2. 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

3. 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%

4. 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

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

6. 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

7. 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.

8. Apr May Jun Jul Aug Sep Oct Nop Des
THE RESEARCH ACTIVITY
This Study
Feedback 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

9. 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

10. % 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%

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

12. 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

13. Sleman District
THANK YOU