Workshop on“ How to reduce

unnecessary IV/IM vitamin injection in primary care”

IntroductionDr Aung Pyi Soe

M.B.,B.S (YGN), Dip. Med. Sc (Family Medicine)

Myanmar belief

အဆ= အရွိ��

IV/IM vitamin injection

• Vitamin B complex ( B1 + B6 + B12)• Vitamin B1• Vitamin B12• Vitamin C• Glucose 25%, 50%• Glucose + multivitamin infusion• Calcium gluconate• Amino acid injection

Strange!

• A lot of such practices are present around us.But,

• Nothing was seen in the medical textbooks.• Nothing was taught in the medical schools.

Factors promoting vitamin injections

• Patient factors

• Doctor factors

• Health system factors

• Culture factors

Factors promoting vitamin injections

Patient factor –• patient demand – dependent psychologically on

injection• perception on treatment – will get better by

injection rather than oral, one can see skill of a doctor

• Health belief – I will boost my energy by this injection

Factors promoting vitamin injections

Doctor factor –• Finances – doctors are underpaid or greedy• Poor knowledge on disease management –

do not know what the patient is actually suffering (failure of continuous professional development)

Factors promoting vitamin injections

Health system factor – • Poor regulation on quacks and drug shops –

more pressure to use injection practice that cannot be used by non-medical personnel

Culture factor – • Family and society pressure – all the people are

doing• Pain culture – no pain, no gain (will get better if

I receive pain by injection)

Ethical points of view

• ထိုးေထိုးေထိုးေထိုးေထိုးေထိုးေထိုးေထိုးေထိုးေ ထိုးေထိုးေထိုးေလူ�နက ေ��တင္�ဆ��လူ��႔ထို��ပတပ။Autonomy ≠ Right to demandAutonomy is right to deny and right to know.

• ထိုးေထိုးေထိုးေထိုးေထိုးေထိုးေထိုးေထိုးေထိုးေ ထိုးေထိုးေထိုးေလူ�န စိ�တ���က�နပ���အင္�ထို��ပတပ။Beneficence ≠ making patient satisfiedBeneficence is doing good for the patient.

• ထိုးေထိုးေ ထိုးေထိုးေထိုးေထိုးေထိုးေထိုးေထိုးေထိုးေထိုးေထိုးေထိုးေ ထိုးေထိုးေထိုးေထိုးေထိုးေထိုးေထိုးေထိုးေအဆထို��လူ��႔ဘဆ��က���မွ�မွ�ဖစိ�။Non - maleficence ≠ avoiding death and disabilityNon - maleficence is not doing any harm.

Professional points of view

• Doctors are professionals.• Being professional is fulfilling the client needs

with the understanding of the risk and benefits of any service given in terms of the best interest for the client.

• Practicing medicine is not doing a business.

More importantly, people should be able to expect more from physicians. Patients come to us for genuine answers—if they wanted a witch doctor, they would have found one. I think we need to hold ourselves to a higher standard than a huckster at the carnival. We’re not here to promise that we’ve got all the answers. We are here to be honest, and to use the best knowledge that science has to offer, using genuine compassion and thought. Let’s leave the quacking to the quacks. We’ll stick with real medicine.

Roy Benaroch, pediatricianFebrurary 3,2013

http://www.kevinmd.com/blog/2013/02/fetish-vitamin-b12-shots.html

Problem?

• Is it the problem?• Yes, it is.• Is it manageable one?• Yes, it is.• Why wouldn’t we do?• Because, we don’t know how.• Then, we will together find out the solution.

Today is the history

Workshop on “ How to reduce the unnecessary

IV/IM multivitamin injection in primary care”

Objectives

• To increase awareness of the problem of unnecessary IV/IM vitamin injection among doctors and public

• To find out the practical solutions to reduce unnecessary IV/IM vitamin injection

• To collaborate among the GPs in reducing unnecessary IV/IM vitamin injection

• To announce the position statement and recommendations to reduce unnecessary IV/IM vitamin injection in primary care

Agenda – morning sessionTime Topics

8:00-8:30am Registration and morning tea

8:30-8:45am Introduction Dr Aung Pyi Soe

8:45-9:30am Keynote lectures

1) Scope of the problem Dr Kyaw Thet Soe

2) Biochemical and nutritional aspects of IV/IM vitamin injection

Dr Theikdi Oo

9:30-10:30am Discussion from audience

10:30-12:00am Workshop 1Who and why the patients are received Vit injection?

Facilitator – Dr Kyaw Thet Soe

12:00-12:45pm Lunch

Keynote lecture themes

• IV/IM vitamin injection is the huge but covert problem in primary care practice that uses up the health resources – medications, money, human, time.

• This practice is questionably beneficial to the patient but definitely harmful to individuals and public in some extent – in terms of contents and ways of administration

Workshop (1) objectives

• to find out what is the patient population that are receiving the treatment

• to stratify and classify this population• to dig into the idea, concern and expectation

of those patients

Agenda – afternoon sessionTime Topics

12:45-2:15pm Workshop (2)Various ways to reduce unnecessary IV/IM vitamin injection

Facilitator – Dr Aung Pyi Soe

2:15-2:30pm Afternoon tea break

2:30-3:30pm ConclusionFinalizing position statement and recommendation

Workshop (2) objectives

• to brainstorm ways to reduce unnecessary IV/IM Vit Injection together with advantages and disadvantages

• to decide and list the effective ways on the board to use in reducing unnecessary IV/IM Vit injection

• to draft approach to use the various ways to reduce unnecessary IV/IM Vit injection

• to present the draft approach and discuss the practicability and pitfalls

Summarization

• to write the position statement as a workshop output

• to write the recommendation for reduction of unnecessary IV/IM vitamin injection as a workshop output

• to plan for future task

THANK YOU