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THE IMPORTANCE OF FEEDBACK TO ENHANCE THE IMPACT OF EFFECTIVE INTERVENTIONS TO REDUCE ANTIBIOTICS IN ACUTE RESPIRATORY- TRACT INFECTION Yudatiningsih I.

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Presentation on theme: "THE IMPORTANCE OF FEEDBACK TO ENHANCE THE IMPACT OF EFFECTIVE INTERVENTIONS TO REDUCE ANTIBIOTICS IN ACUTE RESPIRATORY- TRACT INFECTION Yudatiningsih I."— Presentation transcript:

1 THE IMPORTANCE OF FEEDBACK TO ENHANCE THE IMPACT OF EFFECTIVE INTERVENTIONS TO REDUCE ANTIBIOTICS IN ACUTE RESPIRATORY- TRACT INFECTION Yudatiningsih I. 1,Sunartono H. 1,SuryawatiS. 2 1 Sleman District Health Office, 2 Center for Clinical Pharmacology and Drug Policy Studies, Gadjah Mada University, Yogyakarta, Indonesia Yogyakarta, Indonesia

2 Problem Statement: To gain a maximum impact, efforts to improve rational use of medicine should be continuously conducted, especially at the primary health service level. The Sleman District Health Office conducted a managerial intervention using Monitoring-Training-Planning (MTP)strategy at 31 health centers (HCs) in 1999. The MTP activity reduced antibiotic use for acute respiratory infection (ARI) from 50% to 20%. One year after MTP, antibiotic use was measured again, and the result showed that it varied among HCs from 12% to 53%. This finding indicated that the antibiotic use after MTP could increase again, and therefore enforcement efforts should be conducted. References indicated that feedback is effective in enforcing the impact of interventions Objectives: To evaluate whether feedback could maintain the effect of MTP in reducing the use of antibiotics. Design: Randomized controlled study with parallel design. Setting and Populations: Twelve of 25 HCs were randomly selected to participate in the study. They were randomly assigned into two groups: the test group (6 HCs) received feedback and the control group (6HCs) did not receive feedback. Data collection was conducted at 6 month before and 6-month after the feedback sessions. Intervention: Feedback was carried out by district health office staff in a single 2-hour meeting at the district health office, including the presentation of pre-MTP, post-MTP and pre-feedback data. Participants in the feedback meeting consisted of doctors, nurses, and midwives from 6 HCs. Outcome Measures: % antibiotics given and average number of drugs per encounter for ARI treatment in children 0-14 years old. Results: Compared with the MTP results, the pre-feedback data on antibiotic use showed an increase, although it did not achieve the level o significance (p>0.05). After feedback, the test group showed a significant decrease in % antibiotics given (from 34% to 11% ) and the average number of drugs per encounter (from 3.5 to 3.2), while the control group showed a significant increase in % antibiotics (from 35% to 40%) and average number of drugs per encounter (from 3.6 to 3.7). This means that MTP has a lasting impact, but the feedback enhanced the impact significantly. Conclusions: Feedback enhances the impact of even an effective intervention such as MTP. ABSTRACT

3 Acute respiratory tract infection (ARI) is still a leading cause of childhood morbidity in developing countries. In Indonesia, the prevalence of ARI is about 21.4 per 1000 population, with >60 % of cases in the under-five age group. Acute respiratory tract infection (ARI) is still a leading cause of childhood morbidity in developing countries. In Indonesia, the prevalence of ARI is about 21.4 per 1000 population, with >60 % of cases in the under-five age group. The problem that related to ARI treatment is inappropriate antibiotics medications. Percentage of antibiotics used for ARI treatment in children achieves 68%, while pneumonia cases are only 2% of the total ARI cases. The problem that related to ARI treatment is inappropriate antibiotics medications. Percentage of antibiotics used for ARI treatment in children achieves 68%, while pneumonia cases are only 2% of the total ARI cases. BACKGROUND

4 In 1999, Sleman district health office conducted a managerial intervention using Monitoring-Training- Planning (MTP) strategy to improve use of medicine at 31 HCs In 1999, Sleman district health office conducted a managerial intervention using Monitoring-Training- Planning (MTP) strategy to improve use of medicine at 31 HCs The MTP activity reduced the antibiotics use for ARI from 50% to 20%. The MTP activity reduced the antibiotics use for ARI from 50% to 20%. One year after MTP, the antibiotics use was re- evaluated. The result showed that it varied among HCs, from 12% to 53% One year after MTP, the antibiotics use was re- evaluated. The result showed that it varied among HCs, from 12% to 53% This finding indicated that the antibiotics use after MTP increased, therefore enforcement should be conducted. Previous studies suggested that feedback is effective to enforce the impact of interventions This finding indicated that the antibiotics use after MTP increased, therefore enforcement should be conducted. Previous studies suggested that feedback is effective to enforce the impact of interventions BACKGROUND (Cont)

5 To evaluate whether a feedback could maintain the effect of MTP (Monitoring - Training - Planning) in reducing the use of antibiotics OBJECTIVES

