Impact of Impact of WHO Guide to Good PrescribingWHO Guide to Good Prescribing

on Medical Studentson 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 6steps to improve students’ reasoning and solving capabilities in pharmacotherapywith a study over a 3 years (to insure data reproducibility); To discuss the inter-relationship between pharmacotherapy and other disciplines for more opennessand 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)

ICIUM 2011, Antalya Nov 14th – 18th 2011

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

Design of the study1

Study tests Open problems Structured problems

Measurements

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

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

T0: Prestudy test

Control Group

Control Group

Study Group

Study GroupStudy Group

T1: Test immediately after the training period of 8 weeks

T2: Test 4 weeks later (remembering of method)

Control Group

* P < 0.05

Y: Years of the study

ICIUM 2011, Antalya Nov 14th – 18th 2011

Step1: Define the patient's problem (diagnosis) (Maximum Score:5)

0

1

2

3

4

5

6

7

Problem A Problems X,Y,Z Problems B, C

y1 y2 y3 y1 y2 y3 y1 y2 y3

T0: Prestudy test

Control Group

Control Group

Study Group

Study GroupStudy Group

T1: Test immediately after the training period of 8 weeks

T2: Test 4 weeks later (remembering of method)

Control Group

* P < 0.05

Y: Years of the study

ICIUM 2011, Antalya Nov 14th – 18th 2011

Step 2 : Specify the therapeutic objective (Maximum Score:10)

0

2

4

6

8

10

12

Problem A Problems X,Y,Z Problems B, C

* * * **

* **

* * ** *

** ** *

y1 y2 y3y1 y2 y3 y1 y2 y3

T0: Prestudy test

Control Group

Control Group

Study Group

Study GroupStudy Group

T1: Test immediately after the training period of 8 weeks

T2: Test 4 weeks later (remembering of method)

Control Group

* P < 0.05

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)

0

5

10

15

20

25

30

Problem A Problems X,Y,Z Problems B, C

* ** *

* ** *

* *

*

** * * *

* *

y1 y2 y3 y1 y2 y3 y1 y2 y3

T0: Prestudy test

Control Group

Control Group

Study Group

Study GroupStudy Group

T1: Test immediately after the training period of 8 weeks

T2: Test 4 weeks later (remembering of method)

Control Group

* P < 0.05

Y: Years of the study

ICIUM 2011, Antalya Nov 14th – 18th 2011

Step 4 : Write a prescription (Maximum Score:25)

0

5

10

15

20

25

30

Problem A Problems X,Y,Z Problems B, C

* ** * * * * *

** * *

** * *

*

y1 y2 y3 y1 y2 y3 y1 y2 y3

T0: Prestudy test

Control Group

Control Group

Study Group

Study GroupStudy Group

T1: Test immediately after the training period of 8 weeks

T2: Test 4 weeks later (remembering of method)

Control Group

* P < 0.05

Y: Years of the study

ICIUM 2011, Antalya Nov 14th – 18th 2011

Step 5 : Inform and intruct the patient (Maximum Score: 25)

0

5

10

15

20

25

Problem A Problems X,Y,Z Problems B, C

** * *

* **

* * *

**

*

* * * **

y1 y2 y3 y1 y2 y3y1 y2

y3

T0: Prestudy test

Control Group

Control Group

Study Group

Study GroupStudy Group

T1: Test immediately after the training period of 8 weeks

T2: Test 4 weeks later (remembering of method)

Control Group

* P < 0.05

Y: Years of the study

ICIUM 2011, Antalya Nov 14th – 18th 2011

Step 6 : Monitor and/or stop the treatment (Maximum Score: 10)

0

2

4

6

8

10

12

Problem A Problems X,Y,Z Problems B, C

* * * * * *

*

*

** *

**

* ** *

y1 y2 y3y1 y2 y3 y1 y2

y3

*

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