Transcript Poster presentation

ABSTRACT
THE IMPACT OF CONTINUOUS MEDICAL EDUCATION ON PRESCRIBING
HABITS IN MISSION HOSPITALS IN KENYA
By John Kiambuthi
Mission for essential drugs and supplies
Problem statement :The mission for essential drugs and supplies conducts institutional
training interventions in mission hospitals. These consist of three phases: a baseline
survey using the international network for rational use of drugs (INRUD) indicators,
the training intervention and a follow-up evaluation one year later. Some hospitals then
start their own in-house continuous medical education (CME) program.
Objectives: To assess the impact of training interventions on prescribing habits in
hospitals and the impact of complementing this with an in-house CME program.
Design: Retrospective before/after with a comparison.
Setting and population :Three mission hospitals in Kenya, using patient records. In
each ,a hundred prescriptions sampled out.
Intervention: Institutional training interventions were conducted in each hospital. In
one hospital, this was complemented by a regular in-house CME program organized
by the drugs and therapeutics committee (DTC ).The staff are fully involved in the
CME as facilitators, and the treatment protocol is updated after each CME session.
Outcome measures: Average number of drugs per case, percentage of generic drugs
prescribed, percentage of cases prescribed antibiotics, and percentage of cases
prescribed injections.
Results: In one hospital, 3 of 4 indicators showed improvement, and 1 of 4
deteriorated. In the second hospital, 1 of 4 indicators showed improvement, 1 of 4 did
not change and 2 of 4 deteriorated. In the third hospital , which had the CME program,
all 4 indicators showed dramatic improvement, especially antibiotic and injection use.
Conclusions: Training by external facilitators has mixed success in improving
prescribing habits. When complemented by a CME program, it is much more
successful. Additional studies would be helpful in assessing these two forms of
educational intervention in drug use.
STUDY SETTING
The mission for essential drugs and supplies (MEDS) is an
ecumenical organization based in Kenya in East Africa
Has two main mandates :
- To source, stock and supply quality but affordable
essential drugs to not-for-profit organizations
- To organize and conduct training for workers in these
organizations.
TRAINING STYLES
Conducted either in a central location for nearby facilities
or in a health facility for the staff working there.
When conducted in a health facility, has three phases:
- training needs assessment
- training intervention
- post-training evaluation(one year after training
intervention)
During training , facilities are encouraged to start their
own continuous medical education(CME) programs to
continually address drug use issues.
QUESTION
Does a training intervention by an outside team have any
impact on prescribing habits in health facilities ?
What effect does complementing this with an own CME
program have ??
METHODOLOGY (1)
The study is retrospective, using data collected in three
hospitals all of which received training over a period of
one year.
In each, all phases of the facility-based training were
conducted. In phase one a hundred prescriptions were
sampled out in the out-patient department. Analysis was
done using the INRUD indicators.
METHODOLOGY (2)
The analysis covered the average number of
drugs per prescription, percentage of drugs
prescribed in generic names, percentage of
prescriptions with an antibiotic prescribed and
percentage of prescriptions with an injection
INTERVENTION (1)
A training intervention was conducted in all three
hospitals soon after the training needs assessment.
This was done by a team of external facilitators (MEDS).
The areas addressed were the ones identified during
phase one in order to improve prescribing behavior.
INTERVENTION (2)
In one hospital a
continuous medical
education (CME)
program was started
soon after the training
intervention. The staff
members were fully
involved in the program
as facilitators.
No such program was
started in the other two
hospitals.
Hospitals A,B,C
hospitalA
Training intervention
hospitalB
Training intervention
hospitalC
Training intervention+CME programme
RESULTS (1)
In one hospital three of the four indicators improved
while one deteriorated. In another, one improved, one
did not change while two deteriorated. In the third
hospital which had a CME program, all four
indicators showed remarkable improvement.
RESULTS (2)
Facility A
Indicator
Before
Facility B
After
Before
Facility C
After
Before
After
Number of
drugs per
prescription
3
2.94
3.4
3.3
3.3
2.35
% of
prescriptions
with
antibiotic
48
67
69
75
61
30
% of
prescriptions
with injection
19
4
36
49
57
11
% of drugs in
generic name
43
56
44
44
52
73
RESULTS (3)
Percentage Improvement
Indicator
Facility A
Facility B
Facility C
Number of drugs per
prescription
2%
2.94%
28.8%
% at prescription
with antibiotic
-39.6%
-8.70%
50.8%
% of prescription
with injection
79%
-36.1%
80.7%
% of drugs in generic
name
30.23%
0%
40.38%
CONCLUSION
From the results above, the following conclusions can be
made :
 The study presents comparative results from studies on
two forms of the training intervention in improving the
use of medicines
 Training intervention by external facilitators is helpful
in improving drug use
 When the training intervention is combined with an
own CME program the improvement is much greater.
To get a better insight into the relative effectiveness of
these two forms of training intervention in improving
drug use, more studies are needed.