1. Learning About Drug Use1 An Overview of the Process of Changing Drug Use 1. EXAMINE Measure Existing Practices (Descriptive Quantitative Studies) 2. DIAGNOSE Identify Specific Problems & Causes (In-depth Quantitative & Qualitative Studies) 3. TREAT Design & Implement Interventions (Collect Data to Measure Outcomes) 4. FOLLOW UP Measure Changes in Outcomes in Outcomes (Quantitative & Qualitative Evaluation) improve intervention improvediagnosis

2. Learning About Drug Use2 Changing Drug Use Problems: 1. Examine Identify drug use issue of interest – –highest clinical risk? – –widely used or expensive drugs? – –easiest to correct? Collect data to describe practices – –in all subgroups or interest – –most important prescribers? – –high risk patients?

3. Learning About Drug Use3 Who is a Prescriber? Or Whose Behavior Do We Change? physicians paramedics pharmacists injectionists patients clinical officers clinic attendants dispensers drug sellers relatives/friends

4. Learning About Drug Use4 How to Collect Data Quantitative MethodsQuantitative Methods –counts –rates –classifications –What? or How Much? Qualitative MethodsQualitative Methods –opinions –descriptions –observations –Why? or How Strong?

5. Learning About Drug Use5 Quantitative Methods Routine Data – –drug supply or consumption data – –morbidity and mortality reports Record Systems – –medical records – –pharmacy records Sample Surveys – –drug use encounters – –provider interviews – –patient & community interviews

6. Learning About Drug Use6 Data Available at Health Facilities Retrospective – –patient registers – –treatment logs – –pharmacy receipts – –medical records Prospective – –observation of clinical encounters – –patient exit surveys – –inpatient surveys

7. Learning About Drug Use7 Data From Drug Encounters FACILITYFACILITY PATIENTPATIENT PROVIDERPROVIDER INTERACTIONINTERACTION DRUGSDRUGS ID, characteristics, equipment, drugs available ID, date, age, gender, symptoms knowledge, beliefs, attitudes qualification, training, access to information, knowledge, beliefs, attitudes exams, history, diagnosis, time spent, explanation about illness, explanation about drugs brand, generic, strength, form, quantity, duration, if dispensed, how labeled, cost, patient charge

8. Learning About Drug Use8 Qualitative Methods These methods answer the question why. They provide insights into the reasons for behaviors. Types of Qualitative Methods – –In-depth interviews – –Focus Group Discussions – –Structured Observations – –Structured Questionnaires – –Simulated Purchase Visits Qualitative methods require skilled trained data collectors. Data analysis is more difficult than for quantitative data. But the results can be very useful.

9. Learning About Drug Use9 Conclusion: Which Method to Use? Best method depends on: – –nature of the problem – –objectives of collecting data – –available resources and time – –local capacity and experience Use multiple methods – –quantitative + qualitative – –"triangulate" findings – –each method can look at different aspects of a problem

10. Learning About Drug Use10 Describe problem in detail – –"gold standard" to assess quality? – –specific problem behavior – –define important providers or patients Identify determinants of the problem – –knowledge and beliefs – –cultural factors or peer practices – –patient demand and expectations Identify constraints to change – –economic constraints – –drug supply – –work environment Changing Drug Use Problems: 2. Diagnose

11. Learning About Drug Use11 Why use drug use indicator studies? 1. To assertion current treatment practices 2. To compare the performances of different health facilities or individual prescribers 3. To monitor periodical specific drug use behaviors 4. To assess the impact of an intervention

12. Learning About Drug Use12 Prescribing Indicators Average number of drugs per encounter Percentage of drugs prescribed by generic name Percentage of encounters with an antibiotic prescribed Percentage of encounters with an injection prescribed Percentage of drugs prescribed from essential drugs list or formulae

13. Learning About Drug Use13 Drug Care Indicators 6. Average consultation time 7. Average dispensing time 8. Percentage of drugs actually dispensed 9. Percentage of drugs adequately labeled 10. Patients Knowledge of the Correct Dosage

14. Learning About Drug Use14 Facility Indicators 11. Availability of copy of essential drugs list or formulae 12. Availability of Key Drugs

15. Learning About Drug Use15 Complimentary Drug Use Indicators 1. Percentage of Patients Treated without Drugs 2. The Average Drug Cost per Encounter 3. Percentage of Drug Costs spent on Antibiotics 4. Percentage of Drug Costs spent on Injections 5. Prescriptions in Accordance with Treatment Guidelines 6. Percentage of Patients satisfied with the Care They Received 7. Percentage of Health Facilities with Access to Impartial Drug Information