Nghiên cứu một số biện pháp can thiệp đối với danh mục thuốc sử dụng tại bệnh viện quân y 103 giai đoạn 2013 – 2016 tt tiếng anh

MINISTRY OF EDUCATION MINISTRY OF DEFENCE AND TRAINING VIETNAM MILITARY MEDICAL UNIVERSITY DAO THI KHANH A STUDY ON SOME INTERVENTIONS FOR THE LISTS OF MEDICINES USED IN MILITARY HOSPITAL 103 DURING THE PERIOD OF 2013 - 2016 Major: Pharmacy Management Specialization Code number: 9720212 SUMMARY OF PHARMACEUTICAL DOCTORAL THESIS HANOI – 2020 THIS PROJECT WAS FULFILLED IN VIETNAM MILITARY MEDICAL UNIVERSITY Scientific instructors: Assoc Prof Tran The Tang Dr Phan Thi Hoa Critic 1: Assoc Prof Nguyen Van Yen Hanoi Department of Health Critic 2: Dr Nguyen Son Nam 108 Military Center Hospital Critic 3: Assoc Prof Nguyen Thi Thanh Huong Hanoi University of Pharmacy This thesis will be presented with the supervision of the university-level council at: This thesis can be found in: National Library of Vietnam Library of Vietnam Military Medical University BACKGROUND Health facilities, especially hospitals play a crucial role in preventing and treating diseases for citizens There are a plethora of researches conducted about drug tendering, drug distribution and drug-use management in health facilities Beside some achievements, there are an abundance of intractable problems which still have existed for a long time in copious hospitals, such as: overusing imported medicines and originator brands having exorbitant costs, abusing antibiotics These real situations posed a challenge to both the government and health facilities: must find practical remedies for drug use in general and antibiotics in particular, thereby contributing to improving the drug distribution and drug use in health facilities, guaranteeing the suitability, safety and effectiveness of drugs used Military Hospital 103 (Hospital 103) is a hospital of Vietnam miliraty, in relation to Vietnam Military Medical Academy Up to the year 2013, there are no researches involving drug supply and drug-use management conducted in this hospital With the aim of improving the effectiveness of drug supply for Military Hospital 103 and finding some useful solutions for antibiotics use and drug supply, this thesis was carried out and named: “A study on some interventions for the lists of medicines used in Military Hospital 103 during the period of 2013 – 2016” with following objectives: To analyze the effectiveness of some interventions for the drug list using ABC, VEN analysis in Hospital 103 during period of 2013-2016 To evaluate the effectiveness of some intervetions in drug use management, a case study in antibiotic use and bacteria resisting antibiotics in Hospital 103 The thesis included following main parts: Chapter OVERVIEW 1.1 The activities of drug supply in hospital 1.1.1 Drug selection 1.1.2 Drug procurement 1.1.3 Drug distribution 1.1.4 Drug-use management 1.1.5 Methods used in analyzing drug lists 1.2 The reality of drug supply and drug use in hospitals 1.3 Introduction to Military Hospital 103 Chapter STUDY OBJECT & METHODOLOGY 2.1 Study objects: The study objects of the 1st objective were all medicines used to treat diseases for patient groups (military personnel and people with health insurance card(s) (HIC)) in Military Hospital 103 during the period of 2013-2016 For the 2nd objective, study objects were antibiotics and bacteria resisting antibiotics 2.2 Methodology 2.2.1 Study design: This study uses following methods: observation, descriptive cross-sectional combining analysis Data about used drugs was collected from 2013 to 2016 to analyze and several interventions in relation to drug selection and drug use were also observed 2.2.2 Data collection: Data about used drugs was collected based on myriad available sources from Military Hospital 103, such as: The report of drug-use management, The report of drug use of each kind of patients (military personnel, people with HIC), The drugs list classified VEN by Treatment and Medicine Council 2.2.3 Data analysis: After being collected, data about medicines was encoded and analyzed through softwares: Microsoft Excel 2016 and R version 3.6.3 The drug list was analyzed by some following methods: percentage, ABC/VEN and treatment group analysis To compare pre-intervention to post-intervention, the results of 2013 were used to compare to those of 2016 (p1) In addition, the results of 2014 and 2015 were compared with the intention of