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MTP experience to reduce injection overuse in Lao PDR. Dr. Amphayvanh Panyanouvong Department of Curative Medicine Ministry of Health, Lao PDR. HEALTH FACILITIES. 2 General hospitals 6 Special hospitals 5 Regional hospital 13 Provincial hospitals 126District hospitals
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MTP experience to reduce injection overuse in Lao PDR Dr. Amphayvanh Panyanouvong Department of Curative Medicine Ministry of Health, Lao PDR
HEALTH FACILITIES • 2 General hospitals • 6 Special hospitals • 5 Regional hospital • 13 Provincial hospitals • 126District hospitals • 596 Health centers
RATIONAL USE OF DRUG • 1992: National Drug Policy 1993 • 1998: Standard Treatment Guideline (FDD- CMD) • 1999: Setting up Drug & Therapeutic Committee (DTC) in 7 central and provincial hospitals, designing & implementation of DTC indicators • 2001: Introduction & implementation of MTP strategy to be used by DTC to improve rational use of drugs in other 5 provincial hospitals
DTC activities in 5 hospitals • Focus on RUD, STG and Drug Consumption • Set up DTC indicators • Collect DTC indicators and feedback to prescribers
Problems with DTC indicators • Lots of efforts (time, energy, money) from MOH to conduct activities • Hospital teams are too dependent to MOH • Activity is not sustainable: no “project” (no funding), no activity • Need to encourage hospital to improve prescribing by themselves 2001: FDD-CMD-University work together to introduce MTP strategy to be used by DTCs as a tool to improve drug use
MTP strategy • Monitoring – Training - Planning • A serial of small group discussions in hospital, involving hospital DTC members and the prescribers who have problems in a particular drug use • Each serial discussion focuses on ONE problem (e.g. high injection use) • Monitoring: collect data by themselves (e.g. % patients receiving injection) • Training: solve the problem (why it is high and what to do to reduce it) • Planning: Setting up the target, i.e., to what level they have to reduce and when they should collect the data again, too see if they are approaching the target
MTP is a continuous activity • 3-4 cycles for each problem P P P P P T T T T T M M M M M MTP meeting MTP cycle
1st Workshop: 8 PHs 2nd Workshop: 8 PHs + 23 DHs Workshop in Central Hospital Sep 2001 May-Aug 2002 May 2001 MTP - implementation • Started in May 2001 by FDD in collaboration with CMD and Faculty of Medicine (supported by WHO)
MTP Action plans in Lao PDR • Overuse of AB in malaria treatment • Overuse of AB in pediatric ARI • Overuse of AB in pediatric diarrhea • Overuse of IV fluids in emergency department • Overuse of injection in adult malaria treatment • Incorrect use of AB in pneumonia • Etc.
MTP experience - Bokeo • Bokeo provincial hospital: 100 beds • Baseline DTC data: inappropriate use of IV fluids in emergency department (78% ) • MTP was set up in July, 2001: MTP plans to reduce to 25-30% • 5 MTP meetings were held
Fig 4. Bokeo hospital % patient receiving iv fluids
MTP experience - Xayabury • Xayabury provincial hospital: 100 beds • Baseline DTC data: overuse of injection in malaria treatment (96% ) • MTP was set up in September 2001 at internal medicine ward: MTP plans to reduce injection use to 30% • 3 MTP meetings were held
Fig 4. Xayabury hospital % patient receiving injection for malaria
WORK PLAN • DTC will be set up in all provincial hospital in the year 2002 • DTC workshop will be held in 5 provincial hospital (supported by Sida) • Conducting DTC & MTP monitoring & supervision at all hospital (central, regional and provincial) • Implementation of MTP in other district hospitals will request support from WHO