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  • Ra#onal use of Medicines in Public health facili#es of Tamil Nadu; A Providers

    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 FDCs 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#ents 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 didnt have probable diagnosis thus couldnt link to DDD and standard treatment guidelines.

  • THANK YOU

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