Developing Drug System Standards in Primary Care Units Using the SMART Model: A Participatory Action Research Study in Northern Thailand

Why It Matters

The findings demonstrate that structured, pharmacist‑driven teamwork can rapidly elevate primary care drug safety and rational use, addressing a critical gap in resource‑constrained health systems. This has direct implications for national drug‑policy goals and antimicrobial stewardship in emerging economies.

Key Takeaways

• SMART model raised average pharmacy compliance from 61% to 87%
• All five PCUs exceeded the 80% national standard threshold
• Antibiotic prescriptions for acute diarrhea dropped to zero across sites
• Pharmacist-led teamwork addressed stock‑outs and data gaps
• Model offers replicable framework for resource‑limited primary care

Pulse Analysis

Thailand’s primary care network has long struggled with fragmented drug‑management processes, limited on‑site pharmacy expertise, and inconsistent adherence to national standards. These gaps not only jeopardize patient safety but also inflate costs through wasteful inventory practices and inappropriate prescribing. By embedding a structured, participatory approach—SMART (Study, Motivation, Advisor, Regulation, Teamwork)—the pilot aligned frontline staff around shared metrics, real‑time data, and continuous feedback, creating a culture of accountability that many low‑resource settings lack.

The intervention’s mixed‑methods design combined quantitative scoring with qualitative insights from 15 health workers and 28 chronic‑disease patients. The 31‑point jump in composite compliance, driven largely by a 14‑point gain in inventory management, illustrates how targeted training and collaborative governance can translate into measurable performance. Notably, the eradication of antibiotic use for acute diarrhea underscores the model’s impact on antimicrobial stewardship, a priority for both Thai health authorities and global health agencies seeking to curb resistance.

Beyond the immediate results, the SMART framework offers a scalable blueprint for other districts and countries facing similar pharmacist shortages. Its emphasis on local ownership, data‑driven decision‑making, and cross‑disciplinary teamwork aligns with World Health Organization recommendations for primary health‑care strengthening. Future research should assess long‑term sustainability, cost‑effectiveness, and adaptability across diverse health system architectures, positioning SMART as a potential catalyst for broader reforms in primary care drug safety.