Abstract
An inappropriate use of antimicrobial is not only a major cause of antimicrobial resistance but also a huge wasted expenditure in many countries including Thailand especially in teaching hospital. Many appropriate antimicrobial prescribing interventions can improve rational antimicrobial use. Therefore, the objective of this study was to select the most appropriate rational antimicrobial prescribing interventions for Thai health care system. The focus group technique was used to select the rational antimicrobial prescribing interventions. The members of focus group included the experts who have had experienced in rational antimicrobial prescribing interventions and stakeholders who would have an impact if the selected interventions were implemented.
Based on all international and national literatures related to interventions, many rational antimicrobial prescribing interventions were available. Due to a diversity of setting and methodology used in each study, the efficacy of interventions was not concluded in a harmonious direction and a comparison between interventions were needed to compare by indirect method. Multifaceted interventions were more effective than single intervention. Moreover, the effective interventions such as education, antimicrobial order form, infectious disease specialist approval and clinical pharmacist acting as a reviewer and decision supporter were proposed to a focus group as a preliminary data. Then discussion and judgment of the intervention selection was made among members.
The consensus of focus group suggested that the above interventions were not appropriate for Thai health care system because there were many limitations. For example, there were not enough infectious disease specialists and clinical pharmacists, the role of clinical pharmacists were not so accepted as compared to developed countries and physicians still had the highest power in prescribing. However, the intervention called drug use evaluation (DUE), a process to monitor and promote the rational use of drugs might be used as a tool for solving this problem. In addition, pharmacists who have had experienced with antimicrobial DUE in hospitals suggested that the explicit policy related to DUE from the central was very necessary and should be restricted. It may be a feasible measure to promote rational antimicrobial use in Thai healthcare system in the future.
