title: Responding to cough presentations: an interview study with Cambodian pharmacies participating in a National Tuberculosis Referral Program.
abstract: OBJECTIVE
  Asia-Pacific carries a high burden of respiratory-related mortality. Timely referral and detection of tuberculosis cases optimizes patient and public health outcomes. Registered private pharmacies in Cambodia participate in a National Tuberculosis Referral Program to refer clients with cough suggestive of tuberculosis to public sector clinics for diagnosis and care. The objective of this study was to investigate clinical intentions of pharmacy staff when presented with a hypothetical case of a client with prolonged cough suggestive of tuberculosis.
  
  
  METHODS
  A random sample of 180 pharmacies was selected. Trained interviewers administered a hypothetical case scenario to trained pharmacy staff. Participants provided 'yes'/'no' responses to five clinical actions presented in the scenario. Actions were not mutually exclusive. Data were tabulated and compared using chi-square tests or Fisher's exact tests.
  
  
  RESULTS
  Overall, 156 (92%) participants would have referred the symptomatic client in the case scenario. Participants who would have referred the client were less likely to sell a cough medicine (42% vs. 100%, P < 0.001) and less likely to sell an antibiotic (19% vs. 79%, P < 0.001) than those who would not have referred the client.
  
  
  CONCLUSIONS
  Involving pharmacies in a Referral Program may have introduced concepts of appropriate clinical care when responding to clients presenting with cough suggestive of tuberculosis. However, results showed enhancing clinical competence among all referral programme participants particularly among non-referring pharmacies and those making concurrent sales of cough-related products would optimize pharmacy-initiated referral. Further research into actual clinical practices at Referral Program pharmacies would be justified.
authors.affiliation: Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Bell
authors.affiliation: National Center for Tuberculosis and Leprosy Control (CENAT), Phnom Penh, Cambodia.
authors.forename: Koeut
authors.initials: K
authors.lastname: Pichenda
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
authors.forename: Jenni
authors.initials: J
authors.lastname: Ilomäki
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Duncan
authors.affiliation: National Center for Tuberculosis and Leprosy Control (CENAT), Phnom Penh, Cambodia.
authors.forename: Mao Tan
authors.initials: MT
authors.lastname: Eang
authors.affiliation: Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Bandana
authors.initials: B
authors.lastname: Saini
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002160:Cambodia; D003157:Community Pharmacy Services / Q000458:organization & administration*; D003371:Cough / Q000209:etiology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation / Q000458:organization & administration*; D014376:Tuberculosis / Q000150:complications* / Q000175:diagnosis*
keywords: Cambodia; clinical competence; cough; pharmacies; tuberculosis