Đánh giá thực trạng kê đơn và chăm sóc bệnh nhân điều trị ngoại trú bảo hiểm y tế tại một số cơ sở y tế công lập ở thành phố cần thơ giai đoạn 2016 2018 tt tiếng anh

MINISTRY OF EDUCATION AND TRAINING MINISTRY OF MILITARY MILITARY MEDICAL UNIVERSITY HUNG NGUYEN PHUC ASSESSMENT OF PRESCRIPTION AND CARE FOR OUTPATIENTS WITH HEALTH INSURANCE AT SOME PUBLIC HEALTHCARE FACILITIES IN CAN THO CITY IN THE PERIOD OF 2016-2018 Major: Pharmaceutical management organization Code: 72 02 12 SUMMARY OF PHARMACEUTICAL Ph.D THESIS HA NOI – 2020 THE RESEARCH WORK ACCOMPLISHED AT MILITARY MEDICAL UNIVERSITY Scientific supervisors: Assoc.Prof Chinh Nguyen Minh Reviewer 1: Assoc.Prof Vu Hoang Thy Nhac Reviewer 2: PhD My Nguyen Huu Reviewer 3: Prof Binh Nguyen Thanh The Thesis will be defended against the Council of Military Medical University at: o’clock day month year This thesis can be referred at: National Library of Vietnam Library of Military Medical University INTRODUCTION Drugs have an important role in the disease treatments, but they have various side effects In case of incorrect use, it will cause bad consequences that directly affect human health such as prolonging treatment time, increasing the death rate of patients, increasing the cost of treatment, especially increasing the drug dependence in general and antibiotic resistance in particular Statistically, more than 50% of drugs are used improperly worldwide In 1985, the World Health Organization held a large conference in Nairobi - Kenya on rational use of drugs and developed drug use indicators In Vietnam, the situation of prescription is not out of the general trend of developing countries, which is the abuse of antibiotics, injections, vitamins, prescribing too many drugs in a prescription In addition, in the past time, some medical facilities have not paid adequate attention to the conditions to serve patients and improve the quality of medical examination and treatment; and the quality of health services organization does not commensurate with the cost At the public health facilities in Can Tho receiving medical examination and treatment with health insurance in 2015, about 6,351 outpatients visited the hospital per day and 97% of them had health insurance cards Therefore, the work of prescribing medical examination and care for patients with health insurance at the hospital should be more closely monitored From the above practices, the topic: "Assessment of virtual prescription and care for outpatient with health insurance at some public healthcare facilities in Can Tho city in the period of 2016-2018" has been done with the following goals: Assess the status of prescription and the effectiveness of some interventions in prescribing outpatient health insurance drugs at some public health facilities in Can Tho city for the period 20162018 Assess the situation of patient care and the effectiveness of some interventions in the care of patients with outpatient health insurance at some public health facilities in Can Tho city in the period of 2016-2018 New contributions of the thesis: The study was conducted to fully evaluate the prescribing activities of physicians through evaluating the implementation of the prescription regulations and comprehensive indicators, and at the same time assess the satisfaction of the people about the health facility The study compared the effectiveness of some interventions at healthcare facilities, which serves as a basis for broad deployment of the solutions from the experience at these facilities in Can Tho City, the largest and most developed city in the Mekong Delta with a large number of medical examinations and treatment facilities (11 facilities) Thus, the research results will be representative and has scientific value The layout of the thesis: The content of the thesis is presented in 146 pages, including chapters: Introduction: pages; Chapter - Overview: 34 pages; Chapter - Subjects and research methods: 25 pages; Chapter Research results: 42 pages; Chapter - Discussion: 40 pages; Conclusion: pages; Recommendations: page The thesis includes: 54 tables, diagrams, and 120 references Chapter OVERVIEW 1.1 Rules of prescriptions for outpatient treatment, indicators of drug use, the factors affecting drug use 1.1.1 Rules of prescriptions for outpatient treatment According to Article of Circular No 05/2016 / TT-BYT of the Ministry of Health, general requirements for prescription drug contain: * Complete, clear and correct writing of the items that are printed on the prescription * Exact written address of permanent or temporary residence * For children under 72 months of age, the number of months and the name of the father must be recorded * Write down the drug names according to the international