Abstract
The purpose of this study was to develop indicators for monitoring and evaluating rational drug use (RDU) community driving outcome in Thailand. This study was classified into the following four parts. Part 1: Gathering the relevant indicators towards RDU promotion at the community level from literature reviews (i.e., WHO INRUD and other international and national organizations nations). Part 2: Investigating people’s drug usage in four pilot provinces under the Food and Drug Administration’s country project on rational drug use (RDU Province) includes the provinces of Chiang Rai, Uthai Thani, Sisaket, and Surat Thani. A total of 374 people participated in this study and well-trained personnel performed face-to-face interview with them. Open-ended questions about knowledge, attitudes, behavior of RDU, and perceptions of RDU project, household drug surpluses, and elderly drug usage were utilized. In addition, data from 827 samples were gathered for the RDU literacy rapid survey from four pilot areas and four additional provinces (Nakhon Nayok province, Saraburi province, Lampang province, and Narathiwat province). The relationship between explanatory factors and the people's rational drug use behavior was analyzed using multiple logistic regression. Including data gathering from guidelines for driving rational drug use in accordance with the five key activities and visiting grocery stores with pharmacists (RDU Coordinator), lessons learned in four prototype regions from the provider and the public sector representatives through focus group discussion. Part 3: Drafting a set of RDU community indicators (RDUCMI) and entering the process of selecting indicators with the help of experts (representing policy makers, academics, practitioners and public sector). The index of consistency between the list of indicators and the research objectives was applied at this point to determine content validity (Item-Objective Congruence Index; IOC). In addition, the Delphi technique for three rounds with the criteria of taking into consideration three indicators for the following: (i) appropriateness of indicators for monitoring and evaluating the results of driving RDU Community, (ii) the importance of the indicators in promoting the implementation of the RDU Community, and (iii) the possibility of evaluating (collecting data) and processing the indicators (feasibility) by using Median and Interquartile range (IQR) statistics to find consensus in selecting indicators and to test for Inter-rater reliability (IRR) using Cohen's kappa statistics (k) for confirmation of selected indicators. Part 4: testing the feasibility of RDUCMI for monitoring and evaluating the RDU community by using public hearing and database related indicators. The results of this study revealed that there were 13 key indicators of rational drug use in the community (RDUCMI) were extracted from this final research process. In order to assess the possibility of bringing developed and selected indicators for monitoring and evaluating the rational drug use in the community. Therefore, this set of indicators was taken to a public hearing at a forum with research areas in eight provinces and other provinces across the country. It was observed that the operation should be carried out over three flights of stairs. Starting at Level 1: there are five indicators that the area can be operated and can be measured as of 2023, (i) the presence of a proactive drug safety surveillance information system in the community; and (ii) the presence of a connected surveillance system, drug safety and health products in service units and communities, and reports to achieve surveillance and solve problems in the province; (iii) percentage of drug dealers in the community (Drug store type Khor. Yor. 2/ grocery store, hawker, flea market) that detects the sale of dangerous drugs, especially controlled drugs and drug combinations; (iv) percentage of drug combinations; and (v) percentage of steroid-contaminated health products found in households. Level 2: the area can implement a total of four indicators starting in 2023, which can be measured and evaluated starting in 2024. These indicators are: (i) inclusion of rational drug use content in the curricula for primary, secondary, vocational, and nonformal education; 2) reporting of the situation by area regarding the distribution of dangerous drugs, drug combinations and products that are unsafe for the public, including adverse drug reaction (ADR) and adverse drug event (ADE) from drug use and products. The community network at each level can monitor unsafe drugs in their local area and issue warnings to the community and to other networks; (iii) promoting knowledge about RDU at the community level; (iv) percentage of pharmacists who have had formal training in the rational use of drugs for pharmacists in pharmacies. Level 3: there are a total of four indicators that the area can operate starting in 2023 and can be measured and evaluated starting in 2025. These indicators are: (i) community network partners driving drug use consistently and sustainably in the community at the district/sub-district level; (ii) percentage of model districts of rational drug use in each province; (iii) percentage of provinces that have developed to rational drug use districts; and 4) the percentage of people in the community who have knowledge of rational drug use. Moreover, there are 8 additional indicators that the working group for the community's rational drug use and safety development system agreed should be reinstated from the existing default set of indicators to be used as key indicators to completely drivethe RDU community in the future and consisted of 1) Number of patients screened for risk/problem from drug use by trigger tools separated by disease and product, 2) Use of ICD-P in the Hosxp program of hospitals, 3) Percentage of private hospitals, clinics with RDU labeling (Correct/Proper/Complete), 4) Percentage of drugstores (KorKhor.1) that met the criteria for GPP Category 5, 5) Percentage of households with antibiotics left over, 6) Percentage of antibiotics/NSAIDs sold in Khor.Yor. 2, grocery stores, hawkers and flea markets in the community, 7), the community participates in organizing RDU activities/ projects in the area, and 8) percentage of multidisciplinary health personnel in the community such as nurse practitioners, public health technical officer, public health officer with literate of rational drug prescribing and dispensing. In conclusion, there are a total of 21 key indicators. The following are important implementation levers for this draft RDUCMI indicator set for monitoring and evaluation: (i) Each phase of the community mobilization assessment should clearly define the main issues that need to be monitored and evaluated. Including use of specific drug combinations, as well as purchasing health products from media and online channels. (ii) In the private health sectors, such as clinics, pharmacies, grocery stores, and convenience stores, the implementation of RDU guidelines for monitoring and evaluating has been voluntary; however, systematic action are still a limitation. (iii) The design of the database structure in the form of “data storage” derived from surveys related to RDU activities “in the community” is important that should be developed from the RDUCMI set of indicators for follow and systematically assess the results in the community. This kind of database would support the set of indicators of rational drug use in the community as proposed in this research project.
