Development of a Pharmacist-Led Multidisciplinary Antimicrobial Stewardship Program at Xieng Khouang Provincial Hospital, Lao People's Democratic Republic

Abstract

Objective: To develop and evaluate an antimicrobial stewardship program (ASP) led by pharmacists in collaboration with a multidisciplinary team at Xieng Khouang Provincial Hospital, Lao People’s Democratic Republic. Methods: This study employed a mixed-methods action research design conducted from September to December 2024 in four inpatient wards of Xieng Khouang Provincial Hospital, namely internal medicine, infectious diseases, pediatrics, and surgery. The study comprised two phases: (1) a qualitative phase to explore the context and problems through in-depth interviews with nine healthcare personnel, and (2)a quantitative phase to develop and evaluate the ASP by comparing the appropriateness of ceftriaxone use among patients diagnosed with infectious diseases before implementation of the program (n=78) and after implementation (n=63). Results: The developed ASP was a pharmacist- led system in which pharmacists reviewed the appropriateness of ceftriaxone use according to criteria established based on the hospital context and provided information and consultation to the treatment team to promote rational antibiotic use. After implementation of the ASP, the appropriateness of antibiotic use showed an increasing trend. The proportion of appropriate antibiotic selection in definite therapy increased from 62.5% to 80.0%, although this increase was not statistically significant (P = 0.856). The appropriateness of dose and dosing frequency increased significantly from 93.6% to 100.0% (P =0.025). The rate of intravenous-to-oral conversion increased from 84.2% to 87.5%, but this was not statistically significant (P = 0.733). The appropriateness of treatment duration increased from 87.1% to 95.2%, but this  was not statistically significant (P=0.168). In addition, physicians accepted 90.9% of the pharmacists’ recommendations, resulting in a reduction in injectable ceftriaxone consumption from 368.8 to 181.4 DDDs per 1,000 patient-days, representing a 50.3% decrease. Drug expenditure decreased from 96,161 THB in the pre-implementation period (August) to 46,791 THB in the post-implementation period (December), representing a 51.3% reduction. The average length of hospital stay also decreased from 6.3 days to 5.3 days. Conclusion: The developed pharmacist-led ASP for evaluating and advising on antibiotic use in collaboration with a multidisciplinary team tended to improve appropriateness of antibiotic use, reduce antibiotic consumption and drug costs, and improve clinical outcomes. This approach may therefore serve as a model for further ASP development in hospitals in the Lao People’s Democratic Republic.