The effect of two educational activities on the practices of drugstore sellers in the Philippines Rainier M Galang Executive Director National Drug Information Center Manila, Philippines

Background  Drugstore sellers in the Philippines * In privately-owned drugstores * No formal training in pharmacy * Sought by consumers for advice * Dispense drugs without supervision from pharmacist  Privately-owned drugstores * Largest source of drugs nationwide

Objectives  To determine the prevalence of three undesired practices of drugstore sellers  To evaluate the effect of two educational interventions on these practices

The practices were  Incomplete dispensing [outright filling of erroneous single prescription of rifampicin for tuberculosis (TB)];  Dispensing amoxicillin without prescription for a child with acute respiratory tract infection (ARI) and;  Recommending antibiotics where they may not be needed for an adult with flu symptoms.

Methods Study design : Non-randomized comparative, pre-post intervention study Interventions Moderated interactive group discussion (IGD): 1. Moderated interactive group discussion (IGD):  Involving drugstore sellers and mothers  Discussed rational treatment of tuberculosis, acute respiratory tract infection and flu (as well as of wounds)  Leaflets distributed

Methods Interventions 2. Drugstore visit (DSV): (Drugstores not represented at IGDs)  5-10 minute visit from research team  Main educational messages were conveyed verbally  Leaflets distributed

Outcome Measures 3 dispensing practices -Before intervention and 1-month post- intervention -Collected through trained surrogate clients

Results  Study population : 271 drug stores 85 in the IGD intervention group 52 in the DSV group 134 in the control group (average 2 to 3 sellers per drugstore).  Drugstore sellers Almost all female year age group Age range: years Only 90 sellers [10.2% ] were pharmacists of which 50 were drugstore owners  Intervention and control groups comparable

Results (For all groups)  99.3% of drugstores filled erroneous single prescriptions of rifampicin for TB  83.4% dispensed amoxicillin without a prescription for ARI  73.4% recommended antibiotics for flu symptoms Baseline practices

Results Post-intervention practices  Filling erroneous prescription for TB: No change in all 3 groups  Dispensing amoxicillin: IGD group: reduced 23.1%, p=0.001 DSV group: reduced 11.0%, p= Control group: increased 18.7%, p=  Recommending antibiotics for flu symptoms: IGD group: reduced 17.3%, p= DSV group: reduced 2.1%, p= Control group: reduced 7.3%, p=0.2207

Results Multiple logistic regression analysis (MLRA) Pre-intervention practice had significant effect on post- intervention practice in the IGD group  Dispensing amoxicillin [OR=0.27, (95% CI: )]  Recommending antibiotic for flu [OR=12.54, (95%CI: )]

Figure. Comparison of pre- and post-intervention practices of drug sellers (IGD group: n = 85, DSV group: n = 52, Control group: n = 134) Note: IGD = Interactive group discussion DSV = Drug store visit ARI = Acute respiratory tract infection

Conclusions  Filling erroneous single prescriptions of rifampicin was not significantly changed in all groups.  Dispensing amoxicillin without prescription for a child with ARI was significantly decreased in the IGD intervention group.  Recommending antibiotics for flu symptoms was significantly decreased in the IGD intervention group.

Conclusions The drug seller profile  No training on dispensing (Only 90 of the 855 sellers [in 271 drugstores in the study] were trained pharmacists)  Young female  With little formal schooling Recommendations  Drugstore sellers education  Enforcement of minimum standards of practice

THANK YOU Research team: IC Sia, RM Galang, O Mendoza, JA Reyes, AMA Bernardo, D Estrada, C Quiroga, A Santiago National Drug Information Center & Drug Use Study Group, University of the Philippines Manila Supported by Applied Research on Child Health project (ARCH)