Transcript ABSTRACT - WHO archives

ABSTRACT
Problem statement: The Lao PDR National Drug Policy (NDP) Program,
implemented by the Ministry of Health supported by the Swedish International
Development Agency, has rational use of drug as one component. The NDP aims to
improve the prescribing in hospitals through Drug and Therapeutic Committee
(DTC), using indicators, regular meeting, and feedback to all prescribers. The MTP
approach. implemented in 2001, provided hospitals with a complementary tool for
intervening on smaller scale problems and structures. Hospitals focused on solving
problems that had not responded well to the previous DTC approach.
Objective: To evaluate the effectiveness of the MTP approach in reducing irrational
use of drugs for specific diseases, with targets defined by individual
departments in study hospitals.
Setting: Initially implemented in 11 provincial hospitals then extended to 14
provincial and 14 district hospitals.
Study Design: Before and after design
Population: Specific problems, and patient populations were defined by each
hospital.
Intervention: The MTP approach involves a series of small group discussions
among prescribers in individual hospital departments. After training in the use of
MTP, these groups: defined a problem of interest, selected targets to be
achieved, applied a problem solving approach, and monitored indicators
to observe response.
Outcome measures: Depended on the target problem; examples include %
receiving injection, % receiving antibiotics, % receiving IV fluids, waiting time,
correct diagnosis.
Results: The MTP approach frequently met defined targets in 2-3 monthly meeting
cycles; in some hospitals, targets were not met, but decision makers were satisfied
enough to move to another problem. Bokeo Hospital aimed to reduce waiting time
for ultrasound from 43 minutes to 20 minutes, after 2 cycles, waiting time was 25
minutes. Saravan Hospital increased recording of respiratory rate in pediatric
pneuminia from 60% to 80% (3 cycles). Vientiane (Lao-Luxembourg) Hospital
aimed to reduce post-operative antibiotic prescription from 60% to 45% and
achieved rate of 49% (3 cycles). Mahosoth Central Hospital reduce injections
from 78% to 51% of patients, and reduce post-operative antibiotic use from 46% to
29% (3 cycles). Mittaphap Central Hospital reduce IV fluid use for gastritis from
78% to 46% and antibiotic use from 40% to 20% (3 cycles). Oudomxay Hospital
reduce antibiotic use in out patients from 60% to 45% (3 cycles).
Conclusion: The MTP approach was effective in solving drug use problems in in
small setting, especially district hospitals and departments of provincial and central
hospitals. Problem defined by the DTC research process (Hospital Medical Routine)
were solved by the MTP approach. Therefore, the MTP has been extended to 23
district hospitals and will be to all hospitals in the country.
BACKGROUND
• Irrational use of drug, including over prescription,
prescription of brand name, prescription out of
essential drug list, high antibiotic use, high
injection use, irrational use IV fluid, the
prescription unclear
• Limited opportunity prescribers to be trained or
trained different institution or project,
• National Drug Policy (NDP): Component 2
Rational Use of Drug (RUD) Standard Treatment
Guideline (STG) were develop and introduced to
all prescribers at central and provincial hospital
• Drug and Therapeutic Committee (DTC)
established in all provincial and central hospitals to
monitored RUD and STG implemented.
• Monitoring Training Planning (MTP) team were
established in central hospitals, some provincial
and district hospitals
OBJECTIVES
• To evaluate the effectiveness
of the MTP approach in
reducing irrational use of
drugs for specific diseases,
with targets defined by
individual departments in
study hospitals.
• To train the MTP technique to
the prescribers to solves the
drug problem by themselves
and to be sustainable
MONITORING
•
•
•
•
Identify the specific drug use problems
Select a priority problem
Determine indicators and data source
Identify the target of intervention
When MTP has been running:
• Follow up commitments from the
previous session
• Measure the impact of intervention
• Conclude the achievement
TRAINING
• Discuss the problem agreed in the
Monitoring in more details
• Collect supporting information
• Collect related scientific information to
set up the norms or standard reference,
e.g., reference books, standard
treatment guidelines, etc.
• Collect information about the
intervention efforts considered effective,
and to discuss the suitable intervention
strategy to choose.
• Agree upon an intervention strategy
and to discuss the intervention steps.
PLANNING
• Set a target of achievement
• Set measures to achieve target,
including the sequence of
activity, the program, and the
person responsible for
execution.
• Agree on who is responsible for
the execution of the plan.
• Facilitate communication and
coordination among MTP team
members
• Agree upon schedule of the
next MTP session.
RESULTS
• The MTP approach
frequently met defined
targets in 2-3 monthly
meeting cycles; in some
hospitals, targets were not
met, but decision makers
were satisfied enough to
move to another problem.
ANTIBIOTIC USE
70
60
50
Vientiane
Mahosoth
Mittaphap
Oudomxay
40
30
20
10
0
1st M
2nd M
3rd M
target
Respiratory rate
Saravane
90
80
70
60
50
40
30
Respiratory Record
20
10
0
1st M
2nd M
3rd M
target
Waiting time
Bokeo
50
45
40
35
30
25
20
15
10
5
0
Ultrsound
1st M
2nd M
3rd M
target
IV fluid and Injection
90
80
70
60
50
40
30
IV fluid
Injection
20
10
0
1st M
2nd M
3rd M
target
CONCLUSION
• The MTP approach was effective
in solving drug use problems in
small setting, especially the
specific problem in the
departments of hospitals.
• The MTP can solve any problems
by discussion and agreement in the
teamwork
• The MTP were useful at the
district level
Key lessons
•
•
•
•
Team development
Supports from hospital
Scenario
Distribution of activities
within MTP team
• Identification of internal
resources
• Conducting MTP session