generic name, except for drugs containing many active ingredients In case of additional drug names according to trade names, trade names must be put in parentheses after the international nonproprietary name * Note the drug name, concentration / content, quantity, dose, route of administration, time of use of each drug * Number of addictive drugs must be written in letters and the first letters are capitalized * Number of medicine: write the number beforehand if the number only has one digit (less than 10) * In case of amendment of the application, the prescriber must sign next to the corrected content * Cross the blank paper from the bottom of the prescription contents to the signature of the prescriber; Sign, write (or stamp) the full name of the prescriber 1.1.2 Indicators of drug use 1.1.2.1 Objective Studies to assess the use of drugs will vary widely from place to place, depending on many factors such as the specific information needs of health managers, the type of record keeping system available on-site, service providers with the described routines, resources to conduct research In general, drug use studies are based on indicators that fall into the following four broad groups: * Description of prescription practice * Comparing the implementation of drug use indicators between health facilities or prescribers or between health care groups * Supervise and monitor each specific period of the year on drug use habits * Evaluation of intervention effectiveness 1.1.3 Factors affecting drug use 1.1.3.1 According to the World Health Organization * Simple, short-term training strategies are often ineffective and their effects are not sustainable * Using printed materials is usually not effective * Cooperation strategies, especially various strategies such as training combined with management often give better results * Workshops focused on small groups and face-to-face discussions have proven to be effective, especially with competent trainers and coordinators * Monitoring, feedback and evaluation are very effective strategies, but it requires consistency in the use of certain standards to evaluate prescription (e.g standard treatment guidelines) * The reward bracket is an effective way of changing behavior; however, there are disadvantages that can lead to undesirable behaviors and promote inappropriate use of drugs * Legal interventions may have an adverse effect worse than originally anticipated (e.g replacing prohibited drugs with inappropriate drugs) 1.1.3.2 According to the US Center for Medical Management Science (MSH: Management Sciences for Health) Many factors affect drug use: the health system; prescriber; medicine dispensers; patients and the community MSH recommends intervention strategies to improve drug use: education strategy; Management strategy; economic strategy; regulatory strategy 1.2.4 Summary of several studies on patient prescription and care in the world and in Vietnam * Limitations of the topics: + Studies are cross-sectional studies, so the results are representative for one time of the year, not completely representative of the establishment's use of drugs in the most comprehensive way + Limited mention of possible interventions as well as recommendations to the state management agencies for monitoring and evaluating + The sample size of the studies is quite small, so the indexes are not fully evaluated + Studies in Vietnam are often conducted at one healthcare facility, so it has not appreciated the situation of drug use when comparing between different health facilities or between different areas at the same time Therefore, the results of some studies not represent an entire region or country + A number of studies were conducted at a third-class hospital and therefore it is necessary to further study these parameters at the central level + Studies have investigated the economic aspects of drug use However, they have not assessed the relationship between rational safety and economy + Researchers have not comprehensively assessed the causes of rational and safe use of drugs Overcrowding in healthcare facilities requires assessments and solutions + Interventions and supervision in drug use have not been thoroughly implemented Researchers have not boldly intervened and impacted the prescription system of drug use Research is therefore limited to warning levels for healthcare regulators * Regarding the research scope: + The problem that needs to be researched and resolved here is: How medical examination and treatment facilities operate, comply with the regulations and guidelines, and effectively affect the prescription and how to dispense drugs by healthcare workers through information and counseling activities on drug use + The medicine and treatment council