CAMBODIA EXPERIENCES ON MTP MONITORINGTRAININGPLANNING TO REDUCE INAPPROPRIATE MEDICINE USE IN HOSPI

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CAMBODIA EXPERIENCES ON MTP (MONITORING-TRAINING-P
LANNING) TO REDUCE INAPPROPRIATE MEDICINE USE IN
HOSPITAL
Prepared by Dr. Sok Srun and Dr. Chroeng
Sokhan
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1- Background

• Previous indicator-based supervision and
  monitoring program in Cambodia did not show
  significant improvement.
• Inappropriate prescribing practices in health
  facilities
• Intervention to improve prescribing is uneasy to
  conduct, especially in private facilities
• Interventions needs to be incorporated in the
  existing management system

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2- Objective

• To discuss the problems of drug use in the health
  care system
• To discuss the efforts in improving drug use
  carried out so far
• To develop the innovative strategy for rational
  drug use in the health care system.

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3- Intervention Method (Stage 1)

• Select 6 pilot hospitals
• Assign 6 people of each hospital as Hospital
  MTP Teams
• Training of MTP Teams on MTP process
• Schedule the meeting to
• define problems on drugs use
• develop an innovative strategy to improve drug
  use
• define target
• monitor the implementation and evaluate the
  achievements
• National evaluation workshop
• Wider implementation (Stage 2) if Stage 1 is
  successful

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4- Self-monitoring vs MTP
Periodic evaluation at MOH
Self- Monitoring strategy
Indicator
Indicator
Indicator
Indicator
Indicator
Indicator
Indicator
M T P
M T P
M T P
M T P
M T P
MTP approach
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5- Stage 1 Result 1
Kandal RH Reduction of AB use in normal delivery
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6-Stage 1Result 2
Kg Cham Reduction AB use in post Cesarean and
Post Scrotal Hernia surgery
of patients receiving antibiotics
Reduction of the average medicine cost per
patient from 15.3 to US 6.1 (US 2000/month)
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7- Intervention Method (Stage 2)

• Select 7 pilot hospitals
• Assign 6 people of each hospital as Hospital
  MTP Teams
• Training of MTP Teams on MTP process
• Schedule the meeting to
• define problems on drugs use
• develop an innovative strategy to improve drug
  use
• define target
• monitor the implementation and evaluate the
  achievements
• National evaluation workshop involving hospitals
  from Stage 1
• Nation-wide implementation if Stage 2 is
  successful

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8-Stage 2 Result 1
Siem Reap RH AB use in Traumatology Ward
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9-Stage 2 Result 2
OM Chhey RH IV Fluid reduction in normal
delivery
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10- Stage 2 Result 3 (Battambang)
IV fluid reduction in the Maternity and the
Trauma Ward
AB Reduction in the Malaria
Battambang
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5- Conclusion (1)

• Flexible approach, not time-consuming, not costly
  to improve appropriate use of drugs in hospitals
• MTP is good for solving sensitive problems
• Encourage Hospital Technical Committees to
  initiate activities in improving appropriate use
  of drugs
• A comprehensive approach, a combination of adult
  learning and managerial strategies.
• Involving stakeholders in hospital, the
  negative consequences of rational drug use
  could be discussed accordingly

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5- Conclusion(2)

• MTP can be implemented in both sector public and
  private. With the supports from PHDs, MTP can be
  used to solve drug use problems by themselves.
• MTP can be extended nationwide. The right
  people should be selected from each hospitals.
• If MTP imlementation is conducted with
  monitoring, supervision, and continuous training,
  MTP can reduce the health care cost. The
  community will participate and support this
  efforts
• To reduce the prescribing problems and improve
  RUD for healthcare workers and patients.