The impact of supervision on stock management and adherence to treatment guidelines: a randomized controlled trial

Abstract

Ensuring the availability of essential drugs and using them appropriately are crucial if limited resources for health care are to be used optimally. While training of health workers throughout Zimbabwe in drug management (including stock management and rational drug use) resulted in significant improvements in a variety of drug use indicators, these achievements could not be sustained, and a new strategy was introduced based on the supervision of primary health care providers. This was launched in 1995 with a training course in supervisory skills for district pharmacy staff. In order to evaluate the impact of the supervision and the effectiveness of the training programme, adherence to standard treatment guidelines (STG) and stock management protocols was evaluated in a randomized controlled trial. The study compared three different groups of health facilities: those that received supervision for either use of STG (n = 23) or stock management (n = 21) - each facility acting as control for the other area of supervision - and a comparison group of facilities which received no supervision (n = 18). On-the-spot supervision by a specially trained pharmacy staff, based around identified deficiencies, took place at the start of the study and 3 months later. The evaluation compared performance on a variety of drug management indicators at baseline and 6-8 months after the second supervisory visit. The results of the study showed that, following supervision, overall stock management improved significantly when compared with the control and comparison groups. Similar improvements were demonstrated for adherence to STG, although the effect was confounded by other interventions. The study also showed that supervision has a positive effect on improving performance in areas other than those supervised, and demonstrated that pharmacy technicians with limited clinical skills can be trained to influence primary health care workers to positively improve prescribing practices. Allocating resources to supervision is likely to result in improved performance of health workers with regard to the rational use of essential drugs, resulting in improved efficiency and effectiveness.

Supervising community health workers in low-income countries – a review of impact and implementation issues

“…Neither intervention had significant impact on outcomes, including job satisfaction, patient satisfaction, or quality of hypertension or diabetes care (29); however, the impact of these models may have been limited by not taking a more comprehensive approach. In Zimbabwe, pharmacists and pharmacy technicians without supervision experience were trained to supervise primary health care workers in a three-arm randomized control trial comparing interventions to improve stock management and adherence to treatment guidelines to each other and to a control (88). A comprehensive 2-week supervisor training covered a range of topics including supervision skills, use of checklists, report writing, interpretation of data, and review of stock management and standard treatment guidelines (88).…”

“…In Zimbabwe, pharmacists and pharmacy technicians without supervision experience were trained to supervise primary health care workers in a three-arm randomized control trial comparing interventions to improve stock management and adherence to treatment guidelines to each other and to a control (88). A comprehensive 2-week supervisor training covered a range of topics including supervision skills, use of checklists, report writing, interpretation of data, and review of stock management and standard treatment guidelines (88). Two supervisor visits to each randomly assigned intervention facility focused on addressing either stock management or treatment guidelines and resulted in statistically significant improvements of overall indicators in both intervention groups as well as improvement in some indicators from the comparator group (88).…”

Evidence gap map of performance measurement and management in primary care delivery systems in low- and middle-income countries – Study protocol

“…It will include lean management as one of the approaches used to improve efficiency and quality in service provider organizations 61 65 ; and, 8) Supervision , defined as routine control visits by senior primary care staff to providers and facilities 66 72 .…”

Quality indicators to compare accredited independent pharmacies and accredited chain pharmacies in Thailand

“…Quality indicators also contribute to quality improvement. By repeating practice assessments, it is possible to make comparisons between assessments and quantify the impact of interventions [4,5]. Good quality indicators should be specific and comprehensive to evaluate the actual pharmacy practice and should make it simple to assess how well pharmacists perform [6].…”