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1、Putting theory into practice:Lessons learned from Antibiotics Smart Use ProgramNithima Sumpradit,Ph.D.1,2 Kanyada Anuwong,Ph.D.3 Pisonthi Chongtrakul,MD.4 Somying Pumthong,Ph.D.31.International Health Policy Program,Ministry of Public Health,Thailand2.Food and Drug Administration,Ministry of Public
2、Health,Thailand3.Faculty of Pharmacy,Srinakarintharawiroj University,Thailand4.Faculty of Medicine,Chulalongkorn University,ThailandThe 4th National Health Research Forum to Promote the Health Research Systems Strengthening in Lao PDROctober 8,2010Shared issues:.To create societal change on rational
3、 use of medicines,we need to find a common area that everybody can work together.Antibiotic resistance&Global warming Picture source:Similarities:Burning issue but well-tolerated(no sense of urgency)Everybodys matters Effects on mankindDifference:Unlike the global warming,antibiotic resistance is no
4、t well-recognized among outsiders.Antibiotics profile,ThailandAnti-infective drugs(including antibiotics)are the top value for being imported and manufactured since 2000.In 2007,this drug group was accounted for approximately 20,000 m.baht(625 m.US$)or 20%of all medicine values.Drug groupValues(mill
5、ion baht)Anti-infective drugs20,094Alimentary tract and metabolism 15,747Central nervous system13,719Cardiovascular system9,909Source:Drug Control Division,Food and Drug Administration,Thailand(2007).Antibiotic resistance crisisSource:In Thailand,Acinetobacter baumannii resistance to Cabapenam incre
6、ases from 2.1%in 1998 to 61%in 2010.We cannot outrun bacteria.So,we must stop creating selective pressure on them.unnecessary use of antibioticsSTOPBacteria/MicrobesPicture source:Purposes of ASU1.To reduce unnecessary antibiotic use in three common diseases:Upper Respiratory Infection(URI)cold with
7、 sore throatAcute diarrhea e.g.,food poisoningSimple woundInclusion criteria:OPD patients,2 years and older with overall good health.Exclusion criteria:IPD patients,patients who are seriously ill or diabetic,or people with low or compromised immune system.2.To create the decentralized,collaborative
8、networks between national and local stakeholders.-Well-accepted national policy on antibiotics-Social normsConceptual frameworkVersiom June 19,2010/Nithima SumpraditPatientsQuality of life Prescribing behavior Hospital/healthcare setting context IntentionKnowledge,perception&attitude toward disease&
9、antibioticsSubjective norm,perception of patients expectationEnabling factorsHospital formulary,Medical devicesPerceived behavioral control&Self-efficacyHospital networking context Community context National context Indicator 1:Knowledge,attitude,self-efficacy,and intentionIndicator 3:Percent of tar
10、geted patients who were not prescribed with antibioticsIndicator 4:Patients knowledge,perceived health and satisfactionReinforcing factorsDirective policyFinancial incentives Predisposing factorsCostIndicator 2:Amount of antibiotics being prescribedASU Conceptual frameworkBased on:PRECEDE-PROCEED pl
11、anning modelTheory of Planned BehaviorSocial Cognitive Theory Intervention implementationASU is a voluntary program with an incentive policy support from NHSO.10 good reasons to join ASULocal healthcare team(LHT)in each province or setting plans their own ASU project and can name their own project(s
12、ense of ownership).LHT can request support from the ASU program e.g.,materials,speakers and technical support.Example of materials to be shown.LHT implements the program.Activities are for example:Training or group discussionHerbal medicine substitutionLocal/Provincial policyPositive competition/Cam
13、paignReminder(e.g.,salary pay slip)etc.The ASU program monitor progress from LHT and provide support to LHT.All supportive materials can be download fromIndicator 3:Percent of targeted patients who did not receive ABO(Goal:20%increase)45.574.644.242.3Intervention,N 8,099 Control,N 5,865Sample:Two co
14、mmunity hospitals and 4 primary health centers from an intervention province and the control provinceData analysis:Chi-square(before-after)(MayOct 07 vs.Dec 07May 08)Source:Kunyada Anuwong&Somying PumtongEffects on prescribing behavior%of patients not receiving antibioticsIndicator 2:Change in antib
15、iotics use (Goal:10%reduction)Data collection:Before(Dec 06Oct 07)vs.After(Dec 07Oct 08)Sample:All 10 community hospitals and 87 primary health centers in Saraburi(RR=50%)Source:Kunyada Anuwong&Somying PumtongAmount of ABO(Capsules/Tablets)-39%-18%-46%-23%Amount of ABO(Bottles)Result:antibiotics red
16、uction is accounted for approximately 34,000 US$/yearIndication 4:Patients perception of health status and satisfaction despite no antibiotics prescription(Goal:70%)Source:Kunyada Anuwong&Somying PumtongData collection:Telephone interviews targeted patients after their hospital visit for 7-10 daysSa
17、mple:3 settings(N=2,286):Sarabuti province(n=1,200),Samutsongkarn province(n=151),Srivichai private hospital(n=917)Almost all patients(97.1%,96%and 99.3%,respectively)were fully recovered or felt better.Over 80-90%were satisfied with medical services and treatment outcome and intended to return to t
18、his healthcare setting for the next medical visit.Effects on patients health and satisfactionConclusionPurpose 1:Reduction of antibiotics useBased on a theoretically-guided,multifaceted interventions,ASU is successful in changing antibiotic prescribing behavior.Purpose 2:Developing decentralized,col
19、laborative network between national and local stakeholdersAt the end of 2nd year,more than 10,000 people/health professionals was trained and involved in this programSome local teams start to apply the ASU framework to irrational use of other medicines e.g.,NSAIDs Local materials and media were init
20、iated.Strengthening research capacity of local teams via their own ASU program(22 local projects on ASU in 2010)International collaboration opportunity e.g.,exchange program and joined project Saraburi province team“R2R Outstanding Award”Ayutthaya province team“Excellence Poster Award”Strengths and
21、limitationsStrengths:Characteristics of the program ASU concept is not complex and it is part of their routine workRelatively advantage e.g.,cost savingCompatible with health professionals values e.g.,patient safetyObservable outcomes e.g.,patients recoveryMultisectoral partnersSupportive mechanism
22、for local healthcare teams Autonomy“decentralization sense of ownership”Limitations:Limited resourcesResistance to changeApplication to big hospitals or private healthcare settingThank you for your attention.Thank you for ASU partners and network.Thai Food and Drug AdministrationWorld Health Organiz
23、ation Health Systems Research InstitutionNational Health Security OfficeDrug System Monitoring and Development CenterFaculty of Medicine at Chulalongkorn University,Konkean University and Thammasart University Faculty of Pharmacy at Srinakarintharawiroj University,Chulalongkorn University,Maha Sarakram UniversityHealth professionals and participants inSaraburi,Ayutthaya,Samutsongkhram and Ubonratchathani Kantang community hospital network Srivichai private hospital networkmany other provinces and settingsInternational Health Policy Program,Thailand