Evaluation of rational drug use project, under the support of national health security office, on drug utilization and drug management in community care clinics in Bangkok

Abstract

Background: “The Network of Rational Drug Use Clinic (RDU Clinic)” campaign implemented in August 2015 to promote rational drug use in community caring clinic operated under National Health Security Office (NHSO) in Bangkok. The intervention composed of various measures such as education, managerial intervention, regulatory, and financial incentive. The purpose of the project is to evaluate and monitor the program effectiveness.

Objectives: The purpose of the study is to evaluate the impact of RDU project on the quality of drug use in community care clinics in Bangkok using an interrupted time-series intervention analysis

Methods: Quasi-experimental study using interrupted time series analysis was applied to compare the outcome variables before and after intervention. The aggregated weekly prescriptions data was extract from NHSO medical claim database between October 2013 to September 2019. Auto Regressive Integrated Moving Average (ARIMA) model was developed to estimate the level and trend in the pre-intervention data segment compare with the estimated changes in level and trend in post-intervention. : Five indicators are selected as outcome of interest for ARIMA model analysis; 1) antibiotics (ATBs) utilization, 2) percentage of encounters with antibiotics prescribed, 3) percentage of prescriptions of antibiotics in accordance with clinical guidelines, 4) average medicines cost per encounter, and 5) percentage of drug costs spent on antibiotics.

Results: ATBs utilization was significantly affected by financial intervention in Total ATBs, (p < 0.05, p = 0.004). Percentage encounter with ATBs, was significantly affect by education (p < 0.05, p = 0.017) The percentage of prescript adhere with guideline has an increasing trend but has no significant effect (p > 0.05). Average medicine cost per encounter is not significantly impacted by the interventions. The percentage of drug cost spent on ATBs has significant impacted by education intervention (p < 0.05, p = 0.001)ใ

Conclusions: RDU clinics project is partially effective to improve quality of drug use in terms of ATBs utilization, prescriptions and cost. Since financial intervention was implemented approximately one year after the beginning of the intervention, we can deduce that the effect of the financial intervention was leveraged by previously education..