Knowledge and Rational Drug Use of the Community of Ban Nongyang in Tambon Hua Ruea, Mueang District, Ubon Ratchathani Province, Thailand

Introduction

The drug administration in Thailand is a major issue as far as the health system is concerned. The problems related to the drug system include increased spending on drugs, wrong and necessary use of drugs, inaccessibility to drugs, etc. The survey found that there was worryingly high spending on drugs. For more than three decades, the spending on drugs has been steadily increasing. In 2008 alone, up to 272,841 million baht was spent on drugs, accounting for 46.39% or 3.01 of GDP [1]. The annual rate of drug use is 7 -8 % higher than GDP which grows at 5 -6% per year. In 2014, it was found that the value of drug consumption of Thais was hundred billion baht. In this respect, the unnecessary drug use cost up to two billion baht. Use of drugs with suspicious results was four billion baht. Negatively, as many as 38,000 people developed a drug resistance. The spending on drugs is close to the spending on health which is 7 -8% a year. Importantly, irrational drug use was found in all levels ranging from the hospital to the community [1]. For example, people about 40 -60% in provincial areas and 70 -80 % in Bangkok habitually use antibiotics for a common cold [2].

In 2010, rational drug use was stipulated in the 2010 National Drug Policy. The aim was to encourage the drug use in a rational and valuable fashion. The policy in question has the strategies on the drug use. The strategy no. 3 described the development of mechanism and tools for appropriate and rational drug use [3]. Thanks to that strategy, there came RDU or Rational Drug Use Hospital.

RDU hospital means the treatment site following six policies in promoting the rational drug use. The policies are: 1) strength of the pharmacy and therapeutics committee or PTC, 2) standardization of drugs and labels, and the public’s access to drug information, 3) essential tools for rational drug use, 4) awareness on the part of medical personnel and medical recipients, 5) medical care for special groups, and 6) promotion of ethics in drug prescription [4, 5, 6, 7, 8].

Thailand has operated the RDU hospital project since 2014. Seventy-two hospitals participate in the project. The Ministry of Public Health had come out with the policy on the rational drug use to improve the health service in 2017 [9]. Although their knowledge on the rational drug use has increased, medical personnel do not have an increased awareness in terms of the policy on the rational drug use. It was found that due attention should be given to the following: drug prescription, a handbook on drugs, proper drug use in terms of dose and methods, vigilance in special groups, consideration of the patients’ rights [10].

The Hua Ruea Community Health Hospital is the primary service unit providing the health service to the local residents of the surrounding communities. The communities under study have 1477 households from 10 villages and 6,069 inhabitants. The Faculty of Nursing of Ratchathani University, Ubon Ratchathani and the Hua Ruea Health Promotion Hospital had worked together on the health issue. To carry out the project, the fourth-year nursing students from Ratchathani University had worked on the helath issue in Ban Nongyang where 817 local inhabitants lived. Of these residents, 410 were males and 417 were females.

Based on the family visit, it was found that there were patients suffering from chronic illness. They regularly got medicine from the hospital. It was also found that the subjects had little or no knowledge on drug use. In addition, they did not have an understanding of the rational drug use. With the problems found and the significance of the rational drug use realized, the research team aimed to raise an awareness of the rational drug use among the residents in their everyday life and to prevent unnecessary drug use. To achieve the goal, the team conducted the study on knowledge and rational drug use of the communities of Ban Nongyang in Mueang district of Ubon Ratchathani province, Thailand. It is expected that acquired data can be utilized to develop the rational drug use in the communities in question [11, 12, 13].

Material & Methods

The samples were 817 residents of Ban Nongyang, derived by the Krejcie and Morgan’s table. Some subjects were excluded by 10%. Hence the samples in the study stood at 292. Importantly, the samples in the research were to be literate and help themselves. Independent variables were sex, age, educational levels, occupations, monthly incomes, status, and treatment rights. Dependent variables were medicinal knowledge and behavior in self-medication. The research instrument was a questionnaire.

The average evaluation was based on the concept of Boonchom Sisa-ard (2009: 103). In evaluating the instrument, Likert’s five-rating scale was employed with the following criteria: 4.50 – 5.00 means self-medication/care at the highest level (5), 3.51 -4.50 means self-medication/care at a high level (4), 2.51 -3.50 means self-medication/care at a moderate level (3), 1.51 -2.50 means self-medication/care at a low level (2), and 0.00 -1.50 means self-medication/care at the lowest level (1).

• Data Analysis
• Personal factors were sex, age, marital status, educational levels, occupations, status, rights to treatment, and diseases suffered by individuals. Statistics used were frequency, percentage, means, standard deviation.
• Dependent and independent variables were analyzed by one-way ANOVA Tables 1-5.

Results

Behavior in using drugs

Self-care during illness

1. You go to a pharmacist for counseling. 2.63 1.222 moderate

2. If given a prescription, you go to the pharmacy where a pharmacist is in charge. 2.93 1.271 Moderate

3.You choose to buy medicine from the drug store where the pharmacist is in charge. 3.06 1.315 Moderate means 2.87 1.269 Moderate Rational drug use

4. You give the medicine you use to others suffering from the same disease. 2 1.02 Low

5. You try the medicine as recommended by your friend when you are sick. 1.86 0.989 Low SD level

Discussion

It was found that the subjects had a Moderate level of knowledge70.23% regarding the drug use. The findings are supported by Chat chai Khawaeaw [14] found that 60.27percent the knowledge of Drug use of the population Most of them had knowledge about medication use at a moderate level,. While the findings are supported by Parinda Isaroon [15] found that the sample group has an average score of 12.55 ± 2.86 from a full score of 20, indicating that there is a moderate level of knowledge. This may be due to the fact that they have little or no access to the information on drugs. A majority of the samples have to rely on the explanation and counseling from medical officials. They have little knowledge in using modern technology to search for information by them. Hence, it is essential to resort to other means to help them in this regard and make them aware of the right method in using drugs. It is important for them to know how to use drugs appropriately. In addition, they have to realize their own rights to treatment, rights to protection and their own behaviors in using drugs. Their awareness in these aspects should be raised as much as possible. The study also found that the behavior in using drugs for self- medication purpose was at a moderate level. The findings are supported by Dow Rung, et al. [16] found that 82.8% of the subjects had good drug use behaviors. Only 17.2 percent were at a moderate level. They should be involved to get counseling from a pharmacist when they want to buy a medicine for their chronic disease. They are to be taught how to properly behave when it comes to using drug in a safe and right manner.

Conclusion

The general public has to be equipped with information on health. Follow-up, evaluation and access to information for the public and improvement of the service system are all important. The medical network has a vital role to play to support the operation. Local mechanisms should be used to solve the problems. Attention should be given to the performance of the local hospital officials in terms of using drugs, and providing counseling. Attention is also to be given to the relations between the service providers and the people who are the recipients of the service WHO [17, 18, 19].