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Improving the performance of Drug and Therapeutics Committees in hospitals – a quasi-experimental study in Laos

  • Chu VangEmail author
  • Goran Tomson
  • Sengchan Kounnavong
  • Thanakhanh Southammavong
  • Amphayvanh Phanyanouvong
  • Rolf Johansson
  • Bo Eriksson
  • Rolf WahlstromEmail author
Pharmacoepidemiology and Prescription

Abstract

Background and objectives

Drug and Therapeutics Committees (DTCs), which are essential for ensuring the rational use of drugs (RUD) in hospitals, have recently been established in Laos. Sub-optimal performance had been reported. The aims of this study were to determine those factors in the working environment that relate to DTC performance in Lao hospitals and evaluate whether DTC performance could be improved through an educational intervention utilizing auditing and feedback targeted towards DTC members.

Methods

This was a quasi-experimental (before and after) study. Two central and seven provincial hospitals and the DTC members from these hospitals participated in the study. Performance of the DTCs was assessed by means of specifically developed indicators on structure and process combined with indicators for RUD and adherence to Standard Treatment Guidelines (STG). Data were collected for a 3-month period at baseline and for three consecutive periods thereafter. The results of the first three data collections were shared and discussed with the DTC members during feedback sessions. The DTC members were also interviewed in order to identify factors they thought may have an impact on DTC performance.

Results

Following the intervention, there was a significant improvement in the overall score for DTC performance (p<0.001) and, in particular, in general activity and feedback and drug information to staff. The STG scores also improved (p<0.01). Interviews indicated that one negative factor was the experience of the DTC members being overloaded with other work, resulting in DTC meetings being held irregularly and drawing poor attendance.

Conclusion

Continuous self-monitoring of performance by means of indicators, followed by feedback discussions, is suggested the means of improving the work of the DTC.

Keywords

Drug and Therapeutics Committee Standard Treatment Guidelines Rational use of drug Health systems research Lao PDR 

Notes

Acknowledgements

The authors of this study wish to acknowledge the Swedish International Development Cooperation Agency (Sida) for funding, and Professor Boungnong Boupha and Associate Professor Kongsap Akkhavong for their supervision of the project. Grateful thanks are also extended to Dr. Bouathong Sisounthone (deceased December 2004), Dr. Phat Keungsaneth and Dr. Sommay Rattanavong as members of the research team and to all DTC Task force and VIP members from the nine DTC units involved in the study.

