Transcript Poster presentation

IMPROVING PERFORMANCE OF DRUG
THERAPEUTIC COMMITTEES
IN LAO P.D.R
Vang C1; Wahlstrom R2; Tomson G2. Southammavong T1;
Phanyanouvong A1; Kounnavong S1; Sisounthone B1; Keungsaneth
P1;Rattanavong S1; Eriksson B 2 , Johansson R2
1 Ministry of Health, Laos
2 International Health Care Research , Karolinska Institute, Sweden
PROBLEM STATEMENT
 The Lao PDR is still a developing country.
 There is still little health care resource.
 It is a very important for the Lao PDR the
need for
 accurate prescribing decision
 appropriate treatment
 rational use of drug
 Drug Therapeutic Committees (DTC),
essential for rational use of drug (RUD) in
hospitals, have recently been established in
Lao P.D.R
 Problems with their performance have been
reported, but it was not clear how to
improve the situation
 OBJECTIVES
 To determine factors in the working environment
that relate to DTC performance and whether it
could be improved through an educational
intervention using feedback targeted towards
the DTC members
 STUDY DESIGN
 Quasi-experimental (before and after) study.
 SETTING AND STUDY POPULATION
 Nine provincial hospitals and the DTC members
from these hospitals were included
 INTERVENTION
 Feedback sessions using structure and
performance indicators
 OUTCOME MEASUREMENT
 Performance of DTC units was assessed
through specifically developed DTC indicators
on structure and process combined with RUD
and Standard Treatment Guidelines (STG)
scores on Malaria, Diarrhoea and Pneumonia
 94 DTC members were interviewed to identify
factors, which could impact on DTC
performance
 Data was collected for three-months periods at
baseline and for three consecutive periods
 The results of the first three data collections
were shown and discussed with the DTC
members during feedback sessions
 Data recorded in the pre-intervention and postintervention periods were compared
Process of Intervention, Data Collection and Analysis
Comparison
1st DTC members
interview with 1st
round of DTC, STG
and RUD baseline
scores collection
2nd and 3 rd rounds
of DTC, STG, RUD
scores collection
Intervention period
(4 months)
Pre-intervention
period (3 months)
feedback
feedback
feedback
3 educational feedback
intervention sessions to DTC
members
2nd DTC members
interview with 4th
DTC, STG and
RUD scores
collection
Post-intervention
period (3 months)
Changes in DTC Performance After Feedback Intervention by
the Research Team (n = 9)
10
9
*
*
Scores
8
7
6
5
4
* *
* **
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
3
2
1
0
Structure Reports
Activities Feedback Drug Info
Baseline data
After Intervention II
* p < 0.05
ADR
DDD/Cost
After Intervention I
After Intervention III
 p < 0.01
HMR
Changes in DTC , STG and RUD Indicators Scores
After Feedback Intervention (n = 9)
10
8
6
scores
4

*
*
* *
This is where a large graphic or chart can go.
2
0
Mean DTC
Baseline data
After intervention II
* p < 0.01
Mean STG
Mean RUD
After intervention I
After intervention III
 p < 0.001
Positions Held by the Interviewed DTC Members in Hospital
Administration (n= 94)
70
60
50
40
%
30
20
10
0
Decision makers
Staffs
Positions Held by the Interviewed DTC Members in Hospital
Administration and DTC Organization (n= 94)
100
80
%
60
40
20
0
VIP
Staffs
Task force
Decision makers
Time Available for DTC Activities (n= 94)
100
90
80
70
60
% 50
40
30
20
10
0
No time
Not enough time
Pre-intervention
Enough time
Post-intervention
Negative Factors on DTC Performance (n = 94)
Irregular DTC meeting
DTC members overloaded
Little interest from Hospital Director on
DTC activities
Insufficient DTC knowledge
DTC members moved to other places
Hospital Director not included in DTC
0
20
40
60
80
100
%
CONCLUSIONS
 Inefficient DTC performance
recorded in the pre-intervention
period may be related to that DTC
members are overloaded by other
works
 DTC performance improved
significantly after intervention with
feedback sessions
RECOMMENDATIONS
 Continuous monitoring of the performance
by means of the indicators is suggested to
improve DTC work
 Special attention should be given to areas
with low scores like ADR, hospital routines
and cost aspects
 Adequate time should be allocated for DTC
members