AN EVALUATION OF THE WHO RATIONAL PHARMACOTHERAPY AN EVALUATION OF THE WHO RATIONAL PHARMACOTHERAPY TEACHING PROGRAMTEACHING PROGRAM

• The Guide to Good Prescribing (GGP) was first published in 1994, describing a 6-step approach to rational prescribing.

• A short course based on the Guide was shown to be effective in improving medical students’ prescribing in 1995. Measures of outcome were: - Ability to use 6 step systematic approach to

prescribing - Retention of knowledge - Transfer of knowledge to new problems1

• The first ‘train the trainers program’ for the GGP took place in 1994.

• WHO has sponsored courses in several countries throughout the world, in three languages.

• Anecdotally the course has helped to produce change in prescribing education, but the extent of this has not been documented.

• Secular changes, unrelated to the course itself, may also have resulted in curricular change.

Results – Evaluation groupResults – Evaluation group• 36 evaluation responses were returned as of 12th March

(14.8% response rate). See figure 2 for details.• Prior to attending the course, 56% of respondents

reported the use of didactic teaching methods at their institution, 18% used problem-based learning, and 26% used other methods (usually a mixture of the above two options).

Methods (continued)Methods (continued)• Participants came from 158 different institutions in 71

different countries (see map).• The questionnaire sought:

• details of current teaching in pharmacotherapy;• use of rational/evidence-based prescribing as taught

in the GGP course; and• any changes occurring as a result of the participant

attending the course.• Control institutions: a list of non-participating university

faculties was collated to match the country/institution of course participants. The controls (and contact details) were found through internet searches.

Figure 1 Country of residence for participants at the time of the course (larger dot indicates greater number of participants)

Hill S1, Smith AJ1, Thambiran M1, Walkom E1, Hogerzeil HV2

1. School of Medical Practice and Population Health; 2. World Health Organisation

WHO Collaborating Centre for Training in Pharmacoeconomics and Rational Pharmacotherapy

ConclusionConclusionWHO continues to fund a large number of training programs. In relation to the GGP training course one or two countries have had a large number of people trained, but most countries have only 1 or 2 attendees. It is essential that objective evaluations be undertaken to determine whether these training programs have a measurable impact as they are expensive and time-consuming.

There is qualitative evidence of some impact of these programs in terms of effect on teaching and training. However, the evaluation has been hampered by the lack of up to date contact details for participants, the difficulty of identifying a control group and therefore determining whether any effects are as a result of the course or due to secular change in teaching methods in the country of interest.

ReferencesReferences1. de Vries TPGM, Henning RH, Hogerzeil HV, Bapna JS, Bero L, Kafle KK, Mabadeje AFB, Santoso B, Smith AJ. Impact of a short course in pharmacotherapy fro undergraduate medical students: and international randomised controlled study. Lancet 1995;346:1454-1457.

AcknowledgementsAcknowledgementsEvaluation funded by the World Health Organisation.

Thanks to members of the reference group: Karen Barnes, Theo de Vries, Dennis Ross-Degnan, Budiono Santoso, Rob Summers.

AbstractAbstractAn Evaluation of the WHO Rational Pharmacotherapy Teaching ProgramHill S, Smith AJ, Thambiran M, Walkom E, Hogerzeil HVProblem Statement: The WHO has sponsored a training program for clinical pharmacologists and those teaching in pharmacy and medical schools about rational pharmacotherapies since 1994 (the Guide to Good Prescribing, GGP). There has been no assessment of the impact of the provision of this training program.Objectives: To carry out a follow-up evaluation of the international GGP courses and to assess the effect on change in pharmacotherapy curricula and teaching methods in comparison to secular changes that have occurred over time in institutions in the same countries. Design: Cross-sectional questionnaire survey of participants in the program with matched control group.Setting: International follow-up of all course participants. Sample of institutions without course participants matched by country.Intervention: All English Language International GGP courses run from 1994 (South Africa, The Netherlands, South East Asia) until the end of 2001.Outcome Measures: Self-reported change in curricula, teaching methods, use of the components of the GGP process, self-reported assessment of barriers and facilitators to curricular change. Self-reported nature of teaching programs in medicine, pharmacy and health professional schools. Results: There were 245 recorded participants in 11 international courses in the period from 1994 to 2001. These participants were from 75 countries and 158 institutions. The largest cohort of participants was from South Africa (45/245, 18%), and those attendees came from all but one tertiary institution in that country. The next largest cohort was 13/245, from Turkey. 27 countries have had only a single participant attend a course.Updated contact details were found for 102/245 (42%). Questionnaires were emailed to 39 participants and posted to the remainder. Responses have been received so far from 36 participants. The comments from these respondents indicate that the program assisted them in developing new graduate programs, teaching programs in hospitals, national training courses for other teachers of pharmacotherapy, as well as contributing to the development of research projects and pharmacy and therapeutics committees. Identification of control institutions was possible for 103 participant institutions. For South Africa, there was only one possible control institution and for 17 countries, there was no possible control. For these countries, before and after evaluations of teaching methods would be the only possible way to measure the impact of the course. 12 control responses have been received to date.Conclusions: WHO continues to fund a large number of training programs. In relation to the GGP training course one or two countries have had a large number of people trained, but most countries have only 1 or 2 attendees. It is essential that objective evaluations be undertaken to determine whether these training programs have a measurable impact as they are expensive and time-consuming. There is qualitative evidence of some impact of these programs in terms of effect on teaching and training. However, the evaluation has been hampered by the lack of up to date contact details for participants, the difficulty of identifying a control group and therefore determining whether any effects are as a result of the course or due to secular change in teaching methods in the country of interest.

