Although the CBC currently employs regulatory, supervisory and training strategies in all of its facilities, the implementation of these strategies varies between clinics. For example, although most clinics receive some supervision, the type and frequency of supervision differs in each facility. This variation, and the fact that education, training and supervision could be controlled for, enabled the authors to identify which of the strategies correlated with prescribing and dispensing behaviour. By correlating training and supervision with drug prescribing and dispensing, this study does more than contribute to the growing body of literature that suggests that these methods are the most effective means of promoting appropriate drug use. It goes a step further and through original analysis begins to identify the specific characteristics of effective supervisory and training methods.
Specific independent and dependent variables examined in this study can be categorized as training, education, experience and supervision. For non-medical doctor prescribers, training included either a three-month, six-week, one-week or four-day course on diagnosis and prescription. For dispensers, training was a one-week course in dispensing. Education was considered non-health-related formal education; primary, secondary, high school and university. Experience was both number of years experience with the CBC and number of years experience at present job. Supervision was categorized as either off-site or on-site, or specifically doctors' supervision of prescribers. Not only the type of supervision was examined but also the corresponding frequency: daily, weekly, monthly, bimonthly, semi-annually or annually.
This study also considered indicators of the environment in which a prescription was written and dispensed, including average outpatient visits per day and number of prescribers/dispensers. Complementary WHO drug and patient indicators were tested: prescription in accordance with standard treatment guidelines, average drug cost per encounter and dispensary waiting times. Other indicators were modified such as patient knowledge, to include not only regimen but also name, purpose and side-effects of the drug prescribed. New indicators were tested which looked at accurate diagnosis based upon etiology described in standard treatment guidelines, utilization of diagnostic tools such as laboratory referral rates, and chloroquine: quinine prescription rates. This information was gathered not only at the CBC's request, but also because it is potentially important to all individuals, organizations, institutions and governments concerned with improving drug use.