assessing drug list in the period which Hospital 103 was reconstructed (p2) Antibiotics were calculated/collected about DDD, DDD/100 bed days, the expenditure for 1-day treatment and information about antibiotic resistance Chapter RESULTS 3.1 The analyzis of the effectiveness of some interventions for the drug list using ABC, VEN analysis in Hospital 103 (2013-2016) 3.1.1 The structure of drug list classified through origins: The number of items of imported medicines was roughly 1.3 times as many as that of domestic medicines and the expenditure of the former was – times as much as that of the latter Furthermore, the expenditure and the percentage of the expenditure of imported medicines were on the increase during 2013-2016 period (Table 3.1 and 3.2) 3.1.2 The structure of the list of chemical medicines classified into originator brands (OBs) and generic medicines (GMs) (Table 3.3 and 3.4) The number of GMs was far higher than that of OBs (4 – times) The percentages of item number of OBs were on the increase The percentages of the expenditure of OBs were quite high and went up Table 3.1 The structure of drug items classified through origins Pre-intervention Post-intervention 2013 2014 2015 2016 Domestic medicines n (%) unit: items 661 720 904 848 Total list (43.63) (43.98) (44.16) (43.35) 425 444 537 511 Military personnel (41.67) (42.09) (42.82) (42.65) 563 701 676 People with 504 HIC (42.75) (43.64) (42.95) (41.57) Imported medicines n (%) unit: items 854 917 1.143 1.108 Total list (56.37) (56.02) (55.84) (56.65) 595 611 717 687 Military personnel (58.33) (57.91) (57.18) (57.35) 675 727 931 950 People with HIC (57.25%) (56.36%) (57.05%) (58.43%) Origins p (p1, p2) > 0.05 > 0.05 Table 3.2 The expenditure of used drugs classified through origins Pre-intervention Post-intervention 2013 2014 2015 2016 Domestic medicines n (%) unit: million VND 25,408.83 32,989.90 31,062.23 28,933.48 Total list (16.55) (18.12) (15.29) (12.74) 5,527.21 5,264.75 5,840.61 4,175.87 Military personnel (21.79) (18.69) (15.99) (12.26) 19,881.62 27,725.15 25.221,62 24,757.61 People with HIC (15.52) (18.01) (15.14) (12.83) Imported medicines n (%) unit: million VND 128,088.42 149,099.54 172,073.97 198,101.88 Total list (83.45) (81.88) (84.71) (87.26) 19,843.66 22,901.61 30,696.55 29,897.66 Military personnel (78.21) (81.31) (84.01) (87.74) 108,244.76 126,197.93 141,377.42 168,204.22 People with HIC (84.48) (81.99) (84.86) (87.17) Origins p (p1,p2) < 0.001 < 0.001 Table 3.3 The structure of medicines classified into OBs and GMs Groups Pre-intervention 2013 2014 Originator brands 195 (12.93) 159 Military personnel (15.68) 163 People with HIC (13.83) Generic medicines 1,313 Total list (87.07) 855 Military personnel (84.32) 1,016 People with HIC (86.17) Total list 225 (13.76) 156 (14.83) 204 (15.81) 1,410 (86.24) 896 (85.17) 1,086 (84.19) Post-intervention 2015 2016 n (%) unit: items 336 352 (16.45) (18.03) 208 214 (16.61) (17.91) 315 332 (19.34) (20.43) n (%) unit: items 1,706 1,600 (83.55) (81.97) 1,044 981 (83.39) (82.09) 1,314 1,293 (80.66) (79.57) p (p1, p2) < 0.05 > 0.05 < 0.05 < 0.05 > 0.05 < 0.05 Table 3.4 The expenditure of chemical medicines classified into originator brands and generic medicines Pre-intervention Post-intervention 2013 2014 2015 2016 Originator brands n (%) unit: million VND 56,431.65 75,502.77 93,614.03 104,809.29 Total list (36.79) (41.47) (46.09) (46.17) 9,994.36 11,502.98 19,207.11 17,995.81 Military personnel (39.56) (40.86) (52.57) (52.82) 46,437.29 63,999.79 74,406.92 86,813.48 People with HIC (36.24) (41.58) (44.66) (44.99) Generic medicines n (%) unit: million VND 96,961.21 106,573.78 109,513.53 122,221.92 Total list (63.21) (58.53) (53.91) (53.83) 15,272.11 16,650.49 17,328.90 16,073.83 Military personnel (60.44) (59.14) (47.43) (47.18) 81,689.10 89,923.29 92,184.63 106,148.09 People with HIC (63.76) (58.42) (55.34) (55.01) Groups p (p1, p2) < 0.001 < 0.001 3.1.3 The structure of drug list classified through administrations: In the period of 2013-2016, Military Hospital 103 mainly used oral medicines and injection/infusions The item number of the former was higher than that of the latter but the expenditure of the latter was higher than that of the former (approximately times) Table 3.5 The structure of drugs classified through administrations Pre-intervention 2013 2014 Administration Oral medicines Total list Military personnel People with HIC Injection/infusions