ผลของมาตรการควบคุมการใช้ยาปฏิชีวนะตามแนวคิด Behavioral economics : กรณีศึกษาในโรงพยาบาลทั่วไปแห่งหนึ่งในจังหวัดปัตตานี

Abstract

The objectives of this study were to developed an intervention to contain antibiotic prescribing rate based on behavioral economics theory and to evaluate effectiveness of the intervention by comparing antibiotic prescribing rate and expenditure before and after intervention. This study was pre-post single group experimental design assessing effectiveness of the developed intervention. The intervention in this study was the provision of feedback information on antibiotic prescription rate for each individual prescribers comparing to the hospital’s average and the committed goal. Two feedback frequencies were implemented: quarterly feedback for 8 quarters (October 2018–September 2020) and followed by monthly feedback for 6 months (October 2020-March 2021). The antibiotic prescribing rates were compared between pre and post intervention in 4 diseases in which were evidently proved of antibiotics unnecessity. Those are fresh traumatic wound (FTW), respiratory infection (RI), acute diarrhea (AD) and antibiotic prophylaxis in vaginal delivery of normal term labor (APL). The segmented regression analysis of interrupted time series were employed. Qualitative methods were used to collect and analyze stakeholders opinions and the interrupted events. The results of study showed that after intervention took place, the reduction of antibiotic prescribing rate (percent per quarter) and antibiotic expenditure (bath per quarter) were observed for all 4 diseases. The interrupted time series regression analysis found significant reduction trend of antibiotic prescribing after intervention both in terms of antibiotic prescribing rate and antibiotic expenditure in FTW. The antibiotic prescribing rate was decreased by 1.893% per quarter (95%CI: -2.720 to -1.066), while the expenditure decreased by 2,935.15 bath per quarter (95%CI: -4,427.434 to -1,442.864). Although the decreasing changes were observed in some of other 3 diseases, there is no significant reduction of antibiotic prescribing both in terms of antibiotic prescribing rates and expenditures. The study concluded that only single intervention of feedback information to individual prescriber was less likely to be effective in containing antibiotic prescribing in all diseases in which were evidently proved of antibiotics unnecessity. Multiple interventions were then proposed to be taken in place for further studies and real practice in containing antibiotic use.