INTERVENTION TEST OF TRAINING AND SUPERVISION ON Dispensing PRACTICES Study on... · 2019-05-25 ·...

INTERVENTION TEST OF TRAINING AND

SUPERVISION ON Dispensing PRACTICES

Submitted to USAID/RPM/JSI, Nepal

August, 1995 Kathmandu, Nepal

CONTENTS Page No CONTENTS i-ii ACKNOWLEDGEMENT iii PERSONNEL INVOLVED iv EXECUTIVE SUMMARY v-vi INTRODUCTION 1. BACKGROUND 1 2. PURPOSE AND SIGNIFICANCE 2 2.1 Study Objectives 2 2.2 Significance of the Study 2 METHODS 3. OVERALL APPROACH AND DESIGN 3 4. DETAILED METHODOLOGY 4 4.1 Sample Selection 4 4.2 Instruments 8 4.3 Intervention Strategy and Implemention 8 4.4 Recruitment, Orientation and Supervision of 9 Survey Team 4.5 Secondary Coding 10 4.6 Data analysis 11 i

Page RESULTS 5. DISPENSING PRACTICES 5.1 Average Dispensing Time 12 5.2 Percentage of Drugs Adequately Labelled 13 5.3 Percentage of Patient Knowledge of Correct Dosage 13 6. DISPENSER KNOWLEDGE 6.1 Information 16 6.2 Testing Understanding of Therapy 16 6.3 Adequate Label 16 6.4 Instruction on Drug 16 6.5 Quality of Tablet 16 6.6 FIFO 16 6.7 Cool Place 17 6.8 STAT 17 6.9 Good Compliance 17 CONCLUSION 18 REFERENCES 19 ANNEXE 20-43 ii

ACKNOWLEDGEMENT We express sincere thanks to Dr P.C Karmacharya, Dean, Institute of Medicine for administrative support. We are grateful to USAID/JSI particularly, Mr. Mathew Friedman, Mr. Brice Atkinson and Dr. Penny Dowson, for financial support and for having study done through INRUD, Nepal. We are grateful to RPM Team member, particularly Mr James Bates, Dr. R.O.Laing, and Dr. Budiono Santoso for valuable guidance and support. Thanks are also due to Department of Health Services, Department of Drug Administration (DDA) in particular, Dr. Asfaq Sheak, Chief Drug Administrator and Mr. D.D. Bhattrai, and Nepal Chemist and Druggist Association for their valuable help in carrying out this study. We express thanks to District Health Officers, particularly Dr. T.N.Jha, Late Dr.G.R. Karki, Dr. R.L. Karwa, Dr. V.K.Singh, Dr. S.S. Jha, Dr.(Mrs) S. Verma, Dr. G.P. Ojha, and Dr. B.R. Bhatta; District Public Health Officers, in particular, Mr. H.N. Yadav and Mr. S.B. Verma and members of research team for their co-operation, and hard and sincere work. Lastly but not the least, we would like to thank Ms. Jeanne Madden for helping us in developing the proposal, Mr. Iswor Bahadur Shrestha and Mr. Arjun Pandey for statistical work, Mrs.Jyoti Shrestha of HLMC for language editing and Mr. Kumar Prasad Baral for data compilation, analysis and report typing. Research Team INRUD, Nepal

iii

PERSONNEL INVOLVED

1. Principal Investigator Prof. Kumud Kumar Kafle 2. Co-principal Investigator Mr. Ananda Dev Shrestha Mr. Shiba Bahadur Karkee Dr. B.P. Yadav Mr. Radha Raman Prasad 3. Assistant Investigator Mr. Naveen Shrestha Mr. Prabhakar Lal Das 4. Consultant Dr. Yogendra Man Singh Pradhan 5. Resource Person - Dr. Tara Nanda Jha ( DHO, Jhapa) - Dr. Shiva Shanker Jha ( DHO, Sarlahi) - Dr. Bhoj Raj Bhatta (DHO, Kanchanpur) EXECUTIVE SUMMARY

iv

Study Objective The objective of the study was to evaluate : - the impacts of two interventions - training and

supervision/monitoring on the dispensing practices in the public and private sectors.

Sample and Technique The study was conducted in Nine Terai districts grouped into control, intervention I and II; each group comprised of 21 health facilities (3 X 4 HPs and 3 X 3 SHPs) from three districts. The study also included 30 private dispensers in each group (10 dispensers from each district ). Of the 10 private dispensers, six were from the district headquarter and the rest from nearby HPs/SHPs area. Intervention group I was assigned to give training to dispensers (both public and private sectors). Training to dispensers was provided as designed in the study by the Research Team. Intervention group II was assigned to give training plus supervision/ monitoring with feedback to dispensers, both from public and private sectors. Group III was control group having no intervention. All three groups were evaluated for practices by observation technique using WHO indicators. For evaluating the knowledge, an interview was conducted using structured questionnaire in post-test only. v

Results The following results were obtained: Dispensing Practices Dispensing time increased significantly with training plus supervising/monitoring in public sector. Patient knowledge of correct dosage increased significantly with training only in public sector. The private sector showed no significant changes in indicators either with training only or with training plus supervision/monitoring. Dispensing Knowledge The correct knowledge on quality of tablet and cool place was more in intervention I than in control group in public sector . The correct knowledge on adequate label, cool place and stat. was more in intervention II than in control group in public sector. The correct knowledge on `testing understanding of therapy', adequate label, FIFO, cool place and good compliance was more in intervention I than in control group in private sector. The correct knowledge on `testing understanding of therapy', adequate label, instruction on drug, FIFO, cool place and good compliance was more in intervention II than in control group in private sector. vi

1

INTRODUCTION 1. BACKGROUND The study conducted in health posts of Kathmandu, Patan and Bhaktpur showed only 56% of patients had knowledge of dosing [1,5]. The study in other district also had similar findings [2]. However, the practice of prescribing and dispensing is affected by several factors. HMG, Nepal, has decided to implement a Community Drug Programme (CDP) to improve supply, and prescribing and dispensing through training. The rational use of drugs can be measured by using WHO indicators [4]. These indicators can be used to measure impact of intervention. The indicators can also serve as simple supervisory tools to detect problems in performance by individual prescriber, dispenser or health facility.

