MULTI-CENTER INDICATOR INTERVENTION RESEARCH ON SURGICAL PHROPHYLAXIS IN 2 HOSPITALS OF CHINA Wang Qing Wang Yuqin

BACKGROUND Self-medication, polypharmacy, overuse of antibiotics and injections are easy to be ovserved. Data from national pharmaceutical situation survey in 2001: The percentage of antibiotic use:47.82%; The percentage of injection use: 35.13%; In the treatment of nonpneumonia-acute respiratory tract infection in outpatients among 26 hospitals: The percentage of antibiotic use: 83.5%, and only 16.5% are the proper handling cases.

BACKGROUND The problems of antibiotics used during perisurgical period: Incorrect indication for prophylactic use; Selection of an inappropriate antibiotic or dosage; Initiation of antibiotic therapy several days before surgery without sign of infection; Continuation of therapy for an incorrect length of time.

BACKGROUND RDU has not been an important indicator for health unit evaluation now, and also it is still not the key component of national drug policy. National treatment guidelines are not available for Chinese doctors to follow up. It is common that 50% of hospital revenues from the sale of drugs in China, which may lead to physicians prescribing greater numbers of drugs and more expensive drugs. Independent information is not easy to access for Chinese people. Knowledge on RDU is not enough for doctors and consumers. The work of PRDU in China was initiated 20 years ago, but all of the researches are separately and no comparison, the methodology applied was not consistent.

OBJECTIVES To formulate agreed prophylaxis guidelines, to cut down inappropriate use and decrease costs. To explore an objective and scientific evaluation and research method to promote the work of RDU in China.

METHODS Two third level general hospitals were selected and separated into intervention hospital and control hospital. Intervention was given to the intervention hospital from February 2001 to August 2001, and the comparison research was carried out during the same period of inpatient surgical cases of thyroidectomy, mastectomy, cholecystectomy, and hysteromyomectomy +appendix from 2000 to 2002.

INTERVENTIONS Education: Training, printed educational materials and face-to-face educational methods are used to different educational targets. To doctors and pharmacists: The antibiotic prophylaxis guideline was formulated and discussed by experts and doctors from different departments of intervention hospital. The process of soliciting suggestions from clinical departments was treated as an important part of guideline development. Several RDU workshops and seminars were conducted to introduce the RDU knowledge at the beginning and during the research. Printed RDU materials. For example, "Why and what is the rational drug use?", "The situation of irrational drug use on antibiotics", "The guideline of antibiotics use", "Rational use of antibiotics", etc. Several sets of reference books were disseminated to every related department of intervention hospital. To administrators of hospital The administrators were moved and affected by attending PRDU semiars and many times of face to face reports. Their understanding, supporting and assisting is one of the key factors for the success of the research.

INTERVENTIONS Management: formulated the standard and inspected regularly The formulation of the standard treatment guideline Regular meeting of intervention hospital. All members of the study team have meetings at least two times one month. And for the core investigators, there was at least one short meeting one week. Monitor in intervention hospital was appointed to do the inspection. Two monitors in intervention hospital were appointed to do the daily inspection. Whenever the problem happened, the monitor would report to the director of the department, and the director of the department would discuss or communicate with the doctor or pharmacist in the department to handle the problem.

Results

Intervention Hospital Hysteromyomectomy + Appendix General information for intervention and control hospital   Hospital/Year Intervention Hospital Control Hospital 2000 2001 2002 Total cases 118 122 121 120 Male 17 15 19 22 16 Female 101 107 102 98 104 Average age 48.36 50.22 49.2 48.32 48.68 Thyroidectomy 38 41 36 29 32 Mastectomy 10 Cholecystectomy 34 33 Hysteromyomectomy + Appendix 39

Intervention Hospital Incidence of post-surgical infection RESULTS 1. Rationality comparison for antibiotic prophylaxis use   Rationality Intervention Hospital Control Hospital 2000 2001 2002 Rational cases 37 (31.35%) 112 (91.8%)** 64 (52.88%) Irrational cases 81 (68.64%) 10 (8.2%)** 57 (47.12%) 120 (100%) Total 118 122 121 120 Incidence of post-surgical infection Note: ** p<0.01

RESULTS 2. Rationality comparison for antibiotic prophylaxis use in intervention hospital

RESULTS 3. Irrational antibiotic use analysis in intervention hospital 2000 2001 2002 Problems Times %(/181*) %(/200) %(/230) Antibiotic use after 3 days of operation 94 51.93 Incorrect administration route 8 4.00 after 3 days of operation 47 20.4 Inappropriate antibiotic use 46 25.41 5 2.50 Over dosage 45 19.6 Incorrect antibiotic use interval 40 22.09 Others 2 1.00 9 3.9 38 20.99 Incorrect drug use interval 1 0.50 7 3.0 11 6.07   Incorrect antibiotics combination 4 1.7 before 24 hours of operation 1.10 before 24 hours of 0.9

RESULTS 4. Comparison of average antibiotic cost in 2000, 2001 and 2002 Variation rate % : 52.4 Variation rate % : 37.1

RESULTS 5. Average Hysteromyomectomy operation cost in 13 hospitals of Beijing from 2000 to 2002 6.0% 17.2% 24.5%

CONCLUSIONS By including surgeons in formulating evidenced-based prophylaxis guidelines, carrying out small group training and actively monitoring compliance, it is possible to make significant improvements in practice. But the study also showed that promoting rational drug use is a long-term task. National treatment guidelines should be formulated and more researches and interventions should be implemented to make a more rational drug use environment.

SOME THOUGHTS Why this research can be successful? What lessons we got from this research? What are the implications for implementing policies and programs to improve use of medicines? What can we do in the future? Welcome more communication, more cooperation!

THANK YOU FOR YOUR ATTENTION! SHANGHAI, CHINA