Inadequate drug advice in the pharmacies of Guatemala and Mexico: the scale of the problem and explanatory factors

A study of urban pharmacies in Guatemala and in Chiapas, southern Mexico, w as undertaken to analyse the scale of the inadequate drug advice provided, and to identify the contributing factors. The estimate of the scale of the problem was based on the results of 969 approaches to 191 pharmacies by 'ma gic clients' (i.e. researchers pretending to be looking for treatment for r elatives who had one of three 'tracer' diseases), interviews with 4469 phar macy users as they left the same 191 pharmacies, and a comparison of the qu ality of advice offered by public and private pharmacies in Guatemala (base d on exit interviews with 150 users). The contributing factors were explore d using a provider survey (interviews with 166 pharmacy supervisors and 371 drug vendors), an in-depth study analysing large-chain and independent Mex ican pharmacies, and a review of the national drug policies in both countri es. Although only about 11% of all drug treatments were recommended in pharmaci es (the rest being prescribed by physicians or recommended by kin-groups), this still represents large numbers of treatments. Overall, 501 individuals who visited the 191 study pharmacies over 2 days of observation received d rugs recommended by pharmacy staff. Much of the pharmacy advice was reveale d to be poor >80% of the treatments recommended to the 'magic clients' for diarrhoeal disease or acute respiratory infection included unnecessary or d angerous drugs. Few of those who worked in the pharmacies based their advic e on careful case histories. Drug advice in pharmacies was much more likely to be of poor quality than that from physicians or even kin-groups. The fa ctors behind this poor advice were identified as a lack of knowledge about standard treatments and legal regulations, incompetence among pharmacy staf f, commercial pressures (particularly in the large-chain pharmacies of Mexi co), and a failure to implement the existing regulations covering the drug market and its retail practices. It is recommended that: (1) pharmacy owners and drug vendors be made more a ware that the selling of drugs should involve provision of healthcare (as w ell as reasonable profit-making); (2) existing drug-related legislation be reinforced (through consensus-building rather than coercion); and (3) mass training of pharmacy supervisors and drug vendors, in the standard treatmen t of common diseases, be undertaken. This process will be challenging and s low.