What motivates antibiotic dispensing in accredited drug dispensing outlets in Tanzania? A qualitative study
What motivates antibiotic dispensing in accredited drug dispensing outlets in Tanzania? A qualitative study
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DOI：
10.1186/s13756-015-0073-4
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发表时间：
2015-07-21
影响因子：
5.5
通讯作者：
Chalker, John
中科院分区：
文献类型：
--
作者：
Dillip, Angel;Embrey, Martha;Chalker, John
背景：坦桑尼亚在十多年前推出了经认证的药品分销点（ADDO）计划。以往的评估一般表明，ADDO比未经认证的网点更符合规定的业务标准。然而，ADDO仍然面临着过度使用抗生素治疗急性呼吸道感染（ARI）和单纯腹泻的挑战，这导致了耐药性的出现。本研究旨在探讨ADDO业主和配药对抗生素配药的态度，并了解认证如何影响他们的配药behavior.Methods：本研究采用了定性的方法。我们进行了深入的采访，ADDO业主和配药鲁伍马和坦加地区，政府实施ADDO计划下集中和分散的方法，分别第二个目的是比较两个regions.Results之间的差异：结果表明，ADDO计划带来了积极的变化，配药的做法知识。受访者能够正确解释ARI和腹泻的治疗指南。几乎所有的配药员和所有者都表示，不必要地使用抗生素会导致抗菌素耐药性。尽管有这些知识，但将其转化为适当的配药实践仍然很少。配药员的行为是由客户需求，习惯（“Mazoea”），以下不适当的卫生设施处方，并需要赚取利润。虽然大多数配药员报告说，他们在顾客不必要地要求抗生素的情况下进行了干预，但他们往往屈服于顾客的要求。两个研究区域之间的差异很小;例如，鲁伍马的一些配药员报告说，他们将处方不正确的客户送回卫生设施，这种做法可能反映了ADDO实施和儿童疾病综合管理培训的区域差异。配药在农村环境中报告更多的挑战，在管理ARI和腹泻比城市people does.Conclusion：为了减少不适当的抗生素使用，综合干预措施必须包括社区，卫生设施，和ADDO。强调沟通技巧的定期复习培训对于帮助配药员与需要抗生素的客户打交道至关重要。主管当局应确保ADDO始终拥有必要的工具和资源。
Background: Tanzania introduced the accredited drug dispensing outlet (ADDO) program more than a decade ago. Previous evaluations have generally shown that ADDOs meet defined standards of practice better than non-accredited outlets. However, ADDOs still face challenges with overuse of antibiotics for acute respiratory infections (ARI) and simple diarrhea, which contributes to the emergence of drug resistance. This study aimed to explore the attitudes of ADDO owners and dispensers toward antibiotic dispensing and to learn how accreditation has influenced their dispensing behavior.Methods: The study used a qualitative approach. We conducted in-depth interviews with ADDO owners and dispensers in Ruvuma and Tanga regions where the government implemented the ADDO program under centralized and decentralized approaches, respectively; a secondary aim was to compare differences between the two regions.Results: Findings indicate that the ADDO program has brought about positive changes in knowledge of dispensing practices. Respondents were able to correctly explain treatment guidelines for ARI and diarrhea. Almost all dispensers and owners indicated that unnecessary use of antibiotics contributed to antimicrobial resistance. Despite this knowledge, translating it to appropriate dispensing practice is still low. Dispensers' behavior is driven by customer demand, habit ("mazoea"), following inappropriate health facility prescriptions, and the need to make a profit. Although the majority of dispensers reported that they had intervened in situations where customers asked for antibiotics unnecessarily, they tended to give in to clients' requests. Small variations were noted between the two study regions; for example, some dispensers in Ruvuma reported sending clients with incorrect prescriptions back to the health facility, a practice that may reflect regional differences in ADDO implementation and in Integrated Management of Childhood Illness training. Dispensers in rural settings reported more challenges in managing ARI and diarrhea than their urban counterparts did.Conclusion: To reduce inappropriate antibiotic use, integrated interventions must include communities, health facilities, and ADDOs. Periodic refresher training with an emphasis on communication skills is crucial in helping dispensers deal with customers who demand antibiotics. Responsible authorities should ensure that ADDOs always have the necessary tools and resources available.