2. PURPOSE AND SIGNIFICANCE

2

2.1 Study Objectives The specific objectives of this study was : - to evaluate the impacts of two interventions-training

and supervision/monitoring on the dispensing practices in the public and private sectors.

2.2 Significance of the study The study was significant in testing different intervention

strategies that could improve dispensing practices, which in turn would improve patient compliance thereby enhancing public confidence towards the services provided, mainly in the public sector.

METHODS

3

3. OVERALL APPROACH AND DESIGN The study was conducted in Nine Terai Districts and consisted of: a. interview with dispenser; b. interview with patient/patient attendant; c. observation. The unit of analysis was health institution or drug retailer. Dispensing time, adequate label, and patient knowledge of correct ose were applied to both health institution and drug retailer. d 4. DETAILED METHODOLOGY 4.1 Sample Selection The study was conducted in Nine Terai Districts. Three Terai districts were randomly selected from the five

initial districts where UNICEF training on the SDTS as a part of National Drug Scheme implementation was proposed. This was labelled Group I.

An other three Terai districts were randomly selected from 17

Terai districts. This was labelled Group II. Another three districts were randomly selected from the

remaining Terai districts and was labelled Group III. Altogether Nine districts, all from Terai, were covered and

grouped as given below: Group I: Morang, Dhanusha and Kailali. Group II: Jhapa, Sarlahi and Kanchanpur. Group III: Siraha, Chitwan and Bardia.

4

Selection of Health posts and Subhealth posts From each district four health posts (HPs) were randomly

selected. In addition, three subhealth posts (SHPs) were selected from nearby the selected health posts, making a total of seven facilities per district. In total, there were 21 facilities in each group.

Group I Morang 1. Tankisinuwari HP 2. Bayarban HP 3. Haraincha HP 4. Dadarbairiya HP 5. Nochha SHP 6. Pathari SHP 7. Sanischare SHP Dhanusha 1. Parbaha HP 2. Ghodghas HP 3. Dhalkebar HP 4. Sinurjora HP 5. Sapahi SHP 6. Bateshwore SHP 7. Bhuinchakkarpur SHP Kailali 1. Basauti HP 2. Pahalmanpur HP 3. Chaumala HP 4. Malakheti HP 5. Pabera SHP 6. Sahajpur SHP 7. Baliya SHP Group II Jhapa 1.Dhulawari HP 2. Baniyani HP 3. Damak HP 4. Kumarkhod HP 5. Budhabare SHP 6. Topgachhi SHP 7. Gauradaha SHP Sarlahi 1. Gangapur HP 2. Jamunia HP 3. Sisautia HP 4. Sasapur HP 5. Pipariya SHP 6. Khutauna SHP 7. Kaudena SHP

5

Kanchanpur 1. Shreepur HP 2. Jimua HP 3. Parasan HP 4. Daiji HP 5. Kalika SHP 6. Gulariya SHP 7. Laxmipur SHP Group III Siraha 1. Khirauna HP 2. Nayanpur HP 3. Golbazar HP 4. Malahaniya HP 5. Madar SHP 6. Chandraudayapur SHP 7. Sukhchaina SHP Chitwan 1. Khairhani HP 2. Bharatpur HP 3. Shardanagar HP 4. Shivanagar HP 5. Gunjanagar SHP 6. Divyanagar SHP 7. Shaktikhor SHP Bardiya 1. Shorahawa HP 2. Bagnaha HP 3. Nyaulapur HP 4. Magargadhi HP 5. Kalika SHP 6. Thakurdwara SHP 7. Thothari SHP Selection of Private Dispensers Ten private dispensers were randomly selected in each

district. Among the ten dispensers, six were selected from district headquarter and the rest from nearby HP/SHP area. Therefore, a total of 90 dispensers were selected for this study. But, during post test six dispensers dropped out due to permanent closure.

Dispensing time, adequate label and patient knowledge on dose

were applied as indicators to both public and private dispensers.

On an average 10 encounters per private dispenser were

collected for dispensing time, patient knowledge and adequate label, whereas 30 encounters for patient knowledge and adequate label, and 10 encounters for dispensing time were recorded from health institution (Table-I & II).

