E-drug: Intervention research in rational use of drugs: a review
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[abstract + comments by the authors.
Abstract copied from public website:
http://www3.oup.co.uk/heapol/contents/
Health Policy and Planning, Volume 14, Issue 2, pp. 89-102
Review Article. Intervention research in rational use of drugs: a
review
by Amanda Le Grand1, Hans V Hogerzeil2 and Floor M Haaijer-Ruskamp3
1 Consultant in Public Health, Nairobi, Kenya,
email: amanda@ken.healthnet.org,
2 Action Programme on Essential Drugs, World Health Organization,
Geneva, Switzerland, email: hogerzeilh@who.ch,
3 WHO Collaborating Centre for Teaching and Training, Department of
Clinical Pharmacology, University of Groningen, The Netherlands
Email: f.m.haaijer-ruskamp@med.rug.nl
[abstract]
Many studies have been done to document drug use patterns,
and indicate that overprescribing, multi-drug prescribing,
misuse of drugs, use of unnecessary expensive drugs and
overuse of antibiotics and injections are the most common
problems of irrational drug use by prescribers as well as
consumers. Improving drug use would have important financial
and public health benefits. Many efforts have been
undertaken to improve drug use, but few evaluations have
been done in this field. This article provides an overview
of 50 intervention studies to improve drug use in developing
countries. It highlights what type of interventions exist
and what is known about their impact.
It reveals that commonly used interventions, such as an
essential drug list and standard treatment guidelines have
rarely been systematically evaluated so far. The majority of
intervention studies are focused on prescribers in a public
health setting, while irrational use of drugs is also
widespread in the private sector. Furthermore, the magnitude
of inappropriate drug use at community level is often
overlooked and few interventions address drug use for a
consumer's perspective. More research on different types of
intervention strategies in various health care settings is
needed to draw conclusions on the effectiveness of a
specific intervention strategy. Also more research is needed
on socio-cultural factors influencing the impact of drug use
interventions, particularly from a user perspective. To
enhance evaluative research, more technical support will be
needed for researchers in developing countries. The design
of available studies from developing countries is generally
weak, only six of the 50 studies included in this interview
were randomized controlled studies. In order to provide
technical support and coordination of future intervention
research the establishment of an international resource
centre for drug use intervention research is recommended.
[comment by F.M.Haaijer-Ruskamp <f.m.haaijer-ruskamp@med.rug.nl>]
At present an international resource network is being developed to
review studies looking at the effect of different approaches to
implement rational drug use in developing countries. In the
network centres in developing countries, INRUD, the Cochrane
Collaboration EPOC group and the WHO Collaborating Centre for
pharmacotherapy teaching and training in Groningen, The Netherlands
will collaborate. The results will be made available on a website.
E-druggers will be informed as soon as more information is available.
F.M.Haaijer-Ruskamp
Prof drug utilization studies
Dept Clin Pharmacology
Ant Deusinglaan 1
9713 AV Groningen, The Netherlands
tel 31 50 3633216
fax 31 50 3633082
Email: f.m.haaijer-ruskamp@med.rug.nl
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