Evaluating International Drug and Therapeutics Committees Courses in the Developing World Chalker, Holloway and Green

Evaluating International Drug and Therapeutics Committees courses in the Developing World John Chalker, Kathy Holloway and Terry Green Rational Pharmaceutical Management Plus Management Sciences for Health and World Health Organization March 2004 RPM Plus is supported by the U.S. Agency for International Development

What is a DTC? Drug & Therapeutics Committees The committee designated to ensure the safe & effective use of medicines in health facilities develops policies for managing drug use, administers and manages the formulary system, evaluates the clinical use of drugs. DTCs are important because there is widespread inappropriate use of medicines Polypharmacy, antibiotic overuse, injection overuse and non-sterile injections, non-compliance with guidelines… leading to increased antimicrobial resistance, spread of hepatitis B/C & HIV, waste of resources, increased adverse drug reactions and poor patient outcome

Objective of the MSH/WHO DTC Project To promote effective DTCs in the developing world To design, field test, implement and evaluate an interactive course to promote DTCs

Interventions during 2000-3 DTC training materials were developed by MSH and WHO and field tested in Thailand. 4 international and 8 national courses conducted in Asia, Africa, Latin America, E.Europe. During the course participants designed work plans for the coming year. Accompanying DTC manual developed by WHO and MSH and published in 2004

Evaluation and Promotion of effectiveness Because purely educational interventions are not effective to promote sustainable behaviour change: A DTC web site was set up to post work plans and monitor progress. E-mail follow-up of participants progress was undertaken A follow-up workshop was held for most active participants

Evaluative methods – the ideal To assess the effectiveness of DTCs a time series or a randomly selected control group of hospitals Using predetermined and easy to gather indicators of behaviour change

Obstacles to the ideal DTCs are ongoing multifunctional institutional committees Relevant DTC activity varies with each institution. So no universal indicators Process’s fairly easy to measure remotely but outcomes much harder.

Training results 361 people trained from 56 countries 87 (24%)responded to follow-up e-mail request 57 (16%) participants had undertaken 159 DTC related activities 24 (7%) participants from 10 countries attended the follow-up workshop for active participants

Most of these results were process oriented 29 training courses organized by DTC participants 72 DTCs in 14 countries created/restructured 9 new drug selection processes in 6 countries STGs developed in 12 institutions in 6 countries 7 DUEs undertaken in 4 countries 8 ABC/VEN analyses undertaken in 5 countries 7 ADR reporting systems developed in 5 countries 8 training programmes on rational use of drugs in 6 countries

The Web site and E-mail follow-up To set up and maintain the Web site was expensive although less expensive than employing face to face consultants The majority of participants did not have easy web access - so not greatly used Most had access to e-mail MSH sent approximately 950 e-mails in 18 months taking about 180 hours

Follow-up Workshop A follow-up workshop was held for the most active participants in Africa Presentation of DTC activities Problems identified for establishing and maintaining a DTC Solutions developed for implementing effective DTCs Workplans developed for future activities

Conclusions: Key Lessons Difficult to follow-up international courses: needs time and resources Increased follow-up support increased the productivity of many DTC course participants Not everyone responds to web based or e-mail follow-up. Face to face follow-up would have been much more expensive

Conclusions: Key Lessons-2 Evaluation, assessment and follow-up are all part of the effort to improve effectiveness Most evaluation was “process” evaluation. We gained very little data on outcomes (drug use actually changed, etc) Maybe if we had funded specific projects we could have determined specific results.

Future Research Most productive next steps Rigorous evaluation of the impact of DTCs on drug use and costs saved from improved use Most productive next steps Institute country programs where the training is only one facet of the program. Local institutions or programs to follow-up, supervise and evaluate ongoing activity This would need resources and probably support from international organisations.