Promoting Parenteral-Oral Drug Switching for Hospitalized Patients (การส่งเสริมการแทนยาฉีดยากินสำหรับผู้ป่วยที่นอนพักรักษาในโรงพยาบาล)

A quasi experiment was conducted at Lampang Hospital during October 2003 - November2004 to determine the effectiveness of the multifaceted group interventions in promoting parenteraloral(IV-PO) drug switching for hospitalized patients and to survey an attitude of physician towardsIV-PO switching program. Medical charts of inpatients who were prescribed target IV drugs morethan 24 hours were reviewed prospectively by a clinical pharmacist for two weeks in each phase;phase I as a baseline period, phase II as 2 months after intervention, and phase III as six months afterintervention. Candidates for the switching were identified according to the hospital guideline. Excessdays, durations of IV drug use, and potentially avoidable costs were determined. The generalizedlinear model was used to adjust relevant factors in the multivariate analysis.Of all reviewed hospitalized patients, 629, 647 and 593 were prescribed the target IV medicationsthat comprised 940, 1,007 and 917 prescriptions in phases I, II and III, respectively. Accordingto the switching guideline, 25.7 percent, 19.7 percent and 24.2 percent of prescriptions were identifiedas the candidates in phases I, II and III, respectively. The multifaceted group interventionscould significantly reduce only an incidence of switching candidate in short-term period (p<0.05),but not the other expected outcomes both in short-term and long-term periods. After six months,significant improvement could no longer be observed. Based on the physician opinions, more than90 percent agreed with the implementing of IV-PO switching program in the hospital, more than 80percent thought that the most effective strategy in promoting IV-PO drug switching was clinicalpractice guideline implementation whereas about 20 percent thought that the most effective waspolicy implementation. The physicians preferred communication with pharmacists via direct contact(44.2%) to via written form (28.9%). Since the multifaceted group interventions could reduceonly incidence of switching candidates for a short while, it should be implemented along with aspecific reminder system to increase the effectiveness of the IV-PO switching program in the hospital.Key words: pharmacist, impact, promotion, IV-PO switching, hospitalized patients