6

Table : I

Health Facilities Encounters and Drug Prescribed in Study Districts

Morang Dhanusha Kailali Jhapa Sarlahi Kanchanpur Siraha Chitwan Bardiya

Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post

test test test test test test test test test test test test test test test test test test

Number of Health Facility

7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7

Encounter 210 209 210 210 211 200 216 217 210 213 214 205 210 210 211 210 210 210

Total Drug Prescribed

476 456 536 458 417 449 484 561 469 384 466 386 492 476 361 459 436 371

Dispensing Time Encounter

70 70 66 70 70 70 70 70 70 70 70 70 70 70 70 70 70 70

7

Table : II

Private Dispensers, Encounters and Drug Prescribed in Study Districts

Morang Dhanusha Kailali Jhapa Sarlahi Kanchanpur Siraha Chitwan Bardiya Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post test test test test test test test test test test test test test test test test test test

Number of Private Dispenser

9 9 10 10 8 8 10 10 10 10 9 9 10 10 10 10 8 8

Encounter

88

90

99

100

80

80

100

102

100

100

90

90

100

100

99

100

80

80

Total Drug Prescribed

223

223

220

198

146

188

250

208

250

204

189

190

212

288

231

258

171

133

Dispensing Time Encounter

87

90

98

100

80

80

100

100

100

100

90

90

100

100

100

100

79

70

4.2 Instruments

8

For collecting data on dispensing practices, Dispensing form

was developed. Structured questionnaire was developed to assess Dispenser Knowledge during post test only.

All the developed instruments were field-tested in one health

post of Bhaktapur district and then modified. 4.3 Intervention Strategy and Implementation Group I was assigned intervention strategy one ie Training

for public and private sector dispensers by a Research Team. Group II was assigned Intervention strategy two ie training

of dispensers from both public and private sector by the Research Team followed by on-site supervision and monitoring with feed back.

Group III was control group ie without intervention. Dispensers both from public and private sector received

focussed training two weeks after baseline data collection on proper dispensing practices. The curriculum for this training was developed by the Research Team. It was one and half day training programme which consisted of two hours lecture using handout and poster and three hours dispensing practical on day one, second half day included field visit, reporting and group discussion.

The two-hour lecture included aim of dispensing, defining

prescription, steps of proper dispensing, calculations, abbreviations, care and storage including expiry and record keeping, patient counselling, patient compliance, concept of essential drugs, physical characters for identification of quality drugs and patient advice.

The poster is annexed. The dispensing practical included dispensing a prescription,

checking physical character of drug/s, date expiry and patient counselling and testing understanding of therapy involving each student.

The field visit included visit to a private retailer for

private sector dispensers and public sector dispensing outlet for public sector dispenser. The field included observing dispensing time, checking label for adequacy and patient knowledge of dosing.

9

The field visit was followed by reporting and discussion. Health post and subhealth post dispensers in Group II

received training followed by first on-site supervision and monitoring visits by DHO/DPHO one month after base line data collection, and second visit two months later. During each visit DHO/DPHO evaluated the dispensing practices using supervision/monitoring tools and the result were immediately fed back to the dispenser. The guidelines and tools were developed by the Research Team and field-tested in one of the health posts of Bhaktapur district.

DHO/DPHO were oriented to supervision/ monitoring tools by

investigators and they were also given guidelines on how to use tools and give feedback. The tools included the same WHO indicators, simplified by the Research Team (see annex).

The private dispensers also got supervision and monitoring

visit one month after baseline and second visit two months later using supervision/monitoring tools and guidelines. The results were immediately fed back to the dispensers on his/her dispensing performance. Supervisory visit was done by DDA Regional Incharges. The guidelines and tools were developed by the Research Team and field-tested in two areas of Kathmandu district.

DDA officers were oriented to supervision/monitoring tools by

investigators and they were also given guidelines on how to use tools and give feedback. The tools included the same WHO indicators, simplified by the Research Team (see annex).

In the second supervision/monitoring DHO/DPHO/DDA, Regional

Incharges were also provided with data from the first supervision/monitoring for comparative feedback.

Group three health posts and subhealth posts being control

received no intervention. 4.4. Recruitment, Orientation and Supervision of Survey Team The survey was conducted by six teams. Each Team comprised

of two research assistants and one supervisor, the investigator. Research assistants were either MBBS students or Bachelor or Master in Public Health students. The research assistants were oriented to instruments and involved in field testing.

10

The baseline data was collected in October, 1994 and the

final data in May, 1995. 4.5 Secondary Coding Collected data were coded based on knowledge and practices.

The coding for practices were grouped into indicators among WHO indicators of dispensing practices.

Dispensing Indicators 1 Average dispensing Time - Average, calculated by the

total time for dispensing drugs to a series of patients, by the number encounters.

2 Percentage of Drugs Adequately Labelled - Percentage,

calculated by dividing the number of drug packages containing at least patient name, drug name and when the drug should be taken, by the total number of drug packages dispensed, multiplied by hundred.

3 Patient Knowledge of Correct Dosage - Percentage,

calculated by dividing the number of patients who can adequately report the dosage schedule i.e at least when and how should be taken for all drugs, by the total number of patients interviewed, multiplied by hundred.

Dispensing Knowledge 1. Drug Use Information - was defined correct based on

information on dose and frequency. 2. Testing Understanding of Therapy - was defined correct

based on `immediate feedback of provided information'. 3. Adequate Label - was defined adequate based on patient

name, drug name, frequency and dose . 4. Instruction on Drug - was defined correct based on

antacid tablet to be chewed before swallowing and/ or to be taken one hour after food and at bed time.

11

5. Quality of Tablet - was defined correct based on colour

change or breakage or chipping or change in odour or date expiry.

6. FIFO - was defined correct based on `first in first

out'. 7 Cool Place - was defined correct based on temperature

between 8-25oc. 8. Stat - was defined correct based on `to be taken

immediately'. 9. Good Compliance - It was defined correct based on use of

correct dosage of medicine for right duration following given instruction.

