Objective: To assess progress in improving use of medicines in developing and transitional countries
by reviewing empirical evidence, 1990–2009, concerning patterns of primary care medicine use and
intervention effects.
methods We extracted data on medicines use, study setting, methodology and interventions from
published and unpublished studies on primary care medicine use. We calculated the medians of six
medicines use indicators by study year, country income level, geographic region, facility ownership
and prescriber type. To estimate intervention impacts, we calculated greatest positive (GES) and
median effect sizes (MES) from studies meeting accepted design criteria.
results Our review comprises 900 studies conducted in 104 countries, reporting data on 1033
study groups from public (62%), and private (mostly for profit) facilities (26%), and households. The
proportion of treatment according to standard treatment guidelines was 40% in public and <30% in
private-for-profit sector facilities. Most indicators showed suboptimal use and little progress over
time: Average number of medicines prescribed per patient increased from 2.1 to 2.8 and the
percentage of patients receiving antibiotics from 45% to 54%. Of 405 (39%) studies reporting on
interventions, 110 (27%) used adequate study design and were further analysed. Multicomponent
interventions had larger effects than single component ones. Median GES was 40% for provider and
consumer education with supervision, 17% for provider education alone and 8% for distribution of
printed education materials alone. Median MES showed more modest improvements.
conclusions Inappropriate medicine use remains a serious global problem
