MULTI-CENTER INDICATOR INTERVENTION RESEARCH ON SURGICAL PHROPHYLAXIS IN 2 HOSPITALS OF

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MULTI-CENTER INDICATOR INTERVENTION RESEARCH
ON SURGICAL PHROPHYLAXIS IN 2 HOSPITALS OF
CHINA

Wang Qing
Wang Yuqin
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BACKGROUND

• Self-medication, polypharmacy, overuse of
  antibiotics and injections are easy to be
  ovserved.
• Data from national pharmaceutical situation
  survey in 2001 The percentage of antibiotic
  use47.82
• The percentage of injection use 35.13
• In the treatment of nonpneumonia-acute
  respiratory tract infection in outpatients among
  26 hospitals
• The percentage of antibiotic use 83.5, and
  only 16.5 are the proper handling cases.

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BACKGROUND

• The problems of antibiotics used during
  perisurgical period
• Incorrect indication for prophylactic use
• Selection of an inappropriate antibiotic or
  dosage
• Initiation of antibiotic therapy several days
  before surgery without sign of infection
• Continuation of therapy for an incorrect length
  of time.

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BACKGROUND

• RDU has not been an important indicator for
  health unit evaluation now, and also it is still
  not the key component of national drug policy.
• National treatment guidelines are not available
  for Chinese doctors to follow up.
• It is common that 50 of hospital revenues from
  the sale of drugs in China, which may lead to
  physicians prescribing greater numbers of drugs
  and more expensive drugs.
• Independent information is not easy to access for
  Chinese people. Knowledge on RDU is not enough
  for doctors and consumers.
• The work of PRDU in China was initiated 20 years
  ago, but all of the researches are separately and
  no comparison, the methodology applied was not
  consistent.

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OBJECTIVES

• To formulate agreed prophylaxis guidelines,
  to cut down inappropriate use and decrease costs.
• To explore an objective and scientific
  evaluation and research method to promote the
  work of RDU in China.

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METHODS

• Two third level general hospitals were
  selected and separated into intervention hospital
  and control hospital.
• Intervention was given to the intervention
  hospital from February 2001 to August 2001, and
  the comparison research was carried out during
  the same period of inpatient surgical cases of
  thyroidectomy, mastectomy, cholecystectomy, and
  hysteromyomectomy appendix from 2000 to 2002.

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INTERVENTIONS

• Education Training, printed educational
  materials and face-to-face educational methods
  are used to different educational targets.
• To doctors and pharmacists
• The antibiotic prophylaxis guideline was
  formulated and discussed by experts and doctors
  from different departments of intervention
  hospital. The process of soliciting suggestions
  from clinical departments was treated as an
  important part of guideline development.
• Several RDU workshops and seminars were conducted
  to introduce the RDU knowledge at the beginning
  and during the research.
• Printed RDU materials. For example, "Why and what
  is the rational drug use?", "The situation of
  irrational drug use on antibiotics", "The
  guideline of antibiotics use", "Rational use of
  antibiotics", etc.
• Several sets of reference books were disseminated
  to every related department of intervention
  hospital.
• To administrators of hospital
• The administrators were moved and affected by
  attending PRDU semiars and many times of face to
  face reports. Their understanding, supporting and
  assisting is one of the key factors for the
  success of the research.

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INTERVENTIONS

• Management formulated the standard and inspected
  regularly
• The formulation of the standard treatment
  guideline
• Regular meeting of intervention hospital. All
  members of the study team have meetings at least
  two times one month. And for the core
  investigators, there was at least one short
  meeting one week.
• Monitor in intervention hospital was appointed to
  do the inspection.
• Two monitors in intervention hospital were
  appointed to do the daily inspection. Whenever
  the problem happened, the monitor would report to
  the director of the department, and the director
  of the department would discuss or communicate
  with the doctor or pharmacist in the department
  to handle the problem.

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Results
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General information for intervention and control
hospital
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RESULTS
1. Rationality comparison for antibiotic
prophylaxis use
Note plt0.01
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RESULTS

• 2. Rationality comparison for antibiotic
  prophylaxis use in intervention hospital

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RESULTS
3. Irrational antibiotic use analysis in
intervention hospital
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RESULTS
4. Comparison of average antibiotic cost in 2000,
2001 and 2002
Variation rate 52.4
Variation rate 37.1
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5. Average Hysteromyomectomy operation cost in
13 hospitals of Beijing from 2000 to 2002
RESULTS
6.0
17.2
24.5
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CONCLUSIONS

• By including surgeons in formulating
  evidenced-based prophylaxis guidelines, carrying
  out small group training and actively monitoring
  compliance, it is possible to make significant
  improvements in practice.
• But the study also showed that promoting rational
  drug use is a long-term task. National treatment
  guidelines should be formulated and more
  researches and interventions should be
  implemented to make a more rational drug use
  environment.

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SOME THOUGHTS

• Why this research can be successful?
• What lessons we got from this research?
• What are the implications for implementing
  policies and programs to improve use of
  medicines?
• What can we do in the future?
• Welcome more communication, more cooperation!

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THANK YOU FOR YOUR ATTENTION!

• SHANGHAI, CHINA