Total list Military personnel People with HIC 754 (49.77) 529 (51.86) 552 (46.82) 821 (50.15) 555 (52.61) 602 (46.67) 643 (42.44) 423 (41.47) 541 (45.89) 705 (43.07) 437 (41.42) 603 (46.74) Post-intervention 2015 2016 n (%) unit: items 1,061 1,047 (51.83) (53.53) 648 629 (51.67) (52.50) 807 836 (49.45) (51.41) n (%) unit: items 864 792 (42.21) (40.49) 539 510 (42.98) (42.57) 735 689 (45.04) (42.37) p (p1, p2) p10.05 > 0.05 p10.05 > 0.05 Table 3.6 The expenditure of used drugs classified through administrations Pre-intervention Post-intervention Administrations 2013 2014 2015 2016 Oral medicines n (%) unit: million VND 43,088.24 53,554.66 62,026.86 76,284.77 Total list (28.07) (29.41) (30.53) (33.60) 10,780.17 12,412.73 15,523.82 15,404.07 Military personnel (42.49) (44.07) (42.49) (45.21) 32,308.07 41,141.93 46,503.03 60,880.70 People with HIC (25.22) (26.73) (27.91) (31.55) p (p1,p2) < 0.001 Pre-intervention Post-intervention Administrations 2013 2014 2015 2016 Injection/infusions n (%) unit: million VND 109,372.51 127,324.30 140,243.73 149,230.22 Total list (71.25) (69.92) (69.04) (65.73) 14,529.70 15,694.37 20,871.64 18,564.51 Military personnel (57.27) (55.72) (57.12) (54.48) 94,842.81 111,629.93 119,372.09 130,665.71 People with HIC (74.02) (72.52) (71.65) (67.72) p (p1,p2) < 0.001 3.1.4 The structure of the list of chemical medicines classified into single/multiple active elements Drugs containing only active element had high percentage of both the number of items and the expenditure For the group of multiple active elements, the percentage of the number of drug items and the expenditure had a tendency to increase Table 3.7 The structure of chemical medicines classified into single/multiple active elements Pre-intervention 2013 2014 Single active element 1,386 1,510 Total list (91.91) (92.35) 928 979 Military personnel (91.52) (93.06) 1,098 1,191 People with HIC (93.13) (92.33) Multiple active elements 122 125 Total list (8.09) (7.65) 86 73 Military personnel (8.48) (6.94) 81 99 People with HIC (6.87) (7.67) Groups Post-intervention 2015 2016 n (%) unit: items 1,864 1,776 (91.28) (90.98) 1,156 1,100 (92.33) (92.05) 1,498 1,485 (91.96) (91.38) n (%) unit: items 178 176 (8.72) (9.02) 96 95 (7.67) (7.95) 131 140 (8.04) (8.62) p (p1, p2) > 0.05 > 0.05 Table 3.8 The expenditure of chemical medicines classified into single/multiple active elements Pre-intervention Post-intervention 2013 2014 2015 2016 Single active element n (%) unit: million VND 148,310.10 175,036.48 193,643.55 216,635.94 Total list (96.69) (96.13) (95.33) (95.42) 24,160.14 27,163.67 34,622.85 32,278.39 Military personnel (95.62) (96.48) (94.76) (94.74) 124,149.96 147,872.81 159,020.62 184,357.56 People with HIC (96.90) (96.07) (95.46) (95.54) Multiple active elements n (%) unit: million VND 5,082.76 7,040.07 9,484.07 10,395.26 Total list (3.31) (3.87) (4.67) (4.58) 1,106.33 989.80 1,913.15 1,791.25 Military personnel (4.38) (3.52) (5.24) (5.26) 3,976.43 6,050.27 7,570.92 8,604.01 People with HIC (3.10) (3.93) (4.54) (4.46) p (p1,p2) Groups < 0.001 < 0.001 3.1.5 The structure of drug list classified through pharmacological effects Some groups of medicines have high percentages about the number of drug items and their expenditure, including: (1) medicines treating cancer and hamonizing immune system, (2) medicines treating parasites and bacteria, (3) medicines treating cardiovascular diseases, (4) medicines treating maladies involving digestive tract and (5) medicines affecting blood system Vitamins and minerals were also the group which needs to be concerned as the number of drug items and their expenditure were quite high during the period of studying 11 Pre-intervention 2013 2014 Vitamins and minerals n (%) 2,105.60 2,585.32 Total list (1.37) (1.42) 515.96 509.23 Military personnel (2.03) (1.81) 1,589.64 2,076.09 People with HIC (1.24) (1.35) Groups Post-intervention 2015 2016 2,380.48 (1.17) 806.12 (2.21) 1,574.36 (0.94) 1,899.93 (0.84) 550.41 (1.62) 1,349.52 (0.70) p (p1, p2) < 0.001 3.1.6 The structure of drug list classified using ABC analysis Table 3.11 The structure of drug items classified using ABC analysis Groups Pre-intervention 2013 2014 Groups A Total list Military personnel People with HIC Groups B Total list Military personnel People with HIC Groups C Total list Military personnel People with HIC 167 (11.02) 123 (12.06) 143 (12.13) 181 (11.06) 112 (10.62) 161 (12.48) 