AN EVALUATION OF THE WHO RATIONAL PHARMACOTHERAPY TEACHING PROGRAM

1
AN EVALUATION OF THE WHO RATIONAL PHARMACOTHERAPY
TEACHING PROGRAM
Hill S1, Smith AJ1, Thambiran M1, Walkom E1,
Hogerzeil HV2 1. School of Medical Practice and
Population Health 2. World Health Organisation
Abstract An Evaluation of the WHO Rational
Pharmacotherapy Teaching Program Hill S, Smith
AJ, Thambiran M, Walkom E, Hogerzeil HV Problem
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.

• 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.

• 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 countrys institutions as a result
  of their attending the course.

• Results 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).

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

• 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 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).

Conclusion 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.
Study 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
  participants subsequent academic work.

• Methods
• 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

References 1. 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 19953461454-1457.
Acknowledgements Evaluation 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.
WHO Collaborating Centre for Training in
Pharmacoeconomics and Rational Pharmacotherapy