has not been promoted in hospitals, most of the activities are still faint and of a coping nature, have not gone into analyzing the use and dispensing of drugs in hospitals to propose remedies No studies have analyzed the interventions on the activities of the hospital medicines and treatment Council and then re-evaluate the indicators of drug use as well as rational use of drugs + The main research topics on the subject are doctors, pharmacists, while not evaluating and analyzing prescription CHAPTER SUBJECTS AND RESEARCH METHODS 2.1 Subjects * 11 facilities that meet the research conditions * Outpatient health insurance prescriptions during the study period 2.1.1 Patient selection criteria * Public health facilities with health insurance holders; patients and their relatives agree to participate in the study and fully answer questions in the interview * Outpatient prescription with health insurance who encountered common disease in the community 2.1.2 Exclusion criteria * Medical facilities, doctors at examination departments, pharmacists dispensing drugs, patients and/or their family members disagree to participate in the study * Patients who come for outpatient examination but are transferred inpatient or emergency at a hospital 2.2 Methods 2.2.1 Research designs * Direct observation of prescription and dispensing activities * Direct interview of patients * Descriptive method with analysis before - after intervention 2.2.2 Sample sizes Based on the guidelines on survey of drug used index of WHO, for each healthcare facility, at least 100 prescriptions were chosen, according to the 2015-statistical table of Can Tho Social Insurance Can Tho University of Medicine and Pharmacy Hospital had the lowest average number of daily outpatient visited, thus the sample size wes 100 prescriptions According to the corresponding ratio, the number of prescriptions and insurance patients to be interviewed at each facility is as follow: Table 2.2 The number of samples to be divided according to 11 healthcare facilities No 10 11 Healthcare Facilities No of prescriptions No of patients Binh Thuy 136 136 Co Do 249 249 O Mon 681 681 Thot Not 630 630 Cai Rang 163 163 Phong Dien 303 303 Thoi Lai 377 377 Vinh Thanh 304 304 Can Tho Central General 218 218 CTUMP 100 100 Can Tho City General 885 885 Total 4,046 4,046 After intervention, samples with disease patterns, age group, gender, education level are similar to those of before intervention The number of samples that needs to be collected at healthcare facilities after intervention is equal to that of before intervention 2.2.4 Research content 2.2.4.1 Prescribing state in outpatient treatment with health insurance at some public healthcare facilities in Can Tho city in the period of 2016-2017 * Determining prescriptions to comply with the Minister of Health's prescriptions for outpatient treatment * Prescription indicators: average number of prescriptions per one prescription, percentage of drugs prescribed by generic or international generic names (except for multi-ingredient medicines 11 health insurance drugs at some public health facilities in Can Tho city in the period of 2016- 2018 3.1.1 Results of assessing the situation of prescribing for outpatient health insurance at some public health facilities in Can Tho city in the period of 2016-2017 3.1.1.1 Survey results on compliance with outpatient prescriptions * Regarding compliance with administrative procedures regulations: the implementation of the provisions on administrative procedures needed in a prescription is quite well implemented (4/5 requests reach 100%), although there are still errors in recording patient's home address, only reaching average overall 88.3%, the error is usually due to missing address details or sometimes writing the name of the patient's work agency * Regarding the compliance with the prescriptions: the percentage of correct implementation of regulations on compulsory contents in a prescription: 89.8% have correct full contents of the prescription, 96% have correct number of medicines 3.1.1.2 Assessment results in prescription index * The average number of prescription drugs in a single prescription: The average for all survey samples is 5.00 * The proportion of drugs prescribed by the generic name and international common name: Cai Rang district general hospital is the only facility that does not achieve absolute success with 85.32% In which, most pharmaceuticals were listed without the active ingredient names are Apitim (amlodipine) (12.55%), Domitral (nitroglycerin) (11.63%), and Detracyl (mephenesin) (6.36%) * The proportion of applications with antibiotics: The average number of applications with antibiotics is 31.1% Antibiotics was initially selected for the