268 (17.69) 186 (18.24) 225 (19.08) 298 (18.20) 193 (18.29) 254 (19.69) 1,080 (71.29) 711 (69.70) 811 (68.79) 1,158 (70.74) 750 (71.09) 875 (67.83) Post-intervention 2015 2016 n (%) unit: items 195 186 (9.53) (9.51) 122 114 (9.73) (9.52) 180 179 (11.03) (11.01) n (%) unit: items 352 312 (17.20) (15.95) 222 220 (17.70) (18.36) 309 285 (18.93) (17.53) n (%) unit: items 1,500 1,458 (73.28) (74.54) 910 864 (72.57) (72.12) 1.143 1.162 (70.04) (71.46) p (p1, p2) > 0.05 > 0.05 p10.05 > 0.05 12 Table 3.13 The number of medicines (equivalent about element actives, contents/concentrations and pharmaceutical forms) used both in group A and C unit: items Indicators Total list The number Total % Military personnel The number Total % People with HIC The number Total % 2013 2014 2015 2016 47 1,515 3.10 50 1,637 3.05 57 2,047 2.78 68 1,956 3.48 30 1,020 2.94 30 1,055 2.84 28 1,254 2.23 30 1,198 2.50 36 1,179 3.05 33 1,290 2.56 52 1,632 3.19 50 1,626 3.08 Medicines used both in group A and C (equivalent about element actives, contents/concentrations and pharmaceutical forms) mainly belonged to some following groups: (1) medicines treating cancer, (2) antibiotics and (3) medicines treating cardiovascular diseases With regard to drugs used for military personnel, almost drugs having the highest expenses were those treating cancer while for the group of people with HIC, they were mainly antibiotics 3.1.7 The structure of drug list classified using VEN analysis About the drug items, group V constituted high proportion (more than 34% during 2013-2016 period) but the proportion was on the decrease In addition, the percentage of the number of drug items of group N diminished About drug expenditure, the percentage of N-medicines expenditure significantly declined after years 13 Table 3.15 The expenditure of used drugs classified using VEN analysis Groups Pre-intervention 2013 2014 Groups V Total list Military personnel People with HIC Groups E Total list Military personnel People with HIC Groups N Total list Military personnel People with HIC 32,622.75 (21.25) 5,829.20 (22.98) 26,793.55 (20.91) 35,956.29 (19.75) 7,109.52 (25.24) 28,846.77 (18.74) 112,096.89 (73.03) 18,447.48 (72.71) 93,649.39 (73.09) 137,676.60 (75.61) 19,879.19 (70.58) 117,796.68 (76.53) 8,777.62 (5.72) 1,094.19 (4.31) 7,683.45 (6.00) 8,456.55 (4.64) 1,177.65 (4.18) 7,279.63 (4.73) Post-intervention 2015 2016 n (%) unit: million VND 43,130.94 47,264.49 (21.23) (20.82) 6,715.46 5,722.31 (18.38) (16.79) 36,415.48 41,542.19 (21.86) (21.53) n (%) unit: million VND 155,732.81 177,014.01 (76.66) (77.97) 28,278.15 27,582.85 (77.40) (80.95) 127,454.67 149,431.16 (76.50) (77.44) n (%) unit: million VND 4,272.44 2,756.87 (2.10) (1.21) 1,543.55 768.38 (4.22) (2.26) 2,728.89 1,988.49 (1.64) (1.03) p (p1, p2) < 0.05 < 0.001 < 0.001 p10.05 < 0.001 p10.05 < 0.001 3.1.8 The structure of drug list classified using ABC/VEN matrix AN is the subgroup which needs to be concerned most when the drug lists are analyzed using ABC/VEN matrix After interventions, both the number of AN-drug items and their expenditure significantly descreased (p < 0.001) Furthermore, AN medicines were mainly used to treat liver diseases (like glutathion, cycloferon, glycyrhizin ) 14 3.2 Evaluation of the effectiveness of some intervetions in druguse management, a case study in antibiotics use and bacteria resisting antibiotics in Hospital 103 3.2.1 The structure of antibiotics used in the period of 2013-2016 Betalactams (almost cephalosporins) and quinolones were subgroups of antibiotics which were made use of the most (about both the number of antibiotic items and their expenses) in Hospital 103 during 2013-2016 period of time Moreover, fosfomycin was an antibiotic which was of paramount importance since the number of drug items was low but its expenditure was extremely high Table 3.18 The expenditure of antibiotics (unit: million VND) No Groups β-lactam Military personnel People with HIC Aminoside Military personnel People with HIC Nitroimidazole Military personnel People with HIC Pre-intervention Post-intervention 2013 2014 2015 2016 18,341.16 (45.67) 2,635.37 (66.90) 15,705.79 (43.36) 322.12 (0.80) 112.68 (2.86) 209.44 (0.58) 511.16 (1.27) 140.92 (3.58) 370.24 (1.02) 18,602.43 (41.83) 3,697.68 (74.75) 14,904.75 (37.71) 276.19 (0.62) 65.23 (1.32) 210.96 (0.53) 438.93 (0.99) 121.16 (2.45) 317.77 (0.80) 22,084.24 (43.68) 3,219.23 (52.82) 18,865.01 (42.43) 