Private pharmacy staff in Hanoi dispensing steroids - theory and practice
Objective: To investigate self reported practice and actual practice of private pharmacy staff in relation to drug regulations and provision of prednisolone (a prescription-only corticosteroid) on request to treat lower back pain.
Method: Sixty private pharmacies in Hanoi were randomly selected. Self reported practice was assessed through interviews with pharmacy staff using a questionnaire; actual practice was assessed with the Simulated Client Method with 5 encounters in each pharmacy (a total of 295 encounters).
Results: Sixty percent of the pharmacy staff interviewed said that they would not dispense corticosteroids without prescription and 60% could mention some adverse effects. In practice all but one pharmacy dispensed corticosteroids without prescription in 76 % of all the encounters. Questions and advice given to the clients were associated with significantly lower dispensing of corticosteroids.
Conclusion: The low compliance with prescription regulations and the discrepancy between stated practice and actual practice raises concerns. This study indicates that commercial pressures exceed the deterrent effect of current drug regulations and their implementation and hence enforcement of regulations needs to be improved.
2. Syhakhang L. The quality of private pharmacy services in a province of Lao PDR: Perceptions, practices and regulatory enforcements. (Thesis). Academic. Department, Karolinska Institutet, Stockholm, 2002.
3. Hongoro C, Kumaranayake L. Do they work? Regulating for-profit providers in Zimbabwe. Health Policy Plan 2000;15:368-77.
4. Wolffers, I. The role of pharmaceuticals in the privatization process in Vietnam's health-care system. Soc Sci Med 1995;41:1325-32.
5. World-Bank. Vietnam: Growing Healthy - A Review of Vietnam's Health Sector. World Bank Publications. 2001.
6. Chalker J. Viet Nam: profit and loss in health care. World Health Forum 1995;16:194-5.
7. Witter S. 'Doi moi' and health: the effect of economic reforms on the health system in Vietnam. Int J Health Plann Manage 1996;11:159-72.
8. Phuong D. Towards rational use of antibiotics in Vietnam: present status of infectious diseases in Vietnam. Australian prescriber 1997;20:134-5.
9. Goel P, Ross-Degnan D, Berman P, Soumerai S. Retail pharmacies in developing countries: a behavior and intervention framework. Soc Sci Med 1996;42:1155-61.
10. Tomson G, Sterky G. Self-prescribing by way of pharmacies in three Asian developing countries. Lancet 1986;2:620-2.
11. Kamat, V. R. and Nichter, M. (1998). Pharmacies, self-medication and pharmaceutical marketing in Bombay, India. Soc Sci Med, 47, 779-94.
12. FIP. The Tokyo Declaration : Standards for quality of pharmacy services. Federation Internationale Pharmaceutique. Tokyo, 1993.
13. WHO. Role of the pharmacist in support of the WHO revised drug strategy. Geneva: World Health Organisation;1994.
14. MOH. The third list of essential drugs in Vietnam. Hanoi: Ministry of Health; 1995.
15. MOH. Strategic orientation for people's health care and protection in the period of 1996-2000 and Vietnam's national drug policy. Hanoi(Vietnam): Ministry of Health; 1996.
16. Chuc NT, Larsson M, Falkenberg T, Do NT, Binh NT, Tomson GB. Management of childhood acute respiratory infections at private pharmacies in Vietnam. Ann Pharmacother 2001;35:1283-8.
17. Chuc NT, Tomson G. "Doi moi" and private pharmacies: a case study on dispensing and financial issues in Hanoi, Vietnam. Eur J Clin Pharmacol 1999;55:325-32.
18. Lam L, Tien L, Chuc N, Yen N. Study on rational and safe use of drug in Vietnam. Hanoi: MOH; 1997.
19. Ferraz MB, Pereira RB, Paiva JG, Atra E, Dos Santos JQ. Availability of over-the-counter drugs for arthritis in Sao Paulo, Brazil. Soc Sci Med 1996;42:1129-31.
