MTP Approach to Reduce Inappropriate Use of Antibiotics in Hospitals: Results of the Field Test Suryawati S, Setiyawati E, Saleh-Danu S, Rustamaji A, Santoso B Center for Clinical Pharmacology and Medicine Policy Studies Gadjah Mada University, Yogyakarta

Background Inappropriate prescribing practices in health facilities Intervention to improve prescribing is uneasy to conduct, especially in private health facilities Needs of self-initiative, self-conduct, self-assessment, self-decision making Interventions needs to be incorporated in the existing management system

Indicator-based monitoring strategy Self-monitoring approach to improve drug use practices (Sunartono & Darminto, 1996) MTP (Monitoring - Training -Planning) approach to improve efficiency in drug management (MSH, 1998) MTP to improve drug use practices?

Objectives To measure the effectiveness and usefulness of indicator-based MTP to improve prescribing practices: general teaching hospitals private hospitals public hospitals

Problem solving & scientific/reality testing What is MTP? 80% 20% Setting the target of improvement Description of the recent situation Problem solving & scientific/reality testing Reflection of previous experience P M T Monitoring - Training - Planning Adult learning process

Flow of MTP activities 3-4 cycles for each problem Simultaneous or parallel activities P P P P P T T T T T M M M M M MTP cycle MTP meeting

Drug use problems Site of intervention - Operation theatre - Operation theatre - Ped & Internal OPDs - Operation theatre - General OPD - General OPD Priority problem - Overuse of ABs in hernia surgery - Overuse of ABs in scrotal hernia surg. - Overuse of ABs in acute diarrhea - Overuse of ABs in Caesarian surgery - Overuse of ABs in ARI - Overuse of ABs in diarrhea Health facility Teaching Hospital: - Sardjito - Karyadi Public Hospital: - Sleman - Yogya Private Hospital: - Panti Rapih - PKU

MTP at General Teaching Hospitals Result 1: MTP at General Teaching Hospitals Problem: Pre- and post surgery ABs in elective hernia surgery Indicator: % patients receiving antibiotics This is where a large graphic or chart can go. Revision of STG Sardjito Teaching Hospital Karyadi Teaching Hospital

MTP at Public Hospitals Result 2: MTP at Public Hospitals Problem: - Overuse of AB in acute diarrhea (Sleman) - Pre- and post-surgery ABs in Caesarian surgery (Yogya) Indicator: - % patients receiving antibiotics Discussion on STG and diagnosis Sleman District Hospital Yogya District Hospital

MTP at Private Hospitals Result 3: MTP at Private Hospitals Problem: - Overuse of antibiotics in acute respiratory tract infections - Overuse of antibiotics in acute diarrhea Indicator: - % patients receiving antibiotics Impact of data collection? Clinicians refused the data Panti Rapih Hospital PKU Hospital

Hospitals’ comments on MTP approach Flexible approach, not time-consuming, not costly A comprehensive approach, a combination of adult learning and managerial strategies Encourage DTC to initiate activities Encourage internal experts to contribute Involved stakeholders in hospital Good approach for sensitive issues, the “negative impacts” of promoting rational drug use can be discussed internally

Lessons learnt Factors of success: Self-initiated and self-planned: idea for improvements was developed and decided within the group Self-executed and self evaluated: empowerment of internal actors Comprehensive approach: educational & managerial MTP can be conducted at low cost, using the existing mechanism and routine meetings in hospitals MTP is promising for use in groups with high resistance