IMPACT OF EDUCATIONAL INTERVENTION ON PRESCRIBING BEHAVIOUR AND COST OF THERAPY IN BRONCHIAL ASTHMA

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IMPACT OF EDUCATIONAL INTERVENTION ON
PRESCRIBING BEHAVIOUR AND COST OF THERAPY IN
BRONCHIAL ASTHMA IN COLONY HOSPITALS OF DELHI

• Kotwani A, Gupta U, Suri J C, RoyChaudhury R
• Department of Pharmacology, Maulana Azad Medical
  College, New Delhi.
• Respiratory Medicine, Safdurjung Hospital,
  DSPRUD, New Delhi.

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BACKGROUND

• Cost of irrational drug prescribing is enormous.
• Need for promoting rational use of drugs.
• Standard Treatment Guidelines (STG) represents
  one approach to promote effective and
  economically efficient prescribing.
• Chronic common illness, like bronchial asthma
  and hypertension are an economic burden to the
  country.
• A base line survey was conducted for drug use
  pattern and cost of treatment at secondary(colony
  hospital) and tertiary(teaching hospital) health
  facility for two chronic diseases that is mild
  essential hypertension and mild chronic bronchial
  asthma.

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• Survey results revealed that 98 and 39
  prescriptions were according to STG for mild
  hypertension at colony and teaching hospital
  respectively.
• For bronchial asthma 3 and 21 prescriptions
  were according to STG at colony and teaching
  hospital respectively, and cost of therapy was
  significantly more (plt0.001) when prescriptions
  were not according to STG.
• Qualitative assessment of prescribers behaviour
  revealed that misconception of treatment of
  bronchial asthma is a major cause of irrational
  prescribing.
• An educational intervention study was conducted
  for prescribers.

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AIMS OF THE STUDY

• Impact of two consecutive educational
  intervention on prescribing behaviour of doctors
  for bronchial asthma treatment in colony
  hospital.
• Effect of change in prescribing behaviour, if
  any, after intervention on cost of therapy in
  bronchial asthma.

STUDY DESIGN

• A prospective randomized controlled study of
  prescription monitoring from the outpatient
  department of two public colony hospitals.

SAMPLE SIZE

• Prescribers of two colony hospitals, intervention
  and control.
• 100 prescriptions of patients who were on
  maintenance therapy for bronchial asthma at each
  health facility.

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METHODS

• Two colony hospitals who had shown in baseline
  survey irrational prescription were chosen, in
  one, educational intervention was done and other
  acted as control.
• A training programme (face-to-face educational
  intervention) was done for prescribers of one
  colony hospital at respiratory medicine
  department of a tertiary care hospital.
• STGs for treatment of bronchial asthma, patient
  education and proper use of inhalers were
  discussed. Published literature was given.
• STGs for chronic bronchial asthma Regular use
  of inhaled corticosteroid, like Budesonide,
  Flutiacasone or Beclomethasone (400-1600 ?g) as
  per severity of disease. Use of bronchodilater
  (salbutamol) as and when required.

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Intervention
Educational training programme
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METHODS Contd.

• After one month of training, hundred
  prescriptions of chronic bronchial asthma from
  OPD of colony hospitals (intervention and
  control) were monitored using the same performa
  as was used for base line survey (characteristics
  of the patient, diagnosis, no. of drugs
  prescribed, their name, dose, duration and route
  of administration).
• For re-enforcement, a second, similar training
  programme for the same prescribers was done after
  a gap of 3 months.
• After one month of the second training programme,
  100 prescriptions were monitored as before, from
  both the health facilities.

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RESULTS

• All completed performas were computed with regard
  to number of drugs prescribed, drugs from EDL and
  cost of 14 days treatment at the rate at which
  the public facility is procuring medicines
  (pooled procurement).
• 14 days estimated cost of therapy according to
  STG was calculated for each patient at pooled
  procurement rate.
• 14 days cost of therapy for each patient was also
  calculated at retail/market price.

Prescription Monitoring
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Effect of 1st Intervention on prescribing
behaviour in chronic bronchial asthma patients
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Cost of treatment for bronchial asthma after 1st
intervention
p lt 0.001
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Effect of 2nd Intervention on prescribing
behaviour in chronic bronchial asthma patients
NOTE- 9 prescriptions had steroid inhalers, but
in addition they also contained antihistaminics
which are not there in the STG.
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Cost of treatment for bronchial asthma after 2nd
intervention
p lt 0.001
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CONCLUSIONS

• This study has shown that even though the
  prescribers are prescribing from EDL, their
  prescriptions for chronic bronchial asthma are
  irrational.
• Two face-to-face educational training programmes
  have changed the prescribing behaviour to a small
  extent in the treatment of bronchial asthma.
• Pooled procurement system of purchasing medicines
  is very economical and money saved can be used to
  purchase more essential drugs.

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• RECOMMENDATIONS
• Another mode of intervention e.g. managerial or
  regulatory may also be used along with
  educational intervention to change the
  prescribing behaviour of doctors for the
  treatment of bronchial asthma.
• Corticosteroid inhalers should be included in
  essential drug list and made available for all
  public facilities.