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RATIONAL DRUG MANAGEMENT IN PRIVATE SECTOR THROUGH INTERVENTION
Bapna JS, Jain Amit, Hussain Mumtaz, Bhargava Jyotsna, Lalvani Paul
Indian Institute Of Health Management Research, Jaipur, India
Problem Statement: A survey at a private society run community health centre indicated that irrational prescribing such as poly
pharmacy, over use of costly medicines and injections was common.
Objectives: Two successive interventions involving face-to-face discussion and limited drugs lists were made to improve the
prescribing of medicines to reduce the costs and use of injections
Design: It was a before and after study of prescriptions utilizing rapid assessment indicators of MSH. The cost of medicines
was determined.
Setting: The society to rehabilitate 250 handloom weaverss, charged users fee of Rs. 50 per family for registration, and then
Rs. 50 for each of the prescriptions dispensed by the selected private pharmacy. The balance cost of medicines and laboratory
investigations were born by the society. The expenses were mounting and it was necessary to contain wasteful expenditure.
The scope of study was local.
Study Population: Sixty consecutive prescriptions each, before and after the interventions were were analyzed
Intervention(s): The interventions consisted of face-to face discussion with the prescribers and limited drugs list prepared by
them. They were told that the average number of medicines per prescription range between 2 to 4 in most of the situations
instead of 8 to 9 prescribed by them. Some of the typical irrational prescriptions where poly pharmacy was common, were used
for discussion without disclosing the identity of the prescriber. The issues such as peer review of prescription and prescription
audit that exists at some of the health facilities were discussed. They were sensitized to the concept of essential drugs and
rational drug use and the advantages of the limited drug lists. The example of beneficial effect of rational drug use programme
at other places involving proper selection, efficient procurement and use of standard treatment guidelines were shown to them.
Analysis of prescriptions was done one month after the intervention. This was followed by the second intervention of limited
medicines list after a gap of 3 months. In this they prepared a list of 50 medicines for 25 commonest ailments. Following this a
set of next 60 prescriptions was analyzed.
Outcome Measure(s): The intervention improved the prescribing in terms of reduction of number of medicines, injections per
prescription and the costs were determined.
Results: With the with the first intervention average no of drugs per prescription decreased from 8. 88±0.67 to 6.97±0.48 (p<
0.05), injections from 3.03±.40 to 1.68±0.31 (p<0.05) and the cost from Rs. 500±42 to 353±36 (p<0.05). However the second
intervention of limited drugs list prepared by them reduced these to 3.370.22 (p<0.05), 0.120.04 (p<0.05) and 13618.17
(p<0.05) respectively.
Conclusions: The intervention involving face-to face discussion with the prescribers though reduced the number of medicines
per prescription, poly pharmacy persisted. The use injections and trhe cost decreased. However the second intervention
consisting of limited medicines list brought these at par with the good prescribing practices. The introduction of standard
treatment guidelines may further promote rational prescribing.
Funding Source(s): Rehwa Society, Maheshwar and IIHMR, Jaipur, India