Multiple challenges of antibiotic use in a large hospital in Ethiopia – a ward-specific study showing high rates of hospital-acquired infections and ineffective prophylaxis

Background This project aims to study the use of antibiotics in three clinical wards in the largest tertiary teaching hospital in Ethiopia for a period of 1 year. The specific aims were to assess the prevalence of patients on antibiotics, quantify the antibiotic consumption and identify the main indications of use. Method The material was all the medical charts (n = 2231) retrieved from three clinical wards (internal medicine, gynecology/obstetrics and surgery) in Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa between September 2013 and September 2014. Data collection was performed manually by four pharmacists. Results Each medical chart represented one patient. About 60% of the patients were admitted to internal medicine, 20% to each of the other two wards. The number of bed days (BD) was on average 16.5. Antibiotics for systemic use were prescribed to 73.7% of the patients (on average: 2.1 antibiotics/patient) of whom 86.6% got a third or fourth generation cephalosporin (mainly ceftriaxone). The average consumption of antibiotics was 81.6 DDD/100BD, varying from 91.8 in internal medicine and 71.6 in surgery to 47.6 in gynecology/obstetrics. The five most frequently occurring infections were pneumonia (26.6%), surgical site infections (21.5%), neutropenic fever (6.9%), sepsis (6.4%) and urinary tract infections (4.7%). About one fourth of the prescriptions were for prophylactic purposes. Hospital acquired infections occurred in 23.5% of the patients (353 cases of surgical site infection). The prescribing was based on empirical treatment and sensitivity testing was reported in only 3.8% of the cases. Conclusions In the present study from three wards in the largest tertiary teaching hospital in Ethiopia, three out of four patients were prescribed antibiotics, primarily empirically. The mean antibiotic consumption was 81.6 DDD/100BD. Surgical site infections constituted a large burden of the infections treated in the hospital, despite extensive prescribing of prophylaxis. The findings show the need to implement antibiotic stewardship programs in Ethiopian hospitals with focus on rational prescribing, increased sensitivity testing and better procedures to prevent hospital acquired infections

Price control as a strategy for pharmaceutical cost containment--What has been achieved in Norway in the period 1994-2004?

Objectives To describe and evaluate the different price control strategies implemented in Norway after its accession to the European Economic Area (1994-2004).Methods Interviews with ten key persons who had broad insight into the field in question were held. All the available literature was reviewed.Results Direct price control involving international reference pricing of prescription drugs, and the subsequent price revisions, that occurred from the year 2000 onwards, resulted in predictable and substantial price reductions. With respect to the indirect methods which targeted the off-patent market, the price reductions resulting from reference-based pricing (1993-2000) were only marginal and the achieved savings derived mainly from increased patients' charges. The introduction of generic substitution in 2001 led to increased market shares for non-branded products, but discounts from the manufacturers were not reflected in retail prices. An index price system (2003-2004) was therefore created; but as it entailed negative economical incentives for the pharmacy chains, the price changes did not meet the expectations.Conclusion The direct pricing strategy, i.e. the international reference pricing, was considered to be the most successful method. In contrast, due to the unpredictability of the market situation, the resulting effects of the indirect methods, i.e. reference-based pricing, generic substitution, and index pricing, were more limited.Cost control Generic drugs Norway Reimbursement

Helsepersonells oppfatninger om multidosepakkede legemidler

Beskriver en studie hvor hensikten var å undersøke hvordan leger, sykepleiere og hjelpepleiere oppfattet at innføring av multidosepakkede legemidler påvirket legemiddelhåndtering og informasjonsutveksling.Bakgrunn: maskinell dosepakking (multidose) av legemidler er i dag et satsingsområde for å gi mindre feilbruk av legemidler. Det er mangelfull kunnskap om hvordan multidosepakninger påvirker rutinene og kvaliteten av legemiddelhåndtering i åpen omsorg. Materiale og metode: vi gjennomførte en intervjuundersøkelse med strukturert spørreskjema hos 27 fastleger og 121 ansatte (sykepleiere og annet pleiepersonell) i fire pleiedistrikter i Fredrikstad kommune. Resultater: et flertall mente multidosepakkingen gjorde at de nå følte seg tryggere på at pasientene fikk riktige medisiner (hjemmetjenesten 73%, leger 78%), at rutinene i forbindelse med legemiddelhåndteringen var blitt bedre (hjemmetjenesten 84%, legene 52 %; p < 0,001) og at det var blitt enklere å ha oversikt over pasientenes medisiner (hjemmetjenesten 76%, legene 56 %; p = 0,03). 44% av legene mente at de måtte bruke mer tid på legemiddelordinering etter innføringen. Det var ulike rutiner for informasjonsflyt og koordinering av dokumentasjon i forhold til legene i de fire distriktene. Fortolkning: multidosesystemet ble opplevd som en forbedring fra tidligere situasjon med tanke på rutiner og kvalitet av legemiddelhåndteringen. At legene var mindre fornøyde med ordningen enn sykepleierne, kan skyldes at de måtte forholde seg til forskjellige distrikter med ulike informasjonsrutiner. Ved innføring av multidosepakkede legemidler er det viktig med klare ansvarsforhold og ensartede rutiner for samhandling mellom leger, hjemmetjeneste og apotek/pakkeprodusent

Experiences of Kurdish immigrants with the management of type 2 diabetes: a qualitative study from Norway

Objective: To explore the experiences of immigrant Kurdish patients in Oslo, Norway, related to the management of type 2 diabetes mellitus (T2DM). Design: A qualitative study with focus group interviews. Setting: Participants were recruited at meeting places in Oslo through Kurdish networks. Subjects: Eighteen Kurdish immigrants (9 females and 9 males) living in Oslo, aged 40 to 64 years, diagnosed with T2DM participated in a total of five focus groups. Participants had to be proficient in the Norwegian language to be eligible. Main outcome measures: Immigrant Kurdish patients’ experiences with being diagnosed with T2DM, their disease management, and need for medical information. Results: Participants stressed that living with T2DM was emotionally challenging, mainly because they were afraid of possible complications of the disease. They claimed to adhere satisfactorily to their medicines and blood glucose measurements. The majority of participants shared that they had made changes to their diet, even though it was difficult. To the contrary, physical activity received only minimal attention. The participants’ main source of information was general practitioners and the majority of them were satisfied with the information that they had received about their disease and its management. Conclusion: Kurdish T2DM patients in the present study from Norway reported that they adhered to the medical treatment, even if they were stressed about living with the disease. However, they were more occupied with changing their diet than to be physically active. Therefore, healthcare personnel should try to be aware of lifestyle challenges among their patients