Decision Making for Rational Drug Use Interventions

1. Decision Making for Rational Drug Use Interventions

2. Decision Making for Rational Drug Use Interventions: Objectives • Review intervention strategies • Choose between interventions • Develop a plan to undertake an intervention Decision Making for RDU Interventions

3. Choosing Strategies • Expected magnitude of impact • Likelihood of success • Risk of unintended effect • Political and cultural feasibility • Technical feasibility • Cost (economic feasibility) • Potential for donor support Decision Making for RDU Interventions

4. FORMATIVE STUDIES 1. Define Problems with Drug Use Patterns 2. Identify Motivating Factors/Underlying Causes • prescribing • dispensing • patient use • informational • economic • social, cultural • supply logistics INTERVENTION STUDIES 3. List Possible Interventions 4. Choose Intervention(s) to test 5. Conduct controlled study of Intervention(s) • educational • managerial • regulatory • cultural acceptance • likelihood of success • potential impact • feasibility FOLLOW UP IMPLEMENT cost effective interventions on a larger scale REVISE AND RESTUDY partially effective or costly interventions DROP ineffective, uneconomical interventions Source: Quick et al. 1991. Framework for Intervention Studies Decision Making for RDU Interventions

5. Selecting an InterventionStage 1: Choosing a Target • Characterize situation (indicator study) • Clarify problem (follow-up quantitative studies) • Investigate underlying factors (qualitative studies) • Motivations of prescribers • Patient expectations • Constraints of system • Synthesize data to choose targets • Key behaviors to change • Target group Decision Making for RDU Interventions

6. Selecting an InterventionStage 2: Choosing an Intervention • List possible interventions • Consider available resources • Financial • Human • Administrative structure • Choose an intervention (or interventions) • Feasibility • Likely to change target behaviors • No absolute constraints Decision Making for RDU Interventions

7. Types of Study Design • Post Only: • After the event • Pre-Post • Before and after • Randomized Trial • Random assignment of study and control group • Time Series • Multiple measures before and after Not Recommended Not Recommended Recommended Recommended Decision Making for RDU Interventions

8. Principles of Good Intervention Testing • Use a relevant comparison group • Randomly assigned if possible • Data collected like study group • Measure outcomes at multiple time points • Before and after intervention • Time series? • Focus on key outcome measures • Behaviors targeted by intervention • Feasible to measure Decision Making for RDU Interventions

9. Choosing Useful Outcome Measures • Focus on key behaviors to be changed • Consider likely substitute behaviors • Focus on several important outcomes, not all changes • Choose outcomes that can be— • Clearly defined • Reliably measured • Measure more than one dimension, for example changes in— • Knowledge • Prescribing • Patient knowledge Decision Making for RDU Interventions

10. Issues and Sampling Methods • Simple Random Sampling • Systematic Sampling • Stratified Sampling • Cluster Sampling • Multistage Sampling Unit of analysis must be defined before sampling begins. Sample size must be enough to detect expected changes. Decision Making for RDU Interventions

11. Using Samples to Collect Data • Sample should be typical of the overall group of interest • Accuracy depends on the sample size • If sample units are drawn in clusters, the size of the clusters should be small, and the number of clusters should be large Decision Making for RDU Interventions

12. Involving Decision Makers at Design Stage • Involving decision makers at design stage increases chances of implementation if the intervention is successful • Opportunities for involving decision makers should be actively sought • Asking for input at the design stage increases chances of cooperation and success Decision Making for RDU Interventions

13. Planning an Intervention • Decide what kind of study to use to test the intervention • Define study and control groups • Define sampling process and size • Define outcome variables to measure success • Plan how to collect data • Decide who will analyze the data, how, and when* • Plan how to present the data, and to whom • Decide how to monitor the project * Remember: if you can analyze by hand, a computer may help. If you can't, a computer only makes things worse! Decision Making for RDU Interventions

14. Gantt Chart Decision Making for RDU Interventions

15. Budget Outline Decision Making for RDU Interventions

16. Budget Outline (continued) Decision Making for RDU Interventions

17. ConclusionWhich 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 Decision Making for RDU Interventions

18. Conclusion Points to Consider when Developing Strategy • Specific intended changes in behavior • Possible unintended outcomes due to the intervention • How both intended and unintended changes will be measured • Choice of intervention (or combination of interventions) • Why this is likely to achieve desired changes • Other information needed to design the intervention Decision Making for RDU Interventions