Upper Resp Tract Infection
Conditions
Brief summary
This research project aims to test the effect of two interventions targeted to community pharmacies in the Greater Accra region, Ghana, on antibiotics dispensing rates. The general goal is to inform the design of future policies to address the rising threat of antimicrobial resistance.
Detailed description
Interventions that discourage community pharmacies from providing antibiotics without proper diagnosis and a physician's prescription are critically needed in low- and middle-income countries in order to address the rising threat of antimicrobial resistance. In this study, we will test the effect of two interventions targeted to community pharmacies in the Greater Accra region of Ghana. We will conduct a baseline survey, followed by visits by standardized patients (SPs). We will then implement the interventions (described below) and assess the outcomes again using SPs. The study has 4 key objectives: Objective 1. Assess the effect of two behavioral interventions targeted to community pharmacies on antibiotics dispensing rates. We randomly assign 285 pharmacies in Greater Accra 1:1:1 into one of three arms: 1) Control, 2) Individualized Feedback, and 3) Legal Reminder. In the Individualized Feedback arm, we use information from the first visits to provide customized feedback to the pharmacies. In the Legal Reminder arm, we provide a letter from the Ghana authorities emphasizing that providing antibiotics without a physician prescription is against the law. Objective 2. Assess the extent of know-do gap in antibiotics dispensing behavior among community pharmacies. We compare self-reported data from a baseline survey and the one obtained from SP visits to assess the gap between what the pharmacies know and what they do in practice. Objective 3. Examine the effect of reduced pressure from patients for antibiotics on pharmacies' dispensing behavior. The two demand variations we will test are the following: 1) Patient asks for a medicine (normal demand pressure), 2) Patient explicitly says that they would prefer not to take antibiotics and mention that they do not have a physician prescription and that their condition appears to be viral (reduced demand pressure). Objective 4. Assess differential effects of the two interventions and reduced demand pressure across patient's age.
Interventions
BEHAVIORALIndividualized Feedback
We use information from the baseline visits (e.g., on whether they give antibiotics without a prescription and the time they spend with patients) to provide customized feedback to the pharmacies.
BEHAVIORALLegal Reminder
We provide a letter from the authorities in Ghana emphasizing that providing antibiotics without a physician prescription is against the law.
Sponsors
Penn State University
University of Ghana
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE (Subject, Outcomes Assessor)
Intervention model description
Community pharmacies will be randomized into 3 arms (control, Individualized Feedback, and Legal Reminder). Pharmacies in each arm will be visited by standardized patients under 4 scenarios (low demand-young patient; low demand-old patient, normal demand-young patient, normal demand-old patient).
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
for community pharmacies: * Operating within the Greater Accra region of Ghana * Registered with Ghana Pharmacy Council * "Stand-alone", i.e., not affiliated or next to a hospital
Exclusion criteria
* Operating only outside the Greater Accra region of Ghana * Not registered with Ghana Pharmacy Council * Hospital pharmacy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Non-prescription antibiotics dispensing rate | From baseline (1st SP visit) to the final SP visit (visit 5), lasting approximately 5 months. | Whether the pharmacy dispenses antibiotics without prescription in scenarios not requiring them |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Watch or reserve antibiotics | From baseline (1st SP visit) to the final SP visit (visit 5), lasting approximately 5 months. | Whether the dispensed antibiotics fall into the Watch or Reserve category in the WHO AWaRE classification. |
| Out-of-pocket costs to patients | From baseline (1st SP visit) to the final SP visit (visit 5), lasting approximately 5 months. | Amount patients spend out-of-pocket on medications including antibiotics. |
| Referral to a physician | From baseline (1st SP visit) to the final SP visit (visit 5), lasting approximately 5 months. | Whether the pharmacist recommends the patient to see a doctor before antibiotics can be dispensed. |
| History taking | From baseline (1st SP visit) to the final SP visit (visit 5), lasting approximately 5 months. | Number of questions asked by the pharmacist based on a pre-specified checklist of appropriate history taking behavior |
| Interaction time | From baseline (1st SP visit) to the final SP visit (visit 5), lasting approximately 5 months. | Amount of time the pharmacist spends on the patient before giving medicine. |
Countries
Ghana
Outcome results
None listed