?????????????????????? (Action Research): ???????????????????????????????????????????????? Antibiotics Smart Use

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?????????????????????? (Action Research)
????????????????????????????????????????????????
Antibiotics Smart Use

• ??.??. ?????? ????????????
• ??????????? ????????????????????????????
• 18 ??????? 2551

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?????????????????????

• ????????????????????????????????????? (Action
  research) ??????????????????????????????????
• ?????????????????????????????????????????????????
  ????????????????????????? Antibiotics Smart Use

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?????????????????????? (Action Research AR)

• Learning by doing
• It represents a more sophisticated development of
  this basic trial and error model of learning

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????????????????????????????????????

• ??????????????????????????????????????????????????
  ??
• ???????????????????????????????????????????????
  ??????????????????????? ??????????????????????????
  ?????????? ?????????????????
• ???????????????????????????????????
  ????????????????????????????????????
• ??????????????????????????????????????????????????
  ??????????? (Turning people involved into
  researchers)
• ???????????????????????????? (????
  ???????????????????) ?????????????????? ??????
  (???? ??????????????????????)
• ??????????? 2 ??? (Dual outcomes) ???
  ????????????????? ????????????????????????????????
  ?????? (reflective thinking) ???????? new
  knowledge ???????????????????????????????????????
  (cycle) ?????

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Action research process

• Plan ? Identifying a problem and considering
  alternative courses of action
• Act ? Selecting a course of action
• Observe ? Studying consequences of the action
• Reflect ? Identifying new knowledge to adjust or
  revisit the plan in the next cycle

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?????????????????? Antibiotics Smart Use

• Original plan ? ??????????????????????????????????
  ?????????? (??????????????????????????????????
  ??. ??????????????)
• 1st meeting ?????????????. ??????????
  ?????????????!
• 2nd meeting ???????????!
• --- Reflective thinking ---
• New plan ? outreach training program (on-site
  visit ?????????????????????)

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???????????????????????????????

• Technical action research
• Practical action research
• Participatory action research

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???????????????????????????????????Participatory
action research

• ??????????????????????????????????????????????????
  ????? ?????????????????????????????
  ????????????????? ???????????????????????????????
  ?????????????????????
• ??????????????????????????????????????????????????
  ?????????? ?????????????????????????????????????
  ????????????????????????????? ????????????????????
  ???????

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??????????????????????????

• 1) ?????????????????? (Pre-research Phase)
• 1.1) ????????????????????????????
• 1.2) ???????? ??????????
• 1.3) ????????????? (Selecting Community)
• 1.4) ??????????????? (Entering Community)
• 1.5) ??????????????????????????????????
• 2) ?????????????????? (Research Phase)
• 2.1) ?????????????????????????????? (Problem
  Identification and Diagnosis)
• 2.2) ??????????????????????????????????????????
  ?????
• 2.3) ?????????????????????????????????
  (Planning Phase)
• 2.4) ???????????????????? (Implementation
  Phase)
• 3) ???????????????????????????????? (Monitoring
  and Evaluation Phase)

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The rational use of drugs requires that patients
receive medications appropriate to their clinical
needs, in doses that meet their own individual
requirements for an adequate period of time, and
at the lowest cost to them and their
community. WHO conference of
experts Nairobi 1985

• Dimensions of RUD
• Appropriate indication ? ?????????????????????????
  ?
• Correct drug
• Appropriate drug (efficacy, safety, suitability
  for the patient, and cost)
• Appropriate dosage, administration, duration
• No contraindications
• Correct dispensing, appropriate information for
  patients
• Patient adherence to treatment

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The first principle for patient care is
Do No Harm Antibiotics are not safe medicines!
????????????
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Overuse of antibiotics occurs everyday

• ????????????????????????????? (Acute upper
  respiratory tract infection)
• 80 viral infection ? need no ABO
• ????? URI ?? 10 ?? ????????????????? 2 ??
• ?????????????????? ?????????-??????
• ???????????????????????????????????????????
  40-60
• ?? ???. ?????????????????????????????? 70-80
• ????????????????????????????????
• ??????-??????????????????????????????????????????

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Overuse of antibiotics occurs everyday

• ???????????????????? (Acute diarrhea)
  ???????????? ABO
• 80 ??????? viral infection ???? ????????????
• ???????????????????? ABO ?????????????????????????
  ? (39c) ???????????????????
• ????? acute diarrhea ?? 10 ?? ????????????????? 2
  ??

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Acute diarrhea treatment
Source WHO/PSM database, 2004.
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Overuse of antibiotics occurs everyday

• ???????? (Simple wound)
• Dicloxacillins / Cloxacillin
• ?? 10 ?? ???? 0 ??

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???????????????????????????

• URI ?? 10 ???? 2
• Acute diarrhea ?? 10 ???? 2
• Simple wound ?? 10 ???? 0

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• Evaluation (Indicators)
• Amount of antibiotics use REDUCED.
• Ratio Non-ABO ABO patients INCREASED.
• Patients satisfaction on TX outcome IS HIGH.
• Knowledge Attitude Self-efficacy IS BETTER.

Problem identification unnecessary use of ABO
(or use without proper indications)
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??????? 3 ??????????????

