MTP Approach to Reduce Inappropriate Use of Antibiotics
MTP Approach to Reduce Inappropriate Use of Antibiotics in Hospitals: Results of the Field Test Suryawati S, Setiyawati E, Saleh-Danu S, Rustamaji A, Santoso B Center for Clinical Pharmacology and Medicine Policy Studies Gadjah Mada University, Yogyakarta
Background | Inappropriate prescribing practices in health facilities | Intervention to improve prescribing is uneasy to conduct, especially in private health facilities | Needs of self-initiative, self-conduct, selfassessment, self-decision making | Interventions needs to be incorporated in the existing management system
Indicator-based monitoring strategy | Self-monitoring approach to improve drug use practices (Sunartono & Darminto, 1996) | MTP (Monitoring - Training Planning) approach to improve efficiency in drug management (MSH, 1998) MTP to improve drug use practices?
Objectives To measure the effectiveness and usefulness of indicator-based MTP to improve prescribing practices: | general teaching hospitals | private hospitals | public hospitals
What is MTP? M 80% Description of the recent situation 20% P Setting the target of improvement Reflection of previous experience Problem solving & scientific/reality testing | Monitoring - Training - Planning | Adult learning process T
Flow of MTP activities | 3 -4 cycles for each problem | Simultaneous or parallel activities P T M MTP meeting P T M MTP cycle
Drug use problems Health facility Priority problem Site of intervention Teaching Hospital: - Operation theatre - Overuse of ABs in hernia surgery - Sardjito - Overuse of ABs in scrotal hernia surg. - Operation theatre - Karyadi Public Hospital: - Sleman - Yogya - Ped & Internal OPDs - Overuse of ABs in acute diarrhea - Overuse of ABs in Caesarian surgery - Operation theatre Private Hospital: - Panti Rapih - PKU - Overuse of ABs in ARI - Overuse of ABs in diarrhea - General OPD
Result 1: MTP at General Teaching Hospitals Problem: Pre- and post surgery ABs in elective hernia surgery Indicator: % patients receiving antibiotics This is where a large graphic or chart can go. Revision of STG Sardjito Teaching Hospital Karyadi Teaching Hospital
Result 2: MTP at Public Hospitals Problem: - Overuse of AB in acute diarrhea (Sleman) - Pre- and post-surgery ABs in Caesarian surgery (Yogya) Indicator: - % patients receiving antibiotics Discussion on STG and diagnosis Sleman District Hospital Yogya District Hospital
Result 3: MTP at Private Hospitals Problem: - Overuse of antibiotics in acute respiratory tract infections - Overuse of antibiotics in acute diarrhea Indicator: - % patients receiving antibiotics Impact of data collection? Clinicians refused the data Panti Rapih Hospital PKU Hospital
Hospitals’ comments on MTP approach | Flexible approach, not time-consuming, not costly | A comprehensive approach, a combination of adult learning and managerial strategies | Encourage DTC to initiate activities | Encourage internal experts to contribute | Involved stakeholders in hospital | Good approach for sensitive issues, the “negative impacts” of promoting rational drug use can be discussed internally
Lessons learnt | Factors of success: ü ü Self-initiated and self-planned: idea for improvements was developed and decided within the group Self-executed and self evaluated: empowerment of internal actors | Comprehensive approach: educational & managerial | MTP can be conducted at low cost, using the existing mechanism and routine meetings in hospitals | MTP is promising for use in groups with high resistance
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