promoting rational drug use in the community investigating drug use patterns and identifying...
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WHO 3 Investigating drug use patterns and identifying problems Promoting Rational Drug Use in the Community Why study drug use People often use medicines without health worker advice People have their own experiences with medicines which shape their drug use practices People obtain medicines from informal community sourcesTRANSCRIPT
Promoting rational drug use in th e community
Investigating drug use pattern s and identifying problems
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Objectives
Help you understand when research is needed in the development of interventions
Define what questions you need to ask Identify key quantitative and qualitative
methods Reflect on limitations of available
sources of data on drug use problems
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Why study drug use
People often use medicines without heal th worker advice
People have their own experiences with medicines which shape their drug use pr
actices People obtain medicines from informal c
ommunity sources
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Extent to which health worker ad vice is sought
7 1755Thailand: % of episodes (rural) ((((: 8 % 1 4 1 1 (
(((((( ((((((), 2 0 % 4 2 2 ()
- 56 48Pakistan: % in NGO PHC area, % in ()
42 43Ghana: % in urban, % in rural
Sources: Le Grand A, Sringernyuang L (1989); Hardon A (1991); Hardon AP (1987); Rasmussen ZA et al (1996); Wondergem PW, Senah KA, Glover EK (1989)
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Trends in medicine use Overall, modernmedicinesusedi n ar ound 50%of i l l ness epi sodes t
-reated in self care Whenheal t h wor ker s advi se, near l y al ways
medicines are prescribed - Around50 60per cent of pat i ent s do not compl
y with prescribed regime
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Town
Clinics (2%)
Hospital (1%)
Doctors (7%)
Drugstores (35%)
Household stocks andfree-clinics (8%)
Neighbourhoodstores (40%)
Neighbours andrelatives (5%)
Neighbourhood
MEDICINES (n=1324)
Community drug distribution
Source: Hardon A (1991). Confronting ill health: medicines, self-care and the poor in Manila
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Framework for developing interventions:
When is research needed?
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Step 1 Describedrug use and identify
problems
Step 4Select and
developintervention
Step 5 Pretest
intervention
I mprove intervention
I mprove inte
rvention
Step 3 Analyseproblems and identify
solutions
I mprove a
nalysis
Step 7Monitor and
evaluateintervention
Step 2 Prioritiseproblems
Step 6 I mplementintervention
Steps in an effective communication intervention
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Step1 : descri be
((( (( (((((((( ( ((( ((((( (( (((((((( (((( ((( ((((((( (
(((((((( (((( (((((( (( (((( (((((– - By reviewing a wide range of existin
- g secondary data sources, and– Collecting new data with key qualitat
ive and quantitative methods
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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2 2 22222222222
Develop criteria for prioritisation (((((((( ((((( ((((((((/
((((( (( (((((((((((((( ((((((((()/
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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3Step : analyse and focus
(((((((( (((-((((((((
-Select and analyse core problems
((((((( (((((((( (((((((((
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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2 2222222 2222 222222 222
- Pre testing (Step 5) Evaluation and monitoring (Step 7)
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Activity 1: Inventory of drug use problems
Appoint a facilitator and rapporteur The facilitator asks participants to share the drug
use problems they identified prior to course The rapporteur tries to group them in a logical way The facilitator asks group members to discuss
which problems are most important. Select five! The group discusses a brief description of the 5
problems
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Questions: individual/communitylevel What are common health problems? Ho
w treated? Appropriate? What medicines are commonly used? W
hat for? Appropriate? What are perceived drug use problems? What are important sources of drugs? What are perceived advantages and disa
dvantages of each source?
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Questions: continued individual/community What are important sources of advice on t
reatment of common illnesses? Where do people get information on medi
cines? Is the information adequate in their view? Would they value access to more informat
ion on drugs?
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Questions: Health institution level How appropriate are prescribing practices?
What are the main problems? To what extent do health workers and phar
macy staff provide adequate drug information?
What other health IEC activities take place? Do they contain messages on RDU? Which?