treatment of gastrointestinal, respiratory, urology, mainly the β-lactam group 12 * The ratio of applications having injections: the general percentage is 0.9% * The ratio of applications vitamins: the rate is 24.7% * The proportion of applications with corticosteroids: the general rate for 11 health facilities is 12.1% Phong Dien district healthcare center accounted for the highest rate of 22.8% and the lowest rate belonged to Can Tho University of Medicine and Pharmacy Hospital with 4.0% Prednisolone and Methyl prednisolone are corticosteroids usually used by doctors * The percentage of prescription drugs included in Essential drug list and Main drug list: the average percentage of Essential drug used is 41.98% and Main drug is 63.07% 3.1.2 Evaluate the effectiveness of some interventions in prescribing for outpatient at some public healthcare facilities in Can Tho city in the period of 2017-2018 3.1.2.1 Compliance with regulations in prescribing for outpatient After the intervention, the percentage of compliance with the regulations on correct addressing in O Mon district general hospital was increased but it was not significant This index in Can Tho university of Medicine and Pharmacy hospital and Phong Dien healthcare center had a significant increase with p < 0.05 when Can Tho university of Medicine and Pharmacy hospital increased from 85.0% to 100.0% and Phong Dien district healthcare center increased from 90.8% to 100.0% Requirements on recording drug quantity less than 10 compliance rate after intervention at Can Tho university of Medicine and Pharmacy hospital has changed but not significant with p > 0.05 Particularly, Phong Dien district healthcare center had a statistically significant increase with p < 0.05 in the regulation on drug name, concentration/content, quantity, dose, route, time of use of each drug from 62.7% to 93.2% 13 3.1.2.2 Prescription indicators * Average number of drugs in a prescription after intervention: Table 3.24 The average number of drugs in a prescription after intervention No Quartile No Health facility of p Q25 Q50 Q75 pres Before 100 CTUMP > 0.05 After 100 Before 681 4 O Mon < 0.05 After 681 4 Before 303 6 Phong > 0.05 Dien After 303 6 The average of total number of drugs prescribed by O Mon district general hospital increased significantly after intervention from 4.00 to 5.00 drugs in a single prescription with p < 0.05 and Q75, however this increase is not clinically significant 3.2 Results of assessing the situation of patient care and the effectiveness of some interventions in taking care of patients with outpatient health insurance at some public health facilities in Can Tho city in 2016 -2018 3.2.1 Results of the assessing the situation of taking care of patients with outpatient medical insurance in some public health facilities in Can Tho city in the period of 2016-2017 3.2.1.1 Patient care indicators * Average medical examination time: the lowest and highest medical examination time in each hospital was 0.2 minutes and 33.10 minutes, respectively The overall average for this study is 2.64 minutes 14 * Average dispensing time: this research result is high, however, in our opinion, it is mainly the waiting time at the health insurance dispensing office due to the large number of patients rather than the direct communication time between allocation staff and patients * The percentage of drugs actually distributed: the average percentage of actually distributed at 11/11 health facilities is almost absolute, reaching 99.96% * The percentage of fully labeled applications: the percentage of labeled drugs is as low as 47% * The patients' understanding of using dose: knowledge about the duration of treatment is 77.1%, how to use the medicine is 76.4%, the dosage of each type of medicine is 75.3%, the time to use medicine is 76.7% 3.2.1.2 Patient satisfaction in healthcare service Regarding accessibility, the average of level and level at 11 health facilities was quite high, at 71.58% Information transparency and procedures to achieve satisfaction level of or more with the rate of over 80% in health facilities: Phong Dien district healthcare center, Cai Rang district healthcare center, Thoi Lai district healthcare center The average percentage of 11 medical facilities was 71.77% The attitude and professional capacity of health workers at the survey facilities is assessed to be quite high 3.2.2 Evaluate the effectiveness of some interventions in outpatient care in some public health facilities in Can Tho city in the period of 2017-2018 3.2.2.1 Patient care indicators * Average time of examination: after intervention, time of examination in all hospitals increased significantly with p < 0.05 Can Tho university of Medicine and Pharmacy increased from 