Main Article Content
Anti-Bacterial Agents, Outpatients, Hospitals, Inappropriate Prescribing, Drug Resistance, Bacterial, Public Health, Policy, Diffusion of Innovation, Change Management, Interrupted Time Series Analysis, Thailand
Objective: 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.
Methods: 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.
Results: 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.
Conclusions: The national policy on rational drug use effectively reduced antibiotic prescribing for common but questionable outpatient conditions.
2. Sumpradit N, Suttajit S, Poonplosup S, Chuancheun R, Prakongsai P. Landscape of antimicrobial resistance situations and actions in Thailand by Bureau of Drug Control. http://www.fda.moph.go.th/sites/drug/Shared%20Documents/AMR/06.pdf (accessed Jun 15, 2018).
3. Suda KJ, Hicks LA, Roberts RM, Hunkler RJ, Matusiak LM, Schumock GT. Antibiotic Expenditures by Medication, Class, and Healthcare Setting in the United States, 2010-2015. Clin Infect Dis. 2018;66(2):185-190. https://doi.org/10.1093/cid/cix773
4. Mikulic M. U.S.Total medicine spending 2002 -2019. https://www.statista.com/statistics/238689/us-total-expenditure-on-medicine/ (accessed Dec 25, 2020).
5. Chanvatik S, Kosiyaporn H, Lekagul A, et al. Knowledge and use of antibiotics in Thailand: A 2017 national household survey. PLoS One. 2019;14(8):e0220990. https://doi.org/10.1371/journal.pone.0220990
6. Sumpradit N, Chongtrakul P, Anuwong K, et al. Antibiotics Smart Use: a workable model for promoting the rational use of medicines in Thailand. Bull World Health Organ. 2012;90(12):905-913. https://doi.org/10.2471/blt.12.105445
7. World Health Organization. The Pursuit of Responsible Use of Medicines: Sharing and Learning from Country Experiences. http://apps.who.int/iris/bitstream/10665/75828/1/ (accessed Jun 15, 2018).
8. Rational Drug Use Sub-Committee. Rational drug use hospital manual. Nonthaburi: The Agricultural Cooperative Federation of Thailand; 2015.
9. Chongtrakul P. RDU hospital: the pathway to rational drug use. Thai J Pharmacol. 2015; 37(1):48-62.
10. Shayakul C, Leela-Udomlipi S, Wannakul W, Bunupuradah P, Tanta N, Putchakarn P, Puripunyawanich N, Wananukul W, Tandayya N, Thammawut W. Development of rational drug use hospital. https://kb.hsri.or.th/dspace/handle/11228/4902?locale-attribute=th (accessed Jun 15, 2018).
11. Health Administration Division. Service Plan: Rational drug use manual. http://dmsic.moph.go.th/dmsic/admin/files/userfiles/files/Manual_Service%20Plan%20RDU_Sept2016.pdf (accessed May 1, 2017).
12. World Health Organization. How to investigate drug use in health facilities: selected drug use indicators. https://apps.who.int/medicinedocs/en/d/Js2289e/ (accessed Jun 15, 2018).
13. Adriaenssens N, Coenen S, Tonkin-Crine S, et al. European Surveillance of Antimicrobial Consumption (ESAC): disease-specific quality indicators for outpatient antibiotic prescribing. BMJ Qual Saf. 2011;20(9):764-772. https://doi.org/10.1136/bmjqs.2010.049049
14. International Wound Infection Institute. Wound Infection in Clinical Practice. https://www.woundsinternational.com/resources/details/iwii-wound-infection-clinical-practice (accessed Jun 15, 2018).
15. Sirijatuphat R, Choochan T, Siritongtaworn P, Sripojtham V, Thamlikitkul V. Implementation of antibiotic use guidelines for fresh traumatic wound at Siriraj Hospital. J Med Assoc Thai. 2015;98(3):245-252.
16. Health Data Center. Ministry of Public Health. RDU Service Plan indicators. https://hdcservice.moph.go.th/hdc/reports/page.php?cat_id=03b912ab9ccb4c07280a89bf05e5900e (accessed Dec 1, 2019).
17. Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2017;46(1):348-355. https://doi.org/10.1093/ije/dyw098
18. Prais SJ, Winsten CB. Trend estimators and serial correlation. http://cowles.econ.yale.edu/P/ccdp/st/s-0383.pdf (accessed Jun 15, 2018).
19. Xiao Y, Zhang J, Zheng B, Zhao L, Li S, Li L. Changes in Chinese policies to promote the rational use of antibiotics. PLoS Med. 2013;10(11):e1001556. https://doi.org/10.1371/journal.pmed.1001556
20. Fürst J, Čižman M, Mrak J, et al. The influence of a sustained multifaceted approach to improve antibiotic prescribing in Slovenia during the past decade: findings and implications. Expert Rev Anti Infect Ther. 2015;13(2):279-289. https://doi.org/10.1586/14787210.2015.990381
21. Bernier A, Delarocque-Astagneau E, Ligier C, Vibet MA, Guillemot D, Watier L. Outpatient antibiotic use in France between 2000 and 2010: after the nationwide campaign, it is time to focus on the elderly. Antimicrob Agents Chemother. 2014;58(1):71-77. https://doi.org/10.1128/aac.01813-13
22. Holloway KA, Rosella L, Henry D. The Impact of WHO Essential Medicines Policies on Inappropriate Use of Antibiotics. PLoS One. 2016;11(3):e0152020. https://doi.org/10.1371/journal.pone.0152020
23. Holloway KA, Henry D. WHO essential medicines policies and use in developing and transitional countries: an analysis of reported policy implementation and medicines use surveys. PLoS Med. 2014;11(9):e1001724. https://doi.org/10.1371/journal.pmed.1001724
24. Ho M, Hsiung CA, Yu HT, Chi CL, Chang HJ. Changes before and after a policy to restrict antimicrobial usage in upper respiratory infections in Taiwan. Int J Antimicrob Agents. 2004;23(5):438-445. https://doi.org/10.1016/j.ijantimicag.2003.10.013
25. Santa-Ana-Tellez Y, Mantel-Teeuwisse AK, Dreser A, Leufkens HG, Wirtz VJ. Impact of over-the-counter restrictions on antibiotic consumption in Brazil and Mexico. PLoS One. 2013;8(10):e75550. https://doi.org/10.1371/journal.pone.0075550
26. Zajmi D, Berisha M, Begolli I, et al. Public knowledge, attitudes and practices regarding antibiotic use in Kosovo. Pharm Pract (Granada). 2017;15(1):827. https://doi.org/10.18549/pharmpract.2017.01.827
27. Torres NF, Solomon VP, Middleton LE. Pharmacists' practices for non-prescribed antibiotic dispensing in Mozambique. Pharm Pract (Granada). 2020;18(3):1965. https://doi.org/10.18549/pharmpract.2020.3.1965
28. Gastelurrutia MA, Larrañaga B, Ortega B. First program on rational use of antibiotics in Gipuzkoa. Assessment of 1999-2004 period. Pharm Pract (Granada). 2006;4(1):1-8.
29. Gastelurrutia MA, Larrañaga B, Garay A, Echeveste Fde A, Fernandez-Llimos F. Impact of a program to reduce the dispensing of antibiotics without a prescription in Spain. Pharm Pract (Granada). 2013;11(4):185-190. https://doi.org/10.4321/s1886-36552013000400002