Impact of a public education program on promoting rational Impact of a public education program on promoting rational use of medicines: a household survey in south district of use of medicines: a household survey in south district of Tehran, 2002-2003Tehran, 2002-2003Darbooy SH, Hosseini AR, Mohagheghi MA, Effatpanah MDarbooy SH, Hosseini AR, Mohagheghi MA, Effatpanah MTehran University of Medical Sciences, IRANTehran University of Medical Sciences, IRANProblem StatementProblem Statement: Public education program addressing the use : Public education program addressing the use of medicines have not been appreciated in Iran’s health system. This of medicines have not been appreciated in Iran’s health system. This study is the first that documents social behavior in relation to study is the first that documents social behavior in relation to medicines and tries to positively change this behavior by designing medicines and tries to positively change this behavior by designing and conducting a public education program.and conducting a public education program.Objectives:Objectives: To get insights about the public's knowledge of and To get insights about the public's knowledge of and behavior related to medicines and to study the effects of an behavior related to medicines and to study the effects of an educational program on drug use behavior in community.educational program on drug use behavior in community.Study designStudy design: Pre and post intervention with control group.: Pre and post intervention with control group.Setting and Population:Setting and Population: Three hundred households were selected Three hundred households were selected using a multistage systematic randomized sampling method for each using a multistage systematic randomized sampling method for each control and study group in the Population Lab in districts 16 and 17 in control and study group in the Population Lab in districts 16 and 17 in south of Tehran, respectively. Data were collected from both groups south of Tehran, respectively. Data were collected from both groups pre- and post-intervention using a modified World Health pre- and post-intervention using a modified World Health Organization (WHO) household survey questionnaire. Data collectors Organization (WHO) household survey questionnaire. Data collectors were trained in the procedures of interviewing and checking the were trained in the procedures of interviewing and checking the household medicines in a one-day workshop.household medicines in a one-day workshop.Intervention:Intervention: The educational program consisted of training The educational program consisted of training sessions run by general physicians, in Primary Health Care (PHC) sessions run by general physicians, in Primary Health Care (PHC) centers in the designated area, together with distribution of a booklet centers in the designated area, together with distribution of a booklet containing session notes to the households attending to the program. containing session notes to the households attending to the program. The booklet was designed, pre-tested and published based on The booklet was designed, pre-tested and published based on general facts about medicines used in the community.general facts about medicines used in the community.Outcome measures:Outcome measures: percentage of episodes of illness treated by a percentage of episodes of illness treated by a physician and by self-medication; drugs that people kept in their physician and by self-medication; drugs that people kept in their homes and their knowledge of and behavior towards this drugs ; and homes and their knowledge of and behavior towards this drugs ; and other indicators included in WHO guidelines for investigating drug other indicators included in WHO guidelines for investigating drug use in communities.use in communities.Results: Results: Pre-intervention descriptive results were as follows: Pre-intervention descriptive results were as follows: percentage of illnesses treated in self-medication: 19.3 and 16.3; percentage of illnesses treated in self-medication: 19.3 and 16.3; average number of drugs per household: 7 and 4 for the study and average number of drugs per household: 7 and 4 for the study and control groups, respectively. The drugs that people most commonly control groups, respectively. The drugs that people most commonly had in stock were (category: study group, control group): Antibiotics: had in stock were (category: study group, control group): Antibiotics: 21% , 18%; Over The Counter (OTC) : 11% , 13%; Gastrointestinal: 21% , 18%; Over The Counter (OTC) : 11% , 13%; Gastrointestinal: 11% , 12%; Vitamins: 8% , 14% ; nonsteroidal anti-inflammatory 11% , 12%; Vitamins: 8% , 14% ; nonsteroidal anti-inflammatory drugs(NSAIDs): 8% , 7%; central nervous system(CNS) : 10% , 8%; drugs(NSAIDs): 8% , 7%; central nervous system(CNS) : 10% , 8%; Cardiovascular: 9%, 8%. Of total drugs stocked 27% and 21% were Cardiovascular: 9%, 8%. Of total drugs stocked 27% and 21% were expired; 38% and 35% of interviewees incorrectly explained the drug expired; 38% and 35% of interviewees incorrectly explained the drug indications and 58% and 60% of interviewees stored the drugs for indications and 58% and 60% of interviewees stored the drugs for future use in study and control groups, respectively. We are currently future use in study and control groups, respectively. We are currently collecting post-intervention data and the compared results at the collecting post-intervention data and the compared results at the conference.conference.Conclusion:Conclusion: So far that our program has been successful and very So far that our program has been successful and very interesting especially for our PHC physician colleagues. This program interesting especially for our PHC physician colleagues. This program is capable of being adopted in a national level after it has been is capable of being adopted in a national level after it has been optimized.optimized.Study funded by:Study funded by: Ministry of health and medical education, Ministry of health and medical education, Undersecretary of Food and Drugs, Iran.Undersecretary of Food and Drugs, Iran.

