The Development of a Model for Promoting Rational Drug Use with Alternative Herbal Medicines in Quality Pharmacies Participating in the Common Illness Project in Nakhon Sawan Province

Abstract

Introduction and objectives: Rational drug use in community pharmacies is a policy aimed at reducing the inappropriate use of drugs among Thai people, which requires collaborative efforts from pharmacists. Concurrently, the Common Illnesses (CI) management project by community pharmacists is operational under the Universal Health Coverage (UHC) Scheme. Therefore, this study aimed to: (1) investigate the situations and opinions on the use of herbal medicines (HMs) before and after the implementation of an alternative HM promotion program; (2) develop a model for promoting the use of alternative HMs; and (3) evaluate the model for alternative HM promotion after implementing the model.

Methods: This participatory action research project involved a sample of 11 pharmacists (one each) working at community pharmacies participating in the CI project, and some UHC (goldcard) patients who sought treatment for five conditions: fever, sore throat, runny nose, cough, and diarrhea. The research process had three phases: (1) studying baseline data and situation of the participating drugstores; (2) developing a model to promote the use of alternative HMs; and (3) evaluating the use of the model from August 2023 to March 2024 to compare the situations before and after implementing the model.

Results: Phase 1: The participants had experience in using Andrographis paniculata capsules, compound makham pom cough mixture, and mawaeng lozenges. However, Ya Chanthalila, Ya Ha Rak, Ya Prap Chomphu Thawip, and Ya Lueang Pit Samut were not available at the drugstores. Phase 2: The model for promoting the use of alternative HMs was developed and launched with training sessions, the provision of HMs and the establishment of a Line group for technical support. Phase 3: After implementing the alternative HM promotion model, stand-alone drugstores used more herbal medicines compared to chain drugstores. For fever and sore throat, more Andrographis paniculata capsules, Ya Chanthalila, and Ya Ha Rak were used, while the use of paracetamol, ibuprofen, amoxicillin, and roxithromycin decreased. For runny noses, the use of Ya Prap Chomphu Thawip increased, while the use of cetirizine, chlorpheniramine, and loratadine decreased. For diarrhea, the use of Ya Lueang Pit Samut increased, but the use of loperamide, dioctahedral smectite, and norfloxacin decreased. For cough, the use of mawaeng lozenges and Indian gooseberry cough syrup increased without affecting the use of modern medicines.

Discussion: The implementation of the herbal medicine promotion model resulted in more prescriptions of herbal drugs at stand-alone drugstores, where pharmacists had more autonomy in medication selection.

Conclusion and recommendation: Less use of modern drugs for relieving fever, sore throat, runny nose, cough, and diarrhea, particularly antibiotics, was found to lead to more rational drug use. Further studies should be conducted on herbal drugs with technical evidence by specifically comparing them with modern medicines so as to get more information for promoting rational drug use.