Antibiotic Policy of Regional Hospitals and General Hospitals of the Ministry of Public Health in the Opinion of Hospital Pharmacists - นโยบายยาปฏิชีวนะของโรงพยาบาลศูนย์และโรงพยาบาลทั่วไปในสังกัดกระทรวงสาธารณสุข ในมุมมองของเภสัชกรโรงพยาบาล

Abstract

       Antibiotic policies are necessary for a hospital to support appropriate antibiotic use. The objective of this study was to determine and compare types of antibiotic policy and pharmacists' opinion on effects of antibiotic policy used in the regional and general hospitals of the Ministry of Public Health. This study was a cross-sectional survey. Data were analyzed using Chi-square test and T-test. Data were collected through self-developed questionnaires which were sent to pharmacy department chairs of 25 regional hospitals as well as 69 questionnaires to general hospitals. It was found that the response rate was 56.0% (14 questionnaires) for the regional hospitals, and 31.9% (22 questionnaires) for the general hospitals. There were the range of 2 - 27 antibiotic policies developed and used in a hospital. The 5 most common policies were (1) having physicians and pharmacist responsible for developing antibiotic policies (96.7%), (2) restriction for antibiotic use by indication (86.1%), (3) drug use review (80.6%), (4) replacement of previous drug by a new drug with the same drug category in the hospital formulary (75.0%), and (5) having a pharmacist responsible for monitoring compliance of antibiotic use with the hospital policy (69.4%). Regional hospitals were more significantly to have the following policies than those of general hospitals: (1) requirement of a antimicrobial sensitivity test after prescribing important or expensive antibiotics (85.7% vs. 50.0%; respectively, p<0.05), (2) automatic discontinuation of medicine order for important or expensive antibiotics with no antimicrovial sensitivity test results (28.6% vs. 4.6%; respectively, p<0.05), (3) the pharmacy department had the right to stop dispensing an antibiotic if a physician had not changed the prescription that was not in line with the hospital policy even though some considerable amount of the antibiotic was already given to a patient (42.9% vs. 13.6%; respectively, p<0.05), and (4) the pharmacy department had the right to report to the hospital authority if a physician
did not change medicine order to comply with the hospital policy (50.0% vs. 4.6%; respectively, p<0.05). There was no significant difference in other policies between the 2 levels of hospitals. In general, the respondents believed that antibiotic policies in their hospitals were sufficient and appropriate (3.5±0.9 points of 5 points scale) and the policies had an resulted in appropriate antibiotic use (3.1±0.9 points of 5 points scale). This study indicated that regional and general hospitals had different numbers of antibiotic policies with varying rationale of antibiotic use situations. Some hospitals had very few antibiotic policies. Therefore, some hospitals should consider formulating and adopting more appropriate antibiotic policies in
order to increase the appropriate use and the cost of antibiotics.
Key words: policy, antibiotic, regional hospital, general hospital, Ministry of Public Health