Introduction:Introduction:Although prescribers play an essential role Although prescribers play an essential role in promoting rational use of medicines, the in promoting rational use of medicines, the role of the patient is equally important.role of the patient is equally important.Knowledge; attitude and practice of Knowledge; attitude and practice of patients as the final target in patients as the final target in pharmacotherapy cycle influence health pharmacotherapy cycle influence health improvement in countries.improvement in countries.World Health Organization (WHO) has World Health Organization (WHO) has suggested educational programs as an suggested educational programs as an important strategy to improve rational use important strategy to improve rational use of medicines in communities.of medicines in communities.In Iran since many years ago educational In Iran since many years ago educational programs has been carried out in form of programs has been carried out in form of continuous medical education programs for continuous medical education programs for physicians, pharmacists and other health physicians, pharmacists and other health providers. In these programs many providers. In these programs many seminars and workshops have implemented seminars and workshops have implemented regarding rational use of medicines, but regarding rational use of medicines, but very few programs has focused on public very few programs has focused on public education.education.A number of studies in different countries A number of studies in different countries have shown effectiveness of public have shown effectiveness of public education in promoting rational use of education in promoting rational use of medicines, but apart from a number of medicines, but apart from a number of scattered studies, we had no documented scattered studies, we had no documented information about public's knowledge and information about public's knowledge and behavior related medicines and impact of behavior related medicines and impact of education on promoting them.education on promoting them.

Objectives:Objectives:

This study was undertaken to This study was undertaken to get insight about public's get insight about public's knowledge and behavior knowledge and behavior related to medicines and to related to medicines and to study the effect of an study the effect of an educational program on drug educational program on drug use behavior in the use behavior in the community.community.

It was expected that public It was expected that public education would change drug education would change drug use behavior positively.use behavior positively.

MethodsMethods::Study Design:Study Design:Pre- and post intervention with control Pre- and post intervention with control group.group.Setting and Population:Setting and Population:Tehran municipality has divided this city Tehran municipality has divided this city to twenty two districts for municipal to twenty two districts for municipal services. services. Tehran University Of Medical Sciences is Tehran University Of Medical Sciences is responsible to health care services in responsible to health care services in southern region of Tehran including southern region of Tehran including districts:10,11,16,17,19. This study has districts:10,11,16,17,19. This study has been carried out in districts 17 as study been carried out in districts 17 as study group and district 16 as control group.group and district 16 as control group.Three hundred households were selected Three hundred households were selected using a multistage systematic using a multistage systematic randomized sampling method for each randomized sampling method for each control and study group.control and study group.Data were collected from both groups, Data were collected from both groups, pre-and post intervention using a pre-and post intervention using a modified World Health Organization modified World Health Organization (WHO) household survey questionnaire.(WHO) household survey questionnaire.Data collectors were trained in the Data collectors were trained in the procedures of Interviewing and checking procedures of Interviewing and checking the household medicines in a one-day the household medicines in a one-day workshop.workshop.

