Economic and social drivers of antibiotic dispensing practices among community pharmacies in Nepal

Abstract Background Inappropriate dispensing of antibiotics at community pharmacies is an important driver of antimicrobial resistance (AMR), particularly in low- and middle-income countries. Thus, a better understanding of dispensing practices is crucial to inform national, regional, and global responses to AMR. This requires careful examination of the interactions between vendors and clients, sensitive to the context in which these interactions take place. Methods In 2019, we conducted a qualitative study to examine antibiotic dispensing practices and associated drivers in Indonesia, where self-medication with antibiotics purchased at community pharmacies and drug stores is widespread. Data collection involved 60 in-depth interviews with staff at pharmacies and drug stores (n = 31) and their clients (n = 29), conducted in an urban (Bekasi) and a semi-rural location (Tabalong) to capture different markets and different contexts of access to medicines. Interview transcripts were analysed using thematic content analysis. Results A common dispensing pattern was the direct request of antibiotics by clients, who walked into pharmacies or drug stores and asked for antibiotics without prescription, either by their generic/brand name or by showing an empty package or sample. A less common pattern was recommendation to use antibiotics by the vendor after the patient presented with symptoms. Drivers of inappropriate antibiotic dispensing included poor knowledge of antibiotics and AMR driving patient demand, financial incentives to maximise medicine sales in an increasingly competitive market, the unintended effects of health policy reforms, and weak regulatory enforcement. Conclusions Inappropriate dispensing of antibiotics in community pharmacies is the outcome of complex interactions between vendors and clients, shaped by wider and changing socio-economic processes. Concerted action should be taken to address this complexity and involve such providers in the development and implementation of AMR national action plans.

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Medication counselling and dispensing practices at community pharmacies: a comparative cross sectional study from Pakistan

International Journal of Clinical Pharmacy ◽

10.1007/s11096-011-9554-6 ◽

2011 ◽

Vol 33 (5) ◽

pp. 859-867 ◽

Cited By ~ 17

Author(s):

Azhar Hussain ◽

Mohamed Izham Mohamed Ibrahim

Keyword(s):

Cross Sectional Study ◽

Community Pharmacies ◽

Sectional Study ◽

Cross Sectional ◽

Dispensing Practices ◽

Medication Counselling

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Medical abortion kit dispensing practices of community pharmacies in Pokhara Metropolitan, Nepal

PLoS ONE ◽

10.1371/journal.pone.0244969 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0244969

Author(s):

Nim Bahadur Dangi ◽

Sangam Subedi ◽

Mahasagar Gyawali ◽

Aashish Bhattarai ◽

Tulsi Ram Bhandari

Keyword(s):

Medical Abortion ◽

P Value ◽

Community Pharmacies ◽

Limited Information ◽

Manufacturing Companies ◽

Cross Sectional ◽

Safe Abortion ◽

Male Clients ◽

Dispensing Practices ◽

Pokhara Valley

Background Medical abortion (MA) refers to the use of medicines to terminate the pregnancy. There is an urgent need to spread safe abortion services in the community. This study assessed the MA kit dispensing practices of community pharmacies in Pokhara Valley, Nepal. Methods A cross-sectional descriptive study was conducted in Pokhara Valley, Nepal from December 2017 to November 2018. Among the community pharmacies of Pokhara Valley, 115 community pharmacies were selected using a consecutive sampling method. A semi-structured questionnaire was used to collect data. MA kit and related information were requested by simulated male clients visiting the community pharmacies. The information obtained from the pharmacy workers was recorded in the data collection sheet. Results Nine brands of MA kit from eight manufacturing companies were found in practice in Pokhara Valley, out of those only five (56%) were registered in Nepal. Seven brands were sold at more than the labeled price. The pharmacy workers asked about the gestational age and confirmation of pregnancy in all the cases. Most of them counseled the clients on the frequency, duration, and direction of use. Dispensing practice and level of counseling were found to be significantly correlated (r = 0.40, p value = 0.01). Conclusion Despite the awareness of the pharmacy workers on the MA kit, most of them provided limited information to the clients. Nearly half unregistered MA kits were found in practice at the community pharmacies. Thus, the Department of Drugs Administration and other concerned authorities must provide relevant training and awareness programs to the pharmacy workers of the community pharmacies for preventing the malpractice of MA kit. The Government of Nepal must restrict the illegal entry of unregistered brands and assure the standards of MA kit by regulating drug acts and policies effectively.

