Upaya menurunkan penggunaan antibiotika pada pengobatan ispa melalui Diskusi kelompok kecil paramedis puskesmas di Kabupaten Bantul = Reducing antibiotic overuse with acute respiratory tract infections utilizing a ...

Background: Acute Respiratory Tract Infections (ARI) is the leading cause of child morbidity and mortality in Indonesia, and accounted for 40-60% of patients visiting health facilities. Standard Treatment Guidelines (STG) for ARI in health center level has been developed by the Ministry of Health since 1983, and in 1991 a flowchart of ARI diagnosis and treatment has been provided for all health centers in Indonesia. Unfortunately, there was no training or supervision conducted following the distribution of the STG and flowchart on ARI. The excessive use of antibiotic used in the treatment of ARI in health centers showed that health centers paramedics rarely followed the STG and flowchart. This study, conducted education intervention in the form of small group discussion (SGD), as an effort to reduce antibiotic use in the treatment of ARI given by health center paramedics. Method: This study was conducted using pre-post design with control group and randomization. The study setting was Bantu] district. Eighteen health centers were selected, where 6 health centers underwent small group discussion and 2 feedbacks in 2 consecutive months, 6 health centers underwent small group discussion without feedback, and 6 health centers acted as control. Small Group Discussion was conducted in each health center in intervention group, and participants consisted of 7-9 paramedics, with one paramedic acted as facilitator, and the health center doctor acted as a resource person. Prescribing practice was observed by conducting survey on paramedics' prescriptions on: three months before intervention, post-SGD, post-feedback', and post-feedback.2 Prescriptions taken must had ARI as a single diagnosis, for under five and adult patients. One hundred prescriptions were taken from each health center each month. Data was analyzed using t-test and ANOVA. Result: Study result showed that the group underwent SGD followed by feedback has reduced their antibiotic use for ARI from 49.5% before intervention to 29.2% (40.9%). In the group who underwent SGD without feedback, antibiotic use for ARI reduced from 75.1% before intervention to 57.1% after intervention (28.2%). In the control group, antibiotic use in ARI patients was not reduced. The anova statistical test showed that there was no significant difference between the groups who underwent SGD with feedback and the group who underwent SGD without feedback. Conclusion: It is concluded that education intervention using SGD either with or without feedback reduces antibiotic use in ARI treatment. We suggest continuing the evaluation to find out whether the reduced antibiotic use in ARI treatment can be sustained. Practical guidelines on how to conduct such intervention will be needed for replication of this intervention in larger population. This kind of intervention may also be developed for other health problem besides ARI. Keywords: acute respiratory tract infections, small-group discussion, and feedbac