Pham Duc Minh, Byrkit Mona, Pham Hoang Van, Pham Trung, Nguyen Chien Thang
PATH, Hanoi, Vietnam ; Management Science for Health, Hanoi, Vietnam.
PLoS One. 2013 Oct 3;8(10):e74882. doi: 10.1371/journal.pone.0074882. eCollection 2013.
In many developing countries, private pharmacies play an important role in providing health information and services to local communities for common health issues. The aim of this study was to ascertain medium-term impact of educational interventions on knowledge and practice of pharmacy staff regarding management of childhood diarrhea in Vietnam.
This was a pre- and post-intervention study with 32 and 44 months difference from the time of the baseline survey to the conclusion of trainings and the time of the end-line survey, respectively. Interventions included in-class training for pharmacy staff, printed materials at the pharmacy, and supportive supervision. Knowledge/reported practice and actual practice of pharmacy staff were measured before and after interventions.
After interventions, significant improvements (p<0.01) were observed for all indexes related to pharmacy staff's knowledge about childhood diarrhea; for instance, 31% and 60% of surveyed staff asked about weight of the child and accompanying symptoms of childhood diarrhea, respectively, an increase from 11% and 45% at the baseline. Oral rehydration solution (ORS) was the most frequently reported product recommended (97% to 99%), but probiotics and antidiarrheals were the products most frequently prescribed at pharmacies. Public health facilities remained the preferred choice for referrals from pharmacies, but the use of private clinics was increasing. Consultations and advice provided to caregivers also improved, but considerable gaps between knowledge and actual practice of staff in real pharmacy settings remained.
Educational interventions were effective in improving pharmacy staff knowledge and practice regarding management of childhood diarrhea. Knowledge and actual practice of staff in real pharmacy settings did not always correlate; there is need for a stronger regulatory and law enforcement system. Interventions to improve pharmacy practice in developing countries should be focused, comprehensive, and evidence-based.
在许多发展中国家，私人药店在为当地社区提供常见健康问题的健康信息和服务方面发挥着重要作用。本研究的目的是确定教育干预措施对越南药店工作人员关于儿童腹泻管理的知识和实践的中期影响。
这是一项干预前后的研究，从基线调查到培训结束以及从基线调查到终线调查的时间分别相差32个月和44个月。干预措施包括对药店工作人员的课堂培训、药店的印刷材料以及支持性监督。在干预前后对药店工作人员的知识/报告的实践和实际实践进行了测量。
干预后，观察到与药店工作人员关于儿童腹泻知识相关的所有指标都有显著改善（p<0.01）；例如，分别有31%和60%的受访工作人员询问儿童体重和儿童腹泻的伴随症状，而基线时分别为11%和45%。口服补液盐（ORS）是最常被报告推荐的产品（97%至99%），但益生菌和止泻药是药店最常开具的产品。公共卫生设施仍然是药店转诊的首选，但私人诊所的使用正在增加。向照顾者提供的咨询和建议也有所改善，但在实际药店环境中工作人员的知识与实际实践之间仍存在相当大的差距。
教育干预措施在提高药店工作人员关于儿童腹泻管理的知识和实践方面是有效的。实际药店环境中工作人员的知识与实际实践并不总是相关的；需要一个更强有力的监管和执法系统。在发展中国家改善药店实践的干预措施应该是有针对性的、全面的和基于证据的。
