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Impact of training in Effective Prescribing in Primary Care

This study assesses the effect of a prescribing training intervention for primary healthcare nurses. The study shows improvements in prescribing practices for Upper Respiratory Tract Infections and Diarrhoea & Vomiting. The findings suggest that short-course, in-service training programs can lead to improved prescribing practices in primary care settings.

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Impact of training in Effective Prescribing in Primary Care

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  1. Impact of training in Effective Prescribing in Primary Care Summers RS1, Meyer JC1, Möller H2 • MEDUNSA School of Pharmacy, South Africa • South African Drug Action Programme (SADAP)

  2. Purpose To assess the effect of aprescribing training intervention for primary health care nurses

  3. Framework • The facilities investigated were part of a training cascade presented in two South African provinces • Total of 66 trainers trained a total of 1121 PHC staff in DSM and 946 in Effective Prescribing between 1997 and 2000 (The two provinces have a total of ~980 public sector PHC facilities, including ~220 mobile clinics) • Training was presented with central funding support

  4. Control group Study group Main findings(baseline to Post-test 2) Prescribing for Upper Resp. Tract Infection (included in training) 50 Improvements 40 30 20 % 10 % items EDL % items generic 0 % Rx with AB % non drug Tx % Rx with injection % items STG † Ave items/Rx -10 -20 Deteriorations †as % of baseline

  5. Control group Study group Main findings(baseline to Post-test 2) Prescribing for Diarrhoea & Vomiting (not included in training) 40 Improvements 30 20 % 10 % items EDL % Rx with injection % Rx with AD % Rx with AM % Rx with no ORS 0 † Ave items/Rx % non drug Tx % items generic % Rx with AB % Rx with only ORS % items STG -10 -20 Deteriorations †as % of baseline

  6. Limitations • Study: Sample selected from a single region - may not be fully representative of the entire Province To prove retention, Post-test 2 could have been postponed to 6 months after training – however, the control group would have been lostbecause of the implementation of the training cascade • Training: Funding was discontinued after two years

  7. Percentage of facilities with staff trained within previous 2 years Limpopo Province National • Drug Supply Management: 44% 49% • Rational Drug Use: 39% 31% • Effective Prescribing: 11% 27% (National Essential Drugs Programme Impact Survey 2003- note that no mobile clinics were included in the survey)

  8. Key lessons • Prescribing can be improved by short-course, in-service, well-designed and well-presented training programmes • Training should be in small groups and follow a problem-based approach • Training by qualified teachers notnecessary • Continual monitoring is required • DSM impacts rational prescribing

  9. Implications for policy and programme implementation Cooperation between National Department of Health and academia… • for quality control purposes • to maximise the use of national expertise and resources

  10. Future research agenda • Identification of cause-and-effect relationship between planning, communication and project delivery • Refresher courses for trainers and PHC prescribers • Sustained training programmes • External evaluation by academia • Monitoring systems

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