Outcomes
RTI, mistakes
RTI, SECONDARY
The primary outcome was the rate at which antibiotics were dispensed to patients with RTI without prescriptions, that is, the proportion of visits in which antibiotics were dispensed. The secondary outcome was the rate at which a medical test for identifying bacterial RTI was conducted to inform decisions regarding non-prescription antibiotic dispensation to patients with RTI, that is, the proportion of visits in which relevant tests were conducted.Data were collected by simulated clients who were students of Nnamdi Azikiwe University, Nigeria, recruited by the research team. The simulated clients were trained on what the data collection entailed. The training was fundamentally delivered twice, shortly after the simulated clients were recruited and a few days before data collection started. Each training consisted of a 2-hour lecture. The simulated clients were provided with training materials. Following the second training, they were engaged in a 6-hour role play in which some members of the research team acted as pharmacy staff while the simulated clients acted as patients with RTI. Any mistakes made by them were corrected by members of the research team. On the day that each simulated client would collect data, the research team member who supervised the data collection discussed essential parts of the data collection protocol with them.At baseline, 30 simulated clients collected data over 30 data collection days. On each data collection day, just one simulated client visited and collected data from the 20 PCPs under the supervision of a member of the research team who monitored each visit from a distance. Similarly, post-intervention, 30 simulated clients collected data over 30 data collection days. On each data collection day, just one simulated client visited and collected data from the 20 PCPs under the supervision of a member of the research team who monitored each visit from a distance. The PCPs did not anticipate the visits by the simulated clients. Male and female simulated clients mostly collected data on alternate data collection days. On their data collection day, each simulated client was told the symptoms of RTI to complain about. They complained of the same symptoms across all the 20 PCPs. The symptoms complained of over the 30 days of data collection at baseline, and post-intervention can be found in the appendix. These symptoms were developed leveraging the common symptoms of RTI as documented in the literature After presenting their symptoms without any prescriptions, they asked the pharmacy staff what the best treatments for their symptoms were. They did not request any particular treatments. They did not admit to having any other symptoms outside what they had been told to complain about. They also did not admit to already visiting a doctor or taking any medications. They noted if relevant medical tests were ordered by pharmacy staff to determine suitable treatments and memorized any drugs they recommended. To aid memorization, they mostly memorized the brand names of drugs, these were subsequently categorized as antibiotic or non-antibiotic by a pharmacist. To ensure good simulation, they paid for tests ordered and/or drugs recommended by pharmacy staff. On visits where the budget for drugs was exceeded, they told pharmacy staff that they would return at a later time to purchase recommended drugs. At the end of each visit, they recorded the data collected on a structured data collection form held by the member of the research team who supervised them.