PubMed · 10651503
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K J Ehlen. 1999. Challenges spark creativity.. https://pubmed.ncbi.nlm.nih.gov/10651503/
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Pharmaceuticals represent an increasing share of private and public health care expenditures. However, while most governments are interested in ensuring availability and access to drugs, the issue of adequate use of drugs remains a low priority in most third world countries. This paper summarizes the results of interventions conducted in developing countries aimed at improving patients' compliance with the advice of health professionals and/or to decrease the unnecessary use of drugs by the general population. Forty-five studies were identified through literature searches and networking; and only about a third of them fulfilled the eligibility criteria for inclusion in the review. Given the paucity of information available and the importance of the topic the authors report on all 45 studies identified. Although much remains to be explored there are several interventions that deserve to be highlighted. The authors argue that improving the use of pharmaceuticals through interventions directed only to consumers may have a small impact and suggest that in order to obtain meaningful changes it might be necessary to design interventions to modify the behavior of all the actors in the medication cycle (manufacturers, health professionals, retailers, consumers and governments). They suggest that the extraordinary therapeutic effects of antibiotics, coupled with the problems that may arise when they are inappropriately used and with the extraordinary amount of resources spent on antibiotics worldwide justify a global effort to reduce their inappropriate use and promote their adequate administration. The complexity of this type of intervention would require the support of the pharmaceutical industry, governments, private foundations, and international organizations.
If physicians are able to understand the health status of populations they can use this understanding to develop targeted health care services for their patient populations or communities. Since 1991, the family practice residency program at the State University of New York Health Science Center at Brooklyn has taught community health assessment using a problem-based format. During this four-week rotation, residents gather, classify, and analyze demographic and health data about a specific local population. They use these data and published research literature to create rates that they believe will help to illuminate the health status and health issues of their community. By the end of the rotation, the residents feel comfortable working with rates and understand both their usefulness and their limitations. This rotation also introduces them to the concept of population health and some of the skills necessary to understanding a population-based approach to health care.
The Guide to Community Preventive Services (Community Guide) aims to improve public health practice by increasing the use of effective interventions. The Community Guide summarizes what is known regarding the effectiveness of selected population-based interventions and information about additional benefits and harms of the interventions. Community Guide reviews of interventions for improving vaccine coverage rates and reducing tobacco use have been recently completed and released. Interventions that have been recommended for use based on these reviews are being implemented via national projects. This article describes the status of development of Community Guide reviews and the initiation of dissemination, implementation, and evaluation efforts.