Evidence map›Paper›PMID 39366709›Full record

ArticleBMJ global health2024

The impact of a multi-faceted intervention on non-prescription dispensing of antibiotics by urban community pharmacies in Indonesia: a mixed methods evaluation.

Astri Ferdiana, Yusuf Ari Mashuri, Luh Putu Lila Wulandari, Ihsanti Dwi Rahayu, Miratul Hasanah, Zulfa Ayuningsih, Neha Batura, Mishal Khan, Marco Liverani, Rebecca Guy and 9 more

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Article in BMJ global health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Astri FerdianaFaculty of Medicine and Health Sciences, University of Mataram, Mataram, Indonesia.ORCID http://orcid.org/0000-0003-0666-4302
Yusuf Ari MashuriCenter for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.ORCID http://orcid.org/0000-0002-3494-9842
Luh Putu Lila WulandariThe Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0002-3397-3648
Ihsanti Dwi RahayuFaculty of Pharmacy, Universitas Lampung, Bandar Lampung, Indonesia.
Miratul HasanahCenter for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Zulfa AyuningsihCenter for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Neha BaturaInstitute of Global Health, University College London, London, UK.
Mishal KhanDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
Marco LiveraniDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.ORCID http://orcid.org/0000-0003-0829-291X
Rebecca GuyThe Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
Gill SchierhoutGeorge Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
John KaldorThe Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
Matthew LawThe Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
Richard DaySt Vincent's Clinical Campus, University of New South Wales, Sydney, New South Wales, Australia.
Stephen JanHealth Economics and Process Evaluation Program, The George Institute for Global Health, Sydney, New South Wales, Australia.
Tri WibawaCenter for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Ari ProbandariCenter for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.ORCID http://orcid.org/0000-0003-3171-5271
Shunmay YeungDepartment of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.ORCID http://orcid.org/0000-0002-0997-0850
Virginia WisemanThe Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia v.wiseman@unsw.edu.au.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionNon-prescription antibiotic dispensing is prevalent among community pharmacies in several low- and middle-income countries. We evaluated the impact of a multi-faceted intervention to address this challenge in urban community pharmacies in Indonesia.

methodsA pre-post quasi-experimental study was carried out in Semarang city from January to August 2022 to evaluate a 7-month long intervention comprising: (1) online educational sessions for pharmacists; (2) awareness campaign targeting customers; (3) peer visits; and (4) pharmacy branding and pharmacist certification. All community pharmacies were invited to take part with consenting pharmacies assigned to the participating group and all remaining pharmacies to the non-participating group. The primary outcome (rate of non-prescription antibiotic dispensing) was measured by standardised patients displaying symptoms of upper respiratory tract infection, urinary tract infection (UTI) and seeking care for diarrhoea in a child. χ

findingsEighty pharmacies participated in the study. Postintervention, non-prescription antibiotics were dispensed in 133/240 (55.4%) consultations in the participating group compared with 469/570 (82.3%) in the non-participating group (p value <0.001). The pre-post difference in the non-prescription antibiotic dispensing rate in the participating group was 20.9% (76.3%-55.4%) compared with 2.3% (84.6%-82.3%) in the non-participating group (p value <0.001).Non-prescription antibiotics were less likely to be dispensed in the participating group (OR=0.19 (95% CI 0.09 to 0.43)) and more likely to be dispensed for the UTI scenario (OR=3.29 (95% CI 1.56 to 6.94)). Barriers to prescription-based antibiotic dispensing included fear of losing customers, customer demand, and no supervising pharmacist present.

interpretationMultifaceted interventions targeting community pharmacies can substantially reduce non-prescription antibiotic dispensing. Future studies to evaluate the implementation and sustainability of this intervention on a larger scale are needed.

Indexed as

Anti-Bacterial AgentsCommunity Pharmacy ServicesNonprescription DrugsAdultFemaleHumansIndonesiaMaleMiddle AgedPharmaciesPharmacistsPractice Patterns, Pharmacists'Respiratory Tract InfectionsUrban PopulationAnti-Bacterial AgentsNonprescription DrugsGlobal HealthHealth systemsInfections, diseases, disorders, injuriesIntervention study

Identifiers

PMID39366709
PMCPMC11459306

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LicenceCC BY-NC
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.