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Assessment of Prescribing and Dispensing Practices Based on WHO Core Prescribing Indicators in Hospital and Community Pharmacies in Khartoum State - Sudan

Journal of Medical Informatics and Decision Making ◽

10.14302/issn.2641-5526.jmid-20-3493 ◽

2020 ◽

Vol 1 (3) ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

Dalia Rabie ◽

Salah I. Kheder

Keyword(s):

Drug Use ◽

Drug Prescription ◽

Community Pharmacies ◽

Antibiotic Prescribing ◽

Continuous Assessment ◽

Cross Sectional ◽

Average Percentage ◽

Rational Drug ◽

Hospital Pharmacies ◽

Dispensing Practices

Background Rational drug management has become an increasingly important topic in order to make optimal use of the drug budget to offer health services of the highest possible standard. It is important that continuous assessment for rational prescribing and use of drug have to be carried. Objective of this study was to gather data on existing drug prescription and dispensing practices and to evaluate the prescribing and dispensing indicators as described by the WHO. Method Observational, cross-sectional, prospective study was designed and conducted to evaluate the performance of hospital and community pharmacies in Khartoum state, related to rational drug use and prescribing and dispensing practices during the period from November 2018 to March 2019. 297 Hospital and community pharmacies from public and private sectors were contacted for carrying out this study survey and the collected data were analysed against WHO standards for core drug use indicators. Results The average number of drugs per encounter was 3.98 drugs. Hospital pharmacies had a higher (4.18±1.516) number of drugs prescribed than community pharmacies (3.87±1.331) with significance difference between mean of two types of pharmacies (P = 0.015). The percentage of antibiotic per prescription was (53.7%). Antibiotic prescribing was much higher (54.0%) in the hospital pharmacies compared to (48.6 %) in community pharmacies. The average percentage of injections per prescription at the facilities was found to be (57.6%). The percentage of prescription with written diagnosis was (26%.0) and the percentage of prescriptions with written dose was (78%.0). The average dispensing time was (1.75) minutes, The Percentage of drugs actually dispensed was (55.99%), the average adequacy of labelling of drugs was (30.4%). Overall prescribing and dispensing indicators were higher than WHO standard. Conclusion The degree of poly pharmacy was greater than of WHO criteria. The completeness and rationality of prescription was found suboptimal and components were missed.

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Implementing a non-steroidal anti-inflammatory drugs communication bundle in remote and rural pharmacies and dispensing practices

BMJ Open Quality ◽

10.1136/bmjoq-2017-000303 ◽

2018 ◽

Vol 7 (3) ◽

pp. e000303 ◽

Cited By ~ 1

Author(s):

Clare Morrison ◽

Tracy Beauchamp ◽

Helen MacDonald ◽

Michelle Beattie

Keyword(s):

