Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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 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 3.370.22 (p<0.05), 0.120.04 (p<0.05) and 13618.17 (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 Introduction/Background Problem Statement A survey at a private society run community health centre indicated that irrational prescribing such as • Poly pharmacy, • Over use of injections was common • Costs of medicines was high Introduction/ Background Setting • The society to rehabilitate 250 handloom weavers, • 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 scope of study was local Objectives/ Study Questions To do interventions • Improve the prescribing of medicines through interventions reducing the poly pharmacy, reduce the use of injections and the costs involving – Face-to-face discussion – Limited drugs list Methods Design • It was a before and after study of prescriptions • MSH Rapid assessment drug use indicators were used • The cost of medicines dispensed was determined Study Population • Sixty consecutive prescriptions each, before and after the two interventions were analyzed. Methods Intervention Face-to face discussion with the prescribers. 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 Methods Intervention contd… • 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 before and after the intervention. Limited drugs list • Prescribers were asked to list the common health problems come across by them. • They were asked to list the drugs of choice for these • A list of 25 commonest diseases and 50 drugs was prepared and given to them to prescribe from it as far as possible Results The intervention improved the prescribing • Reduction in number of medicines per prescription • Reduction of number of injections and • Reduction in the costs. Drugs per prescription 10 9 8 7 6 5 4 3 2 1 0 8.88+0.67 6.97+0.48 3.37+0.22 Pre Intervention Post Intervention1 Face to Face P< 0.05 between pre and post intervention 1 and 2 Post Intervention 2 Limited drug list Injections per prescription 4 3.5 3.03+0.40 3 2.5 1.68+0.31 2 1.5 1 0.5 0.12+0.04 0 Pre Intervention Post Intervention1 Post Intervention 2 Face to Face Limited drug list P< 0.05 between pre and post intervention 1 and 2 600 Cost per prescription 500+ 42 500 353+36 400 300 200 136+18 100 0 Pre Intervention Post Intervention1 Face to Face Post Intervention 2 Limited drug list P< 0.05 between pre and post intervention 1 and 2 Implications/Conclusions • The intervention involving face-to face discussion with the prescribers though reduced the number of medicines per prescription, poly pharmacy persisted. • The use of injections and the costs decreased prescriptions. • Further interventions such as limited medicines list brought the prescribing to a near rational.