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.  

 

THANK  YOU