Primary Care ◽

Patient Safety ◽

Hospital Admissions ◽

Safety Information ◽

Care Bundle ◽

Community Pharmacies ◽

Drug Reactions ◽

Dispensing Practices ◽

Inflammatory Drugs ◽

Anti Inflammatory

Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with more emergency hospital admissions due to adverse drug reactions than any other class of medicine. One way to tackle this is to ensure that patients understand how to take their NSAIDs in the safest way possible. The aim of this project was to ensure that key safety information is given to every patient, every time an NSAID is sold or dispensed. The project started as part of the Scottish Patient Safety Programme’s Pharmacy in Primary Care Collaborative. An NSAIDs bundle was developed, tested and implemented using the Model for Improvement as a framework, including multiple Plan, Do, Study, Act cycles. The bundle, and associated improvement package, was developed during phase I of the project and tested by seven teams (five pharmacies and two dispensing practices). Phase II tested the spread of the defined improvement package across an additional five community pharmacies and eight dispensing general practitioner practices. The project has resulted in the development of a simple package to improve communication with patients about NSAIDs, which should enable patients to take NSAIDs safely. Three key safety messages were developed, typical for a care bundle approach, and simple tools were employed to ensure every patient received these three key messages every time. The project aim of 95% compliance with the NSAIDs bundle within the seven initial sites by December 2015 was achieved (when an exclusion was applied). The spread of the defined improvement package to a further 13 sites was achieved by December 2016. By December 2017, all 81 community pharmacies in National Health Service (NHS) Highland had agreed to implement the NSAIDs bundle. In June 2018, a national NSAIDs bundle, based on the NHS Highland work, was introduced in community pharmacies across Scotland. We also believe that the approach could be replicated for other high-risk medicines.

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Knowledge of Malaria and Antimalarial Drug Dispensing Practices in Buea Community

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v11i1.9876 ◽

2019 ◽

Vol 11 (1) ◽

Author(s):

Marcelus U. Ajonina

Keyword(s):

Antimalarial Drug ◽

Treatment Protocol ◽

Plasmodium Species ◽

Monitoring And Evaluation ◽

Antimalarial Drugs ◽

Community Pharmacies ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Drug Dispensing ◽

Dispensing Practices

ObjeciveThis study was aimed at assessing the knowledge of malaria as well as perception and dispensing practices of antimalarials among vendors in Buea communityIntroductionLack of knowledge of rational use of antimalarial drugs among dispensers is a serious problem, especially in areas of intense transmission thus increasing the risk of resistance and adverse drug reactions.MethodsA community-based cross-sectional survey of a random sample of 140 drug vendors living within the Buea community was conducted between March and June 2017. Questionnaire was designed to obtain information from drug vendors on the general knowledge of malaria as well as dispensing practices. Data were analyzed using SPSS Statistics 20.0 and were considered significant at P ≤ 0.05ResultsKnowledge of malaria symptoms, transmission, and prevention was reasonable among 55.8% (77) of the respondents. Only 33.6% (47) of the respondents could attribute the cause of malaria to protozoan of genus Plasmodium species. Of the 140 vendors, 115(82.7%) prescribe antimalarial drugs. The knowledge of the national protocol was malaria case management among dispensers was 35.0%. Vendors in hospital/community pharmacies were 2.4 times (OR = 3.14, 95% CI: 4.14 - 8.74, P < 0.001). more knowledgeable about malaria treatment protocol than those of in drugstores. The prevalence of self-prescription of antimalarials was 39.3%. Self-prescription was significantly higher in drugstores than hospital/community pharmacies (P=0.004). In all, 56(40.6%) of vendors showed good practices regarding antimalarial drug dispensing with majority (51.7%) from community pharmacies (OR=2.27,95% CI: 1.13-4.56).ConclusionsFindings reveal moderate knowledge of malaria but poor prescription and dispensing practices of antimalarial drugs among vendors, thus indicating a need for routine monitoring and evaluation to prevent emergence of resistant strains to current efficacious antimalarials

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Community pharmacies, drug stores, and antibiotic dispensing in Indonesia: a qualitative study

BMC Public Health ◽

10.1186/s12889-021-11885-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Astri Ferdiana ◽

Marco Liverani ◽

Mishal Khan ◽

Luh Putu Lila Wulandari ◽

Yusuf Ari Mashuri ◽

...

