CAMBODIA EXPERIENCE ON MTP (MONITORING, TRAINING,

PLANNING) TO REDUCE INAPPROPRIATE MEDICINE

USE IN HOSPITALS

1-Background-Previous indicator-based supervision and monitoring program in Cambodia did not show significant improvement.

-Inappropriate prescribing practices in health facilities

-Intervention to improve prescribing is uneasy to conduct, especially in private facilities

-Self-initiative, self-conduct, self-assessment, self-decision making

-Interventions needs to be incorporated in the existing management system

2- Objective To learn lessons from experiences in

drug use interventions in the past To discuss the problem of drug use

in the health care system To discuss the efforts in improving

drug use carried out so far To develop the innovative strategy

for rational drug use in the health care system.

3-Intervention Method Select pilot hospitals for MTP implementation Assign 6 people as MTP team Training of MTP Team on MTP process Schedule the meeting to:

define problems on drugs use develop an innovative strategy to improve drug

use define target monitor the implementation and evaluate the

achievements National evaluation workshop

3.1-Flow of activities in MTP

TT

MMMMMMMMMM

TTTTTTTT

PPPP PP PP PP

MM

Indicator IndicatorIndicator

InitialWorkshop

EvaluationWorkshop

3.2-Self-monitoring vs MTP

MTP approach

Self-Monitoringstrategy

MTP

MTP

MTP

MTP

MTP

MTP

MTP

MTP

MTP

MTP

Indicator

Indicator

Indicator

Indicator Indicator Indicator Indicator

Periodic evaluation at MOH

3.3-Monitoring- To identify the specific drug use problem- To select a priority problem- To determine indicators and data source- To identify the target of interventionWhen MTP has been running:- To follow up commitments from the previous session- To measure the impact of intervention- To conclude the achievement

3.4-Training- To discuss the problem agreed in the Monitoring in more details

- To collect supporting information

- To collect related scientific information to set up the norms or standard reference,

e.g., reference books, standard treatment guidelines, etc.

- To collect information about the intervention efforts considered effective, and to discuss

the suitable intervention strategy to choose.

- To agree upon an intervention strategy and to discuss the intervention steps.

3.5-Planning- To set a target of achievement

- To set measures to achieve target, including the sequence of activity, the program,

and the person responsible for execution.

- To agree on who is responsible for the execution of the plan.

- To facilitate communication and coordination among MTP team members

- To agree upon schedule of the next MTP session.

4- Experiences on using MTP

- First phase 6 Hospitals

- Second phase 7 Hospitals

4-Result 1(Kandal Abs Reduction in Normal Delivery)

100%

55%

32%

15%10% 10% 10% 10%

0%

20%

40%

60%

80%

100%

1st meeting 2nd meeting 3rd meeting 4th meeting

Oral antibiotics

Target

% patients received oral antibiotics

4-Result: 2 (Kg Cham Reduce Abs in post Cesarean)

87%

58%44%

36%

100%

10% 10% 10% 10%

33%41%

0%

20%

40%

60%

80%

100%

1st meeting 2nd meeting 3rd meeting 4th meeting

Post Caesarean surgery

Post Scrotal hernia surgery

Target

% of patients receiving antibiotics

Reduction of the average medicine cost per patient from 15.3 to US$ 6.1 (US$ 2000/month)

100

84

7263

SR-Target, 50 SR-Target, 50 SR-Target, 50 SR-Target, 50

0

10

20

30

40

50

60

70

80

90

100

Session 1 Session 2 Session 3 Session 4

SR-Trauma SR-Target

4-Result: 3(Siem Reap: Reduce Abs in Traumatology)

4-Result: 4 (OM Chhey: IV fluid reduction in normal

delivery)

27

0 00 000

5

10

15

20

25

30

Session 1 Session 2 Session 3

OMC-N Delivery Target

70

59

0

50

00 0 0

70

0

10

20

30

40

50

60

70

80

Session 1 Session 2 Session 3

BB-Maternity BB-Trauma Target

4-Result: 5 (BB: IV fluid reduction in Maternity and

Traumatology Ward)

Battambang-Malaria, 20

Battambang-Malaria, 30

Target, 0Target, 0

0

5

10

15

20

25

30

35

Session 1 Session 2

Battambang-Malaria Target

4-Result: 6 (BB: Abs reduction in Malaria)

4-Result 6 (BB Abs Reduction in Malaria)

30

20

0

5

10

15

20

25

30

35

Session 1 Session 2

Battambang-Malaria Target

5-STRONG POINTS MTP is strongly supported by the DG for Health WHO supported both, budget & Technical

expert to develop MTP in CAMBODIA. Existing Technical Working Group in each RH

acting as DTC for improving the Use of Drug. Existing network of supervision and monitoring

system from central to Province and OD level. Good cooperation with National Programs. Sustainable achievement

6-WEAK POINTS Some hospitals have difficulty to define a real

strategy for improving drug use After the end of financial support and

intervention from central level no data will be collected and achievement will not be monitored and reported

Time availability of MTP team member Transfer of some MTP team members to other

facility Reduction of hospital income for drugs.

7-Summary of resultHealth Facilities Priority problem Intervention result

1-Kandal Hospital -Use of Abs in normal delivery

-Reduction from 100% down to 15%(target 10%)

2-Kanpong Cham Hospital

-Use of Abs in post-Caesarean surgery

-Abs use post-scrotal hernia surgery.

-Reduction from 100% down 36%(Target 10%)

-Reduction from 100% (target 10%)down to 33% in 3 meetings-Average cost IPD 15.3 to 6.1$

3-Siem Reap Hospital

-Abs use in Tromatology Ward

-Reduction from 100% down to 63% (target 50%)

4-Oddar Mean Chhey Hospital

-Use of IV fluid in normal delivery

-Reduction from 27% down to 0% (target 0%)

5-Battambang Hospital

-IV fluid use in Maternity

-IV fluid use in Traumato

-Abs use in Malaria

-Reduction from 70% down to 0%.(target 0%)

-Reduction from 70% down to 0% (target 0%).

-Reduction from 30% down to 20%(target 0%)

8-Conclusion(1)

Flexible approach, not time-consuming, not costly Good for sensitive issues Interventions seems not too “sophisticated” Encourage DTC to initiate activities and internal

experts to contribute A comprehensive approach, a combination of adult

learning and managerial strategies. Involved stakeholders in hospital, the “negative”

consequences of rational drug use could be discussed accordingly

8-Conclusion(2)

MTP can be implemented in both sector public and private. Its can be solve problem themselves, if there are any supported from PHD.

MTP can be extended in nationwide, if they select the right people to be train them.

MTP reduce health care cost, if they strictly monitor, supervise and providing the training to prescribers. So the community will be participation and support

To reduce the prescribing problems and improving RUD for healthcare workers and patients.