• ???????????????????? (Conceptualization)
• ????????????????? (Method, Research design)
• ???????????? (Analysis)

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1. ???????????????????? (Conceptualization)

• ???????? ????? ????????????????????????????
• ??????? ?????????????????? ?????????????
  ???????????????????????
• ??????????????????????? (Common pitfall) ???
  ???????????????????????????????????
• Grounded theory ?
• ?? action research ??????????????????????? 2
  ?????? ??????????????????????
• ????????????????????????????????????? ?
  ?????????????????????? ???? ????????????????????
  Health Belief Model, Theory of Planned Behavior
  ???????
• ???????????????????????????? ? ??????????????????
  ?????????????????????? ???? The Precede-Proceed
  Planning Model, Social Marketing of Health,
  Ecological framework ???????

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The Precede-Proceed Planning Model
PRECEDE
Step 2Epidemiological assessment
Step 1Social assessment
Step 5Administrative and policy assessment
Step 4 Educational and ecological assessment
Step 3Behavioral and environmental assessment
Predisposingfactors
Health promotion
Healtheducation
Reinforcingfactors
Behavior and lifestyle
Health
Quality of life
Policy regulation organization
Enabling factors
Environment
Step 6Implementation
Step 7Process evaluation
Step 8Impact evaluation
Step 9Outcome evaluation
PROCEED
Source Green Krenter, 1999
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PRECEDE
Step 2Epidemiological assessment
Step 1Social assessment
Step 5Administrative and policy assessment
Step 4 Educational ecological assessment
Step 3Behavioral and environmental assessment
??????? ????????? ??????? etc.
???????????????? ???? ??????????????????? ????
???????????????????????????? ??????????

• ???????????????????
• ???????? ?????????????????
• ??????????????????????????
• ????????
• ????????????????????????
• ??????????????????

• ???????????????????? ABO ?? 3 ???????????

Predisposingfactors
Health promotion
Healtheducation
Reinforcingfactors
Behavior and lifestyle
Health
Quality of life
??????? ??????????????
Policy regulation organization
Enabling factors
Environment
Step 6Implementation
Step 7Process evaluation
Step 8Impact evaluation
Step 9Outcome evaluation
PROCEED
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PRECEDE
Step 2Epidemiological assessment
Step 1Social assessment
Step 5Administrative and policy assessment
Step 4 Educational ecological assessment
Step 3Behavioral and environmental assessment
??????? ????????? ??????? etc.
???????????????? ???? ??????????????????? ????
???????????????????????????? ??????????

• ???????????????????
• ???????? ?????????????????
• ??????????????????????????
• ????????
• ????????????????????????
• ??????????????????

• ???????????????????? ABO ?? 3 ???????????

Predisposingfactors
Health promotion
Healtheducation
Reinforcingfactors
Behavior and lifestyle
Health
Quality of life
??????? ??????????????
Policy regulation organization
Enabling factors
Environment

• ????????????????? ??????????????????????
• ???????? ABO
• ?????????????? ABO

• ?????????????????? vs.
• ??????????? ABO
• ?????????????? ABO

• ??????? ????????????? ?????????? ????????????
• ?????????? ?????????????

Step 6Implementation
Step 7Process evaluation
Step 8Impact evaluation
Step 9Outcome evaluation
PROCEED
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2. ????????????????? (Method, Research design)

• Action research ??????????????????????????????????
  ?????????????????? (?????????????????????????????)
  
• ??????? Antibiotics Smart Use ?????????? ???????
  Quasi-experimental research design with a control
  group
• ????????????????????????????????????????????
  (interventions)
• ????????? interventions ???????????????????
  ???????????????? ????????????????????????

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Media for health professionals
Media for patients
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3. ???????????????????????????? (Analysis
Synthesis)

• ???????????????????????????????????????
• ?????????? vs. ??????????
• ??????????????????????????????????????????????????
  ???
• Key success factors etc.

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???????????? Antibiotics Smart Use

• ??????????????
• (1) ?????????????????????????????????????????????
  ????????????????????????????????????? 30 - 77
• (2) ?????????????????????????????????????????????
  ??????????????????????????????????????????? 20-40
  
• (3) ???????????????????????????????????????????
  ????????? ??????? ????????????????????????????????
  ?????????????????????????????????????
• (4) ??????????????????????????????????????? 97
  ???????????????????????????? ?????????????
  90-??????????????????????????

• Reflective thinking
• ?????????? ???????????? ????????????????????????
  ???? ???
• ??????????????????????????????????????????????????
  ?????????????????
• ??????????????????????????????????? (Change
  agents effort)
• ????????????????????????? (Will power)
  ?????????????????????????????????
• ??????????
• ??????????????????????????????????????????????????
  ??????????????????????? ??????????????????????????
  ??????????????????????????????????????????????????
  ??????????????????????????????????????????????????
  ?????????????????????????????????????????

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????

• ??????? Antibiotics Smart use (????? 1 ???????
  2550 ??????? 2551)
• ??????? multifaceted interventions
  ??????????????????????????????????????????????????
  
• ??????? Antibiotics Smart Use (????? 2 ???????
  2551 ??????? 2552)
• ??????????????????????????????????????????????

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??????