20. Rang HP, Dale M, Ritter JM. Pharmacology. Churchill Livingstone; 1995.
21. Davidson's. Davidson's Principles & Practice of Medicine. Churchill Livingstone; 1999.
22. Prakash O, Mathur G, Singh Y, Kushwaha K. Prescription audit of under six children living in periurban areas. Indian Pediatr 1998;26:900-4.
23. Borenstein DG. Chronic low back pain. Rheum Dis Clin North Am 1996;22:439-56.
24. Ernst E, White A. Life-threatening adverse reactions after acupuncture? A systematic review. Pain 1997;71:123-6.
25. Madden JM, Quick JD, Ross-Degnan D, Kafle KK. Undercover careseekers: simulated clients in the study of health provider behavior in developing countries. Soc Sci Med 1997;45:1465-82.
26. Bartoloni A, Cutts F, Leoni S, Austin CC, Mantella A, Guglielmetti P, Roselli M, Salazar E, Paradisi F. Patterns of antimicrobial use and antimicrobial resistance among healthy children in Bolivia. Trop Med Int Health 1998;3:116-23.
27. Thamlikitkul V. A correlation of clinical performance on written test and standardised patient. J Med Assoc Thai 1991;74:513-7.
28. MOH. Prescription and dispensing drug regulation No 488. Hanoi: Ministry of Health; 1995.
29. Brugha R, Zwi A. Improving the quality of private sector delivery of public health services: challenges and strategies. Health Policy Plan 1998;13:107-20.
30. Paredes P, de la Pena M, Flores-Guerra E, Diaz J, Trostle J. Factors influencing physicians' prescribing behaviour in the treatment of childhood diarrhoea: knowledge may not be the clue. Soc Sci Med 1996;42: 1141-53.
31. Tran Q. Some results from inspections to private medical and pharmaceutical practices and solutions for fostering the effect and effectiveness of inspections. The State Health Inspectorate, Hanoi: Ministry of Health; 2001.
32. Chuc NTK. Towards good pharmacy practice in Hanoi: A multi-intervention study in private sector (Thesis). Academic. Department, Karolinska Institutet, Stockholm, 2002.
33. Chuc NT, Larsson M, Do NT, Diwan VK, Tomson GB, Falkenberg T. Improving private pharmacy practice: a multi-intervention experiment in Hanoi, Vietnam. J Clin Epidemiol 2002;55:1148-55.
34. Lalvani P, Murray M, Olsson S, Quick J, Tomson G, Wibulpolprasert S. Report of a Ministry of Health/WHO/SIDA. Joint Mission for Development of a Masterplan for the National Drug Policy of Vietnam. WHO and Indevelop Uppsala AB; 1996.
35. Ross-Degnan D, Soumerai SB, Goel PK, Bates J, Makhulo J, Dondi N, Sutoto AD, Ferraz-Tabor L, Hogan R. The impact of face-to-face educational outreach on diarrhoea treatment in pharmacies. Health Policy Plan 1996;11:308-18.
36. Chalker J, Chuc NT, Falkenberg T, Do NT, Tomson G. STD management by private pharmacies in Hanoi: practice and knowledge of drug sellers. Sex Transm Infect 2000;76:299-302.
37. Kroeger A, Ochoa H, Arana B, Diaz A, Rizzo N, Flores W. Inadequate drug advice in the pharmacies of Guatemala and Mexico: the scale of the problem and explanatory factors. Ann Trop Med Parasitol 2001;95:605-16.
38. Lönnroth K. Public health in private hands: studies on private and public tuberculosis care in Ho Chi Minh City, Vietnam (Thesis). Academic. Department, Nordic School of Public Health, Goteborg; 2000.
39. Sjöqvist, F. Drug safety in relation to efficacy: the view of a clinical pharmacologist. Pharmacol Toxicol 2000;86(Suppl 1):30-2.
40. Fass. The Swedish pharmacopeia. Läkemedelsinformation LINFO, Stockholm; 2001.