[e-drug] improving prescribing practices in PHC facilities of Nepal

e-drug
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E-DRUG: improving prescribing practices in PHC facilities of Nepal
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Successful intervention to improve prescribing practices in PHC facilities of Nepal

KK Kafle, SB Karkee, RR Prasad, GB Bhuju, N Shrestha, PL Das, AD Shrestha
INRUD, Nepal

Improving prescribing practices is a major challenge at primary healthcare outlets in developing countries. Randomised controlled pre-post intervention study conducted in 80 health facilities of nine districts of Nepal in 2001 found the peer-group discussion strategy effective in improving prescribing practices. The strategy was found to be less expensive and more convenient for implementation than conventional method of supervision/monitoring. The peer-group discussion strategy is being piloted in all PHC facilities of a district (Chitwan) through the existing district health system for last three years. The significant improvement in practices for tracer conditions compared to baseline is being sustained. The key findings up to July 2006 are as follows:

. Use of ORS alone in acute diarrhoea in children below five years increased from 11.5 % to 100.0 %
. Use of co-trimoxazole or amoxycillin alone or with paracetamol in pneumonia in children below five years increased from 58.2 % to 100.0 %
. Use of Benzyl Benzoate or Gamma benzene hexachloride alone in scabies cases increased from 20.7 % to 100.0 %
. Use of antibiotics in no pneumonia in children below five years decreased from 22.4 % to 0.0 %

[hmm, 3 times 100% and once 0% sounds too good to be true... WB, moderator]

With regards,

K.K.Kafle
INRUD,Nepal

Prof. Kumud K. Kafle
Head of Clinical Pharmacology
Institute of Medicine
TU Teaching Hospital, Kathmandu,Nepal
Tel: 977-1-4115636(Res), 4412605( Work)
Fax: 977-1-4115515
inrud@healthnet.org.np

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E-DRUG: Improving prescribing practices in PHC facilities of Nepal (2)
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The INRUD Nepal study is very unusual indeed!! These
results are extra-ordinary to obtain in behavioural
change! May be a full-length paper from this will help
to enlighten those of us that are not comfortable with
these wonderful results!!!
One hopes that these can be sustained over a long
period of time!

Fola Tayo,
Professor of Clinical Pharmacy
Faculty of Pharmacy, University of Lagos. Nigeria.
(formerly, Professor of Pharmacology)
folatayo2001@yahoo.com.

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E-DRUG: Improving prescribing practices in PHC facilities of Nepal (3)
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Dear All,

Indeed, the results of the intervention to improve
prescribing practices at PHC level in Nepal is
incredulous, too good to be true as rightly observed
by the moderator. If interventions are really that
effective and "rapidly acting" in changing behaviours,
then we should have put this problem behind us a long
time ago. Thers is no doubt that FGD is a good
qualitative method for dealing with exploration and
identification of relevant issues related to
behaviours and how and where to intervene to achieve
desired changes.However, what the abridged results of
Kafle study did not tell us was at what point,
post-intervention, were those results achieved,how
frequently was the intervention applied, what was the
participant mix and what was the results like after,
for example 3 months, 6months, 12months e.t.c
post-intervention.

This will enable objective contextualisation of the
results presented.

Kazeem Babatunde Yusuff
Dept. of Clinical Pharmacy & Pharmacy Administration
Faculty of Pharmacy
University of Ibadan
Ibadan, Nigeria.
Tel:234-80-37220220
e-mail: yusuffkby@yahoo.co.uk