Transcript Oral presentation 2

CAMBODIA EXPERIENCE ON
MTP (MONITORING, TRAINING,
PLANNING) TO REDUCE
INAPPROPRIATE MEDICINE
USE IN HOSPITALS
1-Background
-Previous indicator-based supervision and
monitoring program in Cambodia did not show
significant improvement.
-Inappropriate prescribing practices in health
facilities
-Intervention to improve prescribing is uneasy
to conduct, especially in private facilities
-Self-initiative, self-conduct, self-assessment,
self-decision making
-Interventions needs to be incorporated in the
existing management system
2- Objective
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
To learn lessons from experiences in
drug use interventions in the past
To discuss the problem of drug use
in the health care system
To discuss the efforts in improving
drug use carried out so far
To develop the innovative strategy
for rational drug use in the health
care system.
3-Intervention Method

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Select pilot hospitals for MTP implementation
Assign 6 people as MTP team
Training of MTP Team on MTP process
Schedule the meeting to:
 define problems on drugs use
 develop an innovative strategy to improve drug
use
 define target
 monitor the implementation and evaluate the
achievements
 National evaluation workshop
3.1-Flow of activities in MTP
Indicator
Indicator
Indicator
M
M
M
M
M
M
P
P
T
Initial
Workshop
P
T
P
T
Evaluation
Workshop
P
T
T
3.2-Self-monitoring vs MTP
Periodic evaluation at
MOH
SelfMonitoring
strategy
Indicator
Indicato
r
MTP
approach
Indicator
Indicato
r
M
T
P
M
T
P
Indicator
Indicator
Indicato
r
M
T
P
M
T
P
M
T
P
3.3-Monitoring
- To identify the specific drug use problem
- To select a priority problem
- To determine indicators and data source
- To identify the target of intervention
When MTP has been running:
- To follow up commitments from the previous session
- To measure the impact of intervention
- To conclude the achievement
3.4-Training
- To discuss the problem agreed in the Monitoring in more details
- To collect supporting information
- To collect related scientific information to set up the norms or standard reference,
e.g., reference books, standard treatment guidelines, etc.
- To collect information about the intervention efforts considered effective, and to discuss
the suitable intervention strategy to choose.
- To agree upon an intervention strategy and to discuss the intervention steps.
3.5-Planning
- To set a target of achievement
- To set measures to achieve target, including the sequence of activity, the program,
and the person responsible for execution.
- To agree on who is responsible for the execution of the plan.
- To facilitate communication and coordination among MTP team members
- To agree upon schedule of the next MTP session.
4- Experiences on using MTP
- First phase 6 Hospitals
- Second phase 7 Hospitals
4-Result 1(Kandal Abs Reduction in Normal Delivery)
% patients received oral antibiotics
100%
100%
Oral antibiotics
Target
80%
60%
55%
40%
32%
20%
10%
10%
10%
15%
10%
0%
1st meeting 2nd meeting 3rd meeting 4th meeting
4-Result: 2 (Kg Cham Reduce Abs in post Cesarean)
Post Caesarean surgery
% of patients receiving antibiotics
100%
100%
80%
Target
87%
60%
58%
44%
41%
40%
20%
Post Scrotal hernia surgery
10%
10%
10%
36%
33%
10%
0%
1st meeting 2nd meeting 3rd meeting 4th meeting
Reduction of the average medicine cost per patient from 15.3 to US$ 6.1
(US$ 2000/month)
4-Result: 3(Siem Reap: Reduce Abs in Traumatology)
100
100
90
84
80
72
70
63
60
50
SR-Target, 50
SR-Target, 50
SR-Target, 50
SR-Target, 50
40
30
20
10
0
Session 1
Session 2
SR-Trauma
Session 3
SR-Target
Session 4
4-Result: 4 (OM Chhey: IV fluid reduction in normal
delivery)
30
27
25
20
15
10
5
0
00
0
Session 1
00
Session 2
OMC-N Delivery
Target
Session 3
4-Result: 5 (BB: IV fluid reduction in Maternity and
Traumatology Ward)
80
70
70
70
60
59
50
50
40
30
20
10
0
0
00
0
Session 1
Session 2
BB-Maternity
BB-Trauma
Session 3
Target
4-Result: 6 (BB: Abs reduction in Malaria)
35
Battambang-Malaria,
30
30
25
Battambang-Malaria,
20
20
15
10
5
0
Target, 0
Target, 0
Session 1
Battambang-Malaria
Session 2
Target
4-Result 6 (BB Abs Reduction in Malaria)
35
30
30
25
20
20
15
10
5
0
Session 1
Battambang-Malaria
Session 2
Target
5-STRONG POINTS
 MTP is strongly supported by the DG for Health
 WHO supported both, budget & Technical
expert to develop MTP in CAMBODIA.
 Existing Technical Working Group in each RH
acting as DTC for improving the Use of Drug.
 Existing network of supervision and monitoring
system from central to Province and OD level.
 Good cooperation with National Programs.
 Sustainable achievement
6-WEAK POINTS
 Some hospitals have difficulty to define a real
strategy for improving drug use
 After the end of financial support and
intervention from central level no data will be
collected and achievement will not be monitored
and reported
 Time availability of MTP team member
 Transfer of some MTP team members to other
facility
 Reduction of hospital income for drugs.
7-Summary of result
Health Facilities Priority problem
1-Kandal Hospital -Use of Abs in
normal delivery
Intervention result
-Reduction from 100% down to
15%(target 10%)
-Use of Abs in postCaesarean surgery
-Abs use postscrotal hernia
surgery.
-Reduction from 100% down
36%(Target 10%)
-Reduction from 100% (target
10%)down to 33% in 3 meetings
3-Siem Reap
Hospital
-Abs use in
Tromatology Ward
-Reduction from 100% down to
63% (target 50%)
4-Oddar Mean
Chhey Hospital
-Use of IV fluid in
normal delivery
-Reduction from 27% down to
0% (target 0%)
5-Battambang
Hospital
-IV fluid use in
Maternity
-IV fluid use in
Traumato
-Abs use in Malaria
-Reduction from 70% down to
0%.(target 0%)
-Reduction from 70% down to
0% (target 0%).
-Reduction from 30% down to
20%(target 0%)
2-Kanpong Cham
Hospital
-Average cost IPD 15.3 to 6.1$
8-Conclusion(1)
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Flexible approach, not time-consuming, not costly
Good for sensitive issues
Interventions seems not too “sophisticated”
Encourage DTC to initiate activities and internal
experts to contribute
A comprehensive approach, a combination of adult
learning and managerial strategies.
Involved stakeholders in hospital, the “negative”
consequences of rational drug use could be
discussed accordingly
8-Conclusion(2)
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MTP can be implemented in both sector public and
private. Its can be solve problem themselves, if there
are any supported from PHD.
MTP can be extended in nationwide, if they select
the right people to be train them.
MTP reduce health care cost, if they strictly monitor,
supervise and providing the training to prescribers.
So the community will be participation and support
To reduce the prescribing problems and improving
RUD for healthcare workers and patients.