ABSTRACT - International Conferences on Improving Use of 提高使用抽象的国际会议.ppt

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% (