2. EDUCATIONAL INTERVENTION TO IMPROVE PRESCRIBING HABITS OF PEDIATRICIANS IN TREATMENT OF UNCOMPLICATED ACUTE UPPER RESPIRATORY TRACT INFECTION Ziganshina LE, Pikuza OI, Magsumova DR, Galyautdinova AYu. Kazan State Medical Academy and Kazan State Medical University, Russia

3. Study questions  To analyze the pattern of drug prescribing in children with acute upper respiratory tract infection and acute bronchitis in outpatient clinics of Kazan in 1998, 2000, 2002 in retrospective studies  To assess the appropriateness of drug use to update practical guidelines  To assess the impact of educational intervention on prescribing habits of pediatricians in pharmacotherapy of acute uncomplicated upper respiratory tract infections.

4. Methods  7 outpatient clinics of Kazan in 1998.  The period of education for the practicing physicians in 1999-2000 followed (evaluation planned).  Pharmacotherapy courses (problem based pharmacotherapy teaching methodology).  The subsequent pharmacoepidemiological survey was performed in 2000 and 2002.  Out-patient medical charts of 750 children with uncomplicated acute upper respiratory tract infections were randomly chosen:  in 1998 – 472 cases,  in 2000 – 491 cases,  in 2002 – 288 cases.  The number of prescribed drugs per case, antibiotics, dosage regimens were studied

5. The number of prescriptions (medicines) per case for treatment of acute respiratory infections in children in Kazan. 1998, 2000, 2002 (% ± SE)# # SE – Standart Error, * – p<0,05; ** – p<0,01. Years of the study The number of prescriptions (medicines) per case 0-2 medicines 3-4 medicines More than 5 medicines Total number of patients Number of patients % % % 199871 15.0± 1.6% 322 68.3± 2.0%79 16.7± 2.9%472 2000217 44.2± 2.2%* * 229 46.6± 2.3%* * 45 9.2± 1.3%*491 2002121 42.0± 2.9%129 44.8± 2.9%38 13.2± 2.0%288

6. Figure 1. Prescription of antibacterial drugs for treatment of acute respiratory infection in children in 1998 in Kazan (АТC classification):.J01C - beta-lactams; J01FA - macrolides; J01FF - lincosamides; J01E - sulfonamides and trimothoprim, J01A - tetracyclines; J01G - aminoglycosides; J01MA - fluoroquinolones. 1 - oxacillin, 2 - benzylpenicillin, 3 - ampicillin/ oxacillin, 4 - spiramycin.

7. Figure 2 Prescription of antibacterial drugs for treatment of acute respiratory infections in children in 2000 in Kazan (ATC classification):.J01C - beta-lactames; J01FA - macrolides; J01FF - lincosamides; J01E - sulfonamides and trimothoprim, J01A — tetracyclines; J01G - aminoglycosides; J01MA - fluoroquinolones. 1 - oxacillin, 2 – benzylpenicillin.

8. Figure 3. Prescription of antibacterial drugs for treatment of acute respiratory infections in children in 2002 in Kazan (ATC classification): J01C - beta-lactams; J01FA - macrolides; J01FF - lincosamides; J01E - sulfonamides and trimothoprim, J01A — tetracyclines; J01G - aminoglycosides; J01MA - fluoroquinolones. 1 - oxacillin, 3 - ampicillin/oxacillin, 5 - midecamycin.

9. Discussion  The antibiotics are needlessly overused in treatment of acute upper respiratory tract infection in children.  The educational intervention based on the results of pharmacoepidemiological monitoring was an effective measure to improve the prescribing habits of practitioners ( antibiotic use: 65.7+2.2% (1998)  35.2+2.2% (2000)  31.3+2.7% (2002) ).  Despite of achieved results the usage of inappropriate toxic medications and wrong dosage regimes persisted.  This proves the necessity of furthering educational interventions for primary care physicians and the importance of further pharmacoepidemiological monitoring in this field.

10. Conclusion A problem-based educational intervention proved to be an effective tool to improve the prescribing habits of practicing physicians, and pharmacoepidemiological monitoring is important for furthering the educational impact on prescribing.

11. Conclusion – 2  Strength  Choice of pharmacoepidemiological methodology for evaluation of the educational impact (retrospective study, medical charts)  Weaknesses  Medical charts – practitioners’ prescribing habits only  No information on the actual consumption of medicines  What to do next  Evaluate drug consumption:  Pharmacies  Patients  Monitor drug use and educate on regular basis