Proposal for the collection of baseline information on drug utilisation and treatment seeking behaviour in Southern Africa

 

Any change in a treatment guideline or drug policy requires implementation, not only on paper, but also in day to day practice. Research, which is translated into policy, needs to be further translated into action. A drug use implementation study would examine issues that may inhibit or promote this implementation. These range from ensuring a facility has an adequate drug supply, though to the examination of prescribing or drug use patterns at clinic level and an assessment of treatment seeking behaviour and alternate sources of treatment available to the community in which the change is to be implemented. There are always obstacles to change. One of the biggest of these is the tendency for all people to choose the status quo and to persist with a practice that is habitual.

     
 

A drug use implementation study would examine issues that may inhibit or promote this implementation. These range from ensuring a facility has an adequate drug supply, though to the examination of prescribing or drug use patterns at clinic level and an assessment of treatment seeking behaviour and alternate sources of treatment available to the community in which the change is to be implemented.
 
     

In a disease such as malaria, a refusal to change from ineffectual or harmful practices may result in an increase in plasmodial resistance to the agents in question. The combination of artesunate with S/P is designed to delay emergence of such resistance. If, however, only one of these drugs is available at a primary care facility, or a prescriber prefers to use another drug, such as chloroquine, or a patient does not complete the course of therapy, the benefits expected by using two drugs will be reduced. The inevitable emergence of resistance may be further delayed by the promotion of sound and rational drug use practice.

No comprehensive studies have been published on rational drug utilisation in malaria but there have been a large number of studies covering different aspects which when pieced together provide a comprehensive picture. Can this information be used in the South African context to streamline the introduction of a new antimalarial regime?

Objectives (at baseline):

      To define at baseline (prior to the introduction of CAT) the drug supply management factors that may have a positive or negative impact on drug utilisation during the change in therapeutic protocol.
       To define at baseline the factors affecting rational drug prescription by all "prescribers" (sanctioned and unsanctioned – doctors, nurses, pharmacists, malaria control program field staff) which may have a positive or negative impact on drug utilisation during the change in therapeutic protocol.
       To assess patient and community perspectives in relation to malaria and anti-malarial therapy, compliance and treatment–seeking behaviour.

The data collected above will then be used to successfully implement the change of first line therapy. The needs identified in this baseline evaluation will be used to develop educational materials and methods of implementation which will be used as aids to educate district staff, health care staff, other healers and community members about the intended change in therapy, and the rationale behind it, prior to its implementation. These data collection tools will then be used to monitor drug utilisation practice at years 1 and 3 after implementation of the change to combination therapy.

In collaboration with Dr Holly Ann Williams, Center for Disease Control and Prevention (USA)
[SEACAT] [Introduction] [Exec Summary] [ Study Design] [Participants] [Links]