Comparison of treatments for upper respiratory tract infections recommended in community pharmacies and hospitals in North East Thailand.

Comparative treatments for URTIs in terms of drug therapies, cost and outcomes were evaluated in community pharmacies and hospitals in Mahasarakham province, NE Thailand. A total of 1052 URTI patients was studied, 536 patients in two hospitals (H) where physicians diagnosed and prescribed and 516 patients in ten pharmacies, seven of which had pharmacists with no extra training (PNET) and three pharmacists with extra training (PET). Patient medication records and interview questionnaires were completed. A total of 388 patients (36.9%) reported their outcomes by postcard. Patients’ most common symptoms were cough (73%), fever (65%), sore throat (63%) and runny nose (58%). The most common symptom classifications were acute URTI (39%), cold (33%) and pharyngitis (17%). Most URTI patients attending the hospitals were dispensed antibiotics (86%) and analgesic (82%). In the pharmacies 67% of patients received antibiotics (74.1% by PNET pharmacists and 50.8% by PET pharmacists). Amoxicillin was dispensed to 77.6% and 50.4% of patients from hospitals and pharmacies respectively. In pharmacies 64% of medicines supplied were combinations which comprised analgesics, antihistamines, decongestants and cough suppressants. Generally only 2-3 days medicine was supplied through pharmacies but 7 days through hospitals. Antibiotics were supplied for 5.6 days at H, 3.6 days at PET pharmacies, and 2.1 days at PNET pharmacies. Drug therapy problems were found in 23.7% of H patients, 24% of PET patients, and 48.9% of PNET patients. Inappropriate or unsafe drug use was least in PET pharmacies whilst ineffective drug usage was least in the hospitals. Clinical outcomes of treatments and the health status after treatment in the 3 locations were not different. There were different humanistic outcomes with patients indicating greater satisfaction with the pharmacies in terms of convenience, time spent, and advice given and the last aspect was greatest for the PET pharmacists. Medicine costs in the hospitals were double those of the pharmacies (average 106 baht and 47 baht respectively) (p