3195.0: Monday, October 22, 2001 - Board 2

Abstract #30173

A study of drug seller behaviors in recommending antibiotics and counseling practices in Nepal

In 1998, forty of the 75 districts in Nepal began decentralization of their drug management functions. Rational Pharmaceutical Management (RPM) Project assessments of the pharmaceutical sector found drug shortages, cross border traffic of patients and drugs, insufficient professional training in drug management, indistinct roles of the private and public sector, and a lack of accurate, unbiased drug information. As access to pharmaceuticals through the public sector was uneven, private retail drug sellers have stepped in to fill this gap. RPM conducted a study to discover the extent of the problem and incentives that influence drug seller behavior in recommending antibiotics and counseling practices. The study, conducted in the terai and hill regions of Nepal, found that antibiotics are freely available without a prescription, drug sellers routinely dispense partial courses of therapy, antibiotics are used inappropriately, and other products are used unnecessarily. Factors that influenced drug seller recommendations were financial considerations, patient treatment-seeking patterns, and insufficient training. Apparent financial status of the patient played an important role in determining which products were dispensed; antibiotics provided the highest profit of all dispensed drug products. Drug sellers mimicked physician prescribing, or recommended products based on personal experience or information from medical representatives, rather than formal medical education. The findings of this study were used to design an intervention to enhance appropriate use of antibiotics and to suggest other interventions that may be useful in influencing drug seller behavior.

Learning Objectives:

1. List three ways in which Nepali retail drug seller behavior in dispensing antimicrobials and counseling about them exacerbates the spread of antimicrobial resistance.
2. List three incentives that influence drug seller behavior in dispensing antibiotics.
3. List five sources of information on recommending practices for drug sellers.
4. List three types of interventions that were recommended to promote rational use of antimicrobials.

Keywords: Drug Use, Antimicrobial Drugs

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Management Sciences for Health
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employment

The 129th Annual Meeting of APHA