Vang Chu, Tomson Goran, Kounnavong Sengchan, Southammavong Thanakhanh, Phanyanouvong Amphayvanh, Johansson Rolf, Eriksson Bo, Wahlstrom Rolf
Department of Cardiology, Mahosot Hospital, Vientiane, P.O. Box 5202, Lao People's Democratic Republic (Laos), and Nordic School of Public Health, Goteborg, Sweden.
Eur J Clin Pharmacol. 2006 Jan;62(1):57-63. doi: 10.1007/s00228-005-0069-8. Epub 2005 Dec 22.
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.
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.
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.
Continuous self-monitoring of performance by means of indicators, followed by feedback discussions, is suggested the means of improving the work of the DTC.
药物与治疗学委员会（DTCs）对确保医院合理用药至关重要，老挝近期已设立该委员会。此前有报告称其表现欠佳。本研究旨在确定老挝医院工作环境中与DTC绩效相关的因素，并评估通过针对DTC成员开展利用审核与反馈的教育干预措施，DTC的绩效是否能够得到改善。
这是一项准实验性（前后对照）研究。两家中心医院和七家省级医院以及这些医院的DTC成员参与了研究。通过专门制定的结构和流程指标，结合合理用药指标以及对标准治疗指南（STG）的依从性指标，对DTC的绩效进行评估。在基线期收集了3个月的数据，此后连续收集了三个时期的数据。在反馈会议期间，与DTC成员分享并讨论了前三次数据收集的结果。还对DTC成员进行了访谈，以确定他们认为可能对DTC绩效产生影响的因素。
干预后，DTC绩效总体得分有显著提高（p<0.001），尤其是在一般活动、向工作人员提供反馈和药物信息方面得分提高。STG得分也有所提高（p<0.01）。访谈表明一个负面因素是DTC成员感到被其他工作过度负担，导致DTC会议不定期召开且参会率低。
建议通过指标对绩效进行持续自我监测，随后进行反馈讨论，以此作为改善DTC工作的方式。
