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Please use this identifier to cite or link to this item:
http://hdl.handle.net/123456789/1925
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| Title: | Impact of an educational intervention to improve prescribing by private physicians in Uganda |
| Authors: | Obua, C.
Ogwal-Okeng, C.W.
Waako, P.
Aupont, O. |
| Keywords: | Medical practioners
Drugs-prescribing
Drug use
Acute respiratory infections
Malaria
Diarrhoea
Private physicians |
| Issue Date: | 2004 |
| Publisher: | Kenya Medical Association |
| Citation: | Obua, C., Ogwal-Okeng, C.W., Waako, P., Aupont, O. (2004). Impact of an educational intervention to improve prescribing by private physicians in Uganda. East African Medical Journal, 81(2). |
| Abstract: | Introduction: Private physicians in urban Uganda treat a large percentage of common
adult illnesses. Improving their prescribing would not only encourage more rational
drug use, but also reduce costs to patients. Interventions to improve drug use are
generally more successful when face-to-face educational methods are included.
Objectives: To determine the effectiveness of a face-to-face educational intervention 011
the treatment of acute respiratory infections (ARI), malaria, and non-dysenteric
diarrhoea by private physicians in three urban areas of Uganda.
Methods: The study used an intervention with comparison group design to evaluate
the impact of the educational intervention. A total of 108 private physicians was divided
into intervention (n=30) and control (n=78) groups. Surrogate patients, trained to
simulate presenting symptoms and signs of the target conditions, were used to colllect
data on the medical practices and prescribing behaviours of the physicians. Intervention
physicians were invited to a one-day interactive educational seminar facilitated by local
opinion leaders that covered principles of rational drug use and the National Standard
Treatment Guidelines for treating the target conditions. Physicians were also provided
with data about baseline practices.
Results: Baseline data indicated high rates of inappropriate treatment practices by both
intervention and control groups. There was nearly universal antibiotic use for ARI (over
go%), high rates of injections recommended for malaria (over 30%), and high rates
of polypharmacy (over thee drugs per patient). After the intervention, some significant
improvements in key practices were observed in the intervention group. Compared to
control physicians, antibiotic prescribing for ARI decreased by 23% in the intervention
group, use of combination products for malaria declined by 28%, there were trends
towards better adherence to guidelines for ARI and malaria, and marginal decreases
in drug costs. However, the overall impacts of the intervention were limited, especially
on quality indicators concerning history taking, adequate examination, and advice to
patients.
Conclusion: The face-to-face educational intervention resulted in some small improvements
in key prescribing practices of private physicians. However, an intervention that
involved repeated contacts with prescribers and which addressed economic considerations
would be needed to obtain larger improvements. Private physicians need to be sensitized
to and encouraged to use the National Standard Treatment Guidelines, and attempts
to improve their prescribing should be supported by community education. |
| URI: | http://hdl.handle.net/123456789/1925 |
| ISSN: | 0012-835X |
| Appears in Collections: | Research Articles (Health-Sciences)
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| obua-chs-res.pdf | | 634Kb | Adobe PDF | View/Open |
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