SMALL-GROUP INTERVENTION VS FORMAL SEMINAR FOR IMPROVING APPROPRIATE DRUG-USE

In an attempt to evaluate the efficacy of different methods of interve ntions to improve the appropriate use of drugs for acute diarrhoea, a controlled study has been carried out in 6 districts in Yogyakarta and Central Java provinces, Indonesia. This study was designed to investi gate the impacts of two different methods of educational intervention, i.e. a small group face-to-face intervention and a formal seminar for prescribers, on prescribing practice in acute diarrhoea. The district s were randomly assigned into 3 groups and 15 health centers were sele cted from each district. Prescribers in Group 1 underwent a small grou p face-to-face intervention conducted in the respective health center. Those in Group 2 attended a formal seminar conducted at the district level. Prescribers in Group 3 served as the control group. Both interv entions were given on a single occasion without follow-up Supervision or monitoring. Written information materials on the appropriate manage ment of acute diarrhoea were developed and were provided to all prescr ibers in the intervention groups. Focus group discussions (FGDs) invol ving prescribers and consumers in the 6 districts were carried out to identify various underlying motivations of drug use in acute diarrhoea . The findings of the FGDs were used as part of the intervention mater ials. To evaluate the impacts of these interventions on prescribing pr actice, a prescribing survey for patients under five years old with ac ute diarrhoea was carried out in health centers covering 3-month perio ds before and after the intervention. The results showed that both int erventions were equally effective in improving the levels of knowledge of prescribers about the appropriate management of acute diarrhoea. T hey were also partially effective in improving the appropriate use of drugs, reducing the use of non-rehydration medications. There was a hi ghly significant reduction of antimicrobial usage either after small-g roup face-to-face intervention (77.4 +/- 2.7% to 60.4 +/- 2.9%; P < 0. 001) or formal seminar (82.3 +/- 3.0% to 72.3 +/- 3.6%; P < 0.001), an d the former caused significantly (P < 0.001) greater reduction than t he latter. There was also a significant (P < 0.01) reduction in the us age of antidiarrhoeals after both interventions, i.e. from 20.3 +/- 3. 7% to 12.5 +/- 3.3% (P < 0.01) after face-to-face intervention and fro m 48.5 +/- 4.1% to 27.0 +/- 4.3% (P < 0.01) after seminar. However, th e formal seminar had a significantly (P < 0.01) greater impact than th e small group face-to-face intervention. There was also a trend toward increased oral rehydration solution (ORS) usage after both interventi ons, but this did not achieve the level of statistical significance (P > 0.05). No changes were observed in the control group. Although the small group face-to-face intervention did not appear to offer greater impacts over large seminars in improving the appropriate use of drugs in acute diarrhoea, since the unit cost of training is far less costly than the seminar, it might be feasibly implemented in the existing su pervisory structure of the health system.