Practice and attitudes regarding the management of childhood diarrhoea among pharmacies in Thailand.

Objectives: to compare practice behaviour and attitudes of pharmacy personnel in the management of childhood diarrhoea between type I (requiring a pharmacist to be on duty) and type II (pharmacist not required) pharmacies, between those surveyed in 2008 and in 2001, and between new-generation (graduation ≤ 10 years) and old-generation (graduation >10 years) pharmacists.

Methods: the setting was 115 pharmacies in a city in the south of Thailand. The study was separated into two phases: a simulated client method to evaluate history taking, drug dispensing and advice giving among pharmacy personnel and a questionnaire to measure attitudes and factors affecting diarrhoea treatment.

Key Findings: in the simulated client method study, questions asked and advice given by the providers (the pharmacists or non-pharmacists responding to the simulated clients), especially in type II pharmacies, were insufficient. Only 5.2% of pharmacies correctly dispensed for a child with viral diarrhoea, using oral rehydration salts (ORS) alone. Appropriate ORS dispensing of providers was not affected by shop type, survey time or peer generation. However, 52.2% of providers inappropriately dispensed antibiotics for such illness. In the questionnaire study, 108 completed surveys were obtained (a response rate of 93.9%). The providers working in 2008 more strongly agreed that ORS was effective, safe, used by health professionals and requested by patients, relative to those in 2001 (P < 0.05). No potential factor influencing the actual ORS dispensing was identified. Nevertheless, antibiotic dispensing was affected by beliefs in producing recovery and high profit.

Conclusions: practice and attitudes of pharmacy personnel were inappropriate in the management of childhood diarrhoea. Revision of the pharmacy curriculum did not result in improvement of practice as seen by the similarity of practice patterns among the 2001 and 2008 samples. Improvement of knowledge and practice behaviour among providers in pharmacies is needed.