Intervention:Intervention:An educational booklet containing An educational booklet containing simple recommendations and simple recommendations and pictures regarding subjects such as pictures regarding subjects such as correct use of medicines, attention correct use of medicines, attention to expiration date of drugs, to expiration date of drugs, completing treatment duration, completing treatment duration, drug abuse and disadvantages of drug abuse and disadvantages of self –medication was designed, pre self –medication was designed, pre tested in target group and tested in target group and published based on pre published based on pre intervention findings.intervention findings.A number of general practitioners A number of general practitioners were trained about communication were trained about communication skills in public education regarding skills in public education regarding appropriate drug use.appropriate drug use.Study group households were Study group households were invited for participating in training invited for participating in training sessions that run by general sessions that run by general practitioners in primary health care practitioners in primary health care centers, together with distribution centers, together with distribution of booklet. of booklet. Post intervention data collection Post intervention data collection has been carried out three months has been carried out three months after training sessions in both of after training sessions in both of study and control group.study and control group.

RERESSULTS:ULTS:About ninety five percent of training About ninety five percent of training session's participants was session's participants was housewives.housewives.Local primary health care center's Local primary health care center's services were used by more than services were used by more than sixty five percent of households. sixty five percent of households. Pharmacy was only source of drug Pharmacy was only source of drug supply in study and control group. supply in study and control group. Before intervention, respectively 58% Before intervention, respectively 58% and 60% of interviewees in study and and 60% of interviewees in study and control groups explained that reuse control groups explained that reuse of drugs in probable future diseases of drugs in probable future diseases was the main reason for storage of was the main reason for storage of drugs in their homes. After drugs in their homes. After intervention this option was 32% in intervention this option was 32% in study group and 55% in control study group and 55% in control group. group. Other results for pre- and post Other results for pre- and post intervention surveys including: intervention surveys including: average number of drugs per average number of drugs per household, drugs that people most household, drugs that people most commonly had in stock, percentage commonly had in stock, percentage of expired drugs in total drugs of expired drugs in total drugs stocked and percentage of stocked and percentage of interviewees that explained the drug interviewees that explained the drug indication correctly are compared in indication correctly are compared in Figures 1 toFigures 1 to 6 6 . .

Figure 1Figure 1

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Discussion:Discussion:Finding of this study showed that public Finding of this study showed that public education about medicines, improved education about medicines, improved drug use behavior in study group in drug use behavior in study group in comparison with control group.comparison with control group.Reduction in average number of drugs per Reduction in average number of drugs per households, percentage of antibiotics and households, percentage of antibiotics and expired drugs which were available in expired drugs which were available in households confirmed that people households confirmed that people attention to completing treatment attention to completing treatment duration and expiration date of drugs has duration and expiration date of drugs has increased.increased.Self- medication as one of the irrational Self- medication as one of the irrational use of medicines indicators in the use of medicines indicators in the community has decreased after community has decreased after Educational intervention.Educational intervention.Besides, this study showed that people Besides, this study showed that people were interested to know more about were interested to know more about drugs which they used. Increased percent drugs which they used. Increased percent of interviewees that explained correctly of interviewees that explained correctly drug indications demonstrated this point.drug indications demonstrated this point.Finally, housewives as health managers in Finally, housewives as health managers in their homes and primary health care their homes and primary health care centers and pharmacies as reliable centers and pharmacies as reliable medical services have essential role in medical services have essential role in improving rational use of medicines in the improving rational use of medicines in the community.community.

Conclusion & recommendations:Conclusion & recommendations:Implementation of training sessions Implementation of training sessions about medicines in southern region about medicines in southern region of Tehran primary health care of Tehran primary health care centers together with using of centers together with using of appropriate printed material, within appropriate printed material, within the short period of evaluation has the short period of evaluation has changed social behavior in relation changed social behavior in relation medicines positively .The study medicines positively .The study needs to be followed by periodic needs to be followed by periodic reinforcement in this region. reinforcement in this region. Besides, doing such studies in other Besides, doing such studies in other areas with similar or different areas with similar or different educational interventions and educational interventions and comparison between obtained comparison between obtained results will give us total insight results will give us total insight about effectiveness of these about effectiveness of these programs. By disseminating the programs. By disseminating the results to health policymakers and results to health policymakers and their advocacies, public education their advocacies, public education about medicines will be as a about medicines will be as a continuous program in national continuous program in national level. Mass media has determinant level. Mass media has determinant role in success of this program.role in success of this program.