Small group intervention vs formal seminar for improving appropriate drug use
Abstract
In an attempt to evaluate the efficacy of different methods of interventions to improve the appropriate use of drugs for acute diarrhoea, a controlled study has been carried out in 6 districts in Yogyakarta and Central Java provinces, Indonesia. This study was designed to investigate the impacts of two different methods of educational intervention, i.e. a small group face-to-face intervention and a formal seminar for prescribers, on prescribing practice in acute diarrhoea. The districts were randomly assigned into 3 groups and 15 health centers were selected from each district. Prescribers in Group 1 underwent a small group face-to-face intervention conducted in the respective health center. Those in Group 2 attended a formal seminar conducted at the district level. Prescribers in Group 3 served as the control group. Both interventions were given on a single occasion without follow-up supervision or monitoring. Written information materials on the appropriate management of acute diarrhoea were developed and were provided to all prescribers in the intervention groups. Focus group discussions (FGDs) involving prescribers and consumers in the 6 districts were carried out to identify various underlying motivations of drug use in acute diarrhoea. The findings of the FGDs were used as part of the intervention materials. To evaluate the impacts of these interventions on prescribing practice, a prescribing survey for patients under five years old with acute diarrhoea was carried out in health centers covering 3-month periods before and after the intervention. The results showed that both interventions were equally effective in improving the levels of knowledge of prescribers about the appropriate management of acute diarrhoea. They were also partially effective in improving the appropriate use of drugs, reducing the use of non-rehydration medications. There was a highly significant reduction of antimicrobial usage either after small-group face-to-face intervention (77.4 +/- 2.7% to 60.4 +/- 2.9%; P < 0.001) or formal seminar (82.3 +/- 3.0% to 72.3 +/- 3.6%; P < 0.001), and the former caused significantly (P < 0.001) greater reduction than the latter. There was also a significant (P < 0.01) reduction in the usage of antidiarrhoeals after both interventions, i.e. from 20.3 +/- 3.7% to 12.5 +/- 3.3% (P < 0.01) after face-to-face intervention and from 48.5 +/- 4.1% to 27.0 +/- 4.3% (P < 0.01) after seminar. However, the formal seminar had a significantly (P < 0.01) greater impact than the small group face-to-face intervention. There was also a trend toward increased oral rehydration solution (ORS) usage after both interventions, but this did not achieve the level of statistical significance (P > 0.05). No changes were observed in the control group. Although the small group face-to-face intervention did not appear to offer greater impacts over large seminars in improving the appropriate use of drugs in acute diarrhoea, since the unit cost of training is far less costly than the seminar, it might be feasibly implemented in the existing supervisory structure of the health system.
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In Santoso 1996, blinding of participants and personnel was at unclear risk of bias.
“Blinding of participants and personnel (performance bias) All outcomes Unclear risk It would not have been possible to blind staff of the study health centres to the intervention group”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Santoso 1996
In Santoso 1996, contamination was at low risk of bias.
“Contamination Low risk Randomisation at the level of the district”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Santoso 1996
In Santoso 1996, selective reporting was at low risk of bias.
“Selective reporting (reporting bias) Low risk Appropriate outcomes reported”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Santoso 1996
In Santoso 1996, other bias was at unclear risk of bias.
“Other bias Unclear risk Contamination is unlikely; baseline characteristics of the health centres are not reported”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Santoso 1996
In Santoso 1996, allocation concealment was at unclear risk of bias.
“Allocation concealment (selection bias) Unclear risk Details not provided”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Santoso 1996
In Santoso 1996, overall risk of bias was high.
“Risk of bias overall High risk 6 unclear risk criteria”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Santoso 1996
In Santoso 1996, baseline characteristics were at unclear risk of bias.
“Baseline characteristics Unclear risk Baseline characteristics not reported”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Santoso 1996
In Santoso 1996, baseline outcomes were at low risk of bias.
“Baseline outcomes Low risk Baseline outcomes similar”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Santoso 1996
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- Authors
- Santoso, B.
- Affiliations
- Universitas Gadjah Mada (ID)
- Corresponding author
- Santoso, Budiono
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 1996-04
- Volume
- 42
- Issue
- 8
- Pages
- 1163-1168
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W2051118092
- Cited by
- 106
- References
- 9
- Citations by year
- 2026: 1 · 2024: 1 · 2021: 4 · 2020: 1 · 2019: 2 · 2018: 1 · 2016: 1 · 2015: 3 · 2014: 2 · 2013: 3 · 2012: 2
- FWCI
- 2.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- acute diarrhea, rational drug use, prescribing patterns, small group intervention, prescriber education, antimicrobial use, antidiarrheal agents, rehydration therapy, children under five, health centers, intervention efficacy, Yogyakarta, Central Java, Indonesia, focus groups
- MeSH terms
- Acute Disease, Anti-Bacterial Agents, Antidiarrheals, Child, Child, Preschool, Developing Countries, Diarrhea, Female, Fluid Therapy, Health Services Misuse, Humans, Indonesia, Infant, Inservice Training, Health Knowledge, Attitudes, Practice, Male, Pharmaceutical Services, Drug Prescriptions, Drug Utilization Review
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