Transcript Investigating drug use patterns

Promoting rational drug use in the
community
Investigating drug use patterns
and identifying problems
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 problems
Promoting Rational Drug Use in the Community
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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 sources
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Promoting Rational Drug Use in the Community
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Extent to which health worker advice
is sought
 Thailand: 7% of 1755 episodes (rural)
 Philippines: 8% of 1411 episodes (urban),
20% of 422 episodes (rural infants)
 Pakistan: 56% in NGO-PHC area, 48% in
controls (rural)
 Ghana: 42% in urban, 43% 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)
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Trends in medicine use
 Overall, modern medicines used in around
50% of illness episodes treated in self-care
 When health workers advise, nearly always
medicines are prescribed
 Around 50-60 percent of patients do not
comply with prescribed regime
Investigating drug use patterns and identifying problems
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Community drug distribution
Town
Drugstores (35%)
Neighbourhood
stores (40%)
Clinics (2%)
Hospital (1%)
MEDICINES (n=1324)
Doctors (7%)
Household stocks and
free-clinics (8%)
Neighbours and
relatives (5%)
Neighbourhood
Source: Hardon A (1991). Confronting ill health: medicines, self-care and the
poor in Manila
Investigating drug use patterns and identifying problems
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Framework for developing
interventions:
When is research needed?
Investigating drug use patterns and identifying problems
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Steps in an effective communication
intervention
Step 1 Describe
drug use and identify
problems
Step 2 Prioritise
problems
sis
ve
ro
p
Im
Step 7
Monitor and
evaluate
intervention
aly
an
Step 3 Analyse
problems and identify
solutions
Step 4
Select and
develop
intervention
Improve intervention
v
pro
Im
Step 6
Implement
intervention
Investigating drug use patterns and identifying problems
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Step 5
Pretest
intervention
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Step 1: describe
 Aim to identify wide range of possible drug
use problems
 Describe what people DO with drugs
– By reviewing a wide-range of existing
secondary data-sources, and
– Collecting new data with key qualitative
and quantitative methods
Investigating drug use patterns and identifying problems
Promoting Rational Drug Use in the Community
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Step 2: prioritise
 Develop criteria for prioritisation
 Rate/rank problems using criteria
 Select priority problem(s) based on
rating/ranking exercise
Investigating drug use patterns and identifying problems
Promoting Rational Drug Use in the Community
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Step 3: analyse and focus
 Identify sub-problems
 Select and analyse core-problems
 Explore possible solutions
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Promoting Rational Drug Use in the Community
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Research also needed for
 Pre-testing (Step 5)
 Evaluation and monitoring (Step 7)
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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
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Questions: individual/community level
 What are common health problems? How
treated? Appropriate?
 What medicines are commonly used? What
for? Appropriate?
 What are perceived drug use problems?
 What are important sources of drugs?
 What are perceived advantages and
disadvantages of each source?
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Questions: continued
individual/community
 What are important sources of advice on
treatment of common illnesses?
 Where do people get information on
medicines?
 Is the information adequate in their view?
 Would they value access to more
information on drugs?
Investigating drug use patterns and identifying problems
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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
pharmacy 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
staff consider to be problems in drug use
by consumers?
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Questions: National level
 What are key messages in drug
advertisements directed towards
consumers?
 What medicines are sold most in the
country. For what? Appropriate?
 Does the government have a NDP? Is it
implemented? What is done to promote
RDU? To regulate drug promotion?
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Activity 1, Step 2
Review 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?
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Matrix for review of existing data
sources
PROBLEM
SOURCE OF
DATA/EVIDENCE
Investigating drug use patterns and identifying problems
Promoting Rational Drug Use in the Community
LIMITATIONS OF
EXISTING DATA
ADD ITION AL
RESEARCH
NEEDED
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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 data
But: often focus on specific health
problems --> difficult to generalise
 Data often limited geographically
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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?
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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
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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
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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
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Key qualitative methods
 Focus group discussions
 Key informant interviews with variety of
stakeholders
Investigating drug use patterns and identifying problems
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Research methods: Individual
level/community
 Surveys
 Inventory drug
shops/medicine
cabinets
Investigating drug use patterns and identifying problems
Promoting Rational Drug Use in the Community
 common health
problems
 drug use practices
 most popular
medicines
 sources of
treatments
 sources of info on
drugs/therapy
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Research methods:
Individual/Community level continued
 Key informant
interviews
 Focus group
discussions
Investigating drug use patterns and identifying problems
Promoting Rational Drug Use in the Community
 common health
problems and their
treatment
 perceived drug use
problems
 sources of drug
information and
therapy-advice
 perceived adequacy
of drug
information and
treatment advice
 need for more
info?
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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
Investigating drug use patterns and identifying problems
Promoting Rational Drug Use in the Community
 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
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Research methods: National level
 content analysis of
advertisements
directed to
consumers
 sales statistics
 key informant
interviews
Investigating drug use patterns and identifying problems
Promoting Rational Drug Use in the Community
 key messages on
medicines in drug
promotion
 most commonly sold
drugs
 implementation
NDP, regulation of
drug promotion,
activities to
promote RDU
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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 problems
Promoting 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 problems
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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
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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
Investigating drug use patterns and identifying problems
Promoting Rational Drug Use in the Community
WHO
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