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This study explores multi-interventional approaches to improve pharmacy practices in Thailand and Vietnam, focusing on regulatory enforcement, education, and peer influence. Data was collected from 3,339 pharmacies in different areas of Bangkok from 1997 to 2000. Findings suggest positive changes in medicine handling. Limitations include research design and sample size. Key elements for sustainability include policy support, continuity, and participation. Policy recommendations stress the need for a mixed-strategy approach.
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Improving Treatment in Private Drug Outlets: Are There Sustainable Approaches ? Thailand’s country study “ Towards Good Pharmacy Practice in Thailand and Vietnam: a multi-intervention approach reationalise drug use through private pharmacies1997-2000” EU, IHCAR,LSHTM,HSRI
Sampling scheme 3,339 pharmacies 40 districts in Bangkok Industrial Area(6) Suburban Area(7) Downtown Area(21) New living Area(6) random random random random Bangkapi (I) Ratburana (I) Bangkean (C) Ladkrabang (C) Pravase (C) Pranakorn (C) Patumwan (I) Nongkham (I) outeria-based selection N=5 N=5 N=7 N=7 N =13 N =13 N =14 N =14
Overall design indicating data collection schemes and sequence INTERVENTION GROUP CONTROL GROUP REGULATORY ENFORCEMENT PEER-INFLUENCE EDUCATION POST-EDUCATION Survey BASELINE Survey POST-PEER Survey POST-ENFORCEMENT Survey INTERVIEW 1 INTERVIEW 2 SCM 0 SCM 1 SCM 2 SCM 3 Jun 1997 Jun 1998 Jun 1999 Jun 2000
Changes :medicine ---------------------------------------------------------- Scenario Enforcement Education Peer-influence ---------------------------------------------------------- Diarrhea ++ UTI ++ Antibiotic + Steroid++ ----------------------------------------------------------
Changes : question and advice --------------------------------------------------- Scenario Enforcement Education Peer-influence --------------------------------------------------- Diarrhea + + + UTI + + + Antibiotic + Steroid + + + ----------------------------------------------------------
Limitations of the research • Research design • Nature of private pharmacy • Nature of the interventions • Nature of the scenarios • Number of samples
Key elements of sustainability • Policy supports • Continuity • Participation • Willingness
Policy recommendation and future research questions • Complexity in the nature • In-depth understanding is needed • Punishment has limits • Mixed-strategy is key sanctions profit safety