A covering letter was sent to the main distribution centres which were requested to pass on the information to health personnel and institutions within their distribution area. It explained:
• that the MSTG was an approved MOH publication for daily reference;
• that the MSTG should be used together with the Malawi Standard Drug List and the Malawi National Formulary as basic resource documents for prescriber training activities;
• how the document should be distributed and prescribers made aware of its function and status; and
• that follow-up articles about drug information documents, including the MSTG would be published in the quarterly Malawi Drug Bulletin.
Distribution should be carefully planned to ensure prompt and efficient delivery of the publication to the target audience.
Names and addresses of all the intended recipients of the publication should be obtained and entered into a distribution table which is used as a record of the distribution process. To this table would be added the number of copies to be distributed, the date of distribution and a column for some form of confirmation that copies had been received. In order to ensure that distribution occurs as intended, it is useful to have a contact person at each of the main distribution points who is responsible for the onward distribution process and able to confirm at any time the status of the distribution.
It is useful to inform as many as possible of the intended recipients (e.g. through small announcements, articles or radio messages) that they should be expecting to receive copies of the publication and when this should be. They should also be advised to contact the distribution centre for further information if copies have not been received by a certain date.
Active follow-up during distribution is important to keep the process moving and deal promptly with any distribution problems which may occur.
A foreword in the booklet itself described the aim and function of the guidelines, summarised the process by which the content had been agreed, and asked for prescribers to assist in future modification and improvement of the booklet. A modification form was included at the back of the book for prescribers to send in their suggestions (see Appendix 8).
In order to fully inform the target audience on the aims and uses of any drug/therapeutic information text and to ensure the widest possible awareness of the benefits to be obtained through its use, a formal introduction process needs to be agreed.
Possibly the easiest way to achieve this would be to hold a national workshop to introduce the book to senior prescribers, pharmacy personnel, nurses and health policy makers. This could then be followed by regional/district workshops or training seminars at which the book would be introduced to all other prescribers. Widespread publicity covering the introduction and use of the book should be secured through the use of newspaper/magazine articles and radio/TV news or feature programmes.
Other than this, there was no formal introduction of the MSTG to prescribers. Nor was there any systematic follow-up on its distribution, use and usefulness or its impact on prescribing patterns. However anecdotal information and physical evidence of this was obtained during visits to health units and discussions with prescribers. From these limited observations it appeared that the MSTG had reached most of its intended audience, was consulted regularly and was generally found to be very useful in daily clinical work. Several prescribers suggested that one major improvement would be to include an index. A visiting prescriber training consultant suggested several modifications, many of which were subsequently approved by the NDC and included in the second edition (see below).
It is important to obtain feedback on the acceptability and usefulness of the publication and to assess as far as possible its impact on drug utilisation/therapeutic practices, so that appropriate amendments may be made to subsequent editions.
Feedback may be obtained through the use of questionnaires sent out to a representative sample of individuals in the target audience and through direct interviews with health workers. Senior health staff may be asked to assist in obtaining comments and feedback in the course of clinical, drug committee or other health staff meetings called to discuss the publication at a suitable time following its introduction.
Measurement of the impact of the introduction of the publication will need to be done using pre-introduction (base-line) and post-introduction surveys. These are usually in the form of structured questionnaires which are used to interview a statistically significant sample of the target audience. The questionnaire must be carefully designed to permit the investigation and evaluation of certain aspects of drug utilisation and therapeutic practices which are intended (expected) to be improved or modified through the correct and regular use of the publication.