Transcript Poster presentation - WHO archives

Abstract ID: 395
Email: [email protected]
Author Name: Araya Sripairoj
Presenter Name: Araya Sripairoj
Authors: Sripairoj A, Liamputtong P, Harvey K
Institution: La Trobe University, Australia
Title: Pharmacy and Therapeutics Committees in Thai Hospitals under Health Reform
Problem Statement: In Thailand, hospitals under the Office of the Permanent Secretary were first required to
establish PTCs in 1987. At that time, a “Manual of Drug Administration” listed the expected structure, roles and
responsibilities of PTCs. Since 1997, Thai hospitals have faced economic crisis, quality improvement and
accreditation, universal coverage health reform and structural change in the Ministry of Public Health (MoPH).
Objectives: To examine PTC performance during these changes and use the information obtained to suggest
possible improvements.
Design: Retrospective document review, in-depth interviews, questionnaire survey, a focus group, and participant
observation.
Setting and Study Population: This study was conducted from mid-December 2002 to mid-December 2003.
Seventeen hospitals (2 regional hospitals, 3 provincial hospitals, and 12 district hospitals), in 4 regions of Thailand
were studied. Ten key informants who were the Chairperson, the Secretary or members of PTCs in those hospitals
were interviewed, as were 15 stakeholders. Questionnaires were distributed to 452 PTC Chairpersons and
Secretaries respectively in 25 regional hospitals, 67 provincial hospitals and 360 district hospitals. Eight key
participants participated in a focus group. PTCs in three regional hospitals were observed.
Outcome Measures: PTC meetings, possible PTC performance indicators and factors that may improve PTC
performance.
Results: The questionnaire response rate was 36% from PTC Chairpersons and 66% from Secretaries. Around
90% of PTC Chairpersons were Hospital Directors and 90% of Secretaries were Heads of Pharmacy Department.
The average of the number of PTC members in regional, provincial and district hospitals was 19, 20, and 10
members, respectively. In each fiscal year (from 1996-2002), there were only 2-3 PTC meetings in regional or
provincial hospitals because their PTC Chairpersons wanted to delay the selection of new or expensive drugs into
hospital drug lists and also limit the hospital drug lists as required by MoPH. There were only 1-2 PTC meetings in
district hospitals because problems relating to drugs were discussed at the monthly Administration Committee
meeting. PTCs at all levels of hospital focused their activities on drug selection and budget as this was the main
focus of the 1987 “Manual”. The recommended PTC performance indicators were the number of PTC meetings
and the number of drug items in hospital drug lists. To extend PTCs function to areas such as rational drug use it is
suggested that a revised manual containing practical guidance and additional performance indicators are needed,
overseen by a responsible organisation. In addition, the role of PTCs should be included in the education programs
in universities or colleges that produce health workers. A PTC network was also suggested in order to share
experiences between Thai PTCs.
Conclusions: A responsible organization that facilitated networking among PTCs, better education, and a revised
PTC Manual that provided more practical help on rational drug use activities, including performance indicators,
would help PTCs expand their activities.
Study Funding: World Health Organization
Background
• In Thailand, hospitals under the Office of
the Permanent Secretary were first required
to establish Pharmacy and Therapeutics
Committees (PTCs) in 1987.
• A Manual of Drug Administration (1987)
listed the expected structure, roles and
responsibilities of PTCs.
• Since 1997, Thai hospitals have faced
economic crisis, quality improvement and
accreditation, universal coverage health
reform and structural change in the
Ministry of Public Health (MoPH).
Objectives
• To examine PTC performance during this
period of change and reform.
• To determine the opinion of the PTC
Chairpersons and the PTC Secretaries
about defining good PTC performance,
ways to improving PTC performance, and
possible PTC performance indicators.
• To create a Manual that provides more
practical help on rational drug use
activities, including performance
indicators.
Methods
Retrospective
document review
In-depth
interviews
Questionnaire
survey
A focus group
Participant
observation
Sample & methods
• Seventeen hospitals (2 regional hospitals, 3
provincial hospitals, and 12 district
hospitals) in 4 regions of Thailand.
• Ten key informants who were the
Chairperson, the Secretary or members of
the PTC were interviewed.
• Fifteen key informants who involved with
PTC or who are responsible for drug
information centers were interviewed.
• Questionnaires were distributed to 452 PTC
Chairpersons and Secretaries respectively in
25 regional hospitals, 67 provincial
hospitals and 360 district hospitals.
• Eight key participants who were PTC
stakeholders participated in a focus group.
• PTCs in 3 regional hospitals were observed.