232.31 (0.46) 48.46 (0.80) 183.85 (0.41) 430.59 (0.85) 135.68 (2.23) 294.91 (0.66) 23,930.66 (44.82) 2,540.01 (47.22) 21,390.65 (44.55) 174.31 (0.33) 37.43 (0.70) 136.88 (0.29) 490.93 (0.92) 94.18 (1.75) 396.75 (0.83) 15 No Groups Macrolide Military personnel People with HIC Quinolone Military personnel People with HIC Pre-intervention Post-intervention 2013 2014 2015 2016 381.22 (0.95) 76.61 (1.94) 304.61 (0.84) 9,074.15 (22.59) 685.97 (17.41) 8,388.18 (23.15) 326.75 (0.73) 84.17 (1.70) 242.58 (0.61) 10,155.19 (22.83) 656.79 (13.28) 9,498.40 (24.03) 291.75 (0.58) 65.26 (1.07) 226.49 (0.51) 11,643.50 (23.03) 1,396.19 (22.91) 10,247.31 (23.05) 555.23 (1.04) 68.85 (1.28) 486.38 (1.01) 16,555.13 (31.01) 1,447.52 (26.91) 15,107.61 (31.46) 3.2.2 DDD/100 bed days of antibiotics DDD/100 bed days of antibiotics used for inpatients having HIC was 1.5 times as high as that of antibiotics used for military inpatients About 25% inpatients having HIC received DDD dose of antibiotics per day while that indicator for military inpatients was 33% Table 3.20 DDD/100 bed days of antibiotics TT 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 Groups Military personnel Penicillin Cephalosporin gen Cephalosporin gen Cephalosporin gen Cephalosporin gen Carbapenem Quinolone Tetracyclin Aminoside Macrolide Pre-intervention 2013 2014 4.12 1.08 0.11 6.40 0.19 0.37 3.87 1.26 2.94 1.02 2.70 2.42 0.56 5.83 0.05 0.62 4.08 1.02 2.52 0.97 Post-intervention 2015 2016 3.43 1.20 1.10 5.87 0.37 0.58 5.17 0.93 1.72 1.14 2.20 2.56 2.01 3.11 0.19 0.41 6.67 0.58 0.69 3.13 16 TT 1.11 1.12 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 2.12 Groups Nitroimidazole Else Total People with HIC Penicillin Cephalosporin gen Cephalosporin gen Cephalosporin gen Cephalosporin gen Carbapenem Quinolone Tetracyclin Aminoside Macrolide Nitroimidazole Else Total Pre-intervention 2013 2014 1.60 1.76 1.24 1.26 24.21 23.79 4.95 1.20 1.99 4.04 3.15 0.53 10.70 0.10 1.77 0.98 1.14 3.07 33.62 4.19 0.45 1.69 3.22 3.99 0.70 11.99 0.07 1.19 0.81 1.50 3.76 33.57 Post-intervention 2015 2016 2.11 1.37 1.49 1.32 25.11 24.07 2.77 0.59 1.08 3.38 3.47 0.78 7.27 0.04 0.78 0.70 1.62 3.58 26.06 2.09 2.26 1.71 4.13 1.78 1.00 13.01 0.08 0.36 2.04 1.55 2.49 32.50 Betalactams and quinolones were subgroups having the highest DDD/100 bed days Antibiotics having the highest DDD/100 bed days in betalactam group were amoxicillin and cephalosporins gen while those in quinolones group were levofloxacin and ciprofloxacin Cefepim, cefpirom (cephalosporins gen 4) and fosfomycin were antibiotics having high DDD/100 bed days for people with HIC 3.2.3 Estimated treatment costs per day for antibiotics In general, treatment costs per day of almost antibiotics were constant or descreased (such as amoxicillin oral use, cefazolin injection ) However, there were some antibiotics which their treatment costs per day increased during 2013-2016 period, such as cotrimoxazole oral use, ampicillin/sulbactam injection 17 3.2.4 Bacteria tests and bacteria resisting antibiotics in Military Hospital 103 during the period of 2013 – 2016 The number of samples used for doing bacteria tests (in order to define the name of bacteria and MIC tests) increased from 2013 to 2016 However, to compare to the number of patients hospitalized and surgeries, the ratio was still low There were 491 patients using preventive antibiotics when doing surgeries from 09/2015 to 12/2016 The number of patients having to change antibiotics was low The number of patients contaminated bacteria soared in 2014 and 2015, declining in 2016 Some kinds of bacteria which patients were usually contaminated included: Acinetobacter, Burkholderia These bacteria usually appeared in some departments like Contamination Department and Resuscitation Department For specific bacteria, Acinetobacter resisted nearly all antibiotics used in Military Hospital 103, even imipenem and meropenem (MDR > 60%) and resisted colistin 21% Burkholderia resisted Ticarcillin (100%), Ticarcillin/ clavulanic acid (100%), Ciprofloxacin (95%), Cotrimoxazol (15%) Klebsiella resisted about 40-70% antibiotics Some XDR species of bateria resisted nearly all antibiotics available in laboratories Chapter DISCUSSION 4.1 The effectiveness of some interventions for the drug list using ABC, VEN analysis in Hospital 103 (2013 – 2016 period) During 2013-2016 period, the number of items of imported drugs was higher than that of domestic