Skip to main content
main-content

01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Health Services Research 1/2018

Effectiveness of an educational intervention to improve antibiotic dispensing practices for acute respiratory illness among drug sellers in pharmacies, a pilot study in Bangladesh

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2018
Autoren:
Fahmida Chowdhury, Katharine Sturm-Ramirez, Abdullah Al Mamun, A. Danielle Iuliano, Mohammod Jobayer Chisti, Makhdum Ahmed, Mejbah Uddin Bhuiyan, Kamal Hossain, Mohammad Sabbir Haider, Shaikh Abdul Aziz, Mahmudur Rahman, Eduardo Azziz-Baumgartner
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12913-018-3486-y) contains supplementary material, which is available to authorized users.

Abstract

Background

Inappropriate dispensing of antibiotics for acute respiratory illness (ARI) is common among drug sellers in Bangladesh. In this study, we evaluated the impact of an educational intervention to promote guidelines for better ARI management among drug sellers.

Methods

From June 2012 to December 2013, we conducted baseline and post-intervention surveys on dispensing practices in 100 pharmacies within Dhaka city. In these surveys, drug sellers participated in 6 standardized role-playing scenarios led by study staffs acting as caregivers of ARI patients and drug sellers were blinded to these surveys. After the baseline survey, we developed ARI guidelines and facilitated a one-day educational intervention about ARI management for drug sellers. Our guidelines only recommended antibiotics for children with complicated ARI. Finally, we conducted the six month post-intervention survey using the same scenarios to record changes in drug dispensing practices.

Results

Only 2/3 of participating pharmacies were licensed and few (11%) of drug sellers had pharmacy training. All the drug sellers were male, had a median age of 34 years (IQR 28–41). For children, dispensing of antibiotics for uncomplicated ARI decreased (30% baseline vs. 21% post-intervention; p = 0.04), but drug sellers were equally likely to dispense antibiotics for complicated ARI (15% baseline vs. 17% post-intervention; p = 0.6) and referrals to physicians for complicated ARIs decreased (70% baseline vs. 58% post-intervention; p = 0.03). For adults, antibiotic dispensing remained similar for uncomplicated ARI (48% baseline vs. 40% post-intervention; p = 0.1) but increased among those with complicated ARI (44% baseline vs. 78% post-intervention; p < 0.001). Although our evidence-based guidelines recommended against prescribing antihistamines for children, drug sellers continued to sell similar amounts for uncomplicated ARI (33% baseline vs. 32% post-intervention; p = 0.9).

Conclusions

Despite the intervention, drug sellers continued to frequently dispense antibiotics for ARI, except for children with uncomplicated ARI. Pairing educational interventions among drug sellers with raising awareness about proper antibiotic use among general population should be further explored. In addition, annual licensing and an reaccreditation system with comprehensive monitoring should be enforced, using penalties for non-compliant pharmacies as possible incentives for appropriate dispensing practices.
Zusatzmaterial
Additional file 1: Poster/Flip chart “Key messages through educational intervention on acute respiratory illness (ARI) management for the drug sellers at pharmacy”. “We had provided a poster to hang in the pharmacy and a flip chart to keep in the pharmacy desk to each drug sellers of the selected study pharmacies with the key messages from the training/education intervention on ARI management” (PDF 72 kb)
12913_2018_3486_MOESM1_ESM.pdf
Additional file 2: Training Manual “Awareness guideline on Acute Respiratory Illness for the drug sellers”. “We have provided this training manual to each drug sellers of the selected study pharmacies which contained details material of the training/education intervention on ARI management” (PDF 69 kb)
12913_2018_3486_MOESM2_ESM.pdf
Additional file 3: Questionnaire for drug sellers after educational intervention. “This was the questionnaire for post intervention survey on knowledge, attitude and practice of the drug sellers to collect information on drug sellers compliance with the educational intervention” (PDF 117 kb)
12913_2018_3486_MOESM3_ESM.pdf
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2018

BMC Health Services Research 1/2018 Zur Ausgabe