Intervention research in rational use of drugs: a review

Many studies have been done to document drug use patterns, and indicate tha t overprescribing, multi-drug prescribing, misuse of drugs, use of unnecess ary expensive drugs and overuse of antibiotics and injections are the most common problems of irrational drug use by prescribers as well as consumers. Improving drug use would have important financial and public health benefi ts. Many efforts have been undertaken to improve drug use, but few evaluati ons have been done in this field. This article provides an overview of 50 i ntervention studies to improve drug use in developing countries. It highlig hts what type of interventions exist and what is known about their impact. It reveals that commonly used interventions, such as an essential drug list and standard treatment guidelines, have rarely been systematically evaluat ed so far. The majority of intervention studies are focused on prescribers in a public health setting, while irrational use of drugs is also widesprea d in the private sector. Furthermore, the magnitude of inappropriate drug u se at community level is often overlooked and few interventions address dru g use from a consumer's perspective. More research on different types of in tervention strategies in various health care settings is needed to draw con clusions on the effectiveness of a specific intervention strategy. Also mor e research is needed on socio-cultural factors influencing the impact of dr ug use interventions, particularly from a user perspective. To enhance eval uative research, more technical support will be needed for researchers in d eveloping countries. The design of available studies from developing countr ies is generally weak, only six of the 50 studies included in this overview were randomized controlled studies. In order to provide technical support and coordination of future intervention research the establishment of an in ternational resource centre for drug use intervention research is recommend ed.