Background and SettingBackground and Setting

Study AimsStudy Aims• To carry out a follow-up evaluation of the international

GGP courses.• To assess the effect on change in pharmacotherapy

curricula and teaching methods in comparison to secular changes that have occurred over time in institutions in the same countries.

• To gain an assessment of the adequacy of the course on its own as a preparation for introducing problem-based pharmacotherapy teaching into undergraduate curricula, and of the need/lack of need of follow-up materials or further training.

• To evaluate the impact of attending the pharmacotherapy teaching course on the participant’s subsequent academic work.

Results – Control groupResults – Control group• 12 control responses have been returned thus far

(9% response rate). See figure 3 for details.• Responses have come from Bulgaria, Czech

Republic, Germany, Indonesia, Nepal, Oman, Sweden, The Netherlands, Turkey (3) and the UK.

• 75% of respondents have heard of the GGP, and 41.7% have used the GGP at their institution (Bulgaria, Oman, Indonesia, The Netherlands, Turkey).

Figure 2. Evaluation questionnaire distribution and replies at 12th March, 2004

Total participants listN = 249

Non-valid contactsn = 4

Participants eligible for inclusionN = 245

Unconfirmed addresses

n = 143 (58.4%)all sent by mail12 Feb 2004

Confirmed addresses

n = 102 (41.6%)

Sent by emailn = 39

03 Feb 2004

Sent by mailn = 63

10 Feb 2004

Replies at 12/03/04n = 36 (14.8% response rate)

n = 19 replies n = 8

n = 9

Replied by emailn = 23

Replied by faxn = 5

Replied by postn = 8

Return to sendern = 2

Figure 3. Control questionnaire distribution and replies at 12th March, 2004

Total controlsN = 135

Sent by mailn = 51

19 Feb 2004

Sent by emailn = 80

19 Feb 2004

Replies at 12/03/04n = 12 (9% response rate)

Replied by emailn = 8

Replied by faxn = 4

Replied by postn = 0

Not an eligible controln = 1

n = 9 replies n = 3 replies

Results (continued)Results (continued)• Over 70% of respondents indicated that they currently

applied the steps of the GGP and used problem-based teaching methods in small groups and/or in other settings.

• 91% of respondents indicated that their personal pharmacotherapy teaching methods had changed as a direct result of attending the course.

• Eighteen (55%) respondents reported changes in other of their country’s institutions as a result of their attending the course.

Barriers to change

Lack of senior academic supportLack of small rooms to run small groupsCentralised medical curriculum without capacity for changeLack of financial supportLack of sympathy with or understanding of PBL

Experiences reported by participants

Comments and suggestions

• Developed and ran training programs for other teachers at national level

• Extended training method to other clinical colleagues and hospitals

• Extended training to other health professionals

• Use of method in other medical disciplines, eg Evidence based health care, drug evaluation

• Modify course to include emphasis on finding evidence-based information on therapy

• Include in the course strategies to implement change in the face of resistance

• Establish network for follow-up with participants

• Provide more training activities!

MethodsMethods• Contact details for course participants were collated from

individual course directors’ lists. Participants were faxed/emailed at last known address and asked for up to date contact information

• Courses evaluated include: Groningen (The Netherlands) 1994-2000; Africa 1996, 1997, 2000; Manila (Philippines) 2001