Cost Implications of Compliance with Treatment Guideline for Children with Acute Upper Respiratory Infection : a case study of King Chulalongkorn Memorial Hospital

Abstract

This thesis aims at assessing treatment variations between actual practice and recommendations of the guideline for the management of Acute Upper Respiratory Infections (AURI) in children below 15 years of age; it also attempts to estimate the associated cost of non compliance with the guideline. The study uses King Chulalongkorn Memorial Hospital as a case study. Two hundred medical records and accompanying prescriptions were collected prospectively in four weeks period. Review of these records was done against the guideline. Results revealed that prescribing practice of doctors in general pediatric outpatient department of King Chulalongkorn Memorial Hospital differs from guideline recommendations in 37.5% of the cases reveiwed and the difference was statistically significant (p<0.05), overall 46% of cases received antibiotics, 9% of cases had history of prior antibiotic medication, 86% of cases were found to be compatible with non bacterial AURI according to the guideline of which 39.5% did not comply with the guideline. The study estimated that there would have been a saving of 31.23 baht per case if prescribing doctors would have followed the guidline and unnecessary cost imposed on treatment of children with AURI avoided.