Trainers Guide. Role of Dispensers in Promoting Rational Drug Use

Transcription

1 Trainers Guide Role of Dispensers in Promoting Rational Drug Use Materials For this session review the session notes, the overheads and the activity. If you want to do a role play of dispensing during the dispensing process sequence obtain drugs to be dispensed and labeling and packaging materials and prepare an assistant to play the dispenser role.. Time: 3 hours This is flexible time and depends on whether a role-play is used and on the time spent on the activity. This is a suitable session for an afternoon session. Deciding when to do the activity depends on how the session is going. It can be done early after the Who is a dispenser? sequence or probably better after the dispensing Practices to Enhance rational drug use and before the break. PURPOSE The main purpose of the session is to recognize that many people dispense and that it is possible to improve the quality of dispensing through training and supervision. In most sessions there are a mixture of doctors and nurses and pharmacists or technicians. Often the doctors or nurses think they know what is required in dispensing but they usually have not had any training and often in fact dispense very badly. Pharmacists and pharmacy technicians have been taught to dispense and often assume that other health workers have also been trained. So they may be surprised at the ignorance of their fellow professionals. NOTES When discussing the case report say that this is a true report and that the pharmacist responsible was sent to jail for 6 months! Emphasize that dispensing is the final stage of the therapeutic process and that the success of the curative process depends on quality dispensing. Before showing VA4 Who are Dispensers? use a flip chart or blackboard to brainstorm suggestions from the class. Discuss the transparency What does a dispenser need? Pointing out pharmacy that these are universal requirements try to briefly describe the situation in different countries. When going through the steps of the dispensing process you may want to use a role play to focus attention on the different steps. Take each step, demonstrate it and then discuss possible problems that might occur at each stage. Participant involvement is easy to elicit with the question What could go wrong at this stage?

2 For the VA Potential Errors or Problems try to elicit additional ones that may have been missed. Point out the key point that dispensing takes time! Discuss the findings from the previous field activities related to the dispensing indicators. When going over the dispensing conditions questions point out that these questions could be used to check on dispensing areas in hospitals or pharmacies. IT IS A GOOD IDEA TO TAKE A BREAK BEFORE DISCUSSING THE ROLE OF PRESCRIBERS AND DISPENSERS IN PROMOTING CORRECT PRESCRIBING This discussion should be carefully handled to avoid doctors or pharmacists accusing each other s profession of shortcomings. Insist on positive suggestions as to how things could be improved. There may be considerable discussion about the pharmacists role in research and in consumer education. When discussing methods to improve compliance try to identify what would need to be done and what the barriers are to doing this. The Public private question needs discussion in this session. Virtually all countries have private sector dispensers and how they relate to the public sector may be complex. The key point to be made is that addressing public sector dispensing alone may neglect most dispensing and that ways have to be found to involve the private sector. The interventions should all be discussed briefly and participants encouraged to view the posters on the CD-ROM. The message of these posters is that all except the Zimbabwe study which was not an intervention, show that changing dispensing practices are possible and are usually effective. The conclusion needs to be reinforced at the end of the session.

3 Visual Aids with Notes Slide 1 The Role of Dispensers in the Rational Use of Drugs 1

4 Slide 2 The Role of Dispensers in the Rational Use of Drugs: Objectives Identify who can be a dispenser Identify factors that influence dispensing Describe methods to enhance dispenser/patient communications Identify ways to influence a dispenser's behavior The Role of Dispensers in Promoting Rational Drug Use 2

5 Slide 3 Case Report A 20 yr. female student suffering from tonsilitis, seen by a doctor in a 600-bed hospital OPD. She obtained a drug from the hospital pharmacy, and took as instructed. She felt very weak after taking the drug, 3 days later she got severely comatose and was admitted to the same hospital.she took chlorpropamide 250 mg 4 times a day. The OPD doctor claimed that he prescribed chloromycetine 4x250 mg daily for her tonsilitis. The patient eventually died 2 weeks after hospital admission. The Role of Dispensers in Promoting Rational Drug Use 3

