Academic journal article Journal of Health Population and Nutrition

Evaluation of Academic Detailing Programme on Childhood Diarrhoea Management by Primary Healthcare Providers in Banke District of Nepal

Academic journal article Journal of Health Population and Nutrition

Evaluation of Academic Detailing Programme on Childhood Diarrhoea Management by Primary Healthcare Providers in Banke District of Nepal

Article excerpt

INTRODUCTION

Academic detailing, an educational intervention programme, in which a trained healthcare professional visits clinicians in their offices to provide evidence-based information, has been used as a major tool to improve rational use of medicines since it was started for the first time in 1983 (1,2). The process involves face-to-face education of clinicians by trained academic detailers. The academic detailers are usually healthcare professionals, like pharmacists, clinicians, nurses, or any persons trained on the subject matter (1). Academic detailing programmes have been particularly used for improving the knowledge of clinicians on particular topics, changing prescribing pattern of targeted drugs to be consistent with medical evidence, providing medical care in cost-effective ways, or minimizing risks to patients due to wrong practice (3-6). A meta-analysis, including 69 studies involving more than 15,000 healthcare professionals, reported that academic detailing, as a single intervention or in combination with other interventions, had relatively small but consistent and important influence on prescribing behaviour. The same study also suggested that effects of academic detailing on other types of professional performance of healthcare providers varied from small to modest improvements; however, the authors were unable to quantify such variations (7).

Academic detailing has been practised for many years in developed countries (2,8-10). However, the concept of academic detailing is still at premature phase in developing countries, like Nepal (11). There are very few studies on academic detailing from developing countries. Hence, our research was carried out in Banke district of Nepal to evaluate the impact of academic detailing programme on childhood diarrhoea management by primary healthcare providers. Prior to this research, a small pilot study was carried out on 10 healthcare professionals in the same district. The pilot study was done to ensure methodological validation, including training of academic detailers, data collectors, and simulated clients (12). This article aims to describe the feasibility of academic detailing in developing countries, like Nepal, by evaluating the outcome of the same programme in terms of (i) clinicians' prescribing pattern, (ii) adherence to childhood diarrhoea treatment guidelines, and (iii) change in their prescription cost. The following hypotheses were set prior to this research:

(a) Academic detailing will significantly increase prescribing of the oral rehydration solutions and zinc for the treatment of diarrhoea without dehydration by primary healthcare providers in the intervention group compared to the control group.

(b) Academic detailing will significantly decrease the prescription of unnecessary medicines, like antimicrobials, medicines affecting gastric motility, vitamins, and enzyme preparations among participants in the intervention group to treat acute diarrhoea without dehydration compared to the control group.

(c) Academic detailing will significantly increase the compliance with WHO/UNICEF-endorsed "Diarrhoea treatment guidelines, including new recommendations for the use of ORS and zinc supplementation for clinic-based healthcare workers" among the primary healthcare providers in the intervention group compared to the control group.

MATERIALS AND METHODS

Study design

A randomized control trial on healthcare was conducted to evaluate the impact of academic detailing programme on the childhood diarrhoea management by primary healthcare providers in Banke district of Nepal. This study consisted of a phase of data collection prior to four different academic detailing sessions and two phases of data collections after those academic detailing sessions.

Study site and duration

The study was carried out from July 2009 to March 2010 in Banke district of Nepal. Banke district lies in the Midwestern region of Nepal. …

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