Waleekhachonloet Onanong, Rattanachotphanit Thananan, Limwattananon Chulaporn, Thammatacharee Noppakun, Limwattananon Supon
PhD. Faculty of Pharmacy, Mahasarakham University. Maha Sarakham (Thailand).
PhD. Faculty of Pharmaceutical Sciences, Khon Kaen University. Khon Kaen (Thailand).
Pharm Pract (Granada). 2021 Jan-Mar;19(1):2201. doi: 10.18549/PharmPract.2021.1.2201. Epub 2021 Feb 9.
This study examined the effects of a national policy advocating rational drug use (RDU), namely, the 'RDU Service Plan', starting in fiscal year 2017 and implemented by the Thai Ministry of Public Health (MOPH), on trends in antibiotic prescribing rates for outpatients. The policy was implemented subsequent to a voluntary campaign involving 136 hospitals, namely, the 'RDU Hospital Project', which was implemented during fiscal years 2014-2016.
Hospital-level antibiotic prescribing rates in fiscal years 2014-2019 for respiratory infections, acute diarrhea, and fresh wounds were aggregated for two hospital groups using equally weighted averages: early adopters of RDU activities through the RDU Hospital Project and late adopters under the RDU Service Plan. Pre-/post-policy annual changes in the prescribing levels and trends were compared between the two groups using an interrupted time-series analysis.
In fiscal years 2014-2016, decreases in antibiotic prescribing rates for respiratory infections and acute diarrhea in both groups reflected a trend that existed before the RDU Service Plan was implemented. The immediate effect of the RDU Service Plan policy occurred in fiscal year 2017, when the prescribing level among the late adopters dropped abruptly for all three conditions with a greater magnitude than in the decrease among the early adopters, despite nonsignificant differences. The medium-term effect of the RDU Service Plan was identified through a further decreasing trend during fiscal years 2017-2019 for all conditions in both groups, except for acute diarrhea among the early adopters.
The national policy on rational drug use effectively reduced antibiotic prescribing for common but questionable outpatient conditions.
本研究考察了泰国公共卫生部（MOPH）自2017财年起实施的一项倡导合理用药（RDU）的国家政策，即“RDU服务计划”，对门诊患者抗生素处方率趋势的影响。该政策是在一项涉及136家医院的自愿性活动，即2014 - 2016财年实施的“RDU医院项目”之后实施的。
使用等权重平均值汇总了2014 - 2019财年两个医院组针对呼吸道感染、急性腹泻和新鲜伤口的医院级抗生素处方率：通过“RDU医院项目”率先开展RDU活动的医院和在“RDU服务计划”下较晚开展活动的医院。使用间断时间序列分析比较了两组在政策实施前后处方水平和趋势的年度变化。
在2014 - 2016财年，两组呼吸道感染和急性腹泻抗生素处方率的下降反映了在“RDU服务计划”实施之前就已存在的趋势。“RDU服务计划”政策的直接影响出现在2017财年，当时较晚开展活动的医院组中所有三种病症的处方水平均突然下降，降幅大于率先开展活动的医院组，尽管差异不显著。“RDU服务计划”的中期影响通过2017 - 2019财年两组所有病症的进一步下降趋势得以体现，但率先开展活动的医院组的急性腹泻病症除外。
国家合理用药政策有效降低了常见但存在疑问的门诊病症的抗生素处方量。