2.50 minutes to 5.09 minutes, O Mon district general hospital increased 15 from 2.25 minutes to 4.62 minutes and Phong Dien district healthcare center increased from 1.88 minutes to 3.93 minutes It can be said that the interventions are somehow effective * Average delivery time: Table 3.37 Average drug delivery time after intervention Quartile No of No Health facility p pres Q25 Q50 Q75 Before 100 5.24 5.8 6.33 CTUMP < 0.05 After 100 5.77 6.29 6.53 Before 681 4.75 6.58 7.83 O Mon < 0.05 After 681 6.34 7.65 9.68 Before 303 2.43 3.1 5.5 Phong < 0.05 Dien After 303 5.45 6.07 6.42 Similar to the time of examination, the time of drug dispensing also increased to statistical significance with p < 0.05 This is also a good sign to prove the effectiveness of interventions * The percentage of prescription which drugs fully labeled after intervention: significant increase in all hospitals with p < 0.05 This improvement is significant with Can Tho university of Medicine and Pharmacy hospital increasing from 30% to 51%, O Mon district general hospital from 16.7% to 36.1% and Phong Dien district healthcare center from 35% to 55.1 % * Patient's understanding of their treatment: the patient's knowledge about surveyed variables increased, but mostly not statistically significant 3.2.2.2 Patient satisfaction with health care service Regarding the provision of medical services, there was a decrease in the percentage of high level of satisfaction at O Mon district general hospital, a slight increase at the two other hospitals, but the increase or decrease mostly did not have statistical 16 significance The majority of patients' satisfaction with accessibility increased after intervention, Phong Dien district healthcare center increased the highest by 12.28%, Can Tho university of Medicine and Pharmacy hospital increased by 8% and O Mon district general hospital increased by 3.08% The transparency of information and procedures with the highest satisfaction rate among patients going to outpatient health insurance after intervention and highest at Can Tho university of Medicine and Pharmacy hospital with all the variables are statistically significant In terms of facilities, this hospital also had a statistically satisfaction in high level In terms of attitude, the professional competence of employees with high satisfaction rate has decreased but not much, most of them are not statistically significant (p > 0.05) CHAPTER DISCUSSION 4.1 Situation of prescribing and effectiveness of some interventions in prescribing health insurance drugs for outpatients at public health facilities in Can Tho city during the period of 2016-2018 4.1.1 Situation of prescribing health insurance drugs for outpatients at public health facilities in Can Tho city during the period 2016-2017 4.1.1.1 Compliance with regulations on outpatient prescription * Compliance with regulations on administrative procedures: Insufficient addressing was due to a variety of reasons For example, with regard to disregarded information, doctors who have to deal with a great number of patients might think that such administrative regulations not affect the examination results and thereby ignoring information about patients * Compliance with regulations on content of prescriptions: 17 The analysis of results showed that the processes of disseminating and guiding the regulations on prescription for doctors have not been synchronized In addition, the dispensing of drugs in the Department of Pharmacy only focused on considering the appropriateness of prescribed drugs rather than focus on other provisions of the prescription regulations Therefore, doctors were still subjective and ignored regulations on content of prescriptions 4.1.1.2 Prescription indicators * The average number of drugs in a prescription: Prescriptions had a high number of drugs because most patients suffered from many diseases The most common ICD codes were typical conditions of the elderly namely I10-idiopathic hypertension (15.7%), K29-gastritis, duodenitis (9.35%), E11-Non Insulin Dependent Diabetes Mellitus (7.29%) * The rate of drugs prescribed under generic or international generic names: The application of information technology to prescriptions may overcome the problem of prescribing with non-generic name Particularly, in Cai Rang district health center, the percentage of drugs prescribed with generic name was the lowest, at 71.66% The reason was that the Faculty of Pharmacy did not closely follow the regulations when sending the list of drugs to the IT department As a result, some single substance drugs were put on the software without their active substance name, which led to the situation of doctors prescribing brand names Therefore, such rate did not meet the WHO's