What do health workers and pharmacy sta ff consider to be problems in drug use by co
nsumers?
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Questions: National level
What are key messages in drug advertis ements directed towards consumers?
What medicines are sold most in the cou ntry. For what? Appropriate?
Does the government have a NDP? Is it i mplemented? What is done to promote R
DU? To regulate drug promotion?
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Activity 1, Step 2Review of existing data sources The trainer gives each group a matrix
on which the four selected problems can be written.
For each problem, review what sources of data on the problem exist.
What are limitations of these sources What additional research is needed?
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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PROBLEM SOURCE OFDATA/EVIDENCE
LIMITATIONS OFEXISTING DATA
ADDITIONALRESEARCHNEEDED
Matrix for review of existing data sources
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Limitations of existing data sources Limited data on drug use by consumers
-- more known about drug prescribing and supply
Surveys are common sources of dataBut: often focus on specific health problems --> difficult to generalise
Data often limited geographically
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Limitations of existing data sources continued
Few attempts to ask consumers what their problems are?
Few studies assess existing drug information channels and messages
Few analyse problems: why do they occur?
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Additional quantitative research needed To describe variety of drug use
practices and how often they occur. To quantify where people go for
medicines and where for advice To give representative data, which can
be generalised
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Additional qualitative data needed To gain insight in problems as defined
by various stakeholders To find out what people think about
existing source of information on drugs To find out what drug information they
need To understand why problems occur
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Key quantitative methods
Weekly illness recalls = what people do in common health problems
Inventory of medicines in household cabinets and/or informal shops selling medicines in communities = popular medicines
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Key qualitative methods
Focus group discussions
Key informant interviews with variety of stakeholders
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Research methods: Individual level/community Surveys Inventory drug sh
ops/medicine cabi((((
common health problems
drug use practices most popular med
(((((( sources of treatm
(((( sources of info on
drugs/therapy
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Research methods: Individual/Co mmunity level continued
((( ((((((((( ((terviews
((((( ((((( ((((ussi ons
common health pro blems and their trea
tment perceived drug use
problems sources of drug info
rmation and therap-y advice
perceived adequac y of drug informati
on and treatment advice
need for more info ?
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Research methods: Health institutions
review of records structured
observations of patient-health worker consultation
key informant interviews
simulated client visits pharmacies
exit interviews
drug prescription practices
perceived drug use problems
provision of drug information in health centres and pharmacies
existing IEC activities in the field of health
Messages on RDU
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Research methods: National level content analysis
of advertisements directed to consumers
sales statistics key informant
interviews
key messages on medicines in drug promotion
most commonly sold drugs
implementation NDP, regulation of drug promotion, activities to promote RDU
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Focus groups Used widely in marketing research Efficient way to collect information on a
wide range of behaviours/ideas Interactions stimulate people to give
their views But, best combined with individual
interviews -- some things may not be shared in a group
Analysis can be difficult
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Focus groups: how to
Homogeneous groups in terms of age, sex, and/or socioeconomic status/ethnicity
6-10 participants Skilled facilitator Neutral venue At least two discussions per category of
respondents Avoid uninvited onlookers
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Focus group content Limit topics to four-five Ensure natural progression from one
topic to another Ensure natural progression from general
topic to specific aspects Start with questions -- summarize into
topics Be flexible -- follow the flow of the
discussion but make sure the topics are covered
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How to analyse FGDs Best to record on tape (ask for consent) But, keep notes as well: non-verbal
observations and who said what Make extended notes Capture exact words/local terms Analyse according to the topics/questions
asked and unexpected themes/issues that emerge.
Avoid quantifying-qualitative information
Investigating drug use patterns and identifying problemsPromoting Rational Drug Use in the Community WHO
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Activity 3: FGD on everyday medicine use You are divided into four groups:
younger women; middle-aged women; young men;middle-aged men
Focus is on every-day medicine use Review the FGD guide: change/adapt Select facilitator and rapporteur Conduct FGD: one hour Reflect on how it went Write extended notes on the results