Goel P, Ross-Degnan D, Berman P, Soumerai S
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Community Health Plan, Boston, MA 02115, USA.
Soc Sci Med. 1996 Apr;42(8):1155-61. doi: 10.1016/0277-9536(95)00388-6.
Retail pharmacies in developing countries are one of the most important sources of advice on pharmaceuticals. Among the reasons the clients give are ease of access; availability of medicines; quality of service (no waiting and convenient hours of operation); and cheaper products, availability of credit, or the option to buy drugs in small amounts. However, the appropriateness of prescribing by retail pharmacy staff has been found to be far from acceptable. In childhood diarrhea, for example, oral rehydration salts (ORS), the appropriate diarrhea treatment, are recommended much less than pharmaceuticals of limited value, such as antimotility agents, adsorbents, etc. Little information is available for reasons underlying such behaviors. In this paper, we present a conceptual framework in which to analyze factors that may affect retail pharmacy prescribing, and we suggest strategies for behavior change. We developed this framework after examining relevant literature on retail pharmacy prescribing. We propose that pharmacy factors, client factors, physician practice and regulatory factors are the four sets of important factors for understanding pharmacy prescribing behavior. For intervention, we present four types of interventions which could be used for changing the behavior of pharmacy staff: information alone, persuasion, incentives and coercion. The behavior and intervention frameworks presented in this paper should also help in guiding further research in this area. For example, new information on the effects of ownership type, availability vs actual role of professional staff and authority structure on pharmacy treatment behaviors would be useful areas for future research. Similarly, additional research is needed on the comparative effects of coercive, persuasive and incentive strategies on pharmacy treatment behaviors.
发展中国家的零售药店是药品咨询最重要的来源之一。顾客给出的原因包括：易于到达；药品供应充足；服务质量（无需等待且营业时间便利）；产品价格更低、可赊购，或可选择小剂量购买药品。然而，人们发现零售药店工作人员的处方合理性远不能令人接受。例如，在儿童腹泻方面，推荐使用的适当腹泻治疗药物口服补液盐（ORS），比诸如止泻剂、吸附剂等价值有限的药品要少得多。关于此类行为背后的原因，几乎没有相关信息。在本文中，我们提出了一个概念框架，用以分析可能影响零售药店处方的因素，并提出行为改变策略。我们在研究了零售药店处方的相关文献后开发了这个框架。我们认为，药店因素、顾客因素、医生执业和监管因素是理解药店处方行为的四组重要因素。对于干预措施，我们提出了四种可用于改变药店工作人员行为的干预方式：仅提供信息、劝说、激励和强制。本文提出的行为和干预框架也应有助于指导该领域的进一步研究。例如，关于所有制类型的影响、专业人员的可获得性与实际作用以及权力结构对药店治疗行为的新信息，将是未来研究的有用领域。同样，需要进一步研究强制、劝说和激励策略对药店治疗行为的比较效果。
