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Improving the performance of Drug and Therapeutics Committees in hospitals – a quasi-experimental study in Laos

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Background and objectives

Drug and Therapeutics Committees (DTCs), which are essential for ensuring the rational use of drugs (RUD) in hospitals, have recently been established in Laos. Sub-optimal performance had been reported. The aims of this study were to determine those factors in the working environment that relate to DTC performance in Lao hospitals and evaluate whether DTC performance could be improved through an educational intervention utilizing auditing and feedback targeted towards DTC members.

Methods

This was a quasi-experimental (before and after) study. Two central and seven provincial hospitals and the DTC members from these hospitals participated in the study. Performance of the DTCs was assessed by means of specifically developed indicators on structure and process combined with indicators for RUD and adherence to Standard Treatment Guidelines (STG). Data were collected for a 3-month period at baseline and for three consecutive periods thereafter. The results of the first three data collections were shared and discussed with the DTC members during feedback sessions. The DTC members were also interviewed in order to identify factors they thought may have an impact on DTC performance.

Results

Following the intervention, there was a significant improvement in the overall score for DTC performance (p<0.001) and, in particular, in general activity and feedback and drug information to staff. The STG scores also improved (p<0.01). Interviews indicated that one negative factor was the experience of the DTC members being overloaded with other work, resulting in DTC meetings being held irregularly and drawing poor attendance.

Conclusion

Continuous self-monitoring of performance by means of indicators, followed by feedback discussions, is suggested the means of improving the work of the DTC.

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Acknowledgements

The authors of this study wish to acknowledge the Swedish International Development Cooperation Agency (Sida) for funding, and Professor Boungnong Boupha and Associate Professor Kongsap Akkhavong for their supervision of the project. Grateful thanks are also extended to Dr. Bouathong Sisounthone (deceased December 2004), Dr. Phat Keungsaneth and Dr. Sommay Rattanavong as members of the research team and to all DTC Task force and VIP members from the nine DTC units involved in the study.

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Authors and Affiliations

  1. Department of Cardiology, Mahosot Hospital, Vientiane, P.O. Box 5202, Lao People’s Democratic Republic (Laos)

    Chu Vang

  2. Division of International Health (IHCAR), Karolinska Institutet, Stockholm, Sweden

    Goran Tomson, Rolf Johansson & Rolf Wahlstrom

  3. Medical Management Center, Karolinska Institutet, Stockholm, Sweden

    Goran Tomson

  4. Out-patient Department, Mahosot Hospital, Vientiane, Laos

    Thanakhanh Southammavong

  5. National Institute of Public Health (NIOPH), Vientiane, Laos

    Sengchan Kounnavong

  6. Curative Department, Ministry of Health, Vientiane, Laos

    Amphayvanh Phanyanouvong

  7. Nordic School of Public Health, Goteborg, Sweden

    Bo Eriksson

Authors
  1. Chu Vang
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  2. Goran Tomson
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  3. Sengchan Kounnavong
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  4. Thanakhanh Southammavong
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  5. Amphayvanh Phanyanouvong
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  6. Rolf Johansson
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  7. Bo Eriksson
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  8. Rolf Wahlstrom
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Corresponding authors

Correspondence to Chu Vang or Rolf Wahlstrom.

Appendices

Appendix 1

Tasks of the Lao Drug and Therapeutics Committees

1. To have an advisory role to the Hospital Board, decision makers and health staff in general

2. To monitor regularly adherence to indicators for STG and RUD

3. To monitor regularly drug consumption at various departments of the hospital

4. To make analyses and report to the head of DTC, who will report to the Hospital Board

5. To propose (and carry out) interventions/feedback

6. To take decisions ‐ based on the Lao EDL (Essential Drugs List) ‐ regarding the EDL of the hospital

7. To develop/improve/follow up on hospital medical routines

8. To stimulate or to give training/teaching (diagnosis, drugs and treatment)

9. To provide objective information regarding drug use to the Hospital Board, decision makers and health staff in general

10. To make a list of anti-dots and to be responsible for emergency kits

11. To stimulate reporting about adverse drug reactions (side effects) to the DTC

12. To have knowledge and acceptance about ongoing clinical studies

13. To co-operate with other Drug Therapeutic Committees

Appendix 2

Indicators for DTC performance

Indicator 1: DTC structure

   Is the Head of DTC from the Board of Hospital Directors?

   Are doctors, nurses and pharmacists recruited to be DTC members?

   Is there any DTC secretary?

Indicator 2: DTC report system

   Is there any available agenda of DTC activities?

   Is there any summary of the result of the meeting?

   How often are the DTC reports sent to the upper administrative/clinical levels in the organization?

   Where do DTC report?

   Is there any special report form?

Indicator 3: DTC activities

   Is there a timetable for meetings within the DTC?

   Number of STG and RUD score collections performed in the last 6 months?

   Are STG books available in all departments?

   What is the percentage of EDL drugs used in the hospital?

Indicator 4: DTC feedback

   How many feedback sessions were held in the last 6 months?

   What are the contents of feedback?

   What percentages of doctors and nurses participated in the feedback sessions?

Indicator 5: DTC drug information

   Is there any EDL in the hospital?

   Number of information activities about new drugs and banned drugs are held per year?

   Is there any promotion on the use of a generic name?

   Is there any information concerning to appropriate use of antibiotics and injections?

Indicator 6: Adverse drug reactions (ADR)/side effects (SE) control

   Is there any person responsible for ADR reporting in the DTC?

   Is there a specific report form?

   Do doctors and nurses know the person where to report an ADR?

   Has the ADR person received any reports?

   Is there any feedback on ADR?

   Are ADR reported to central level ?

Indicator 7: Monitoring of drug cost/consumption (DDD, daily defined doses)

   How often was there a comparison between departments carried out of DDD/cost consumption for antibiotics?

   How often was there a comparison of antibiotic tablets/injections?

   How often was there a comparison of analgesics DDD/cost between departments?

Indicator 8: Hospital medical routines (HMR)

   Is the DTC working with one of the 20 HMR ideas suggested (which?)

   Is the DTC working with other HMR ideas (which?)

   Can the DTC show graphic/data/statistics of monitoring?

   Is there any kind of intervention?

   Who did the intervention and when?

   Is there any follow up/monitoring/graphic available?

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Vang, C., Tomson, G., Kounnavong, S. et al. Improving the performance of Drug and Therapeutics Committees in hospitals – a quasi-experimental study in Laos. Eur J Clin Pharmacol 62, 57–63 (2006). https://doi.org/10.1007/s00228-005-0069-8

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