It is widely acknowledged that improving the use of pharmaceuticals requires interventions at multiple levels: providers, manufacturers, retailers, patients, and communities. This paper examines all patient and community level interventions aimed at improving the use of pharmaceuticals in developing countries that follow a scientifically designed evaluation. Acceptable evaluation designs include the following: randomized controlled trials with at least 40 cases and 40 controls, pre-post with a comparison group, and time series with at least four time points. The number of studies is very small, as of today only 20 studies could be found through intensive searches of Medline and the INRUD Database, bibliographical reviews and inquiries with researchers in this field.
The paper analyzes the quality of the interventions, and raises questions regarding the adequacy and quality of the evaluation designs. Additional questions include: cost-efficiency and cost-effectiveness of the interventions, sustainability, and expansion form the pilot settings to regional/national levels. The paper also discusses the role of CHW and the difficulties in evaluating educational strategies.
After examining the quality of the evaluations the paper concludes there are only a few interventions that can with certainty be considered successful and replicable. Authors acknowledge the need to engage in more rigorous multicentric studies and the establishment of chearinghouses for this field of inquire.
Learning Objectives: (1) to improve evaluation strategies of community-based and patient interventions to enhance compliance with medical regimens; and (2) to design more efficient interventions to improve compliance.
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
Disclosure not received
Relationship: Not Received.