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Development of Drug and Therapeutic Committees in Moldova

This article discusses the history and establishment of Drug and Therapeutic Committees (DTC) in Moldova, highlighting the challenges faced by hospital drug committees and the interventions taken to improve rational drug use. The implications, key lessons, and future activities of the DTCs are also discussed.

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Development of Drug and Therapeutic Committees in Moldova

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  1. Drug and Therapeutics Committeesin Moldova Cebotarenco N, Veltman K, Tchebotarenco S, Shetinina S

  2. Drug Therapeutic Committees in Moldova • History of the DTC Development. • In 1998 –MSH and the USP initiated the process of establishing a new system of medicines management in hospitals in Moldova. • 1999 – the first DTCs were established in five hospitals after participation in the workshop. • 2002 - June–July training of trainers regional workshop and DTC training course conducted by RPM Plus, WHO, AIHA and USP. • 2002-2004 seven local follow-up workshops were held in rural hospitals for 18 DTCs in Moldova.

  3. Drug Therapeutic Committees in Moldova • Ministry of Health adopted the official regulation about the establishment of DTC in each district hospital of Moldova in Mart 2002. • But the official regulation has not been accepted by district level hospitals in Moldova. • Impressive improvements in establishing DTC has been achieved after conducting the training for all potential DTC members in the hospitals at the local level.

  4. Drug Therapeutic Committees in Moldova • Before the intervention, hospital drug comities faced challenges: • lack of knowledge of the Essential Drug Concept • Three different obligatory lists of drugs at the national level • Essential Drug List • National Formulary • Standard Treatment Guidelines Drug List • Lack of independent drug information • Lack of both computers and access to internet in hospitals • Lack of computer skills

  5. Methods • Educational methods for improving rational drug use • Trainings at the hospital level • “MEDEX” – independent drug bulletin distribution • Antibiotic rational use and AMR surveillance • Patient education: face to face discussion, small survey, structured questionnaires design • Computers skills training • Managerial methods • Standard treatment guidelines and Hospitals’ Formulary issue including drug selection. • ABC/VEN analyses conducting • Evaluation of antibiotic consumption

  6. Intervention: • Training intervention approach • Eight-day basic training program divided by workshops of two or three days each. • Each session consists of lessons, case studies, discussion, group work, and role-play • ABC/VEN analysis of drug procurement – is one of the effective tool for the identifying the most costly and inefficient medicines in the hospital.

  7. Project Implications • Moldavian DTCs that past trainings have kit of necessary documents due to participation in the training program, receiving newsletter “MEDEX” and other translated information. • Due the training members of DTCs got knowledge on generic and brands names of medicines and include the generic name in the Formulary only.

  8. Project Implications • DTCs develop and revise the STG based on treatment of choice and local economic situation. • According the monitoring of Ministry of Health and National Institute of Pharmacy the DTCs that received training function much better than other DTCs. • The DTC Network was established In December 2003 by the initiative of DTCs

  9. Key Lessons: • Training intervention approach • The qualitative methods such as Focus Group Discussion with patients and health care workers, questionnaire design, interview – were the most complicate methods for DTC members. • The initial training program, follow-up workshops, monitoring and support of DTC activities are effective methods for ensure sustainability of DTC work and improving RDU at the hospital level.

  10. Key Lessons: • DTCs can play active role in improving public health if its members are equipped with knowledge and practical tools • Small survey made by DTC members themselves is the most effective educational method for the improvement of RDU

  11. DTC group work

  12. The percentage of microbiological testing in Bricheni hospital

  13. Conclusion: • To be effective the National drug policy should penetrate in all levels of public health system, to create the real conditions of collaboration between Ministry of Health and district hospitals. • DTC is one of the key elements of effective national drugs policy that implements its activities into practice and plays an important role in promoting rational drug use in public health care system.

  14. Future activities • The Medical and Pharmacy University of Moldova issues three years clinical pharmacist specialist but no one of them works in hospitals system. • It is necessary initiated the strategy on raising the role of the clinical pharmacist in the hospital and include him (her) in the DTC.

  15. Future activities • Training needed: • WHO indicators for the DTC work evaluation • Pharmacoeconomics • Short and Long- term planning activities • Good Governance for the Network activity

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