4.6 Data Analysis The data were entered into Lotus 123 and Excel and checked

manually several times for accuracy. Some of data were analysed manually also. The t-test and paired t-test were used to compare the changes within the facility as well as study groups. If significant difference was not observed between the groups, a non-parametric test (X2 test) was applied to measure the change. The level of significant difference was stated at 95% confidence limit.

RESULTS

12

5. DISPENSING PRACTICES (Table 2-4 and Annexe) Health Institution 5.1 Average Dispensing Time There has been a decrease by 13% in intervention I, an

increase by 13% in intervention II and a decrease by 18% in control.

There is significant increase in dispensing time with

training plus supervision/monitoring (d.f=40, P< 0.05, t=2.64).

There is a decrease in intervention I (training only)

but is not significant (t = -0.65). There has been an increase in 19% of health institutions

in intervention I, 43% in intervention II and 24% in control.

Applying X2-test; There is no significant increase in intervention I (X2 = 0.14). Private Dispenser There has been an increase by 6% in intervention I, an

increase by 17% in intervention II and an increase by 15% in control.

There is no significant increase both with supervision/

monitoring and with training only ( t = 0.07 and -0.64 respectively).

There has been an increase in 28% of health institutions


Applying X2-test; There is no significant increase both with training plus

supervision/monitoring and training only (X2 = 0.24 and 1.20 respectively).

13

5.2 Percentage of Drugs Adequately Labelled None of the dispensed drugs was adequately labelled

during baseline and final data collection both in public & private sector.

5.3 Percentage of Patient Knowledge of Correct Dosage Health Institution There has been an increase by 17% in intervention I, a

decrease by 9% in intervention II and also a decrease by 16% in control.

There is significant increase in intervention I

(d.f= 40, P < 0.01, t= 2.96, highly significant) but there is no significant increase with training plus supervision/ monitoring (t=0.8)



Applying X2-test; There is no significant increase with training plus

supervision/monitoring (X2 = 0.12). Private Dispenser There has been an increase by 4% in intervention I, an

increase by 2% in intervention II and a decrease by 6% in control.

There is no significant increase both with training plus

supervision/ monitoring and with training only (t=0.75 and 1.26 respectively).



Applying X2-test; There is no significant increase both with training plus

supervision/monitoring and with training only (X2 = 0.55 and 1.50 respectively).

14

Table : III

Dispensing Indicators Control-Interventions

Health Institution

Group

I Group II Group III Control vs Control vs

Intervention I Intervention II Control Intervention I Intervention II Pre Post Pre Post Pre Post `t'-test X2 test `t'-test X2 test test test test test test test

No Number of Facility 21 21 21 21 21 21 - - - -

1 Average Dispensing Time (Sec)

71 58 63.6 76.5 77.5 59.2 -0.65 0.14 2.64 1.71

2 Percentage of Dugs

Adequately 0 0 0 0 0 0 - - - -

Labelled 3 Percentage of Correct

Patient 50.9 67.8 69.2 60.2 64.24 48.4 2.96 3.5 0.8 0.11

Knowledge of Dosage s = significant

15

Table : IV

Dispensing Indicators Control-Interventions

Private Dispenser Group I Group II Group III Control vs Control vs Intervention I Intervention II Control Intervention I Intervention II

Pre Post Pre Post Pre Post `t'-test X2 test `t'-

test X2 test

test test test test test test

No Number of Facility 30 27 30 29 30 28 - - - -

1 Average Dispensing Time (Sec)

88.5 94 76.3 93.1 89.7 105 -0.64 1.19 0.07 0.25

2 Percentage of Dugs

Adequately 0 0 0 0 0 0 - - - -

Labelled 3 Percentage of Correct Patient 77.9 81.9 84.3 86 70.2 64.6 1.26 0.9 0.75 0.002

Knowledge of Dosage s = significant ns = not significant

16

6. DISPENSING KNOWLEDGE 6.1 Information The knowledge on information was correct in 93%, 67% and 62%

of control, intervention I and II respectively in private sector. Whereas it was 90% of control and 52% both of intervention I and II in public sector.

6.2 Testing Understanding of Therapy It was correct in 52%, 63% and 65% of control, intervention I

and II respectively in private sector. Whereas it was 90%, 62% and 43% of control intervention I and II respectively in public sector.

6.3 Adequate Label It was adequate in 0%, 4% and 17% of control, intervention I

and II respectively in private sector. Whereas it was 0% both of control and intervention I and 5% of intervention II in public sector.

6.4 Instruction on Drug The knowledge on instruction to be given was correct in about

4%, both of control and intervention I and 21% of intervention II in private sector. Whereas it was 9%, 0% and 5% of control, intervention I and II respectively in public sector.

6.5 Quality of Tablet The knowledge was correct in about 96% both of control and

intervention I, and 93% of intervention II in private sector. Whereas it was 86% both of control and intervention II and 95% of intervention I in public sector.

6.6 FIFO The knowledge was correct in 0%, 4% and 21% of control,

intervention I and II respectively in private sector. Whereas it was 0% in all three groups in public sector.

6.7 Cool Place

17

The knowledge was correct in 7%, 11% and 17% of control

intervention I and II respectively in private sector. Whereas it was 0% of control and 5% both of intervention I and II in public sector.

6.8 Stat The knowledge was correct in 64%, 55% and 58% of control,

intervention I and II respectively in private sector. Whereas it was 24%, 19% and 28% of control, intervention I and II respectively in public sector.