drugs The expenditure of the former was – times as high as that of the latter The proportion of the number of items of imported drugs slightly increased for the group of people with HIC and slightly went down for the group of military 18 personnel (p > 0.05) The proportion of expense of imported drugs soared in both patient groups (p < 0.001) For OBs, these medicines constituted from 13% to 20% the number of drug items but made up about 36% to 53% the total expenditure of used drugs Comparing to pre-intervention, the proportion of the number of OB items increased, especially for the group of people with HIC (p < 0.05) Moreover, the proportion of the expenditure of OBs dramatically increased for both patient groups (p < 0.001) The fact that imported medicines and OBs were used with high item number and expenses occurred in numerous hospitals Military Hospital 103 is a 1-ranking hospital, being the last line of military hospital system, receiving and curing for innumerable patients contacting severe diseases Hence, Military 103 Hospital must approach and use advanced and vangard equipment and medicines, including exorbitant OBs Military Hospital 103 mainly used injections/infusions and oral drugs The item number of the latter was higher than that of the former whereas the expenditure of the former was higher than that of the latter The percentage of the item number of oral medicines increased while that of injections/infusions slightly increased for military group and went down for the group of people with HIC For the number of drug items, the proportion of oral drugs was seemingly equivalent to that of injections and infusions However, for the expenses, the proportion of the latter was quite higher than that of the former, especially for the group of people with HIC For 2013-2016 period, the number of items of single active element group was far higher than that of multiple active element group (roughly 10 times) The expenditure of the former was about 20 times as much as that of the latter With regard to the multiple active 19 element group, the percentages of their items and expenses went up in general, excluding the percentage of items for military personnel In both patient groups, groups of medicines having high percentages about the items of used medicines and the expenditure included: (1) medicines treating cancer and hamonizing immune system, (2) medicines treating parasites and bacteria, (3) medicines treating cardiovascular diseases, (4) medicines treating maladies involving digestive tract and (5) medicines affecting blood system For the 2nd group, the percentage of their expenditure dramatically declined (p < 0.001) For the first group, the number of items was not high but the expenditure of these medicines was extremely high because nearly all of them were OBs or/and imported drugs For vitamins and minerals, the number of drug items slightly increased but the percentage descreased After interventions, the expenditure and the percentage of their expenditure went down (p < 0.001) In general, the number of drug items for group A, B and C were seemingly sensible, showing that the number of items of drugs procured by Military Hospital 103 was not too high and this hospital mainly focused on necessary medications Nevertheless, regarding medicines (equivalent about active elements, concentration/contents pharmaceutical forms) used for both group A and C, the number of those was quite high, showing that the activities of drug tendering and the use of tendered drugs were still inappropriate For VEN analysis, N is the group needing to be paid attention to due to embracing many inessential medicines After interventions, it seems that the number of drug items of group N was unchanged Nonetheless, the expenditure and the percentage of the expenditure of this group considerably diminished, especially for the group of people 20 with HIC This result of Military Hospital 103 was an achievement in the activities of controlling and managing drug lists In addition, a significant achievement which Hospital 103 attained was the decline of the percentage of the number of drug items for group V (p < 0.05) In ABC/VEN matrix, AN is the subgroup which needs to be concerned most After interventions, the number of drug items of this subgroup significantly went down Up to the year 2016, there were and AN medicines used in Military Hospital 103, respectively for the group of