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The impact of face-to-face educational outreach on diarrhoea treatment in pharmacies.
Health Policy Plan. 1996 Sep; 11(3):308-18.HP

Abstract

Private pharmacies are an important source of health care in developing countries. A number of studies have documented deficiencies in treatment, but little has been done to improve practices. We conducted two controlled trials to determine the efficacy of face-to-face educational outreach in improving communication and product sales for cases of diarrhoea in children in 194 private pharmacies in two developing countries. A training guide was developed to enable a national diarrhoea control programme to identify problems and their causes in pharmacies, using quantitative and qualitative research methods. The guide also facilitates the design, implementation, and evaluation of an educational intervention, which includes brief one-on-one meetings between diarrhoea programme educators and pharmacists/owners, followed by one small group training session with all counter attendants working in the pharmacies. We evaluated the short-term impact of this intervention using a before-and-after comparison group design in Kenya, and a randomized controlled design in Indonesia, with the pharmacy as unit of analysis in both countries (n = 107 pharmacies in Kenya; n = 87 in Indonesia). Using trained surrogate patients posing as mothers of a child under five with diarrhoea, we measured sales of oral rehydration salts (ORS); sales of antidiarrhoeal agents; and history-taking and advice to continue fluids and food. We also measured knowledge about dehydration and drugs to treat diarrhoea among Kenyan pharmacy employees after training. Major discrepancies were found at baseline between reported and observed behaviour. For example, 66% of pharmacy attendants in Kenya, and 53% in Indonesia, reported selling ORS for the previous case of child diarrhoea, but in only 33% and 5% of surrogate patient visits was ORS actually sold for such cases. After training, there was a significant increase in knowledge about diarrhoea and its treatment among counter attendants in Kenya, where these changes were measured. Sales of ORS in intervention pharmacies increased by an average of 30% in Kenya (almost a two-fold increase) and 21% in Indonesia compared to controls (p < 0.05); antidiarrhoeal sales declined by an average of 15% in Kenya and 20% in Indonesia compared to controls (p < 0.05). There was a trend toward increased communication in both countries, and in Kenya we observed significant increases in discussion of dehydration during pharmacy visits (p < 0.05). We conclude that face-to-face training of pharmacy attendants which targets deficits in knowledge and specific problem behaviours can result in significant short-term improvements in product sales and communication with customers. The positive effects and cost-effectiveness of such programmes need to be tested over a longer period for other health problems and in other countries.

Authors+Show Affiliations

Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10160376

Citation

Ross-Degnan, D, et al. "The Impact of Face-to-face Educational Outreach On Diarrhoea Treatment in Pharmacies." Health Policy and Planning, vol. 11, no. 3, 1996, pp. 308-18.
Ross-Degnan D, Soumerai SB, Goel PK, et al. The impact of face-to-face educational outreach on diarrhoea treatment in pharmacies. Health Policy Plan. 1996;11(3):308-18.
Ross-Degnan, D., Soumerai, S. B., Goel, P. K., Bates, J., Makhulo, J., Dondi, N., Sutoto, ., Adi, D., Ferraz-Tabor, L., & Hogan, R. (1996). The impact of face-to-face educational outreach on diarrhoea treatment in pharmacies. Health Policy and Planning, 11(3), 308-18.
Ross-Degnan D, et al. The Impact of Face-to-face Educational Outreach On Diarrhoea Treatment in Pharmacies. Health Policy Plan. 1996;11(3):308-18. PubMed PMID: 10160376.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The impact of face-to-face educational outreach on diarrhoea treatment in pharmacies. AU - Ross-Degnan,D, AU - Soumerai,S B, AU - Goel,P K, AU - Bates,J, AU - Makhulo,J, AU - Dondi,N, AU - Sutoto,, AU - Adi,D, AU - Ferraz-Tabor,L, AU - Hogan,R, PY - 1996/8/5/pubmed PY - 1996/8/5/medline PY - 1996/8/5/entrez KW - Africa KW - Africa South Of The Sahara KW - Age Factors KW - Antibiotics KW - Asia KW - Child KW - Delivery Of Health Care KW - Demographic Factors KW - Developing Countries KW - Diarrhea--prevention and control KW - Diseases KW - Drugs KW - Eastern Africa KW - Education KW - English Speaking Africa KW - Evaluation KW - Evaluation Report KW - Health KW - Health Personnel KW - Indonesia KW - Kenya KW - Oral Rehydration KW - Organization And Administration KW - Pharmacists KW - Population KW - Population Characteristics KW - Program Evaluation KW - Programs KW - Southeastern Asia KW - Training Programs KW - Treatment KW - Youth SP - 308 EP - 18 JF - Health policy and planning JO - Health Policy Plan VL - 11 IS - 3 N2 - Private pharmacies are an important source of health care in developing countries. A number of studies have documented deficiencies in treatment, but little has been done to improve practices. We conducted two controlled trials to determine the efficacy of face-to-face educational outreach in improving communication and product sales for cases of diarrhoea in children in 194 private pharmacies in two developing countries. A training guide was developed to enable a national diarrhoea control programme to identify problems and their causes in pharmacies, using quantitative and qualitative research methods. The guide also facilitates the design, implementation, and evaluation of an educational intervention, which includes brief one-on-one meetings between diarrhoea programme educators and pharmacists/owners, followed by one small group training session with all counter attendants working in the pharmacies. We evaluated the short-term impact of this intervention using a before-and-after comparison group design in Kenya, and a randomized controlled design in Indonesia, with the pharmacy as unit of analysis in both countries (n = 107 pharmacies in Kenya; n = 87 in Indonesia). Using trained surrogate patients posing as mothers of a child under five with diarrhoea, we measured sales of oral rehydration salts (ORS); sales of antidiarrhoeal agents; and history-taking and advice to continue fluids and food. We also measured knowledge about dehydration and drugs to treat diarrhoea among Kenyan pharmacy employees after training. Major discrepancies were found at baseline between reported and observed behaviour. For example, 66% of pharmacy attendants in Kenya, and 53% in Indonesia, reported selling ORS for the previous case of child diarrhoea, but in only 33% and 5% of surrogate patient visits was ORS actually sold for such cases. After training, there was a significant increase in knowledge about diarrhoea and its treatment among counter attendants in Kenya, where these changes were measured. Sales of ORS in intervention pharmacies increased by an average of 30% in Kenya (almost a two-fold increase) and 21% in Indonesia compared to controls (p < 0.05); antidiarrhoeal sales declined by an average of 15% in Kenya and 20% in Indonesia compared to controls (p < 0.05). There was a trend toward increased communication in both countries, and in Kenya we observed significant increases in discussion of dehydration during pharmacy visits (p < 0.05). We conclude that face-to-face training of pharmacy attendants which targets deficits in knowledge and specific problem behaviours can result in significant short-term improvements in product sales and communication with customers. The positive effects and cost-effectiveness of such programmes need to be tested over a longer period for other health problems and in other countries. SN - 0268-1080 UR - https://www.unboundmedicine.com/medline/citation/10160376/The_impact_of_face_to_face_educational_outreach_on_diarrhoea_treatment_in_pharmacies_ L2 - https://academic.oup.com/heapol/article-lookup/doi/10.1093/heapol/11.3.308 DB - PRIME DP - Unbound Medicine ER -