Keyword(s):

Qualitative Study ◽

Financial Incentives ◽

Market Competition ◽

Essential Medicines ◽

Careful Examination ◽

Policy Outcomes ◽

Community Pharmacies ◽

Unintended Effects ◽

Self Medication ◽

Dispensing Practices

Abstract Background Inappropriate dispensing of antibiotics at community pharmacies is an important driver of antimicrobial resistance (AMR), particularly in low- and middle-income countries. Thus, a better understanding of dispensing practices is crucial to inform national, regional, and global responses to AMR. This requires careful examination of the interactions between vendors and clients, sensitive to the context in which these interactions take place. Methods In 2019, we conducted a qualitative study to examine antibiotic dispensing practices and associated drivers in Indonesia, where self-medication with antibiotics purchased at community pharmacies and drug stores is widespread. Data collection involved 59 in-depth interviews with staff at pharmacies and drug stores (n = 31) and their clients (n = 28), conducted in an urban (Bekasi) and a semi-rural location (Tabalong) to capture different markets and different contexts of access to medicines. Interview transcripts were analysed using thematic content analysis. Results A common dispensing pattern was the direct request of antibiotics by clients, who walked into pharmacies or drug stores and asked for antibiotics without prescription, either by their generic/brand name or by showing an empty package or sample. A less common pattern was recommendation to use antibiotics by the vendor after the patient presented with symptoms. Drivers of inappropriate antibiotic dispensing included poor knowledge of antibiotics and AMR, financial incentives to maximise medicine sales in an increasingly competitive market, the unintended effects of health policy reforms to make antibiotics and other essential medicines freely available to all, and weak regulatory enforcement. Conclusions Inappropriate dispensing of antibiotics in community pharmacies and drug stores is the outcome of complex interactions between vendors and clients, shaped by wider and changing socio-economic processes. In Indonesia, as in many other LMICs with large and informal private sectors, concerted action should be taken to engage such providers in plans to reduce AMR. This would help avert unintended effects of market competition and adverse policy outcomes, as observed in this study.

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Recognition of tramadol abuse, dispensing practices, and opinions about its control policy among community pharmacists in Bangkok, Thailand

Asian Biomedicine ◽

10.1515/abm-2019-0006 ◽

2019 ◽

Vol 12 (2) ◽

pp. 91-99

Author(s):

Tulaya Potaros ◽

Suwimon Yeephu

Keyword(s):

Drug Administration ◽

Food And Drug Administration ◽

Community Pharmacists ◽

Control Policy ◽

Cross Sectional Study ◽

Community Pharmacies ◽

Sectional Study ◽

Cross Sectional ◽

Dispensing Practices ◽

Different Parts

AbstractBackgroundTramadol is classified as a pharmacist-only (restricted) medicine by the Food and Drug Administration of Thailand (Thai FDA). Because of concern about its abuse, in September 2013 the Thai FDA announced a policy to control the distribution of tramadol in community pharmacies.ObjectivesTo identify tramadol dispensing practices by community pharmacists in Bangkok, their recognition of tramadol abuse and the Thai FDA control policy announcement; and opinions about the tramadol control policy.MethodsThis descriptive cross-sectional study was conducted in community pharmacies located in Bangkok. Pharmacists on duty were interviewed from September 2015 to April 2016.ResultsData from 305 pharmacists working in 305 pharmacies revealed that tramadol, both single (tramadol alone) and combination (tramadol plus acetaminophen) formulations, was available in 185 pharmacies (60.7%). Most pharmacists dispensed tramadol to supply regular medicine along with previous prescriptions (74%). Among 305 pharmacists, 304 (99.7%) recognized tramadol abuse in combination with cold–cough remedies and carbonated beverages can create euphoria. Most (97.7%) knew about the announcement of the tramadol control policy, and most (82.6%) thought that the policy was practical. Approximately 43% of pharmacists agreed that the policy was effective in reducing the tramadol abuse problem, whereas 36.7% disagreed. Moreover, 60.3% disagreed with rescheduling tramadol as a prescription-only medicine. In their opinion, tramadol should still be available in pharmacies, to be dispensed by community pharmacists to patients with medical necessity.ConclusionsFurther studies nationwide in Thailand are likely to be useful to represent and compare information in different parts of the country.

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