recommendations * The rate of prescription with antibiotics: The reason for the differences among health facilities was that the disease patterns of prescription drugs in surveyed samples were not the same In-depth analysis of antibiotic combinations, cases of 18 using or antibiotics mainly combined drugs with different forms of use, mainly oral and ophthalmic eye drops antibiotic or topical antibiotic or according to the treatment regimen of H pylori stomach ulcers * The rate of prescription with injecting medicine: Results showed that the healthcare facilities did not abuse this kind of drug The reason why there were medical facilities which did not use injecting drugs in the list of outpatient health insurance drugs was that they were graded III in the classification of healthcare facilities Therefore, the permissible health insurance ceilings were lower Injecting drugs were high-cost drugs; therefore, in health facilities, they were only in the list of inpatient medical insurance drugs * The rate of prescription with vitamins: According to WHO, this indicator does not have ideal level which was researched by the Ministry of Health of Vietnam and a number of countries to monitor the use of vitamins in prescription, as well as to avoid overuse of vitamins * The rate of prescription with corticosteroids: The corticosteroids in the survey were mainly used for the treatment of inflammation, asthma or topical application in topical products None of the corticosteroids were abused or misused based on diagnoses * The rate of prescribed drugs in essential medicine list and main medicine list: The percentage of prescription drugs in surveyed facilities’ essential medicine list/main medicine list was low Doctors were only allowed to prescribe drugs in the presented lists; therefore, it was seen that the cause of low rate of prescribed drugs in essential medicine list and main medicine list was not from doctors 19 4.1.2 Effectiveness of some interventions in prescribing medicines for outpatients at public health facilities in Can Tho city during the period of 2017-2018 4.1.2.1 Compliance with regulations on prescribing for outpatients Interventions such as promoting the implementation of regulations, educating and enhancing knowledge by directly propagandizing regulations on prescriptions, distributing materials and regularly reminding during professional meetings has effectively impacted on the awareness and strict adherence to the regulations regarding prescribing 4.1.2.2 Prescription indicators * The average number of drugs in a prescription: This result also highlighted the need to raise awareness of physicians about prescription Medical facilities should have measures for prescribers to be able to calculate the cost of medicine right after prescribing so that they can adjust the price of prescriptions in accordance with the affordability of the patients as well as the health insurance provisions 4.2 Situation of patient health care and effectiveness of some interventions in healthcare of outpatients with health insurance at some public health facilities in Can Tho city during the period of 2016-2018 4.2.1 Situation of patient health care at some public health facilities in Can Tho city during the period of 2016-2018 4.2.1.1 Patient health care indicators: * Average time for medical examination: This indicator was not achieved because the state healthcare facilities in Vietnam in general and Can Tho in particular, especially district healthcare facilities, with relatively few facilities and the lack of human resources, which led to overcrowding In addition, doctors 20 who were not only in charge of medical examination and treatment, but also had to carry out other administrative tasks, thus having a great work pressure which partly limited the effectiveness of medical examination and treatment * Average drug dispense time: In 4,046 surveyed cases, drug dispensers mainly counselled on special drugs or when being requested from patients The counsel content was dosage, usage, frequency and duration of administration This was partly due to the fact that the medical staffs thought that patients had been counselled by physicians and patient prescriptions had quite adequate instructions for using the drug, thus not paying too much attention to such issue * The rate of drugs actually distributed: Drug management software provided by Hau Giang Pharmaceutical Joint-Stock Company was used by 11 health facilities surveyed Accordingly, only drugs in the warehouse were included in the drug list Doctors prescribed based on such software and Pharmaceutical department did not have to notify the status of existing drugs to the departments * The rate of sufficiently labelled prescriptions: This result was low