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The effect of two educational activities on the practices of drugstore sellers in the Philippines

The effect of two educational activities on the practices of drugstore sellers in the Philippines. Rainier M Galang Executive Director National Drug Information Center Manila, Philippines. Background. Drugstore sellers in the Philippines * In privately-owned drugstores

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The effect of two educational activities on the practices of drugstore sellers in the Philippines

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  1. The effect of two educational activities on the practices of drugstore sellers in the Philippines Rainier M Galang Executive Director National Drug Information Center Manila, Philippines

  2. Background • Drugstore sellers in the Philippines * In privately-owned drugstores * No formal training in pharmacy * Sought by consumers for advice * Dispense drugs without supervision from pharmacist • Privately-owned drugstores * Largest source of drugs nationwide 

  3. Objectives • To determine the prevalence of three undesired practices of drugstore sellers • To evaluate the effect of two educational interventions on these practices

  4. The practices were • Incomplete dispensing [outright filling of erroneous single prescription of rifampicin for tuberculosis (TB)]; • Dispensing amoxicillin without prescription for a child with acute respiratory tract infection (ARI) and; • Recommending antibiotics where they may not be needed for an adult with flu symptoms.

  5. Methods Study design : Non-randomized comparative, pre-post intervention study Interventions 1. Moderated interactive group discussion (IGD): • Involving drugstore sellers and mothers • Discussed rational treatment of tuberculosis, acute respiratory tract infection and flu (as well as of wounds) • Leaflets distributed

  6. Methods Interventions 2. Drugstore visit (DSV): (Drugstores not represented at IGDs) • 5-10 minute visit from research team • Main educational messages were conveyed verbally • Leaflets distributed

  7. Outcome Measures 3 dispensing practices -Before intervention and 1-month post- intervention -Collected through trained surrogate clients

  8. Results • Study population : 271 drug stores 85 in the IGD intervention group 52 in the DSV group 134 in the control group (average 2 to 3 sellers per drugstore). • Drugstore sellers Almost all female 20-29 year age group Age range: 14-75 years Only 90 sellers [10.2% ] were pharmacists of which 50 were drugstore owners • Intervention and control groups comparable

  9. Results Baseline practices (For all groups) • 99.3% of drugstores filled erroneous single prescriptions of rifampicin for TB • 83.4% dispensed amoxicillin without a prescription for ARI • 73.4% recommended antibiotics for flu symptoms

  10. Results Post-intervention practices • Filling erroneous prescription for TB: No change in all 3 groups • Dispensing amoxicillin: IGD group: reduced 23.1% , p=0.001 DSV group: reduced 11.0%, p=0.1317 Control group: increased 18.7% , p=0.0018 • Recommending antibiotics for flu symptoms: IGD group: reduced 17.3%, p=0.0046 DSV group: reduced 2.1%, p=0.7389 Control group: reduced 7.3%, p=0.2207

  11. Results Multiple logistic regression analysis (MLRA) Pre-intervention practice had significant effect on post- intervention practice in the IGD group • Dispensing amoxicillin [OR=0.27, (95% CI: 0.12-0.61)] • Recommending antibiotic for flu [OR=12.54, (95%CI:6.2-25.3)]

  12. Figure. Comparison of pre- and post-intervention practices of drug sellers (IGD group: n = 85, DSV group: n = 52, Control group: n = 134) Note: IGD = Interactive group discussion DSV = Drug store visit ARI = Acute respiratory tract infection

  13. Conclusions • Filling erroneous single prescriptions of rifampicin was not significantly changed in all groups. • Dispensing amoxicillin without prescription for a child with ARI was significantly decreased in the IGD intervention group. • Recommending antibiotics for flu symptoms was significantly decreased in the IGD intervention group.

  14. Conclusions The drug seller profile • No training on dispensing (Only 90 of the 855 sellers [in 271 drugstores in the study] were trained pharmacists) • Young female • With little formal schooling Recommendations • Drugstore sellers education • Enforcement of minimum standards of practice

  15. THANK YOU • Research team: • IC Sia, RM Galang, O Mendoza, JA Reyes, • AMA Bernardo, D Estrada, C Quiroga, A Santiago • National Drug Information Center • & • Drug Use Study Group, University of the Philippines Manila • Supported by Applied Research on Child Health project (ARCH)

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