ผลของการแทรกแซงหลายรูปแบบต่อการสั่งใช้ยาปฏิชีวนะในโรคคอหอยอักเสบและท้องร่วงเฉียบพลันในหน่วยบริการสุขภาพปฐมภูมิ อ.ปากพะยูน จ.พัทลุง

Abstract

The purpose of this study was to investigate the effects of interventions consisting of education on rational use of antibiotics in acute pharyngitis (AP) and acute gastroenteritis (AGE), the provision of media for education and diagnostic equipment and supervision of rational use of antibiotic in both diseases among medical personnel in primary care units at Pak Phayun District, Phatthalung. The subjects were prescribers in 18 subdistrict health promotion hospitals (SHPH) and community health centers in Pak Phayun district, Phatthalung Province. The subjects were randomly divided into 2 groups: control group and experimental group. Both groups attended educational session on rational use of antibiotics in AP and AGE, receiving educational media and diagnostic devices. The experimental group was supervised in the second and fourth months after training. The control group was supervised once in the fourth month. The study collected monthly data on prescribing in AP and AGE before and after the intervention for 6 months using the E-tool version 4.0 program. After attending education session, subjects in control and experimental groups were more confident in treating AP without antibiotic use (P=0.027 and 0.027, respectively) and in treating AGE without antibiotic use (P=0.039 and 0.042, respectively). However, there were no change in attitudes toward antibiotic treatment in both diseases, knowledge on the use of antibiotics in both diseases, perception of patients' expectation to receive antibiotics in both diseases, perception on substitutes of antibiotics in both diseases, perception on the lack of educational media regarding the treatment of both diseases without antibiotics, and perception of the lack of diagnostic equipment for AP. The control group and the experimental group had a similar monthly rate of antibiotic use in AP and AGE throughout the six months before intervention, ie 32- 35% and 38-40%, respectively. At 2 months after educational session, rate of antibiotic use in AP and AGE was decreased by 9-10% and 11-12%, respectively. When supervision was conducted in the experimental group at 2 months after education, antibiotics use in AP and AGE of the experimental group was 6 and 8% less than those in the control group (P=0.001 and 0.001) respectively at the 4th month after education. Supervision in control group conducted at the fourth month after education reduced antibiotic use in AP and AGE by approximately 5 and 6%, respectively. The rate of antibiotic use in AP in experimental group with two times of supervision was less than that in the control group undergoing one time of supervision by approximately 3-4%, which was statistically significant at 6 months post-training (P = 0.010). There were no differences between groups with two and one time of supervision in AGE. In summary, interventions by providing education, educational media and diagnostic devices increase confidence in non-antibiotic use in the two targeted diseases. Educational training with monitoring reduces antibiotic use. Two waves of supervision in AP could reduce antibiotic use more than one time of supervision does. However in AGE, the number of follow-up visits does not affect the reduction in antibiotic use.