6.9 Good Compliance The knowledge was correct in 4%, 11% and 7% of control,

intervention I and II respectively in private sector. Whereas it was 0% in all three groups in public sector.

18

CONCLUSION The research has found significant increase in dispensing time with the training plus supervision/monitoring in public sector. A significant change has also been observed in patient knowledge of correct dosage with training only. The patient knowledge, not related only to the practices of prescriber and dispenser, might have been affected by other factor such as educational status of consumers. No significant improvement has been found in dispensing practices with training or training plus supervision/monitoring in the private sector; though knowledge was better in groups I and II than in control group. There has been improvement in knowledge on adequate label with training plus supervision/monitoring, but no improvement in the practices. The lack of stationary, which was observed during the study, might have affected it. Recommendations

. Implement the strategy ie training plus supervision/monitoring and feedback to improve dispensing practices in health institutions.

. Dispensing accessories/articles should be adequately supplied.

. A qualitative study exploring underlying attitudes and beliefs of private sector dispensers.

19

REFERENCES 1. Kafle, K.K; Pradhan, Y.M.S; Shrestha, A.D; Karkee, S.B; :

Drug Use in PHC facilities of Kathmandu. J.INST. MED, 14, NO.4, 318-326, 1992.

2. Kafle, K.K; Pradhan, Y.M.S; Shrestha, A.D; Karkee, S.B;

:INRUD Drug Use Indicators in Nepal: practice pattern in health posts in four districts. INRUD News, Vol. 3, No.1, 1992.

3. Quick, J; Laing, R; Ross, Degnan D; : Intervention research

to promote clinically effective and economically efficient use of Pharmaceuticals: International Network for Rational Use of Drugs (INRUD). J.of Clinical Epidemiology, 44 supp 11, pp 578-668, 1991.

4. Action Programme on Essential Drugs: How to Investigate Drug

Use in Health Facilities: WHO/DAP, 1993. 5. Hogerzeil, H, V; Bimo; Ross-Degnan, D; Laing, R.O; et al :

Field tests for Rational Drug Use in twelve developing Countries. The Lancet, 342 (1), 1408- 1410, 1993.

Annexe: 1

Dispensing Indicators Health Institution

Morang

No Health Facility T.Sinuwari

HP

Hariacha HP

Dadarberiya HP Bayarban HP

Sanischare SHP

Nocha SHP

Pathari SHP

Pre Post `t' Pre Post `t' Pre Post `t' Pre Post `t' Pre Post `t' Pre Post

`t' Pre Post `t '

testtest value test test valu

e test test valu

e test test valu

e test test valu

e test tes

t value

test

test value

1 Averagedispensing time (Sec)

37 53 ns 51 28 ns 58 41 ns 70 69 ns 65 40 ns 31 81 ns 75 120 ns

2 Percentage of drugs adequately labelled

0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 -

3 Percentage of correct patient knowledge of dosage

37.9 51.7 ns 83.3 33.3 s 57.1 53.3 ns 89.7 26.7 s 50 86.7 s 93.3 40 s 76.5

53.3 ns

s = Significant

ns = Not significant

20

Annexe: 2


Dhanusa

Health Facility Sinurjora

HP Ghodghas

HP Dhalkabar

HP

Parbaha HP

Bhuichakarpur SHP

Shapahi HP

Batteshwor SHP

Pre Post

`t' Pre Post

`t' Pre Post

`t' Pre Post `t' Pre Post `t' Pre Post `t' Pre Post `t'test

test value

test test value

test test value

test test value

test test value

test test value

test test value

1 Average

dispensing time (Sec)

63 49 ns 71 62 ns 106 28 ns 99 42 ns 80.5 39 ns 148 39.7 ns 136 38.1 ns


0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 -


60 97 s 27.6 100 s 3.4 100 s 38 100 s 76.9 83 ns 7.4 100 s 17 100 s

s = Significant ns = Not significant

21

Annexe: 3


Kailali

Health Facility Pahalmanpur

HP

Malakheti HP

ChaumalaHP

Basauti HP

Sahajpur SHP

Baliya SHP

PaveraSHP

Pre Post `t' Pre Post `t' Pre Post `t' Pre Post `t' Pre Post `t' Pre Post `t' Pre Post `t'

testtest

value test test value test test value test test value test test value test test value test test value

1 Average dispensing time (Sec)

59 81 ns 83 77 ns 71 51 ns 68 36 ns 27 58 ns 53 51 ns 169 38 ns


0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 -


36.7

32.3 ns 71.4 37.9 s 58.1 17.2 s 65.5 40 s 68.8 60 ns 56.7 62.1 ns 56.7 82.8 s

s = significant ns = not significant

22

Annexe: 4


Jhapa

Health Facility

Damak HP Baniyani HP Dhulabari HP Kumarkhod HP Budhabare SHP Gauradaha SHP Topgachhi SHP


test test value

test test value

test test value

test test value

test test value

test test value

test test value


73 91 ns 83 51 ns 46 41 ns 63 107 ns 44 37 ns 62 37 ns 41 87 ns

2 Percentage of drugs adequately

0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 -

labelled


93.6 36.1 s 66.7 46.7 ns 43.3 16.7 s 63.3 36.7 s 33.3 16.7 ns 87.1 30 s 91.2 87.1 ns

