Download Diapositive 1

Impact of
WHO Guide to Good Prescribing
on Medical Students
Abdelkader Helali*, Nadjat Loumi*
*: Centre National de Pharmacovigilance et de Matériovigilance.
Algiers (Algeria)
ICIUM 2011, Antalya Nov 14th – 18th 2011
Objectives:
To measure the impact of the WHO Guide of Good Prescribing a model with 6
steps to improve students’ reasoning and solving capabilities in pharmacotherapy
with a study over a 3 years (to insure data reproducibility); To discuss the interrelationship between pharmacotherapy and other disciplines for more openness
and pro-active approach in finding allies and forming multidisciplinary coalitions.
Study population: Students at the 6th year undergraduate Algiers’ Faculty of
Medicine (Algeria).
Intervention: 198 Students, randomly selected on voluntary basis, divided into
2 groups: a control group with 65 students and study group with 133 students.
Training: Students were invited to prescribe to relief symptomatic pain (migraine,
acute hepatic colic, acute renal colic, arthritis, irritable bowel syndrome, acute
pharyngitis)
Tests: 3 open problems (A, B, C) and 3 structured problems (X, Y, Z) was
successively presented.
Scoring of tests: 1= no answer, 2= poor answer, 3= arguable answer,
4= acceptable answer, 5= good answer
ICIUM 2011, Antalya Nov 14th – 18th 2011
Design of the study1
Study tests
Open problems
Structured problems
Remembering
the WHO method
learned
(Retention effect)
Applying the
method to new
patient cases
(transfer effect)
Students were
guided in the
reasoning process
(knowledge on drug
treatment)
Pre study test (T0)
Test before training
period.
A
-
X
Study test (T1)
8 weeks later, after
training period
A
B
Y
Post study test (T2)
4 weeks after the
end of training
period
A
C
Z
Measurements
1: Adapted from TPGM de Vries, RH Henning, JS Bapna, HV Hogerzeil & al. Lancet 1995; 346: 1454-57
ICIUM 2011, Antalya Nov 14th – 18th 2011
Step1: Define the patient's problem (diagnosis) (Maximum Score:5)
7
y1
y2
y3
y1
y2
y3
y1
y2
y3
6
5
4
3
2
1
0
Problem A
Problems X,Y,Z
T0: Prestudy test
Problems B, C
T2: Test 4 weeks later
(remembering of method)
Control Group
Control Group
Study Group
Study Group
T1: Test immediately after the
training period of 8 weeks
P < 0.05
Control Group
*
Study Group
Y: Years of the study
ICIUM 2011, Antalya Nov 14th – 18th 2011
Step 2 : Specify the therapeutic objective (Maximum Score:10)
12
10
8
y1
y2
* *
*
y1
y3
*
* *
y2
*
y3
y1
*
*
*
*
*
*
*
y2
y3
*
*
*
*
6
4
2
0
Problem A
Problems X,Y,Z
T0: Prestudy test
Problems B, C
T2: Test 4 weeks later
(remembering of method)
Control Group
Control Group
Study Group
Study Group
T1: Test immediately after the
training period of 8 weeks
P < 0.05
Control Group
*
Study Group
Y: Years of the study
ICIUM 2011, Antalya Nov 14th – 18th 2011
Step 3 : Choose the P-drug and verify the suitability (Maximum Score: 25)
30
25
20
y1
y2
*
*
*
y3
*
y1
* *
y2
* *
y3
y1
*
* *
*
* *
y2
*
y3
*
*
*
15
10
5
0
Problem A
Problems X,Y,Z
T0: Prestudy test
Problems B, C
T2: Test 4 weeks later
(remembering of method)
Control Group
Control Group
Study Group
Study Group
T1: Test immediately after the
training period of 8 weeks
P < 0.05
Control Group
*
Study Group
Y: Years of the study
ICIUM 2011, Antalya Nov 14th – 18th 2011
Step 4 : Write a prescription (Maximum Score:25)
30
25
20
y1
y2
*
*
*
y3
*
y1
* *
y2
*
*
y3
*
*
y1
*
*
*
y2
*
y3
*
*
*
15
10
5
0
Problem A
Problems X,Y,Z
T0: Prestudy test
Problems B, C
T2: Test 4 weeks later
(remembering of method)
Control Group
Control Group
Study Group
Study Group
T1: Test immediately after the
training period of 8 weeks
P < 0.05
Control Group
*
Study Group
Y: Years of the study
ICIUM 2011, Antalya Nov 14th – 18th 2011
Step 5 : Inform and intruct the patient (Maximum Score: 25)
25
y1
y2
y3
y1
y2
y1
y3
20
15
*
* *
*
*
10
*
*
*
y3
*
*
*
*
*
y2
*
*
*
*
*
5
0
Problem A
Problems X,Y,Z
T0: Prestudy test
Problems B, C
T2: Test 4 weeks later
(remembering of method)
Control Group
Control Group
Study Group
Study Group
T1: Test immediately after the
training period of 8 weeks
P < 0.05
Control Group
*
Study Group
Y: Years of the study
ICIUM 2011, Antalya Nov 14th – 18th 2011
Step 6 : Monitor and/or stop the treatment (Maximum Score: 10)
y1
y2
y1
y3
y2
y3
y1
y3
y2
12
10
*
*
8
6
*
*
*
4
*
*
*
*
*
*
*
*
*
*
*
*
*
2
0
Problem A
Problems X,Y,Z
T0: Prestudy test
Problems B, C
T2: Test 4 weeks later
(remembering of method)
Control Group
Control Group
Study Group
Study Group
T1: Test immediately after the
training period of 8 weeks
P < 0.05
Control Group
*
Study Group
Y: Years of the study
ICIUM 2011, Antalya Nov 14th – 18th 2011
Policy implication
1. Foster a critical thinking, self-directed learning and use of
multidisciplinary inputs to bridge the gap between fundamental sciences,
clinical practice, critical analysis, social and behavioural sciences for more
rational prescribing and uses ;
2. Prepare the students to become a part of the healthcare system and
develop their skills. Prepare them to Investigate Drug Use in their health
facilities by using selected drug use indicators for identifying their needs
and planning for continuous training and better use of medicines ;
3. Make students ready to understand community needs for safe practice
and provide with Epidemiology, Method for Selecting Essential Medicines
List at their health facilities or at country level, developing a Personal
Formulary to become more competent in prescribing.
Future study and Research
1. Comparative multicentre studies of cost-effectiveness of teaching WHO
Guide of Good Prescribing as short term pharmacotherapy training in
different setting in undergraduate medical education in low and middle
income countries.
2. Foster Multidisciplinary looking at prescribing practice at real life
scenarios (not only at simulated cases).
3. Promote drawing up a Model Core Curriculum for undergraduate
medical students using WHO Good Prescribing on the basis of WHO
Model Essential Medicines List adjusted to the country needs.
ICIUM 2011, Antalya Nov 14th – 18th 2011