Development of the System for Rational Antibiotic Prescribing: Case Studies of Respiratory Infections and Simple Traumatic Wound in a Community Hospital in Upper Northern

Abstract

Objections: 1) To identify factors affecting physicians’ antibiotics prescribing behaviors in upper respiratory infections (URI) and simple traumatic wound (STW) 2) To develop a system for rational antibiotics prescribing (SRAP) and 3) To evaluate the SRAP. Method: This study was a quasi-experiment in one group of sample group with pre and post tests. The study was composed of 3 stages including 1) identification of factors affecting antibiotics prescribing behaviors in URI and STW by conducting focus group discussion with doctors, pharmacists and nurses 2) developing the SRAP by applying the cycle in action research by discussing with pharmacy and Therapeutics committee (PTC) and 3) evaluating the system with quasi experimental research before and after implementation for 4 months in terms of related expenditure, amount of  prescribing, and pattern of antibiotics prescribing. Results: Factors affecting physicians’ antibiotics prescribing behaviors were 1) predisposing factors including knowledge, experience, familiarity and belief of prescribers 2) reinforcing factors including demand from patients and leaders and 3) enabling factors including drug formulary, the six key aspects of the RDU hospitals and communication. These factors led to a plan for developing the SRAP with setting a clear goal from director of the hospital, guideline for prescribing and dispensing, increased communication between doctors and pharmacist and continuous monitoring by PTC. Implementation of the SRAP resulted in the 18.85% decrease of average rate of antibiotics prescribing in URI and 40.38% in STW. Expense on antibiotics decreased by 21,228.60 baht or 51.84%. Conclusion: Collaborative effort in analysis of problems and development of the SRAP among multidisciplinary team with the consideration of predisposing, reinforcing and enabling factors within the context of the hospital led to more rational prescribing of antibiotics.