s = Signaficant ns = Not signifacint

23

Annexe: 5


Sarlahi

No Health Facility Jamuniya HP Sasapur HP Ganga Pur HP Sisautiya HP Piparia SHP Kaudena SHP Khutauna SHP


testtest test value

test value

test test value

test test value

test test value

test test value

test test value


98 88 ns 75 131 ns 49 108 ns 87 209 ns 59 99 ns 77 114 ns 54 91 ns


0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 -

labelled

3 Percentage of correct patient

46.7 100 s 39.4 100 s 56.7 66.7 ns 76.7 93.3 ns 81.5 97 ns 72.4 100 ns 50 100 s

knowledge of dosage

s = significant

ns = not significant

24

Annexe: 6


Kanchanpur

Health Facility Jimuwa HP Daiji HP Parasan HP Shree Pur HP Laxmi Pur SHP Kalika SHP Gularia SHP


test test value

test test value

test test value

test test value

test test value

test test value

test test value


89 41 ns 84 47 ns 58 43 ns 40 62 ns 32 30 ns 67 62 ns 60 45 ns


0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 -

labelled


80.7 50 s 82.1 50 s 62.5 36.7 s 74.2 48 s 100 33.3 s 73.3 53.6 ns 80 76.7 s

knowledge of dosage

s = Significant


25

Annexe: 7


Siraha

No Health Facility Khirauna HP Gol Bazar HP Nayanpur HP Malahaniya HP Sukhachaina SHP

Madar SHP Chandra Ud. SHP


test test value

test test value

test test value

test test value

test test value

test test value

test test value


50 79 ns 81 48 ns 65 99 ns 120 49 ns 51 84 ns 68 63 ns 50 60 ns


0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 -

labelled


60 43.3 ns 15.4 50 s 40 13.3 s 40 23.3 ns 38.3 43.3 s 60 2.5 ns 95.8 63.3 s

knowledge of dosage

s = Significant


26

Annexe: 8


Chitwan

Health Facility

Shardanagar HP

Khairahani HP

Bharatpur HP

Shivanagar HP

Gunjnagar SHP

Shaktikhor SHP

Divyanagar SHP


test test value

test test value

test test value

test test value

test test value

test test value

test test value


94 84 ns 60 48 ns 75 75 ns 111 88 ns 54 115 ns 71 69 ns 107 98 ns


0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 -

labelled


100 73.3 s 100 70 s 80.7 56.7 s 86.7 63.3 s 53.3 96.7 s 90.3 96.7 ns 90 80 ns

knowledge of dosage

s = Significant


27

Annexe: 9


Bardiya

Health Facility Bagnaha HP Nyaulapur HP Sorahawa HP Magargadhi HP Dhodhari SHP Thakurdwara SHP

Kalika SHP


value

test test test test value

test test value

test test value

test test value

test test value

test test value


77 28 ns 82 28 ns 72 24 ns 72 30 ns 87 26 ns 92 29 ns 94 22 ns


0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 -

labelled


40 53.3 ns 36.7 46.7 ns 43.3 10 s 63.3 10 s 73.3 46.7 s 50 20 s 53.3 16.7 s

knowledge of dosage

s = Significant

ns = Not Significant

28

Annexe: 10

Dispensing Indicators Private Dispenser

Morang

PrivateDispenser

Regmi M Hall Rajbansi M Hall

Amrit Medico Biru M Hall

Sunita M Hall Kailash M Hall

Sangita Medico

Atal Pharmacy

Haraicha M Hall

Pre Post `t' Pre Post `t' Pre Post

`t' Pre Post `t' Pre Post `t' Pre Post

`t' Pre Post

`t' Pre Post

`t' Pre Post

`t'

test test value

test test value

test test

value

test test value

test test value

test

test

value

test test

value

test test

value

test test

value

1 Average dispensing time

62 31 ns 86 127 ns 171 55 ns 78 230 ns 124 41 ns 197 158 ns 125 103 ns 89 70 ns 87 32 ns


0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 -

3 Percentage of correct


patientknowledge of

dosage

s = Significant


29

Annexe :11


Dhanusa

No

Private Dispenser

Anjani M.Hall

Satish M. Hall

Indu M. Hall Nischal M. Hall

Shyam M Hall Joshi M. Hall

RK M. Hall Chaudhari M.Hall

Ranju M.Hall Rajesh M.Hall

Pre `t' Post

Pre Post

`t' Pre Post `t' Pre Post `t' Pre Post `t' Pre Post `t' Pre Post `t' Pre Post

`t' Pre Post `t' Pre Post `t'

test

test

value

test

test

value

test

test value

test

test value

test

test value

test

test value

test

test value

test test

value

test test value

test

test value

1 Average dispensing

70 78 ns 100 69 ns 51 79 ns 117 97 ns 74 61 ns 82 90 ns 86 67 ns 227 58 ns 114 109 ns 102 88 ns

time (sec)


0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 -


70 100 s 69 100 s 100 100 ns 70 100 s 78 100 ns 100 100 ns 30 100 s 60 100 s 90 90 ns 67 100 s

s = Significant ns = Not significant

30

Annex- 12


Kailali

-

PrivateDispenser

Saroj M Hall Upakar M Hall Dinesh M Hall Subedi M Hall Kamal M Hall Raju M Hall Dwarika M Hall