due to the pressure and workload during hospital busiest hours when continuous drug dispenses interfered with the preparation of adequate information on drug use instructions in the patient medicine bags Moreover, the majority of dispensers believed that most of information was already on patient prescriptions so labelling was not necessary and patients only have to follow drug use on the prescription Instead of writing in detail, verbal instructions were given to patients * Patient understanding of medication dose: 21 According to guidelines of WHO, pharmacists when counselling drug use for patients need full information about name of drugs, name of active substances, concentration, content, dosage, usage, duration of treatment, daily time of taking medicine, drug effects, storage Therefore, it is important to raise pharmacist awareness about counselling drug information to patients 4.2.1.2 Satisfaction of the patient on healthcare services: The research results were quite high because the Ministry of Health had implemented solutions to improve healthcare services in public healthcare facilities nationwide In 2013, the Ministry of Health approved the project of "Determining methods to measure people's satisfaction with public health care services" In 2016, the Ministry of Health issued a set of guidelines on measurement methods and tools to measure people's satisfaction with each type of public health service to be consistently performed 4.2.2 Effectiveness of some interventions in healthcare of outpatients with health insurance at some public healthcare facilities in Can Tho city during the period of 2017-2018 4.2.2.1 Patient healthcare indicators * Average time for medical examination: It can be seen that the interventions had been effective and contributed to improve hospital prescription practice In O Mon district general hospital, a significant improvement was witnessed after implementing interventions It was due to an increasing number of patients with health insurance coverage Although the hospital had mobilized more doctors from inpatient departments to examine outpatient, it did not meet the needs of patients in O Mon District * Average drug dispensing time: The intervention solutions showed positive outcomes At the Hospital of Can Tho University of Medicine and Pharmacy, a 22 pharmacy technician was recruited to handle medicine dispensing Phong Dien district healthcare center has increased the number of staffs in the pharmacy department since some of graduates from intermediate level have finished their course in the university and returned to the pharmacy department * Rate of fully labelled prescriptions: After intervention in the drug dispensing process including sending WHO regulatory documents to the Hospital's Medicine and Treatment Council, posting the on-site drug delivery process and providing on-site training sessions, this rate was higher than that of the previous period * Knowledge on the dosage of medicine: With the multi-intervention measures used in the three researched facilities, it can be said that the knowledge and practical skills of health workers in charge of outpatient medicine provision have improved significantly through the implementation of professional and instructional work for drug usage Keith F Ward's study on the intervention in quality of patient care of 222 doctors showed that there was a 50.9% change in patient's cognitive quality Furthermore, there was a significant rise from 4.7% to 13.4% (p < 0.01) in patient knowledge after the intervention in a study in Ghana 4.2.2.2 Patient satisfaction with health care services It can be said that after the intervention, the majority of positive levels of satisfaction have increased, which proved that the intervention solutions have been effective In addition, this result has been brought about partly by the measures from the Ministry of Health to improve the quality of medical examination and treatment at public health facilities nationwide 23 CONCLUSION The current situation of prescription and the effectiveness of some interventions in prescribing outpatient health insurance medicines in some public healthcare facilities in Can Tho city during the period of 2016-2018 has been analysed * Compliance with regulations on outpatient prescriptions: the rate of sufficient, comprehensive and accurate printing items: 100%, accurate address: 88.3%, accurate requirements for children under 72 months old: 100%; the rate of the drug name, concentration/content, quantity, dose, form of use or time of use: 89.8%, accurate amount of medicine below 10: 96.0%; the rate of accurately corrected prescription and crossing out the blank paper with signature and name of the doctor: 100% Interventional solutions by