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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. ABSTRACT.
Suryawati S, Setiyawati E, Saleh-Danu S, Rustamaji A, Santoso B
Center for Clinical Pharmacology and Medicine Policy Studies
Gadjah Mada University, Yogyakarta.
Problem Statement: Experience showed that a successful intervention should focus on a specific problem, address the underlying factors, use a problem-solving approach, repeat the intervention, be interactive, provide feedback to prescribers, and be followed by monitoring and supervision. Moreover, indicator-based monitoring strategies with feedback were found to be effective in improving drug use practices. Unfortunately, few data have been compiled from hospitals.
Objective: To develop and field-test an innovative MTP (Monitoring-Training-Planning) approach to reducing inappropriate prescribing in hospitals.
Indicators: Percentage of patients receiving antibiotics (AB) after hernia surgery and cesarean surgery, percentage of patients with diarrhea receiving AB, percentage of patients with acute respiratory tract infection (ARI) receiving AB, etc.
Design: Field tests were conducted in 6 hospitals: 2 public hospitals (Sleman and Yogyakarta), 2 private hospitals (PKU and Pantirapih), and 2 teaching hospitals (Sardjito and Karyadi). These hospitals were selected based on convenient sampling. The field test included 3 consecutive MTP meetings in each hospital. The impact of MTP was evaluated by comparing the indicators prior to the implementation of MTP (baseline) and after, for each specific drug use problem identified in each hospital. Process evaluation was also undertaken at each hospital.
Study Population: Patients with specific disease problems as defined by each hospital.
Intervention: An MTP team was set up in each hospital. Each team chose a priority problem and planned 3 consecutive MTP meetings involving managers and prescribers. Each meeting was about 2–3 hours.
Outcome Measures: Reduction of percentage of patients receiving AB.
Results: All facilities reported that MTP reduced inappropriate AB use. Sleman reduced AB use for adult diarrhea from 67% to 8%, and for children’s diarrhea from 33% to 0. Yogyakarta reduced AB use postcesarean from 100% to 0. PKU reduced AB use for nonspecific diarrhea from 21% to 4%, and Pantirapih reduced AB use for adults with ARI from 94% to 45%. Sardjito reduced AB use post–hernia surgery from 100% to 13%, and Karyadi reduced AB use post–scrotal hernia surgery from 85% to 8%. Most participants expressed the feeling that the MTP approach was easy to conduct. Participants were optimistic that MTP could be implemented or used in combination with other approaches.
Conclusions: The MTP approach is a combination of educational and managerial strategies. Because the MTP activity is self-initiated, self-planned, self-executed, and self-evaluated by the hospital team, this approach will be more acceptable to hospital managers.
MTP to improve drug use practices?
Description of the
Setting the target
Problem solving & scientific/reality testing
What is MTP?
Monitoring - Training - Planning
Adult learning process
Priority problem- Overuse of ABs in hernia surgery - Overuse of ABs in scrotal hernia surgery- Overuse of ABs in acute diarrhea- Overuse of ABs in Caesarian surgery- Overuse of ABs in ARI- Overuse of ABs in diarrhea
Health facilityTeaching Hospital: - Sardjito - Karyadi Public Hospital: - Sleman - Yogya Private Hospital:- Panti Rapih- PKU
Site of intervention- Operation theatre - Operation theatre- Pediatric & Internal OPDs- Operation theatre - General OPD- General OPD