THE IMPORTANCE OF FEEDBACK TO ENHANCE THE IMPACT OF EFFECTIVE INTERVENTIONS TO REDUCE ANTIBIOTIC IN ACUTE RESPIRATORY-TRACT INFECTION authors: Yudatiningsih I.1, Sunartono H.1, Suryawati S.2 1Sleman District Health Office, 2 Center for Clinical Pharmacology and Drug Policy Studies, Gadjah Mada University, Yogyakarta, Indonesia

BACKGROUND Acute respiratory-tract infection (ARI) is still a leading cause of childhood morbidity in developing countries In Indonesia, >60 % of cases in the under-five years old. The problem that related to ARI treatment is inappropriate antibiotics medications In Sleman District, percentage of antibiotics used for ARI treatment in children ever achieves 68%, while pneumonia cases are only 2%

BACKGROUND (Con’t) In 1999, Sleman district health office conducted a managerial intervention using Monitoring-Training-Planning (MTP) strategy to improve use of medicine at 31 HCs The MTP activity reduced the antibiotics use for ARI from 50% to 20%. One year after MTP, the antibiotics use was re-evaluated. The result is 34 % . Previous studies suggested that feedback is effective to enforce the impact of interventions

OBJECTIVES To evaluate whether a feedback could maintain the effect of MTP (Monitoring - Training - Planning) in reducing the use of antibiotics

DESIGN AND SAMPLE SELECTION Design : Randomised control study with parallel design Involved 12 HCs in Sleman district, which have undergone MTP in 1999 Prescribers : physician, nurse and midwife of HC 12 HCs were randomly assigned into 2 groups: The test group (6 HCs) received feedback The control group (6HCs) didn’t receive feedback Data collections : 6 month before and 6 month after feedback, 100 randomly prescriptions/ month at each HC

FEEDBACK INTERVENTION The feedback was carried out in October, 2000 by district health office staff The Prescribers were invited to feedback meeting in Sleman district health office The feedback was conducted one time, and lasted in 2 hours.

Apr May Jun Jul Aug Sep Oct Nop Des THE RESEARCH ACTIVITY This Study Feedback 6 5 4 3 2 1 1 2 3 4 5 6 6 Test Group HCs Underwent MTP 12 HCs Analysis 6 Control Group Apr May Jun Jul Aug Sep Oct Nop Des Jan Feb Mar Apr 1999 2000 2001

ANALYSIS Indicators: % patients receiving antibiotics The average number of drugs per encounter Statistical Analysis Student’s t-test for the difference of changes between groups

% of patient receiving antibiotics ANTIBIOTIC USE IN ARI TREATMENT % of patient receiving antibiotics This Study 50% Control Group 42% Average 34% Underwent MTP Test Group 20% Feedback 11%

No. drugs prescribed per patient THE NUMBER OF DRUGS PRESCRIBED OF ARI No. drugs prescribed per patient This Study Control Group Underwent MTP Average 3.5 3.7 3.4 3.2 Test Group 3.2 Feedback

CONCLUSION Feedback is proven effective to strengthen an intervention to reduce the use of antibiotics in health centers Feedback enhances the impact of even an effective intervention such as MTP Less-frequent feedback is needed for MTP

Sleman District THANK YOU