military personnel and people with HIC The percentage of the number of AN-drug items strongly declined from 0.88% (2013) to 0.25% (2016) in the former group and went down from 1.02% (2013) to 0.25% (2016) in the latter group Furthermore, the expenditure and the percentage of the expenditure for AN drugs significantly decreased: from 3.52% (2013) to 1.84% (2016) and from 5.50% (2013) to 0.59% (2016), respectively for groups of military personnel and people with HIC (p < 0.001) 4.2 The effectiveness of some intervetions in drug use management, a case study in antibiotics use and bacteria resisting antibiotics in Military Hospital 103 In general, the number of items of antibiotics of the group of people with HIC was higher than that of the group of military personnel Regarding antibiotics, Hospital 103 predominantly used betalactams (cephalosporins) and quinolones, being similar to copious domestic hospitals About the expenses, betalactam was the group which its expenditure was the highest (mainly from cephalosporins and carbapenems) For quinolones, the percentage of their expenses increased in both patient groups DDD/100 bed days of both abovementioned antibiotic groups were also the highest Moreover, 21 although the number of used items of fosfomycin was low, its expense was extremely high and DDD/100 bed days of this antibiotics was quite high Fosfomycin is one kind of reserve antibiotics which need to be managed and controlled in drug use because of the alarming reality of bacteria resisting nearly all antibiotics nowadays The highest value of DDD/100 bed days for betalactam group were amoxicillin and cephalosoprins gen whereas those for quinolone group were levofloxacin and ciprofloxacin In addition, cephalosporins gen (cefepim and cefpirom) and fosfomycin were reserve antibiotics which DDD/100 bed days were high in the group of people with HIC DDD/100 bed days of three abovementioned reserve antibiotics increased in 2014 and 2015, considerably decreasing in 2016 This achievement showed that Military Hospital 103 endeavoured to ensure that their antibiotics were made use of in suitable, safe and effective ways, thereby constraining favourable situations which bacteria have chances to restrict antibiotics The costs for 1-day treatment of antibiotics were estimated in order to assist Military Hospital 103 to make clear decisions in drug selection for upcoming years and not to squander hospital’s budget Overall, the costs for 1-day treatment of multitudinous antibiotics were virtually unchanged during 2013-2016 intervals, even went down This success partially sprang from this hospial’s strict monitoring and controlling in drug tendering and procurement Antibiotic resistance is one of intractable problems in drug use and management not only in Vietnamese hospitals but also in all health facilities all around the world This study conducted some assessments about bacteria resisting antibiotics and bacteria tests in Hospital 103 The results showed that the percentage of patients doing bacteria tests 22 was low Doing these tests can aid doctors in correctly selecting antibiotics in treatment, constraining antibiotic resistance In addition, using preventive antibiotics in surgeries brought about several initial achievements The utilization of preventive antibiotics in departments of Hospital 103 were carried out and kept track of The average time of hospitalization and the percentage of inpatients infecting bacteria was on the descrease during 2013-2016 period Hospital 103 should maintain these achievements for forthcoming years Apart from aforementioned accomplishments, there were some issues which needed to be concerned The results obtaining from bacteria surveys contributed to emphasize the alarming level of antibiotic resistance There were myriad bacteria which resisted nearly all common antibiotics The percentage of antibiotic resistance was on the increase By way of illustration, Acinebacter did resist nearly all antibiotics, even carbapenems Burkholderia and Klebsiella also resisted copious antibiotics, only being susceptible to carbapenems CONCLUSION This study analyzed the effectiveness of some interventions for drug list using ABC, VEN analysis in Hospital 103 (2013 – 2016 period) - The number of items of imported drugs was higher than that of domestic drugs The expenses of imported drugs was 5-6 time as much as that of domestic drugs Interventions in