References

  1. 1.
    Bero LA, Grill R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA (1998) Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. BMJ 317:465–468PubMedGoogle Scholar
  2. 2.
    Bottiger LE (1981) The Swedish Adverse Drug Reaction Committee: an important tool for safer drug therapy. Qual Rev Bull 7:14–20Google Scholar
  3. 3.
    Green T, Holloway KA, Chalker J (2004) Promoting drug and therapeutics committees in the developing world (AC 009). In: Second Int Conf Improv Use Med. Chiangmai, ThailandGoogle Scholar
  4. 4.
    Holloway KA, Green T (2003) Drug and Therapeutics Committee: a practical guide. WHO, GenevaGoogle Scholar
  5. 5.
    Johansson R (2001) The Lao National Drug Policy Project, Phase III 2001–2003, Indicators Lao GPP – 2000, Standard Treatment Guidelines 2, Drug therapeutic committees. IHCAR, Karolinska Institute, StockholmGoogle Scholar
  6. 6.
    Johnston PE (1992) Adverse drug reaction surveillance and risk management. Perspect Health Risk Manage 12:22–24CrossRefGoogle Scholar
  7. 7.
    Kimelblatt BJ, Young SH, Heywood PM, Mandala AR, Gendelman S, Mehl B (1988) Improved reporting of adverse drug reactions. Am J Hosp Pharmacol 45:1086–1089Google Scholar
  8. 8.
    Laing R, Hogerzeil H, Ross-Degnan D (2001) Ten recommendations to improve use of medicine in developing countries. Health Policy Plan 16:13–20PubMedCrossRefGoogle Scholar
  9. 9.
    Ministry of Health (2001) National Health Survey 2000 by the National Institute of Public Health. Vientiane, Ministry of Health, Lao PDRGoogle Scholar
  10. 10.
    Muir Gray JA (2001) Evidence-based health care. Churchill Livingstone, LondonGoogle Scholar
  11. 11.
    Mwenesi, HA (1994) The role of drug delivery system in health care: the case of self-medication. Afr J Health Sci 1:42–48PubMedGoogle Scholar
  12. 12.
    Paphassarang, C, Tomson G, Choprapawon C, Weerasuriya K (1995) The Lao National Drug Policy: lessons along the journey. Lancet 345:433–435PubMedCrossRefGoogle Scholar
  13. 13.
    Saine DR (1992) A successful community hospital program for monitoring adverse drug reactions. Top Hosp Pharmacol Manage 12:19–30Google Scholar
  14. 14.
    Sjöqvist F (1999) The past, present and future of clinical pharmacology. Eur J Clin Pharmacol 55:553–557PubMedCrossRefGoogle Scholar
  15. 15.
    Stenson B, Syhakhang L, Erisson B, Tomson G (2001) Real world pharmacy: assessing the quality of private pharmacy practice in Lao People’s Democratic Republic. Soc Sci Med 52:393–404PubMedCrossRefGoogle Scholar
  16. 16.
    Syhakhang L, Stenson B, Wahlström R, Tomson G (2001) The quality of public and private pharmacies practices: a cross-sectional study in the Savannakhet province, Lao PDR. Eur J Clin Pharmacol 57:221–227CrossRefGoogle Scholar
  17. 17.
    Syhakhang L (2002) The quality of private pharmacy services in a province of Lao PDR: perceptions, practices and regulatory enforcements. PhD thesis, Karolinska Institute, StockholmGoogle Scholar
  18. 18.
    Thomson O’Brien MA, Oxman AD, Haynes RB, Davis DA, Freemantle N, Harvey EL (2001) Educational outreach visits: effects on professional practice and health care outcomes. Update Software, The Cochrane Library, Oxford, Issue 4, 2001Google Scholar
  19. 19.
    Tomson G, Paphassarang C, Jönsson K, Houamboun K, Akkhavong K, Wahlström R (2005) Decision makers and the usefulness of research evidence in policy implementation – a case study from Lao PDR. Soc Sci Med 61: 1291–1299PubMedCrossRefGoogle Scholar
  20. 20.
    Trostle J (1996) Inappropriate distribution of medicines by professionals in developing countries. Soc Sci Med 42:1117–1120PubMedCrossRefGoogle Scholar
  21. 21.
    Wahlström R, Kounnavong S, Sisounthone B, Phanyanouvong A, Southammavong T, Erisson B, Tomson G (2003) Effectiveness of feedback for improving case management of malaria. diarrhoea and pneumonia-a randomized controlled trial at provincial hospitals in Lao PDR. Trop Med Int Health 8:901–909PubMedCrossRefGoogle Scholar
  22. 22.
    Weekes, LM, Brooks C (1996) Drug and Therapeutics Committees in Australia: expected and actual performance. Br J Clin Pharmacol 42:551–557PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Chu Vang
    • 1
    Email author
  • Goran Tomson
    • 2
    • 3
  • Sengchan Kounnavong
    • 5
  • Thanakhanh Southammavong
    • 4
  • Amphayvanh Phanyanouvong
    • 6
  • Rolf Johansson
    • 2
  • Bo Eriksson
    • 7
  • Rolf Wahlstrom
    • 2
    Email author
  1. 1.Department of CardiologyMahosot HospitalVientianeLao People’s Democratic Republic (Laos)
  2. 2.Division of International Health (IHCAR)Karolinska InstitutetStockholmSweden
  3. 3.Medical Management CenterKarolinska InstitutetStockholmSweden
  4. 4.Out-patient DepartmentMahosot HospitalVientianeLaos
  5. 5.National Institute of Public Health (NIOPH)VientianeLaos
  6. 6.Curative DepartmentMinistry of HealthVientianeLaos
  7. 7.Nordic School of Public HealthGoteborgSweden

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