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Transcript of Raonal’use’of’Medicines’in’Public’health’...
Ra#onal use of Medicines in Public health facili#es of Tamil Nadu; A Provider’s
prescrip#on analysis
Indranil Mukhopadhya, Sagri Negi, Kar#k Sharma, Richa Jaswal
Presenter: Richa Jaswal Sr. Research Assistant
Introduc#on
• The ra#onal use of drugs requires that pa#ents receive medica#ons:
- appropriate to their clinical needs,
- in doses that meet their own individual requirements for an adequate period of time - at the lowest cost
• Worldwide more than 50% of all medicines are prescribed, dispensed, or sold inappropriately,
while 50% of pa#ents fail to take them correctly (WHO)
Irra$onal prescribing pa0ern -‐ -‐ Polypharmacy
-‐ -‐unnecessary use of -‐ an#microbials
-‐ -‐ inadequate informa#on to -‐ the pa#ent
Inappropriate medicine demand
Health hazard to community along with
drug Resistance
Cost Burden to both health system and pa#ent
Ra#onal drug use problem; health system relevance
Output Indicators
Maternal and Child health status
Health seeking behavior
Process Indicators
Perceived quality of care and User
experiences
Rational use of Medicine(patient care Indicators)
Structural Indicators
Accessibility Affordability
Availability
Output Indicators
Health facility utilization rate/service coverage
Process Indicators
Adherence to standard treatment protocol
Providers Prescription Practice
Structural Indicators
Infrastructure/HR Equipment's
Medicines
PROVIDERS PERSPECTIVE DATA SOURCES CONSUMERS PERSPECTIVE DATA SOURCES
-Client Exit Interview
Client Exit Interview &Prescription Audits -KIIs
Household Survey
Integrated facility survey
- Medical vignettes - Prescription analysis
-Integrated facility survey -HMIS
Ra#onal drug Use and Quality of care
Changing drug misuse problem
Measure Existing Practices
(Descriptive Quantitative Studies)
Identify Specific Problems and Causes
(In-depth Quantitative and Qualitative Studies)
Design and Implement Interventions
(Collect Data to Measure Outcomes)
Measure Changes in Outcomes
(Quantitative and Qualitative Evaluation)
Research Question
Methodology -‐ WHO/INRUD
Prescribing Indicators
§ Average number of medicines prescribed per patient
§ % medicines prescribed by generic name
§ % encounters with an antibiotic prescribed
§ % medicines prescribed from essential medicines list
§ % of prescription containing fixed dose against single dose
Sampling and Data collec#on methods
Sampling technique : Mul#stage cluster sampling
District hospital
9
• Ist stage • 30% of the total districts
C
CHC 34
• 2nd stage • 30% of the total CHC
PHC 70
• 3rd stage • 2 per CHC
Data collec$on:
-‐ 10-‐15 prescrip#on was collected per facility
-‐ with total of 1589
Unit of analysis: Prescrip#on
Results
• 1539 prescrip#ons were used for the analysis which included (62%) from the PHCs, 399(26%) from the CHCs/SDH, 155(10%) from the district hospitals
Table1: Prescrip$on indicator across Tamil Nadu
Indicator Quan$ty/
percentage
Average number of medicines per encounter 2.7
Percentage of prescrip#on having generic drugs 78
Percentage of prescrip#on having FDC 8
Percentage of encounters with an#bio#cs prescribed 41
Percentage of drugs prescribed from EDL 77
Prescrip#on prac#ce by ATC
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PHC CHC DH
Pres
crip
tion
Prac
tice
by A
TC (%
)
Levels of care
A B C D H J L M N P R S A V
50
25
15 4 3
Vitamins (A11)
Drugs for acid related disorders (A02)
Drugs used in Diabetes (A10)
Antidiarheals/Intestinal Antiinfectives (A07)
Drugs for functional gastrointestinal disorders (A03)
63
18
6 4 6
Betalactam Antibacterial,penicillin Tetracyclines Macrolides Vaccines Other-beta lactam antibacterials
Prescrip$on pa0ern of cat “A” Drugs (%) Figure 8.2 Prescrip$on prac$ce of Cat “J” drugs (%)
Conclusion and Policy Implica#on
Strengths
-‐ With high % encounters with generic drugs and drugs from EDL along with rela#vely low % of FDC’s we
can comment that the Prescrip#on Prac#ce was fairly good in Tamil Nadu. In Literature this type of
prescrip#on paeern is related to:
-‐ containing cost
-‐ retaining pa#ent’s faith in public health facili#es
Weaknesses
-‐ No significant difference in the prescrip#on paeern across level of care warrants the need to strengthen
gatekeeping mechanisms in health care
-‐ Percentage of an#bio#c encounters were in inappropriate range (20-‐50%) as per community sehng
-‐ With growing concern of an#bio#c resistance, a regula$on policy for an$bio$c usage is recommended
Limita#ons
• Cannot comment on ra#onality of prescrip#on as
1. Providers Prescrip#on prac#ce depends on -‐ Pa#ent demand
-‐ supply side factors (availability, affordability, perceived quality) -‐ Providers competence (Adherence to standard treatment protocols/essen#al medicine list) -‐ Incen#ves to prescribe certain drugs 2. Majority prescrip#on didn’t have probable diagnosis thus couldn’t link to DDD and standard treatment guidelines.