education, knowledge enhancing as well as promoting the implementation of regulations at hospitals are efficient At the Hospital of Can Tho University of Medicine and Pharmacy, the practice of accurately recording patient addresses increased from 85% to 100% while the number of medicines slightly decreased from 71% to 70% At O Mon district general hospital, the rate of accurately recording patient addresses increased from 92.5% to 94.6% At Phong Dien District Health Center, this rate increased from 90.8% to 100% while the sufficient recording of drug indications increased from 62.7% to 83.2% * Prescription indicators: the average number of medicines in a prescription: 5.0; the percentage of drugs prescribed under generic name and international generic name: 98.62%; the rate of prescription with antibiotics: 31.2%, the rate of injecting medicine: 0.9%, vitamins: 25.4%, corticosteroids: 12.4%, essential medicines: 41.99%, main medicines: 63.07% The situation of patient healthcare and the effectiveness of some interventions in patient healthcare for outpatients with health insurance at some public healthcare facilities in Can Tho city during the period of 2016-2018 has been analysed 24 * Patient healthcare indicators: average examination time: 2.64 minutes and average drug dispensing time: 8.08 minutes; the rate of drugs actually distributed: 99.96% and sufficiently labeled: 47.0%; patient's understanding of the duration of treatment course: 77.1%, knowledge on how to use the medicine: 76.4%, knowledge on the dosage of each medicine: 75.3%, knowledge on the time of medicine taking: 76.7% The multi-intervention solutions at the three health facilities have been applied effectively After the interventions, the average time for medical examination and dispensing increased while the percentage of fully labeled prescriptions experienced the same rising pattern Furthermore, the percentage of patients understanding the treatment also rose but insignificantly * Positive satisfaction level of the patient on health care services: 61.23% (service supply results), 71.58% (accessibility), 71.77% (transparency of information and procedures for examination and treatment), 63.81% (facilities), 82.45% (attitude and professional capacity of health workers) Most of the above-mentioned indicators rose after the interventions * The combination of interventions has improved the skills of medicine dispensing practice in a positive way by medical staffs in caring for patients, especially the instructions on safety drug use RECOMMENDATIONS * It is advisable to improve human resources for medical examination and treatment and drug dispensing, regularly hold training and educational courses related to prescriptions and dispensing of medicines * It is advisable to enhance the quantity and quality of prescriptions and medical records It is also suggested to put online search websites on drug interactions such as Drugs.com or Medscape.com into prescription software or prescribing processes in order to control drug interactions in the prescription LIST OF PUBLICATIONS RELATED TO THE THESIS WORK Nguyen Phuc Hung; Nguyen Minh Chinh; Vo Thi My Huong (2019), ASSESSMENT OF OUTPATIENT CARE INDICATORS AT ELEVEN HEALTH STATE ESTABLISHMENTS IN CAN THO CITY DURING THE PERIOD OF 2016-2017, Journal of Military PharmacoMedicine, N09, p.195-201 Nguyen Phuc Hung; Nguyen Minh Chinh; Vo Thi My Huong (2019), ASSESSMENT OF THE INTERVENTION EFFICIENCY IN OUTPATIENT DRUG PRESCRIPTION AT ELEVEN GOVERNMENTAL HEALTHCARE FACILITIES IN CAN THO CITY DURING THE PERIOD OF 2016-2018, Journal of Medicine of Vietnam, N02-Nov, p.39-42 Nguyen Phuc Hung; Nguyen Minh Chinh (2020), EVALUATION OF THE EFFICIENCY OF INTERVENTION SOLUTIONS TO OUT-OF-HEALTH CARE SERVICES WITH HEALTH INSURANCE AT SOME PUBLIC HEALTH ESTABLISHMENTS IN CAN THO CITY 2016-2018, Journal of Medicine of Vietnam, N06-Jun, p.9-14 Nguyen Phuc Hung; Nguyen Minh Chinh (2020), EVALUATION THE EFFICIENCY OF INTERVENTION TO THE STATUS OF PRESCRIPTION FOR OUTPATIENTS WITH HEALTH INSURANCE AT SOME PUBLIC HEALTH ESTABLISHMENTS IN CAN THO CITY DURING THE 2016-2018, Journal of Medicine of Vietnam, N06-Jun, p.30-36 ... MILITARY MEDICAL UNIVERSITY Scientific supervisors: Assoc.Prof Chinh Nguyen Minh Reviewer 1: Assoc.Prof Vu Hoang Thy Nhac Reviewer 2: PhD My Nguyen Huu Reviewer 3: Prof Binh Nguyen Thanh The... against the Council of Military Medical University at: o’clock day month year This thesis can be referred at: National Library of Vietnam Library of Military Medical University INTRODUCTION Drugs have... health facilities in Can Tho city in the period of 2016- 2018 New contributions of the thesis: The study was conducted to fully evaluate the prescribing activities of physicians through evaluating