Pre Post `t' Pre Post `t' Pre Post `t' Pre Post `t' Pre Post `t' Pre Post `t' Pre Post `t' Pre Post `t'

testtest value

test value

test test value

test test value

test test value

test test value

test test value

test test value

1 Average dispensing time (sec.)

110 77 ns 39 100 ns 43 161 60 89 ns 39 96 ns 30 194 ns 33 126

Indra M Hall

test

ns ns 61 55 ns


0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0


70 70 ns 100 40 s 60 80 ns 90 20 s 66.7 60 ns 90.9 80 ns 90 60 ns 60 60 ns

s = significant


31

Annexe : 13


Jhapa

No PrivateDispenser

Himalayan M Hall

Kasturi M Hall

Mechi M Hall

Yogesh M Hall

Shiva M Hall

Baniya M Hall

Timilsina Pharmacy

Bimarsha M Hall

Makalu M Hall

Jyoti H Hall

Post

Pre `t' Pre Post

`t' Pre Post

`t' Pre Post

`t' Pre Post

`t' Pre Post

`t' Pre Post

`t' Pre Post

`t' Pre Post

`t' Pre Post

`t'

test

test

value

test

test

value

test

test

value

test

test

value

test

test

value

test

test

value

test

test

value

test

test

value

test

test

value

test

test

value




0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 -


100 90 ns 100 100 ns 60 100 s 80 100 ns 100 80 ns 100 100 ns 90 100 ns 100 100 ns 90 80 ns 100 80 ns

s = Signaficant

ns = Not signifacint

32

Annexe: 14


Sarlahi

No Private Dispenser

Amardip M Hall

Bina Pharmacy

Bijya M Hall Binod M Hall Mahabir M Hall

Mishra M Hall

Chaudari M (.K)

Achraya M Hall

Luitel M Hall

Chaudari M (H)

Post

Pre `t' Pre Post

`t' Pre Post

`t' Pre Post

`t' Pre Post

`t' Pre Post

`t' Pre Post

`t' Pre Post

`t' Pre

Post

`t' Pre

Post

`t'

test

test

value

test

test

value

test

test

value

test

test

value

test

test

value

test

test

value

test

test

value

test

test

value

test

test

value

test

test

value

1 Average dispensing time


2 Percentage of drugs

0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 -

adequately labelled

3 Percentage of correct

70 100 s 70 90 ns 90 86 ns 90 90 ns 60 89 ns 90 90 ns 70 100 s 80 90 ns 73 80 ns 90 100 ns

patientknowledge of

dosage

s = significant ns = not significant

33

Annexe: 15


Kanchanpur

No PrivateDispenser

Uma M Hall Tiwari M Hall

Shakti M Hall

Gautam M Hall

Joshi M Hall Mahakali M Hall

Tara U M Hall

Karuna M Hall

Patani M Hall

Post

Pre `t' Pre Post

`t' Pre Post

`t' Pre Post

`t' Pre Post

`t' Pre

Post

`t' Pre

Post

`t' Pre

Post

`t' Pre

Post

`t'

test

test

value

test

test

value

test

test

value

test

test

value

test

test

value

test

test

value

test

test

value

test

test

value

test

test

value




0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 -


90 90 ns 90 90 ns 50 44 ns 90 70 ns 80 70 ns 60 90 ns 82 70 ns 100

60 s 89 60 ns

s = significant


34

Annex :16


Siraha

Pre

Post

`t' Pre Post

`t' Pre Post

`t' Pre Post

`t' Pre Post

`t' Pre

Post

value st t

ns 56 139 ns 99 ns


0 0 - 0 0 - 0 0 - 0 0


60 100 s 80 30 s 90 20 s 90 20 s 60 40 ns 40 10 30 10 ns 40 40 ns 70 80 ns 60 70 ns

s = significant

No PrivateDispenser

Dinesh M Hall

Anil M Hall Mahalaxmi M Hall

Manju M Hall Sanjib M.Hall

Pintu M Hall

Kishor Pharmacy

Shambu M Hall

Mukesh Pharmacy

Sun Rise Medico

`t' Pre Post

`t' Pre

Post

`t' Pre te

Post

tes

`t' Pre Post

`t'

test

test

value

test 47

test

value test

test

value

test

test

value

test

test

value

test

test

value

test

test

value

test

test

value

test

test

value


76 70 ns 77 113 ns 105 182 ns 82 119 ns 59 93 ns 51 143 ns 86 228 ns 82 144

- 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 -

ns


35

Annexe : 17


Chaudhari M Hall

Khakurel M Hall

Sita Pharma Sangam M Hall

Janasewa M Hall

Amrit M Hall Narayan M Hall

Shrestha M Hall

Gauli M Hall

Private Dispenser

Pre Post

`t' Pre Post

`t' Pre Post

`t' Pre Post

test

value

test

value

test

test

value

test

test

value

test t

value

test t

value

test t

value

test t

value

test t

value

Average dispensing time (sec.)

