Scientific evaluations of interventions to improve the adequate use of pharmaceuticals in Third World countries

The inadequate use of pharmaceuticals continues to be a severe problem in most parts of the world. Developing nations waste very large amounts of scarce health resources on medicines of doubtful therapeutic value, and many persons do not comply with physicians advice or engage in risky self-medication practices contributing to additional misuse of resources and iatrogenia. This paper examines the few scientifically designed interventions at the community and patient s levels to improve the appropriate use of pharmaceuticals in developing nations. The authors analyze the contribution made by these studies and identify several limitations including the absence of independent evaluations of outcomes, lack of sufficient information to judge the quality and adequacy of the instruments used, problems relating to replicability of interventions at regional or country level, or outside the cultural context within which they took place, lack of information on costs of interventions, a crucial variable in poor countries, and the absence of standardized outcome measures that makes comparative analysis very difficult.