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A PROSPECTIVE PHARMACOEPIDEMIOLOGIC STUDY TO PREVENT MEDICATION ERROR AND IMPROVE PRESCRIBING PATTERN. Iwan Dwiprahasto & Erna Kristin Clinical Epidemiology & Biostatistics Unit/Department of Pharmacology, Faculty of Medicine, Gadjah Mada University, Indonesia.
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A PROSPECTIVE PHARMACOEPIDEMIOLOGIC STUDY TO PREVENT MEDICATION ERROR AND IMPROVE PRESCRIBING PATTERN Iwan Dwiprahasto & Erna Kristin Clinical Epidemiology & Biostatistics Unit/Department of Pharmacology, Faculty of Medicine, Gadjah Mada University, Indonesia
Antibiotics prescribing for Acute Respiratory Infection by GP & Pediatricians (1992-1993), and Primary Health Centres 1997-1998 (%) DISTRICT
The use of injection for ARI, Diarrhoea, and Muscle Ache in Primary Health Centres, 1997-1998 (%)
Objectives: • to improve prescribing quality, • To prevent medication error; • to reduce unnecessary drug cost at Primary Health Centers’ (PHCs).
Monitoring • Evaluation • Feedback Selecting Districts Training Districts with intervention Control Districts METHOD F I N A L A S S E S S M E N T II III I • 12 18 • month Baseline Assessment
TRAINING CHARACTERISTICS Problem-based approach Interactive & Motivational Adult learning process Standardized training materials
Definition of Medication error Medication errors were defined as errors in drug ordering, transcribing, dispensing, administering, or monitoring. Examples: An order written for ampicillin without information that drug should be taken before meal (empty stomach) Cocktail medicine containing antibiotics, antipyretics, steroid, and cough mixture in powder preparation
Preparation error Amoxicillin mg 250 Paracetamol mg 100 GG tab ½ Dexamethason tab ½ Phenobarbital mg 30 Vitamin C mg 20 Mfla dtd no. XII S 3dd I Ana, 7 months
R E S U L T Table 1. Demographic characteristics Intervention Group Control Group • No. of Districts 6 2 • No. of PHCs 122 40 • No. of cases: (12.386) (5.437) • ARI (before intervention) 2120 1205 • ARI (after intervention) 5820 1846 • Diarrhoea (before intervention) 982 448 • Diarrhoea (after intervention) 1245 756 • Myalgia (before intervention) 985 496 • Myalgia (after intervention) 1234 686
Figure 1. Incidence of Medication Error in Primary Health Centres Before and after intervention (n=17,823) This is where a large graphic or chart can go.
Figure 2 Use of antibiotics for ARI Before and 6, 12, & 18 after intervention (n=10,991) p = 0,024 p = 0,029 This is where a large graphic or chart can go. p = 0,037
Figure 3 Use of Antibiotics for DIARRHOEA Before and 6, 12, & 18 month after intervention (n=3.431) p = 0,021 p = 0,038 p = 0,032
Figure 4 Use of injection for Muscle Ache (myalgia) before, 6, 12, & 18 month after intervention (n=3401) p = 0,036 p = 0,033 p = 0,012
Figure 5. The use of injection for ARI at baseline, 6, 12, and 18 months after intervention (%) p=0.02 p=0.01 p=0.01 P<0.01 p=0.02 P<0.01
Figure 6. The use of injection for Diarrhoea at baseline, 6, 12, and 18 months after intervention (%) p=0.02 p=0.03 P<0.03 p=0.01 p=0.02 P=0.02
Figure 7. Cost of drugs that could be saved from appropriate prescribing (n=17,823) US$ Av. Cost of drug that could be saved Av. Cost of training
CONCLUSION • Interactive & systematic problem based training on rational use of drugs followed by self monitoring, supervision & feedback significantly improved prescribing pattern and results in significant cost saving.
Special Thanks • Directorate General of Drug and Food Control, Ministry of Health of Indonesia • PHCs physicians and paramedics in 5 provinces of East Java, West Kalimantan, East Kalimantan, West Nusa Tenggara, West Sumatera