imported drugs was ineffective, the percentage of their expenses did not decrease - Generic medicines constituted more than 80% the number of items of used medicines The expenditure of OBs increased during 2013-2016 period The percentage of the number of OB items decreased while the percentage of the expense of OBs increased 23 - During studying intervals, Military Hospital 103 mainly used oral drugs and injections/infusions The number of items of the former was higher than that of the latter while the expenditure of the latter was higher than that of the former - Drugs cointaining single active element were prioritized to use (more than 90% the number of drug items and 92% the expenses of drugs) For drugs containing multiple active elements, the percentage of their expenses did not diminish so interventions were unsuccessful - Medicines treating parasites/bacteria and cardiovascular diseases were groups having the highest number of drug items groups having the highest expenses were medicines treating parasites/bacteria and treating cancer/hamonizing immune system The decline of the percentage of the expense of medicines treating parasites/bacteria and vitamins/minerals showed that interventions were effective - For ABC analysis, the number of items of A-group drugs decreased For VEN analysis, the number of items of V-group medicines also went down The number of items and the expenses of both N-group and AN-subgroup medicines significantly diminished This study analyzed the effectiveness of some intervetions in drug use management, a case study in antibiotics use and bacteria resisting antibiotics in Military Hospital 103: - Betalactams and quinolones were two antibiotic groups which the number of items and the expenses were high Fosfomycin was also the antibiotic which its expense were extremely high - DDD/100 bed days of antibiotics was 24.3 and 31.4, respectively for the group of military personnel and people with HIC Some antibiotic subgroups which DDD/100 bed days were high included: 24 penicillin (amoxicillin), cephalosporins gen cephalosporins (cefepim, gen cefpirom) (cefotaxim), and quinolones (ciprofloxacin and levofloxacin) - The costs for 1-day treatment of myriad antibiotics were nearly constant or decreased during 2013-2016 period - Preventive antibiotics commenced being used and brought about some initial achievements Antibiotic resistance was an intractable problem occuring in Hospital 103 and needing to be concerned RECOMMENDATIONS For Military Hospital 103: - About drug lists: + To some cost-effectiveness analysis in the use of imported OBs having exorbitant costs and vitamins, thereby considering to supplant these medications by domestic generic medicines + To consider to totally eradicate AN-subgroup medicines and put a curb on the use of N-group drugs When doing VEN analysis, considering what kinds of medicines should be sorted into group V and considering whether or not ofloxacin was sorted into group N - About antibiotic use: + To curb the utilization of antibiotics in general, especially reserve antibiotics like cephalosporins gen 4, carbapenems and fosfomycin + To more necessary researches with the intention of assessing antibiotic resistance, especially for bacteria resisting the plethora of antibiotics (for instance, the reality of antibiotic resistance of Pseudomonas aeruginosa) LIST OF PUBLISHED ARTICLES RELATED TO THE RESEARCH Dao Thi Khanh, Phan Thi Hoa, Tran The Tang (2019), “Assessing the reality and several factors affecting on the drug lists used in Military Hospital 103 during the period of 2013 2014”, Vietnam Medical Journal, 481(2): 23-27 Dao Thi Khanh, Tran The Tang, Phan Thi Hoa (2019), “Evaluating the use of some groups of high-cost drugs at Military Hospital 103 in 2013-2016 period”, Journal of Military Pharmaco-Medicine, 7: 81-86 ... Military Hospital 103 during the period of 2013 – 2016? ?? with following objectives: To analyze the effectiveness of some interventions for the drug list using ABC, VEN analysis in Hospital 103 during... Military Hospital 103 during the period of 2013- 2016 For the 2nd objective, study objects were antibiotics and bacteria resisting antibiotics 2.2 Methodology 2.2.1 Study design: This study uses... items of this subgroup significantly went down Up to the year 2016, there were and AN medicines used in Military Hospital 103, respectively for the group of military personnel and people with HIC