Title: An Intervention to Improve Antibiotic Prescribing Habits of Doctors in a Teaching Hospital
Author Name: Francis Ofei
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Presenter Name: Francis Ofei
Authors: Ofei F, Forson A, Tetteh R, Ofori-Adjei D
Institution: University of Ghana Medical School; Korle-Bu Teaching Hospital; and Noguchi Memorial Institute For Medical Research , Accra, Ghana
Problem Statement: Inappropriate prescribing of antibiotics by doctors is common in Ghana. Because of the unique position of hospital consultants as role models in the clinical arena, it is expected that solutions they generate to address this problem will be better adhered to by the junior doctors they mentor.
Objectives: To assess the effect of a managerial and educational intervention selected by hospital consultants for the treatment of Lower Respiratory Tract Infection (LRTI) on the antibiotic prescribing habits of house officers.
Design: A baseline 6-month prospective review of antibiotic prescribing by house officers for community-acquired LRTI for in-patients was followed by a controlled intervention involving three consecutive batches of house officers at the beginning of their house job.
Setting: Two 1500-bed teaching hospitals (study and control groups).
Study Population: Review of clinical notes and prescriptions of all in-patient cases admitted to medical wards at the study site with community-acquired LRTI. Review of prescriptions of house officers doing similar 6-month rotations in internal medicine in another teaching hospital.
Intervention: The results of the baseline data collected were used to prepare guidelines for house officers on the treatment of common medical emergencies including LRTI in collaboration with their consultants. The introduction of the guidelines was accompanied by talks and discussions on the rational use of antibiotics at the start of each housemanship rotation.
Outcome Measures: Appropriateness of antibiotic prescribing; number of drugs per prescription; % antibiotics; antibiotic classes; % on the National Essential Drugs List (EDL); % of other groups of drugs; completeness of prescriptions and final patient outcomes.
Results: The average number of drugs prescribed per patient for LRTI was 5.0 vs. 3.8 at the study and control sites respectively before the intervention and 4.1 vs. 4.7 six months after the intervention. The average number of antibiotics prescribed was 4.9 vs. 3.8 at baseline at the study and control sites respectively and 2.7 vs. 1.7 shortly after the intervention. Prescribing drugs on the EDL and by generics, already low at the study site at baseline compared with control, deteriorated for all drugs as well as antibiotics in the study but not the control group.
Conclusions: These findings are preliminary. Data collection and analysis of the post-intervention phase are ongoing and would be ready by the end of February 2004. The results, however, show a tendency towards improvement in antibiotic prescribing in both groups and a reduction in the number of drugs prescribed in the intervention group.
Study Funding: WHO/Essential Drugs and Medicines and the Applied Research in Child Health (ARCH) project