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Munawaroh S 1 , Sunartono H 2 , Suryawati S 3 1 Yogyakarta Provincial Health Office;

REDUCING ANTIBIOTIC OVERUSE FOR ACUTE RESPIRATORY TRACT INFECTIONS WITH SMALL- GROUP EDUCATIONAL INTERVENTION. Munawaroh S 1 , Sunartono H 2 , Suryawati S 3 1 Yogyakarta Provincial Health Office; 2 Sleman District Health Office;

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Munawaroh S 1 , Sunartono H 2 , Suryawati S 3 1 Yogyakarta Provincial Health Office;

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  1. REDUCING ANTIBIOTIC OVERUSE FOR ACUTE RESPIRATORY TRACT INFECTIONS WITH SMALL- GROUP EDUCATIONAL INTERVENTION Munawaroh S1, Sunartono H2, Suryawati S3 1Yogyakarta Provincial Health Office; 2Sleman District Health Office; 3Department of Clinical Pharmacology, Gadjah Mada University, Indonesia

  2. BACKGROUND • MOH of Indonesia has developed Standard Treatment Guidelines (STG) in 1983, and a diagnosis flow chart for ARIs for Health Center (HC) level in 1991. • The excessive use of antibiotics in treating simple ARI in HCs demonstrates that the STG and flow chart are not followed. • Many evidences showed inappropriate treatment for ARI, including indiscriminate use of antibiotics. • Previous studies showed that Small-Group Educational and Feedback are effective in improving drug use. Special efforts are needed to reduce the overuse of antibiotics

  3. OBJECTIVES General To improve the quality of care of ARI patients (adult and child) in HCs by applying Small-Group Discussion (SGD). Specific • To improve specific prescribing practices in ARI, including: • reducing the overuse of antibiotics • reducing the overuse of antihistamine • reducing the number of drugs per encounter • To compare the effectiveness of Small-Group Discussion, with-and without feedback (FB), in improving ARI treatment.

  4. METHODS (1) • Location • HCs in Bantul District, Indonesia • Subject • Paramedics (target intervention) and doctors (as resource person) in HCs • Design • Randomized controlled study with pre and post evaluation • 18 HCs were randomly assigned into: • 6 HCs underwent SGDs followed by FB meetings in 2 consecutive months (group A) • 6 HCs underwent SGDs without FB meetings (group B) • 6 HCs acted as controls (group C)

  5. METHODS (2) Design Group A (6 HCs) SGD FB1 FB2 18 HCs Group B (6 HCs) Randomized Analysis - - SGD Group C (6 HCs) C O N T R O L FGD = Focus Group Discussion SGD = Small Group Discussion FB = Feedback Timeline Post FB2 Post FB1 Para Post SGD Baseline FGD

  6. METHODS (3) • Prescribing Survey • 100 paramedics’ & 100 doctors’ prescriptions per HC per month at each time point (total 7 time points): • Pre-1, pre-2, pre-3 (3, 2, and 1 months before the intervention) • Para (preparation, 1 month) • post SGD, post FB1, post FB2 (1 month, 2 months, 3 months after the intervention, respectively) • Total amount of sample: 100 prescriptions x 7 time points x 2 providers x 18 HCs = 25,200 prescriptions • Data presentation • Percentage of patients with ARI receiving antibiotics • Percentage of patients with ARI receiving antihistamines • Average number of drugs per prescription • Statistical analysis • t-test to compare reduction of pre vs post intervention • Anova to compare reductions of Group A vs Group B vs Group C

  7. RESULT (1):REDUCTION OF ANTIBIOTICS USE % patients receiving antibiotics % patients receiving antibiotics Paramedics’ prescriptions Doctors’ prescriptions SGD FB1 FB2 SGD FB1 FB2

  8. RESULT (2):REDUCTION OF ANTIHISTAMINE USE % patients receiving antihistamine % patients receiving antihistamine Paramedics’ prescriptions Doctors’ prescriptions SGD SGD FB1 FB2 FB1 FB2

  9. RESULT (3):NUMBER OF DRUGS PER ENCOUNTER Doctors’ prescriptions Paramedics’ prescriptions SGD SGD FB1 FB1 FB2 FB2

  10. DISCUSSIONS (1) Interesting finding Although the target of intervention was paramedics, surprisingly the doctors’ prescriptions also improved. It means that there were double impacts of posing the doctors as resource persons.

  11. DISCUSSIONS (2) The key factors to the success of the intervention are: • Handy printed material, question & answer format, problem-based • Interactive, problem-solving Small-Group Discussion • Feedbacks showing individual achievement • Facilitators are recruited from the target of intervention • Doctor as resource person is a strategy in improving doctor’s behavior

  12. CONCLUSIONS • SGD followed by FBs reduced the overuse of antibiotics and other unnecessary drugs in the treatment of ARI in adult & children in HC level. • SGDs among paramedics with a trained paramedic facilitator and a doctor as a resource person provided fora for paramedics to discuss and solve problems in ARI treatment. Such forum would be also ideal for other medical problems. • Repeating intervention is necessary to reinforce the agreement reached in previous discussions to maintain the impact of the intervention. • Further studies are needed to find out sustainability of long term impact.

  13. “Terima Kasih”Thank you

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