行为产生深远的影响，但效果取决于具体情况和实施方法。讨论了差异的可能原因。 (C) 2004 Elsevier Ltd. 保留所有权利。
Private pharmacies are the first line of health care in many communities, commonly selling antibiotics in small doses and prescription-only drugs such as steroids without medical supervision. The aim was to study the effectiveness of a multi-faceted intervention on the dispensing practices of drug sellers in Hanoi and Bangkok.The study was a randomized, controlled trial with 68 Hanoi and 78 Bangkok pharmacies, randomly selected and assigned for intervention and control. Behaviour was assessed by five simulated client visits per pharmacy per dispensing practice, at baseline and a month or more after each intervention.Three three-month interventions were implemented sequentially with four months in between: enforcement of regulations with local inspectors visiting to emphasize the importance of prescription-only medicine legislation; education, performed face-to-face in Hanoi and by a large group in Bangkok; and peer review, voluntary in Bangkok and compulsory in Hanoi.The intervention resulted in significant improvements in Hanoi, reducing the dispensing of illegal steroids (29% vs. 62%) and low dose antibiotics (69% vs. 90%), sustained by means of the peer review (17% vs. 57% steroids and 71% vs. 95% antibiotics), and in fewer dispensers asking no questions and giving no advice (11% vs. 30% steroids and 51% vs. 81% antibiotics). The only significant improvement in Bangkok was the reduction in illegally dispensing steroids (25% vs. 44%) after the regulatory intervention. In Bangkok, fewer of those in the group who volunteered for the peer review asked no questions and gave no advice for low-dose antibiotics requests after the peer review (58% vs. 81%).A multi-component intervention can have a profound effect in changing dispensers' behaviour, but the effect is dependant on the context and the method of implementation. Possible reasons for differences are discussed. (C) 2004 Elsevier Ltd. All rights reserved.