Questionnaire results (1)
• The questionnaire response rate was 36%
from PTC Chairpersons and 66% from
Secretaries.
• Around 90% of PTC Chairpersons were
Hospital Directors and 90% of Secretaries
were Heads of Pharmacy Department.
• The average of the number of PTC
members in regional, provincial and
district hospitals was 19, 20, and 10
members, respectively.
• There were only 2-3 PTC meetings in
regional or provincial hospitals and only 12 PTC meetings in district hospitals during
each fiscal year (from 1996-2002).
Questionnaire results (2)
• The most important PTC performance
indicators suggested by all PTC
Chairpersons:
– Is PTC responsible for considering and
approving allocation of drug budget proposed
by the Pharmacy section?
– Does PTC have a document providing criteria
for addition and deletion of drug in the hospital
drug list?
– Does PTC have a policy to develop or
implement Clinical Practice Guidelines for
common problems such as acute respiratory
infection, diarrheal diseases, hypertension,
diabetes, epilepsy, and antibiotic prophylaxis,
etc.?
– Does the PTC monitor Pharmacy drug
dispensing to ensure it follows written
standards of pharmacy professional practice?
– Does PTC conduct satisfaction surveys on
hospital staff to receive feedback on PTC
performance?
Questionnaire results (3)
• The most important PTC performance
indicators suggested by PTC Secretaries:
– Does a document identifying goal,
committee, objectives, and functions of
PTC exists?
– Is PTC authorised to select drugs to be
included and excluded in the hospital
drug list?
– Does PTC monitor the percentage of
drugs used outside hospital drug list?
– Does the PTC monitor Pharmacy drug
dispensing to ensure it follows written
standards of pharmacy professional
practice?
– Does PTC have a policy to conduct
satisfaction of patients/clients on the
hospital treatment service?
Questionnaire results (4)
• When asked about the most important
factor needed for the development of an
effective PTC:
– the Chairpersons said it was an effective PTC
Secretary; while
– the Secretaries said it was an effective PTC
Chairperson.
• When asked about external factors that
can contribute to improved performance
of PTC both PTC Chairpersons and
Secretaries in all hospitals agreed that
the most important aspect was:
– a national collaborative drug information
center as a hub for information exchange
between PTC for a decision making purpose.
• In addition, PTC Chairpersons and
PTC Secretaries in regional hospitals
noted that:
– defining the function of PTC in the hospital
accreditation criteria would be helpful.
Results (5)
• The retrospective document review, in-depth
interviews, a focus group and participant
observation noted that:
– Under new structure of Ministry of Public Health,
there was no distinctive responsible organization
who support and monitor PTCs.
– Some hospitals had not updated information about
new PTC members, functions or responsibilities.
– Most PTC activities still focused on drug selection
and controlling drug budget. Activities on rational
drug use were few.
– Many PTCs had not set their own specific goals,
objectives, role and responsibilities.
– Often PTCs had no working plan and there was
also no orientation about goal, objectives, role
and responsibilities for PTC members.
– Many suggested the need for a responsible
organization (perhaps under the Department of
Health Service Support) that would assist PTCs
by:
• Updating Manual of PTC roles and
responsibilities;
• Providing opportunities for PTC networking e.g. by
web site &/or E-mail discussion groups;
• Providing information for PTC to make decisions;
• Supporting the incorporation of PTC performance
indicators in hospital accreditation (Bureau of
Inspection & Evaluation &/or The Institute of
Hospital Quality Improvement& Accreditation);
• Encouraging Universities to provide educational
programs.
Summary
• PTCs at all levels of hospital focused
their activities on drug selection and
budget as this was the main focus of
the 1987 “Manual”.
• There were limited numbers of
meetings of PTCs (1-2 in district
hospitals; 2-3 in regional or provincial
hospitals).
• The recommended PTC performance
indicators were the number of PTC
meetings and the number of drug
items in hospital drug lists.
• Suggestions for improving PTC
performance:
– Setting a responsible organization;
– Encouraging educational programs in
universities; and
– Providing national drug information
center and PTC networking.
Conclusion & Policy
Implications
There is a need for a responsible
organization (perhaps under the
Department of Health Service
Support) that would assist PTCs by:
– Updating a Manual regarding PTC roles
and responsibilities;
– Providing opportunities for PTC
networking e.g. by web site &/or E-mail
discussion groups;
– Providing information for PTC to make
decisions;
– Supporting the incorporation of PTC
performance indicators in hospital
accreditation monitored by:
• Bureau of Inspection & Evaluation &/or
• Institute of Hospital Quality Improvement;
– Encouraging Universities to provide PTC
educational programs.