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Objectives of the Study

Objectives of the Study. To measure patterns of antibiotic use in adults with URIs, and To identify where inappropriate use of antibiotics occurs in the community Methods Cross-sectional study (Oct 02) Systematic random sampling of households

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Objectives of the Study

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  1. Objectives of the Study • To measure patterns of antibiotic use in adults with URIs, and • To identify where inappropriate use of antibiotics occurs in the community Methods • Cross-sectional study (Oct 02) • Systematic random sampling of households • Visit 3,973 hhs, 2 congested communities, BKK • Interview 779 adults with URIs within 2 priorwks. 1

  2. Methods • 4-page semi-structured questionnaire • URIs symptoms, health seeking behavior • Drug use (name, amount, frequency, and duration of drug; reason for taking drug, cost) • Knowledge and attitudes • Identify possible viral or bacterial URIs cases with GAS score1 and signs for sinusitis2 1 McIsaac WJ, White D, Tannenbaum D, Low DE. 1998. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. Canadian Medical Association Journal 158: 75-83. 2 William JW Jr, Simel DL. 1993. Does this patient have sinusitis?: Diagnosing acute sinusitis by history and physical examination. Journal of the American Medical Association 270(10):1242-1246. 2

  3. Adherence • Adherence = the extent to which a person’s behavior corresponds with medical advice • Non-compliance in URIs treatment leads to deterioration of health, ineffective management, additional cost, and antibiotic resistance Methods of measuring adherence • Direct interview • survey, self-report • Objective measuring methods • pill count • biological test e.g. urine test • microelectronic device e.g. MEMS 3

  4. Challenges in Measuring Adherence Challenges in identifying case in community • Cooperation, reported symptoms Challenges in identifying drug & regimen • Some do not know medicine they took (drug name or indication, drug regimen) • The term ‘Ya-kae-uk-sep’, which can mean both ‘antibiotics’ or ‘anti-inflammatory’ drug • Unidentified drug • No drug sample 4

  5. Drug card Dealing with the Challenges in the Household Survey • Drug card: picture of possible tablets used for URIs treatment in community • Clarify the term ‘Ya-kae-uk-sep’ and ‘antibiotic’ • Ask for sample of drug taken for URIs 5

  6. Dealing with the Challenges in the Household Survey • Recheck the information with other members • Use SCM in drug stores and reviewing of prescriptions at health centers to complete the jigsaw • For examples, drug received from SCM suggested: • type of drug usually dispensed • incomplete dosage of antibiotics • incomplete drug information 6

  7. Useful in communi -cation with cases validity& reliability validity& reliability validity& reliability Strengths & Weakness Method used Strengths Weakness Questionnaire with self-report of the patient • Simple • Straightforward • Qualitative info. • Missing of clinical info. • Reliability, Recall bias • Social desirability • Reveal only a proportion of cases Drug card Need previous survey of drug available in community Asking for drug sample NA in case with no leftover drug Recheck with other sources Need more resources 7

  8. Recommendations for Improving Adherence Measurement • Good questionnaire & good interviewer • Aid kit that help in communication between researchers and cases e.g. drug card • Use multiple methods Acknowledgement: Ms. Ratana Somrongthong, Project coordinator Funding: 8

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