1. Kandeke C, Chibuta C, Banda D
Impact of Medicine Management and Rational Use Workshop on Antimicrobial Drug Use in five Hospitals – Eastern Province, Zambia
Kandeke C, Chibuta C, Banda D
Churches Health Association of Zambia, , P.O. Box 34511, Lusaka, Zambia
2. Background and setting
The Churches Health Association of Zambia (CHAZ) is
an interdenominational non-governmental umbrella
organisation of the 116 church health administered
health institutions in Zambia. It is responsible for 30% of
national and 50% of rural health care in Zambia.
CHAZ has been involved in supporting member
institutions in drug supply management and promoting
appropriate use for over ten years. In all these CHAZ has
been involved in training activities, concerns have
always been raised on the use of antimicrobial agents
for in patients. Out patient drug use indicator studies by
various groups estimate that 80% of outpatient
prescriptions have at least one antimicrobial agent
prescribed (Chileshe et al 1998, O.Hazemba 1999).
However, no studies have been conducted in Zambia to
look at antimicrobial use for in patients.
The Churches Health Association of Zambia (CHAZ)
decided to conduct a study on in patient antimicrobial
use in five hospitals in the Eastern Province of Zambia.
This was done following reports of high drug
consumptions and increased drug expenditures in
mission hospitals due to inappropriate use . To compare
how mission hospitals were using AMDs one
government district hospital was included in the study.
The hospitals are located in rural and semi-urban areas
of the province.
1. Abstract ID: 192
Author Name: Kandeke C
Presenter Name: Kandeke C
Authors: Kandeke C, Chibuta C, Banda D
Institution: Churches Health Association of Zambia
Title: Impact of Medicine Management and Rational Use Workshop on Use of Antimicrobial Drugs in Five Hospitals in the Eastern Province, Zambia
Abstract:
Problem Statement: Antimicrobial drugs (AMDs) are the most frequently prescribed therapeutic agents in Zambia. Antimicrobial agents account for 50% to 80% of drug prescriptions. Stock outs may jeopardize lives as they are necessary for the treatment of most bacterial infections; inappropriate use can lead to the development of resistance, adverse drug reactions, and waste of scarce resources.
Objectives: To describe antimicrobial drug prescribing practices in five hospitals (four church affiliated and one government in the eastern provine of Zambia; to compare antimicrobial use among the five hospitals; and to assess changes resulting from a training workshop on the use of antimicrobial drugs in the five hospitals.
Design: Before and after study with no control group was carried out in a sample of four mission and one government hospitals using some of the MSH in-patient drug use indicators.
Setting and Population: Four church and one government hospital in the Eastern Province using in-patient drug charts and case notes. One hundred in-patient records were randomly (simple random sampling) selected from each hospital during baseline and post training phases.
Intervention: A baseline study on antimicrobial use was conducted using selected Management Sciences for Health (MSH) indicators in February 2003, followed by a training workshop on antimicrobial therapy (with experiential practical exercises at a hospital and a health center) in March Participants included medical doctors, clinical officers, pharmacy technologists and nurses. A post training study was then conducted six months after the workshop.
Outcome Measures: Availability of a key set of antimicrobial drugs; average number of days out of stock; % of hospitalizations with one or more AMDs prescribed; average number of AMDs prescribed per hospitalization; % AMDs prescribed consistent with the hospital formulary list; average duration of prescribed antimicrobial treatment; % antimicrobials prescribed by generic name; % of doses of prescribed AMDs actually administered; average duration of hospital stay of patients on antimicrobial drugs; number of AMD sensitivity tests reported per hospital admission including AMD treatment.
Results: Availability of key AMDs on day of study decreased from 95% to 88.6%. Average number of days out of stock increased from 88 to 139; % hospitalisations with or more AMDs decreased from 65.7% to 62.5%; average number of AMDs prescribed per hospitalisation decreased from 1.6 to 1.5; % prescribed consistent with formulary list remained same (100%); percentage of generic AMDs prescribed increased from to 65; percentage of doses of AMDs actually administered increased from 54% to 56%; average duration of hospital stay was reduced; only one hospital admission sensitivity test was conducted.
Conclusions: Training workshop with experiential practical exercises improved use of AMDs in most hospitals. However, there were some outcomes that improved only slightly (% of doses of prescribed AMD actually administered) some were worse than the baseline in some hospitals.
Study Funding: Catholic Organization for Relief and Development (CORDAID) in conjunction with Churches Health Association of Zambia (CHAZ)
3. Study Objectives
To describe antimicrobial drug prescribing
practices in five hospitals (four church affiliated
and one government in the eastern province of
Zambia;
To compare antimicrobial use among the five
hospitals
To assess changes resulting from a training
workshop on the use of antimicrobial drugs in the
five hospitals.
4. Design
Before and after study with no control group was carried out in
a sample of four mission and one government hospitals using
some of the MSH in-patient drug use indicators.
5. Intervention
The training was designed to address problems identified in
the pre-training indicator study.
The target group was health providers involved in prescribing,
dispensing and administering antimicrobial drugs. These
included medical doctors, clinical officers, pharmacy
technologists and nurses.
The training workshop lasted five days. Training methodology
included lectures, group discussions, case studies and
experiential field visits to nearby health facilities.
Facilitators were from CHAZ secretariat and member
institutions and was comprised of a pharmacist, medical
doctor, nurse and a pharmacy technologist.
A post training study was then conducted six months after
the workshop. 31 6 28 23 31 6 64 53
8. Results
6. Data collection
Data was collected retrospectively. In both baseline and post
training studies 100 in patient drug charts for 2002 were
randomly selected and examined for outcome measures of the
study.
7. Outcome measures
1. Availability of a key set of antimicrobial drugs;
2. Average number of days out of stock;
3. Percentage of hospitalizations with one or more AMDs
prescribed;
4. Average number of AMDs prescribed per
hospitalization;
5. Percentage AMDs prescribed consistent with the hospital
formulary list;
6. Average duration of prescribed antimicrobial treatment;
7. Percentage antimicrobials prescribed by generic name;
8. Percentage of doses of prescribed AMDs actually
administered;
9. Average duration of hospital stay of patients on
Antimicrobial drugs;
1. Number of AMD sensitivity tests reported per hospital
admission including AMD treatment. .
9. Summary
Generally results show some improvement in the use of
Antimicrobial drugs in most hospitals after training
workshop. However, there were instances where some
indicators actually deteriorated. For example availability of
key antimicrobials decreased from baseline (there were
logistical problems at the Medical Stores) and others
where there was a very small improvement.
The use of laboratory for sensitivity testing was only done
in two cases at one hospital. Prescriptions for Antimicrobial
drugs were therefore written empirically.
Generally use of AMDs was better in smaller hospitals than
bigger ones.
10. Discussion
Although results show some improvement in the use of
antimicrobials after training, there could have been
other external factors other than the training that could
have affected the results. For example reduced
availability of key antimicrobials could have influenced
prescribing habits.
However, other indicators such as administration of
doses prescribed and generic prescribing could not
have been influenced by availability.
It is recommended that future studies be designed in
such a way that there are control groups. 51 37
Acknowledgements
The authors acknowledge the Catholic Organisation for Relief and
Development (CORDAID) and the Churches Health Association of Zambia
(CHAZ) for funding this study. Special thanks to Mr. Oliver
Hazemba for help with this work.