Effects of a national policy advocating rational drug use on decreases in outpatient antibiotic prescribing rates in Thailand

Waleekhachonloet, Onanong; Rattanachotphanit, Thananan; Limwattananon, Chulaporn; Thammatacharee, Noppakun; Limwattananon, Supon

doi:10.18549/10.18549/pharmpract.2021.1.2201

Cited by 3 publications

(4 citation statements)

References 15 publications

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“…In our study, the most frequently used oral antibiotics in outpatients were amoxicillin, then sulfasalazine followed by trimethoprim/sulfamethoxazole. A study in Thailand by Waleekhachonloet et al 30 examined the effects of a national policy encouraging rational antibiotic prescribing rates in OPD and found that the policy was effective in decreasing antibiotic prescription for questionable cases. The study by Hashimoto et al 31 found that outpatient antibiotic prescription in Japan were high for acute respiratory or gastrointestinal infections, for which the prescription of antibiotics is generally not indicated, but intervention should be by antimicrobial stewardship.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of rational drug use based on World Health Organization indicators in a tertiary hospital, Thailand

Khangtragool¹,

Nukompun²,

Teeyasuntranonn³

et al. 2023

Pharm Sci Asia

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This study aimed to evaluate the rational drug use in a tertiary hospital, Thailand based on World Health Organization (WHO) indicators. This retrospective study was conducted using electronic data from medical records which detailed dispensed prescriptions in the outpatient department (OPD) in a tertiary hospital, Thailand from April 2019 to March 2020. Core rational drug use was determined by the average number of drugs per prescription, percentage of drugs prescribed from the Essential Medicines List (EML) and oral antibiotic consumption using the defined daily dose (DDD). The average number of drugs per prescription in this study was 2.17. The average percentage of the drugs from the national list of essential medicines (NLEMs) in OPD was 66.52%. The DDD from April-September 2019 was 2.51 which increased to 4.61 in the period October 2019-March 2020. In conclusion, this study found the average number of drugs per prescription in outpatients was higher than WHO recommendations. The average percentage of drugs of essential drugs in our study was lower than the expected WHO value. Oral antibiotic consumption measured by DDD had increased. Therefore, policy regarding rational drug use needs to be accelerated as a policy in hospital. Irrational use of medicines is a multidimensional issue and requires interventions at several levels including areas involving health systems, overall organization, doctors, dispensers, patients and community and it remains a challenge in health facilities.

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Section: Discussionmentioning

confidence: 99%

Evaluation of rational drug use based on World Health Organization indicators in a tertiary hospital, Thailand

Khangtragool¹,

Nukompun²,

Teeyasuntranonn³

et al. 2023

Pharm Sci Asia

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“…The five years of Thailand’s national strategic plan on antimicrobial resistance have not been fully reported. There is only a report on decreasing the level of and trend in antibiotic prescribing rates during the years 2017–2019 from the RDU Service Plan [ 31 ]. Reports should evaluate not only the decrease in antimicrobial consumption but also the incidence and prevalence of AMR compared with the antibiotics prescription or consumption rate.…”

Section: Discussionmentioning

confidence: 99%

Community Health Nurses’ Perspective on the Introduced Rational Drug Use Policy in Primary Care Settings in Thailand: A Descriptive Qualitative Study

2022

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Background: To address the problems related to drug resistance and medication safety, the rational drug use (RDU) policy has been implemented in Thailand since 2014. Theoretically, the policy was supposed to bring drastic changes to the way clinicians prescribe medications and its impacts on clinical practice, however, it has not yet been investigated. The study aimed to describe the experience of community health nurses with regard to the impact of RDU policy implementation on their practices. Methods: Focus group interviews and in-depth interviews with community nurses were conducted. Thematic analysis was performed. Results: Five themes emerged from the analysis, namely, (1) a welcome opportunity, (2) RDU as the quality of healthcare, (3) multidisciplinary collaboration, (4) reinventing productive interactions between nurses and patients, and (5) challenges over control of medications prescribed or purchased elsewhere. Conclusions: Implementing RDU in primary care provides opportunities for protecting individual patients and public health as well as safeguarding against professional prescription error. This can be made possible by adopting a systemic approach to changes. Additional educational and organizational support will optimize health professionals’ contribution to the implementation and hence optimal outcomes of this important policy.

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“…These differences among various studies are likely due to differences in national health care systems, culture, and the level of the hospital in which a given study was conducted. GPs in Srinagarind Hospital are mostly young physicians who graduated during the national rational drug use (RDU) campaign [ 8 ]. However, residents in fields other than internal medicine may be more focused on improving their specialized skills and knowledge than on general topics.…”

Section: Discussionmentioning

confidence: 99%

“…Although antibiotics are available over-the-counter in pharmacies in Thailand [ 6 ], public and private health care facilities still provide the majority (70.3%) of such medications [ 7 ]. The pre-intervention prescription rate was approximately 45% in patients with URI (despite the national target being under 20%) [ 8 ], and the most frequently prescribed antibiotics were amoxicillin and co-amoxiclav [ 9 ]. A recent study showed inappropriate antibiotic prescription to be common in URI [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Insertion of a Clinical Pathway Pop-Up Window into a Computer-Based Prescription System: A Method to Promote Antibiotic Stewardship in Upper Respiratory Tract Infection

et al. 2021

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Outpatient antibiotics are most frequently prescribed for upper respiratory tract infection (URI); however, most such prescriptions are inappropriate. We aimed to determine the effect of an electronic clinical pathway on the rates of overall and rational prescription of antibiotics in patients with URI. A pilot quasi-experimental study was conducted in a university hospital and two of its nearby primary care units (PCU) in northeast Thailand from June to September 2020. Clinical pathway pop-up windows were inserted into the hospital’s computer-based prescription system. Care providers were required to check the appropriate boxes before they were able to prescribe amoxicillin or co-amoxiclav. We examined a total of 675 visits to the outpatient department due to URI at three points in time: pre-intervention, immediately post-intervention, and 6 weeks post-intervention. Patients in the latter group tended to be younger and visits were more likely to be general practitioner-related and to the student PCU than in the other two groups. In addition, the rate of antibiotic prescription was significantly lower at 6 weeks after intervention than at either of the other time periods (32.0% vs 53.8% pre-intervention and 46.2% immediately post-intervention; p < 0.001), and the proportion of rational antibiotic prescriptions increased significantly after implementation. Antibiotic prescription rates were lower at the community primary care unit and higher when the physician was a resident or a family doctor. The deployment of an electronic clinical pathway reduced the rate of unnecessary antibiotic prescriptions. The effect was greater at 6 weeks post-implementation. However, discrepancy of patients’ baseline characteristics may have skewed the findings.

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Effects of a national policy advocating rational drug use on decreases in outpatient antibiotic prescribing rates in Thailand

Cited by 3 publications

References 15 publications

Evaluation of rational drug use based on World Health Organization indicators in a tertiary hospital, Thailand

Evaluation of rational drug use based on World Health Organization indicators in a tertiary hospital, Thailand

Community Health Nurses’ Perspective on the Introduced Rational Drug Use Policy in Primary Care Settings in Thailand: A Descriptive Qualitative Study

Insertion of a Clinical Pathway Pop-Up Window into a Computer-Based Prescription System: A Method to Promote Antibiotic Stewardship in Upper Respiratory Tract Infection

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