128 ns 115 112 ns 88 102 ns 103 128 ns 171 182 ns 105 89

0 0 - 0 0 - 0 0 - 0 0 - 0 0 -

3 ns 80 80

Chitawan

Rubi Clinic

`t' Pre Post

tes

`t' Pre Post

tes

`t' Pre Post

tes

`t' Pre Post

tes

`t' Pre Post

tes

`t' Pre Post ̀ t'

test test

test

test value

1 82 ns 130 87 ns 121 87 ns 137 135 ns 95 114 ns

2Percentage of drugs adequately labelled

0 0 - 0 0 - 0 - 0 0 0 - 0 0 -

Percentage of correct patient knowledge of dosage


s = significant


36

Annexe : 18


Bardiya

No Private Dispenser

DP M Hall Bardiya M Hall Sudip M Hall Sadashiva M Hall

SK MHall Janata M Store Paudel M Hall

Pre Post `t' Pre Post `t' Pre Post `t' Pre Post `t' Pre Post `t' Pre Post `t'

test test value

test test value

e of drugs adequately labelled

0 0

70 50

Significant

Kotahi M Hall

Pre Post `t' Pre Post `t'

test test value

test test value

test test value

test test value

test test value

test test value


2 Percentag

83 19 ns 81 30 ns 82 61 ns 92 59 ns 77 27 ns 78 46 ns 87 90 ns 91 - ns

- 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 0 -


50 60 ns 80 40 s 90 90 ns 70 40 ns ns 30 90 s 70 50 ns 50 77.8 ns

s = Significant ns = Not

37

Annexe: 19 Private Dispenser Knowledge: Drug Storage and Dispensing

Control %

Intervention I (%) Intervention II (%)

Knowledge on Dispensing Information Feed back Label Advice Qualitiy of tablet

92.9 57.1 0.0 3.6 96.4

66.7 63.0 3.7 3.7 96.3

62.1 65.5 17.24 20.7 13.10

Knowledge on Terminology FIFO Cool Place Stat Good Compliance

0.0 7.1 64.3 3.6

3.7 11.1 55.6 11.1

20.7 17.2 58.6 6.9

Table : 20 Public Dispenser Knowledge: Drug Storage and Dispensing

Control %

Intervention I % Intervention II (%)

Knowledge on Dispensing Information Feed back Label Advice Quality of tablet

90.5 90.5 0.0 9.5 85.7

52.4 61.9 0.0 0.0 95.2

52.4 42.9 4.8 4.8 85.7

Knowledge on Terminology FIFO Cool Place Stat Good Compliance

0.0 0.0 23.8 0.0

0.0 4.8 19.1 0.0

0.0 4.8 28.6 0.0

38

Annexe: 21 QUESTIONNAIRE Dispenser/Retailer: ................... Post:............... HP/SHP/Private Dispenser:............. District:........... Interviewer:.................. Date:............... Instruction: Put tick [ ] or specify more than one answer (Do not prompt). 1. In your opinion, what instructions should be given to the patient or patient

attendant while dispensing ? [ ] Dosage [ ] Frequency [ ] Drug effect [ ] Side effect [ ] Others (specify) [ ] Don't know 2. Will you tell us, how would you know that the patient or patient attendant has

understood your instruction ? [ ] Immediate feedback [ ] Follow-up [ ] Home visit [ ] Consulting others [ ] Others (specify) [ ] Don't know 3. Will you tell us, what should be included in a label ? [ ] Patient Name [ ] Drug Name [ ] Frequency [ ] Dosage [ ] Others (specify) [ ] Don't know

39

4. Will you tell us, what advice be given while dispensing antacid tablet ? [ ] Take one hour after meal [ ] At bed time [ ] Chew before swallowing [ ] Take in empty stomach [ ] Others (specify) [ ] Don't know 5. In your opinion, what quality of tablet should refrain you dispensing ? [ ] Change in Colour [ ] Breakage [ ] Chipping [ ] Change in odour [ ] Others (specify) [ ] Don't know Instruction: Put the tick [ ] or specify the first response. 6. Will you tell us, what do you understand by FIFO ? [ ] First in First out [ ] First in Last out [ ] Last in First out [ ] Randomly [ ] Others (specify) [ ] Don't know 7. Will you tell us, what do you understand by cool place? [ ] 00 to 80 c. [ ] 80 to 250 c

[ ] 250 to 400 c. [ ] more than 400 c [ ] Others (specify) [ ] Don't know

40

8. Will you tell us, what do you understand by stat. ? [ ] Before food [ ] After food [ ] Immediately [ ] Take [ ] Others (specify) [ ] Don't know 9. In your opinion, what is good compliance ? [ ] Use of Drug for specified duration [ ] Use of drug correctly [ ] Use of correct dosage for right duration following given instruction [ ] Use of right drug [ ] Others (specify) [ ] Don't know

41

Annexe: 22 Supervision/Monitoring Form DISPENSING INDICATOR

#

Patient Identifier (Name)

Dispensing time (Sec.)

Precautions

Drugs 0/1

1

2

3

4

5

6

7

8

9

10

Case count (#)

Sum

Average

Percent of drugs Ilaka/Subhealth Post: ............... District: ............ Private dispenser: ................. Date: ................ Supervisor: .......................

42

Annexe: 23 Supervision/Monitoring Form ENCOUNTER FORM

# Patient Indicator (Name)

Age

Sex

Prescriber Date

Health Problems

Health Problem Discription/Diagnosis

1

2

3

Prescription Character Patient drug knowledge

Label

Drugs name,strength and dose

Dispensed Quantity

When (0/1)

How much (0/1)

Knowl edge (0/1)

Patient name (0/1)

Drug name (0/1)

when (0/1)

1

2

3

4

5

6

7

8

Drugs

9

10 Ilika/Sub Health Post: ...... District: ....... Private Dispenser :........ Date: ........ Supervision: ..........

43

INTERVENTION TEST OF TRAINING AND SUPERVISION ON Dispensing PRACTICES Study on... · 2019-05-25 ·...

Documents

Transcript of INTERVENTION TEST OF TRAINING AND SUPERVISION ON Dispensing PRACTICES Study on... · 2019-05-25 ·...