6 Slide 4 Who are Dispensers? Pharmacists, pharmacy technicians Pharmacy assistants Nurses, nurse aids Doctors Drug sellers Shop keepers Taxi drivers etc. Family members The Role of Dispensers in Promoting Rational Drug Use 4

7 Slide 5 Prescriber and Dispenser In the real world of drug use (rational and irrational) A A PRESCRIBER IS: Anyone with a recommendation for treatment. A A DISPENSER IS: Anyone that give out the treatment. The Role of Dispensers in Promoting Rational Drug Use 5

8 Slide 6 What Does A Dispenser Need? Knowledge/source of information: drug information product information consultation Skills: communication skill promotional/marketing techniques Others: supply dispensing equipment dispenser- prescriber relationship status/role in the health care system The Role of Dispensers in Promoting Rational Drug Use 6

9 Slide 7 The Dispensing Process Receive Prescription Interpret Prescription Retrieve Medication/Ingredients Prepare and Process Communicate with Patient Assure Patient's Understanding Monitor Compliance by Patient Keep Records The Role of Dispensers in Promoting Rational Drug Use 7

10 Slide 8 Potential Error/Problems Wrong interpretation of prescription (or diagnosis) Retrieval of the wrong drug from stock Wrong dosages Inadequate packaging/labeling Inaccurate counting, compounding Inadequate or nonexistent labeling No knowledge of proper drug compliance Insufficient knowledge of the disease process Insufficient time to talk with patients about their drugs Inability to communicate to patients about therapy The Role of Dispensers in Promoting Rational Drug Use 8

11 Slide 9 Assessing Dispensing Conditions Dispensing point conditions Dispensing time? Communication time? How often do errors occur? Who is responsible for dispensing? Dispensing training in country? Salaries and wages for dispensers? Dispensing packaging? The Role of Dispensers in Promoting Rational Drug Use 9

12 Slide 10 Roles of Prescriber/ Physician in Promoting Rational Drug Use Diagnosis Prescribing Drug Information The Role of Dispensers in Promoting Rational Drug Use 10

13 Slide 11 Roles of Pharmacist Dispenser in Ensuring Rational Drug Use Drug Procurement Drug Distribution Drug Prescribing Drug Information Additional roles: Communication with physician Treatment guidelines Research on prescribing and utilization Consumer education The Role of Dispensers in Promoting Rational Drug Use 11

14 Slide 12 Improving Patient Compliance with Therapy Dispenser - patient communication Packaging for patient use Labeling Written information The Role of Dispensers in Promoting Rational Drug Use 12

15 Slide 13 Dispenser-Patient Communication Dispensers communicate with patients how to take drugs Ensuring understanding is very important The Role of Dispensers in Promoting Rational Drug Use 13

16 Slide 14 Packaging for Patient Use The Role of Dispensers in Promoting Rational Drug Use 14

17 Slide 15 Labeling The Role of Dispensers in Promoting Rational Drug Use 15

18 Slide 16 Dispensing Public or Private Sector Public Sector Cheap but long delays and and frequent stock-outs Generic Drugs Private Sector Expensive but convenient Brand name drugs The Role of Dispensers in Promoting Rational Drug Use 16

19 Slide 17 Interventions Ghana Poster Intervention Uganda Field Training Kenya and Indonesia Private Drug Sellers Philippines Discussions with the drug selling storekeepers The Role of Dispensers in Promoting Rational Drug Use 17

20 Slide 18 Conclusion Dispensing is a critical part of drug use. Dispensing is often neglected in training and EDP programs. Interventions exist to improve dispensing. Patients benefit from better dispensing. The Role of Dispensers in Promoting Rational Drug Use 18

21 Slide 19 Sample Package Insert The Role of Dispensers in Promoting Rational Drug Use 19