Kafle K K, Karkee S B, Prasad R R, Bhuju G B, Shrestha N, Das P L, Shrestha A D
Department of Clinical Pharmacology, Institute of Medicine and International Network for Rational Use of Drugs, New Baneshwor, Kathmandu, Nepal.
Kathmandu Univ Med J (KUMJ). 2006 Jan-Mar;4(1):61-4.
Promoting appropriate use of drugs is an essential element in achieving quality of health and medical cares for patients and the community, and also to minimize financial burden.
The objective of this paper is to assess the successful intervention for sustainability and effects in post research phase. To address these problems, a variety of educational, managerial and regulatory strategies to improve prescribing have been tried in Nepal. When training is combined with a managerial intervention i.e. peer-group discussion, it results into improved changes in prescribing practices of paramedics in several practices.
A prospective, three-way design study consisting of small group training, small group training followed by peer-group discussion and control was conducted in three regions of Nepal including one hill and two terai (plains) districts from each region. The study included all health post from the sampled districts, making 80 health posts the study population.
The study revealed the effectiveness of the peer-group discussion approach in improving the prescribing practices. An assessment to identify the sustainability of the strategy and its effect within the district healthcare system after the completion of the research phase was undertaken. The study found that peer-group discussion was discontinued in all targeted districts and the improved practices were not sustained after the completion of the research. Various reasons have been found for not continuing the effective intervention.
促进药物的合理使用是为患者和社区实现健康与医疗质量的关键要素，同时也是减轻经济负担的重要举措。
本文旨在评估研究后阶段干预措施在可持续性和效果方面的成功程度。为解决这些问题，尼泊尔尝试了多种旨在改善处方行为的教育、管理和监管策略。当培训与管理干预（即同伴小组讨论）相结合时，在一些医疗机构中，医护人员的处方行为有了明显改善。
在尼泊尔的三个地区开展了一项前瞻性的三向设计研究，包括小组培训、小组培训后进行同伴小组讨论以及设置对照组。这三个地区分别选取了一个山区和两个平原地区，研究涵盖了抽样地区的所有卫生站，共80个卫生站作为研究对象。
研究表明同伴小组讨论方法在改善处方行为方面具有有效性。在研究阶段结束后，对该策略在地区医疗系统内的可持续性及其效果进行了评估。研究发现，所有目标地区都停止了同伴小组讨论，研究结束后改善的行为未能持续。研究找出了多种导致有效干预未能持续的原因。
