title: Have we improved use of medicines in developing and transitional countries and do we know how to? Two decades of evidence.
abstract: OBJECTIVE
  To assess progress in improving use of medicines in developing and transitional countries by reviewing empirical evidence, 1990-2009, concerning patterns of primary care medicine use and intervention effects.
  
  
  METHODS
  We extracted data on medicines use, study setting, methodology and interventions from published and unpublished studies on primary care medicine use. We calculated the medians of six medicines use indicators by study year, country income level, geographic region, facility ownership and prescriber type. To estimate intervention impacts, we calculated greatest positive (GES) and median effect sizes (MES) from studies meeting accepted design criteria.
  
  
  RESULTS
  Our review comprises 900 studies conducted in 104 countries, reporting data on 1033 study groups from public (62%), and private (mostly for profit) facilities (26%), and households. The proportion of treatment according to standard treatment guidelines was 40% in public and <30% in private-for-profit sector facilities. Most indicators showed suboptimal use and little progress over time: Average number of medicines prescribed per patient increased from 2.1 to 2.8 and the percentage of patients receiving antibiotics from 45% to 54%. Of 405 (39%) studies reporting on interventions, 110 (27%) used adequate study design and were further analysed. Multicomponent interventions had larger effects than single component ones. Median GES was 40% for provider and consumer education with supervision, 17% for provider education alone and 8% for distribution of printed education materials alone. Median MES showed more modest improvements.
  
  
  CONCLUSIONS
  Inappropriate medicine use remains a serious global problem.
authors: WHO Regional Office South East Asia, New Delhi, India. hollowayk@who.int
authors: K A
authors: KA
authors: Holloway
authors: V
authors: V
authors: Ivanovska
authors: A K
authors: AK
authors: Wagner
authors: C
authors: C
authors: Vialle-Valentin
authors: D
authors: D
authors: Ross-Degnan
mesh_terms: D003906:Developing Countries; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care
chemical_list: D004364:Pharmaceutical Preparations