6 Design: randomised control study with parallel design Design: randomised control study with parallel design It involved 12 HCs in Sleman district, Yogyakarta, Indonesia It involved 12 HCs in Sleman district, Yogyakarta, Indonesia Prescribers included physicians, nurses and midwife per HC Prescribers included physicians, nurses and midwife per HC 12 of 25 HCs underwent MTP were randomly selected to participate in the study 12 of 25 HCs underwent MTP were randomly selected to participate in the study 12 HCs were randomly assigned into 2 groups: the test group (6 HCs) received feedback and the control group (6HCs) did not receive feedback 12 HCs were randomly assigned into 2 groups: the test group (6 HCs) received feedback and the control group (6HCs) did not receive feedback Data collections were conducted for 6 month before and 6 month after feedback Data collections were conducted for 6 month before and 6 month after feedback DESIGN AND SAMPLE SELECTION

7 The feedback was carried out in October, 2000. The prescribers consist of 1 doctor, 1 nurses, and 1 midwife in each health centers (test group) were involved in the study. They were invited to feedback meeting in health office of Sleman district The feedback was carried out in October, 2000. The prescribers consist of 1 doctor, 1 nurses, and 1 midwife in each health centers (test group) were involved in the study. They were invited to feedback meeting in health office of Sleman district The feedback was conducted one time only for the test group, and lasted in 2 hours. The meeting were conducted in the formal setting in district health office The feedback was conducted one time only for the test group, and lasted in 2 hours. The meeting were conducted in the formal setting in district health office In this study, the feedback was carried out by district health office staff to show them the data collections displayed their pre-MTP, post-MTP and pre-feedback performances In this study, the feedback was carried out by district health office staff to show them the data collections displayed their pre-MTP, post-MTP and pre-feedback performances FEEDBACK INTERVENTION

8 12 HCs 6 25 HCs 1999 2000 May Jun Jul Aug Sep Okt Nop DesJan Feb Mrt Apr 2001 Underwent MTP Analysis Test Group Control Group 6 5 4 3 2 11 2 3 4 5 6 This Study Feedback postpre 6 THE RESEARCH ACTIVITY

9 The percentage patients receiving antibiotics and average number of drug per encounter for ARI treatment in children 0 - 14 years old were calculated based on 100 randomly selected prescriptions/ month at each HC The percentage patients receiving antibiotics and average number of drug per encounter for ARI treatment in children 0 - 14 years old were calculated based on 100 randomly selected prescriptions/ month at each HC This survey covered the period of 6 months before the feedback (April - September, 2000) and 6 months after the feedback (November, 2000 - April, 2001). Data were collected by staff from the district health office who had been trained in methods recommended by WHO This survey covered the period of 6 months before the feedback (April - September, 2000) and 6 months after the feedback (November, 2000 - April, 2001). Data were collected by staff from the district health office who had been trained in methods recommended by WHO The pre-post change of the study outcomes was then computed, and Students t-test were applied to test the difference between the average change in the test group and the control group The pre-post change of the study outcomes was then computed, and Students t-test were applied to test the difference between the average change in the test group and the control groupANALYSIS

10 The study and control groups were similar during the baseline period in rate of antibiotics use (34% of patients in the test group vs. 35% among control), and in the number of drugs prescribed per patient encounter 3.5 vs 3.6. Non of these differences was statistically significant The study and control groups were similar during the baseline period in rate of antibiotics use (34% of patients in the test group vs. 35% among control), and in the number of drugs prescribed per patient encounter 3.5 vs 3.6. Non of these differences was statistically significant Compare the MTP results, the pre-feedback data on antibiotics use tended to increase, although did not achieve the level of significance (p>0.05). This means that MTP has a long –term impact Compare the MTP results, the pre-feedback data on antibiotics use tended to increase, although did not achieve the level of significance (p>0.05). This means that MTP has a long –term impact After feedback, the test group showed a significant decrease of antibiotic use (from 34% to 11%) and the average number of drug per encounter (from 3.5 to 3.2), while the control group showed significant increases in antibiotic use (from 35% to 40%) and average number of drug per encounter (from 3.6 to 3.7). This means that the feedback is effective in further reducing the use of ABs in the ARI treatment. After feedback, the test group showed a significant decrease of antibiotic use (from 34% to 11%) and the average number of drug per encounter (from 3.5 to 3.2), while the control group showed significant increases in antibiotic use (from 35% to 40%) and average number of drug per encounter (from 3.6 to 3.7). This means that the feedback is effective in further reducing the use of ABs in the ARI treatment.RESULTS

11 Feedback Underwent MTP Control Group % of patient receiving antibiotics Test Group This Study ANTIBIOTIC USE IN ARI TREATMENT

12 Feedback Underwent MTP Control Group No. of drugs prescribed per patient of ARI Test Group This Study THE NUMBER OF DRUGS PRESCRIBED PER PATIENT

13 Feedback is proven effective to strengthen an intervention to reduce the use of antibiotics in health centers Feedback is proven effective to strengthen an intervention to reduce the use of antibiotics in health centers Feedback enhances the impact of even an effective intervention such as MTP Feedback enhances the impact of even an effective intervention such as MTP CONCLUSIONS


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