Addressing pharmacy practice in low and middle income settings in an era of antibiotic resistance

解决抗生素耐药性时代中低收入环境的药学实践

• 批准号: ES/T006854/1
• 负责人: Rosalind Miller
• 金额: $ 12.43万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2019
• 资助国家: 英国
• 起止时间: 2019 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=ES%2FT006854%2F1
• 关键词: Addressing; pharmacy; practice; low; middle

During this fellowship, I aim to publish two further research papers. The first will present data on prices of encounters at both chain and independent pharmacies, and the socioeconomic status of customers patronising these two different pharmacy types (no prior research has been published on this area). The second paper will pool quality of care data from both chain and independent pharmacies to provide a complete picture of how childhood diarrhoea is managed at pharmacies in the urban Indian setting.My second objective for the fellowship is to mobilise support at the global level for the creation of pharmacy-specific guidelines for the management of key conditions. This was a specific, practical recommendation from my PhD, which highlighted the lack of such guidelines for childhood diarrhoea. I have already started to develop my contacts with a network of key players in the field of medicine use, and with the International Federation of Pharmacists, and have received considerable support for taking this idea forward. Many of these individuals already serve as policy entrepreneurs within countries, where they are well-networked and respected and thus can help to shape the policy direction of this field. Following further interaction through networking and consultation, I plan to lead on a 'call to action' paper (with the backing of key individuals and organisations), which would state the need for such guidelines, propose what they might cover, and give thought to what the process of producing them would look like.During the course of my PhD I undertook training in quantitative methods, namely statistic courses provided at the LSHTM, in order undertake my analyses. This fellowship would enable me to further improve my quantitative skills through advanced training in econometrics. I believe the UCL 'econometrics for health' course would particularly enhance my skills as an early career researcher. Finally, I propose to use the fellowship to develop a funding proposal in order to investigate how novel regulatory approaches involving hierarchies of drug control may be used in LMICs to curb the overuse of antibiotics. Antibiotic resistance is widely recognised as a leading threat to the public's health, globally. Antibiotic use is a main driver of selection pressure that leads to resistance, yet this class of medicines continue to be amongst the world's most highly purchased. Promoting antibiotic stewardship in the community, encompassing pharmacies, has been identified as a key area for action. Applying an economic analysis lens to the problem of antimicrobial resistance will likely play an important role in the study of this growing problem, shedding light on both supply and demand in these dynamic markets. Further, given the externalities associated with antibiotic misuse, improving both the design and implementation of effective regulation surrounding the provision of antibiotics will be paramount.This line of enquiry was sparked by a result from my PhD: although the illegal sale of (often inappropriate) antibiotics over the counter was widespread, pharmacy staff were found to follow better practice withrespect to 'H1 medicines'. These are a category of medicines that were introduced (in India) in 2013 in response to growing concerns over antibiotic resistance. The H1 medicine list is comprised mainly of antibiotics (novel classes and anti-tuberculosis drugs) and medicines on the list are subject to additional regulatory controls. In the case of H1 medicines, pharmacy staff were found to be tightly bound by implicit norms that restrict the use of such medicines. The idea that not all antibiotics are equal is an important one, and the potential of using different levels of drug control for different medicines is yet to be explored. New thinking in regulatory theory, such as risk-based and response regulation, will be used to inform this area of study.

在此期间，我的目标是发表两篇进一步的研究论文。第一份将提供连锁药店和独立药店的价格数据，以及光顾这两种不同类型药店的顾客的社会经济地位(之前没有发表过这方面的研究)。第二篇论文将汇集来自连锁药店和独立药房的护理质量数据，以提供印度城市环境中药店如何管理儿童腹泻的完整图景。我设立该奖学金的第二个目标是动员全球一级的支持，为关键疾病的管理制定药房专用指南。这是我的博士提出的一个具体、实用的建议，它强调了儿童腹泻缺乏这样的指导方针。我已经开始与药物使用领域的关键参与者网络和国际药剂师联合会发展联系，并在推动这一想法方面得到了相当大的支持。这些人中的许多人已经在国家内部担任政策性企业家，在那里他们得到了良好的网络和尊重，因此可以帮助塑造这一领域的政策方向。在通过网络和协商进行进一步的互动之后，我计划(在关键个人和组织的支持下)领导一份‘行动号召’文件，其中将说明此类指导方针的必要性，提出它们可能涵盖的内容，并考虑制定这些指导方针的过程将是什么样子。在我的博士课程期间，我接受了量化方法的培训，即LSHTM提供的统计课程，以进行我的分析。这一奖学金将使我能够通过高级计量经济学培训进一步提高我的量化技能。我相信伦敦大学学院的“健康计量经济学”课程将特别提高我作为一名早期职业研究人员的技能。最后，我建议利用这笔奖学金制定一项资助提案，以调查如何在LMICs中使用涉及药物控制层级的新监管方法来遏制抗生素的过度使用。抗生素耐药性被广泛认为是全球公众健康的主要威胁。抗生素的使用是导致耐药性的选择压力的主要驱动因素，但这类药物仍然是世界上购买量最大的药物之一。在包括药房在内的社区中促进抗生素管理已被确定为一个关键的行动领域。将经济分析视角应用于抗菌素耐药性问题，可能会在研究这一日益严重的问题方面发挥重要作用，从而揭示这些动态市场的供需情况。此外，考虑到抗生素滥用带来的外部性，改善围绕抗生素供应的有效监管的设计和实施将是至关重要的。这一系列调查是由我的博士学位引发的：尽管在非处方药中非法销售(通常是不适当的)抗生素的情况很普遍，但药房工作人员被发现在“H1药物”方面遵循更好的做法。这些是2013年(在印度)推出的一类药物，以回应人们对抗生素耐药性日益增长的担忧。H1药品清单主要由抗生素(新型药物和抗结核病药物)组成，清单上的药品受到额外的监管控制。在H1药物的案例中，药房工作人员被发现受到限制使用此类药物的隐性规范的严格约束。并不是所有的抗生素都是平等的，这是一个重要的想法，对不同的药物使用不同级别的药物控制的潜力还有待探索。监管理论中的新思维，如基于风险的监管和响应监管，将被用来为这一研究领域提供信息。

项目成果

Cheaper Medicines for the Better Off? A Comparison of Medicine Prices and Client Socioeconomic Status Between Chain and Independent Retail Pharmacies in Urban India.

• DOI: 10.34172/ijhpm.2020.214
• 发表时间: 2022-05-01
• 期刊: INTERNATIONAL JOURNAL OF HEALTH POLICY AND MANAGEMENT
• 影响因子: 3.5
• 作者: Miller, Rosalind;Goodman, Catherine
• 通讯作者: Goodman, Catherine