INTERACTIONAL GROUP DISCUSSION - RESULTS OF A CONTROLLED TRIAL USING A BEHAVIORAL INTERVENTION TO REDUCE THE USE OF INJECTIONS IN PUBLIC-HEALTH FACILITIES

Injections are commonly overused in Indonesia. More than 60% of patien ts attending public health facilities receive at least one injection, which increases clinical risk and has adverse economic impact. This st udy assesses the efficacy of an innovative behavioral intervention, th e Interactional Group Discussion (IGD), for reducing the overuse of in jections. This study was a controlled trial in a single district with 24 public health centers randomized to intervention and control groups . Prescribers in the intervention group were invited to one IGD, each of which consisted of 6 prescribers and 6 patients; a total of 24 IGDs were held in a 4-week period, and all invited prescribers participate d. The groups, which lasted 90-120 minutes, were facilitated by a beha vioral scientist and a clinician, who also served as a scientific reso urce person. The hypothesized mechanism of behavior change involved re ality testing prescribers' assumptions about patient beliefs, impartin g scientific information about injection efficacy, and establishing pe er norms about correct behavior. Outcomes were measured by a retrospec tive prescribing survey covering the periods 3 months before and 3 mon ths after the intervention, with samples of 100 prescriptions per cent er per month. Rates of injection and average number of drugs per presc ription were computed separately for each center, and t-tests were use d to compare pre-post changes in outcomes in both groups. Results show ed a significant decrease in injection use from 69.5 to 42.3% in the i ntervention group, compared to a decrease from 75.6 to 67.1% among con trols [-18.7.0% intervention vs control, 95% CI = (-31.1%, -6.4%), P < 0.025]. There was also a significant reduction in average number of d rugs per prescription [-0.37 drugs prescribed per patient, 95% CI = (- 0.04, -0.52), P < 0.05], indicating that injections were not substitut ed with other drugs. We conclude that the IGD significantly reduces th e overuse of injections. It is suggested to try out other behavioral i nterventions to improve the rational use of drugs.