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Assessment of Risks Related to Medicine Dispensing by Nonprofessionals in Colombia: Clinical Case Simulations

Associate Consultant; Training Program in International Health; Essential Medicines, Vaccines and Health Technologies Unit; Pan American Health Organization/World Health Organization; Washington, DC

José Orozco, MD MSc

Associate Professor of Pharmacology, School of Medicine, National University of Colombia, Bogotá, Colombia

Albert Figueras, MD

Fundació Institut Català de Farmacologia; Assistant Professor, Departament de Farmacologia Clínica, de Terapèutica i de Toxicologia; Universitat Autònoma de Barcelona; Hospital Vall d'Hebron; Barcelona, Spain

Dolors Capellà, MD

Fundació Institut Català de Farmacologia; Associate Professor, Departament de Farmacologia Clínica, de Terapèutica i de Toxicologia; Universitat Autònoma de Barcelona

Reprints: Ms. Vacca, Training Program in International Health; Essential Medicines, Vaccines and Health Technologies Unit; Pan American Health Organization/World Health Organization, 525 23rd St., NW, Washington, DC 20037-2825, fax 202/659-4513, cvaquis{at}hotmail.com

BACKGROUND: Appropriate dispensing is one of the steps for rational drug use, so it is generally advised that the dispenser should have relevant and updated knowledge, skills, and attitudes.

OBJECTIVE: To assess pharmacies and nonprofessional employees' (NEs) skills and knowledge, as well as their response to several specific case simulations in Bogotá, Colombia.

METHODS: A descriptive cross-sectional study was performed on a random sample of 371 pharmacies in Bogotá. Information from each pharmacy was obtained using 2 approaches: (1) direct interview to collect data on organizational aspects of the store and characteristics of NEs, and (2) simulation (both by direct interview and by telephone) to assess dispensing responses in 6 simulated clinical cases.

RESULTS: More than half of the simulated clinical situations resulted in inappropriate dispensing (direct simulations 57%; telephone simulations 55%). The proportion of correct answers to theoretical questions regarding a specific therapeutic problem during interviews was higher than the response when a simulation presented that same case and a dispensing act was expected. The educational background of the NEs included in the study points to a specific problem: two-thirds of the individuals selling medicines had completed only secondary-level education and only 2% of the sample had a pharmacist as technical director. Continuing education courses were either directly organized by drug manufacturers (one-third of the courses attended by pharmacists) or sponsored by them (more than an additional one-third).

CONCLUSIONS: NEs should be considered part of the therapeutic chain and, if appropriately updated or instructed, could play a very important role in the always difficult promotion of rational drug use. Public health institutions and universities should be more actively involved in the provision of independent, unbiased, and essential information on common therapeutic problems, safety concerns, and new drug prescription restrictions.

Key Words: continuing education, dispensing, drug utilization, rational drug use, simulation

Published Online, February 8, 2005. www.theannals.com, DOI 10.1345/aph.1E420