An Overview of the Process of Changing Drug Use

1. 1. EXAMINE Measure Existing Practices (Descriptive Quantitative Studies) 4. FOLLOW UP improve diagnosis 2. DIAGNOSE Measure Changes Identify Specific in Outcomes Problems & Causes (Quantitative & Qualitative (In-depth Quantitative Evaluation) & Qualitative Studies) improve intervention 3. TREAT Design & Implement Interventions (Collect Data to Measure Outcomes) An Overview of the Process of Changing Drug Use Learning About Drug Use

2. Changing Drug Use Problems:1. Examine • Identify drug use issue of interest • highest clinical risk? • widely used or expensive drugs? • easiest to correct? • Collect data to describe practices • in all subgroups or interest • most important prescribers? • high risk patients? Learning About Drug Use

3. physicians paramedics pharmacists injectionists patients clinical officers clinic attendants dispensers drug sellers relatives/friends Who is a Prescriber?Or Whose Behavior Do We Change? Learning About Drug Use

4. Quantitative Methods counts rates classifications What? or How Much? Qualitative Methods opinions descriptions observations Why? or How Strong? How to Collect Data Learning About Drug Use

5. Quantitative Methods • Routine Data • drug supply or consumption data • morbidity and mortality reports • Record Systems • medical records • pharmacy records • Sample Surveys • drug use encounters • provider interviews • patient & community interviews Learning About Drug Use

6. Data Available at Health Facilities • Retrospective • patient registers • treatment logs • pharmacy receipts • medical records • Prospective • observation of clinical encounters • patient exit surveys • inpatient surveys Learning About Drug Use

7. FACILITY PATIENT PROVIDER INTERACTION DRUGS ID, characteristics, equipment, drugs available ID, date, age, gender, symptoms knowledge, beliefs, attitudes qualification, training, access to information, knowledge, beliefs, attitudes exams, history, diagnosis, time spent, explanation about illness, explanation about drugs brand, generic, strength, form, quantity, duration, if dispensed, how labeled, cost, patient charge Data From Drug Encounters Learning About Drug Use

8. Qualitative Methods • These methods answer the question why. They provide insights into the reasons for behaviors. • Types of Qualitative Methods • In-depth interviews • Focus Group Discussions • Structured Observations • Structured Questionnaires • Simulated Purchase Visits • Qualitative methods require skilled trained data collectors. Data analysis is more difficult than for quantitative data. But the results can be very useful. Learning About Drug Use

9. Conclusion:Which Method to Use? • Best method depends on: • nature of the problem • objectives of collecting data • available resources and time • local capacity and experience • Use multiple methods • quantitative + qualitative • "triangulate" findings • each method can look at different aspects of a problem Learning About Drug Use

10. Changing Drug Use Problems:2. Diagnose • Describe problem in detail • "gold standard" to assess quality? • specific problem behavior • define important providers or patients • Identify determinants of the problem • knowledge and beliefs • cultural factors or peer practices • patient demand and expectations • Identify constraints to change • economic constraints • drug supply • work environment Learning About Drug Use

11. Why use drug use indicator studies? 1. To assertion current treatment practices 2. To compare the performances of different health facilities or individual prescribers 3. To monitor periodical specific drug use behaviors 4. To assess the impact of an intervention Learning About Drug Use

12. Prescribing Indicators Average number of drugs per encounter Percentage of drugs prescribed by generic name Percentage of encounters with an antibiotic prescribed Percentage of encounters with an injection prescribed Percentage of drugs prescribed from essential drugs list or formulae Learning About Drug Use

13. Drug Care Indicators 6. Average consultation time 7. Average dispensing time 8. Percentage of drugs actually dispensed 9. Percentage of drugs adequately labeled 10. Patients Knowledge of the Correct Dosage Learning About Drug Use

14. Facility Indicators 11. Availability of copy of essential drugs list or formulae 12. Availability of Key Drugs Learning About Drug Use

15. Complimentary Drug Use Indicators 1. Percentage of Patients Treated without Drugs 2. The Average Drug Cost per Encounter 3. Percentage of Drug Costs spent on Antibiotics 4. Percentage of Drug Costs spent on Injections 5 . Prescriptions in Accordance with Treatment Guidelines 6. Percentage of Patients satisfied with the Care They Received 7. Percentage of Health Facilities with Access to Impartial Drug Information Learning About Drug Use