1. 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

2. 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

3. 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?

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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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