Chowdhury A K Azad, Khan O F, Matin M A, Begum K, Galib M A
Department of Pharmacy, Dhaka University, Dhaka.
Bangladesh Med Res Counc Bull. 2007 Apr;33(1):21-30.
Inappropriate prescribing for ARI and diarrhoea is a serious health problem in many developing countries including Bangladesh. A baseline retrospective prescribing survey for ARI and diarrhoea have been conducted in randomly selected 60 thana health complexes (THCs) of Dhaka division of Bangladesh. In the 38 of 60 THCs, the prescribers did not comply with the standard treatment guidelines (STG) for ARI. They are marked as 'unsatisfactory performers'. In these THCs unnecessary antibiotics were prescribed in more than 50% of the encounters. The study further revealed that in 26 THCs, comprising 41.6% of the 38 THCs, the situation was even worse regarding the indiscriminate use of antibiotics. In these THCs antibiotics were prescribed in > or =72% of the encounters. For diarrhoea, only in 8.3% of the THCs antibiotics were prescribed in > or =50% of the encounters. Encouragingly, most of the prescribers prescribed ORS. So the diarrhoea cases were dropped from the intervention. The 24 out of 26 worse performing THCs for ARI management, were grouped into three groups: Group-I (implementing STG+ Audit), Group-II (STG) and Group-III (no intervention, control). The prescribers of the THCs belonging to Group-I and Group-II received STG+Audit and STG only respectively as intervention(s). On the contrary, the prescribers of the THCs of Group-III (control) did not receive any intervention. It was observed that after the implementation of interventions the use of the unnecessary antibiotics to treat ARI was significantly reduced (p<0.01) compared to pre-intervention period in Group-I (STG+Audit). In this group highly significant (p<0.000) reduction in antibiotics use was achieved in 6 out of 8 THCs. The average reduction in antibiotic use in terms of encounters was 23.7 and 15.2% in the Group-I and Group-II respectively owing to the intervention(s). Significant reduction in antibiotic use in terms of THCs was 3 (out of 8 THCs) and 2 (out of 8 THCs) belonging to the Group-II and Group-III respectively. When compensated for the change in the control group, the reduction of antibiotic use in terms of encounters was 15.2 and 6.9% in the THCs of the Group-I and Group-II respectively due to introduction of the interventions. The study concludes that STG supported by prescription audit are highly effective interventions to change the prescribing behaviour of the prescribers for ARI in the THCs.
在包括孟加拉国在内的许多发展中国家，急性呼吸道感染（ARI）和腹泻的不恰当用药是一个严重的健康问题。在孟加拉国达卡专区随机选取的60个乡卫生中心（THC）开展了一项关于ARI和腹泻的基线回顾性用药调查。在60个THC中的38个里，开处方者未遵循ARI的标准治疗指南（STG）。他们被标记为“表现不佳者”。在这些THC中，超过50%的诊疗中开出了不必要的抗生素。该研究进一步表明，在26个THC（占38个THC的41.6%）中，抗生素的滥用情况更糟。在这些THC中，≥72%的诊疗中开出了抗生素。对于腹泻，仅在8.3%的THC中，≥50%的诊疗中开出了抗生素。令人鼓舞的是，大多数开处方者开出了口服补液盐（ORS）。所以腹泻病例从干预措施中减少了。在ARI管理方面表现最差的26个THC中的24个被分为三组：第一组（实施STG+审核）、第二组（STG）和第三组（无干预，对照组）。分别属于第一组和第二组的THC的开处方者仅分别接受了STG+审核和STG作为干预措施。相反，第三组（对照组）的THC的开处方者未接受任何干预。据观察，实施干预措施后，与干预前相比，第一组（STG+审核）中用于治疗ARI的不必要抗生素的使用显著减少（p<0.01）。在该组中，8个THC中的6个实现了抗生素使用的高度显著减少（p<0.000）。由于干预措施，第一组和第二组在每次诊疗中抗生素使用的平均减少率分别为23.7%和15.2%。在THC方面，分别属于第二组和第三组的抗生素使用显著减少的THC数量为3个（共8个THC）和2个（共8个THC）。当考虑对照组的变化时，由于引入干预措施，第一组和第二组的THC在每次诊疗中抗生素使用的减少率分别为15.2%和6.9%。该研究得出结论，由处方审核支持的STG是改变乡卫生中心开处方者对ARI的用药行为的高效干预措施。
