Impact of Training, Monitoring and Mentoring on Medicines Therapeutic Committees in Ghana

presenter Kwesi Eghan Chinwe Owunna, Kwesi Eghan and Johannes Addison Presented at the International Conference on Improving Use of Medicines (ICIUM) Antalya, Turkey, November 14 - 18, 2011

Medicine Use in Ghana Background and design of study Results Key Lessons Conclusion

Presentation

National Drug Policy

Ghana has a robust processes for development and reviews of EML, STGS (6th edition)

Training on RUM and establishment of MTCs in several Health Facilities (primary care level)

Key Players-Ministry of Health (Dept of Pharmacy and Ghana National Drugs Program), WHO, Development Partners (e.g DFID) and MSH/SPS

Medicine Use in Ghana

Ghana’s antimalaria drug policy (AMDP) changed in 2004 & 2007 to include the use of artemisinin- based combination therapy (ACT) for the treatment of uncomplicated malaria.

High circulation of Monotherapies. Negative publicity on Amodiaquine -

Artesunate (AS/AQ) due to (anecdotal?) reports on adverse drug effects.

Non compliance by health facilities to revised AMDP

Background to study

To improve health facility Medicines and therapeutics committee’s (MTC) understanding of the new National Anti malarial Drug Policy and

Show how supportive supervision using academic detailing can improve rational medicine use and compliance to AMDP at public health facilities.

Objectives

Before- and- after study with no control group. post-intervention evaluation in two facilities at

month 6

Design

Drug and Therapeutics Committees (DTCs) Improve the Use of Medicines and Preserve Effectiveness of Antimalarials

Training programs • In-service

• Pre-service

CollaborationsWith hospital departments • Infection control • Microbiology • Pharmacy • Hospital Management

Manage formulary or essential medicines lists

• develop and implement • monitor compliance

Identification of medicine use problems

• Indicator Studies• ABC Analysis

Medicine Use Interventions

• compliance with treatment guidelines• drug use evaluations• support for pharmacovigilance

DTCs

Trained in collaboration with MoH Pharmacy Department 155 MTC members from 48 facilities on rational medicine use and the new AMDP.

Conducted supportive supervisory visits at 20 of the 48 health facilities, mentored DTC members and facility prescribers to improve practices.

Supportive supervisory tools used focused on; Process indicators Impact and outcome indicators– quality of prescription

- quality of care -adherence to documented

treatment policies Post visit one-on-one discussions (academic detailing) with

prescribers, dispensers and group meeting with DTC members Percentages of indicators related to AMDP compliance Other parameters were measured website :www.sps.org

Intervention

INDICATOR MAAMOBI POLYCLINIC BASELINE

MAAMOBI POLYCLINIC POST-INTERVENTION

KANESHIE POLYCLINIC BASELINE

KANESHIE POLYCLINIC POST-INTERVENTION

CONFORMITY TO AMDP

85% 92% 80% 87%

TREATMENT WITH AS/AQ

20% 65% 53% 75%

TREATMENT WITH AL

80% 35% 47% 25%

Results

Training followed by regular supportive supervision is an effective way to improve adherence to treatment policies

Supportive supervision and monitoring has resource implications- time and money

For the intervention to be fully accepted by health workers, buy-in and full collaboration of the MOH (NMCP and pharmacy unit of GHS) is key

What key lessons can we learn from your work?

Review the Long term impact of training and supportive supervision- especially use of ‘academic detailing’ and monitoring on health worker behaviors to improve RMU

What specific studies should be included in a future research agenda on your topic?

Although training, supervisory visits, and mentoring can be resource-intensive, the survey showed that these interventions improve rational medicine and increased adherence to AMDP.

Conclusion