Impact of a public education program on promoting rational use of medicines: a household survey in south district of Tehran, 2002-2003 Darbooy SH, Hosseini AR, Mohagheghi MA, Effatpanah M Tehran University of Medical Sciences, IRAN

Introduction: Although prescribers play an essential role in promoting rational use of medicines, the role of the patient is equally important. Knowledge; attitude and practice of patients as the final target in pharmacotherapy cycle influence health improvement in countries. World Health Organization (WHO) has suggested educational programs as an important strategy to improve rational use of medicines in communities. In Iran since many years ago educational programs has been carried out in form of continuous medical education programs for physicians, pharmacists and other health providers. In these programs many seminars and workshops have implemented regarding rational use of medicines, but very few programs has focused on public education. A number of studies in different countries have shown effectiveness of public education in promoting rational use of medicines, but apart from a number of scattered studies, we had no documented information about public's knowledge and behavior related medicines and impact of education on promoting them

Objectives: This study was undertaken to get insight about public's knowledge and behavior related to medicines and to study the effect of an educational program on drug use behavior in the community. It was expected that public education would change drug use behavior positively.

Methods: Study Design: Pre- and post intervention with control group. Setting and Population: Three hundred households were selected using a multistage systematic randomized sampling method for each control and study group. Data were collected from both groups, pre-and post intervention using a modified World Health Organization (WHO) household survey questionnaire.

Intervention: An educational booklet containing simple recommendations and pictures regarding subjects such as correct use of medicines, attention to expiration date of drugs, completing treatment duration, drug abuse and disadvantages of self –medication was designed, pre tested in target group and published based on pre intervention findings. Study group households were invited for participating in training sessions that run by general practitioners in primary health care centers, together with distribution of booklet.

RESULTS: About ninety five percent of training session's participants was housewives. Local primary health care center's services were used by more than sixty five percent of households. Pharmacy was only source of drug supply in study and control group. Before intervention, respectively 58% and 60% of interviewees in study and control groups explained that reuse of drugs in probable future diseases was the main reason for storage of drugs in their homes. After intervention this option was 32% in study group and 55% in control group.

Discussion: Finding of this study showed that public education about medicines, improved drug use behavior in study group in comparison with control group. Reduction in average number of drugs per households, percentage of antibiotics and expired drugs which were available in households confirmed that people attention to completing treatment duration and expiration date of drugs has increased. Self- medication as one of the irrational use of medicines indicators in the community has decreased after Educational intervention. Besides, this study showed that people were interested to know more about drugs which they used. Increased percent of interviewees that explained correctly drug indications demonstrated this point. Finally, housewives as health managers in their homes and primary health care centers and pharmacies as reliable medical services have essential role in improving rational use of medicines in the community.

Conclusion & recommendations: Implementation of training sessions about medicines in southern region of Tehran primary health care centers together with using of appropriate printed material, within the short period of evaluation has changed social behavior in relation medicines positively . The study needs to be followed by periodic reinforcement in this region. Besides, doing such studies in other areas with similar or different educational interventions and comparison between obtained results will give us total insight about effectiveness of these programs. By disseminating the results to health policymakers and their advocacies, public education about medicines will be as a continuous program in national level. Mass media has determinant role in success of this program.