Antibiotics Smart Use: a workable model for promoting the rational use of medicines in Thailand.

The Antibiotics Smart Use (ASU) programme was introduced in Thailand as a model to promote the rational use of medicines, starting with antibiotics. The programme's first phase consisted of assessing interventions intended to change prescribing practices; the second phase examined the feasibility of programme scale-up. Currently the programme is in its third phase, which centres on sustainability. This paper describes the concept behind ASU, the programme's functional modalities, the development of its conceptual framework and the implementation of its first and second phases. To change antibiotic prescription practices, multifaceted interventions at the individual and organizational levels were implemented; to maintain behaviour change and scale up the programme, interventions at the network and policy levels were used. The National Health Security Office has adopted ASU as a pay-for-performance criterion, a major achievement that has led to the programme's expansion nationwide. Despite limited resources, programme scale-up and sustainability have been facilitated by the promotion of local ownership and mutual recognition, which have generated pride and commitment. ASU is clearly a workable entry point for efforts to rationalize the use of medicines in Thailand. Its long-term sustainability will require continued local commitment and political support, effective auditing and integration of ASU into routine systems with appropriate financial incentives.

A multi-method evaluation of the Pharmacy First Minor Ailments scheme.

OBJECTIVES: To evaluate whether the Pharmacy First Minor Ailments scheme achieved its objectives in terms of improving access to medicines and reducing doctor workload for minor ailments by enhancing the role of community pharmacists in the management of minor ailments. SETTING: Nottingham, the United Kingdom. METHODS: A mixed-methods study was conducted, including semi-structured interviews with key stakeholders, a patient survey, and an analysis of the Nottingham City Primary Care Trust data. MAIN OUTCOME MEASURES: Stakeholders' acceptability of the scheme and scheme users' satisfaction with the scheme. RESULTS: Most health care professionals were positive about the implementation of the scheme, although they reported some problems, such as the restricted formulary. The majority of stakeholders perceived benefits of the scheme for both patients and health care professionals. The level of patient satisfaction with the scheme was high, particularly in terms of ease of access and convenience. The current structure of the scheme appears to be an acceptable way to run the scheme. Since its commencement the scheme has enabled the transfer of a substantial number of minor ailments consultations from general practices to community pharmacies. CONCLUSION: It appears that the Nottingham City Primary Care Trust is successful using community pharmacies to improve access to medicines and provide a greater choice in primary care for patients with minor ailments. Thus, the Primary Care Trust should continue the scheme, although there are some important issues (e.g. the restricted formulary, the lack of privacy in some pharmacies) that need to be addressed to improve and develop the service further. The Nottingham City Primary Care Trust should build on this success to further utilise the pharmacy in their primary care service development.