Health Policy and Planning, Vol 14, 89-102, Copyright © 1999 by Oxford University Press
A Le Grand, H V Hogerzeil and F Haaijer-Ruskamp
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.
ARTICLES
Review Article. Intervention research in rational use of drugs: a review
Consultant in Public Health, Nairobi, Kenya; Action Programme on Essential Drugs, World Health Organization, Geneva, Switzerland; WHO Collaborating Centre for Teaching and Training, Department of Clinical Pharmacology, University of Groningen, The Netherlands
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