ICIUM 2004-CHIANG MAI SURVEY REPORT ON RATIONAL USE OF DRUGS In 30 Primary Health Centres of Tamilnadu, India

ICIUM 2004-CHIANG MAI MURALI.R, SATHYANARAYANAN.D, & TITUS.U INSTITUTE OF COMMUNITY MEDICINE, MADRAS MEDICAL COLLEGE, CHENNAI

ICIUM 2004-CHIANG MAI INTRODUCTION An efficient health care delivery system is an important requisite to achieve health for all. Access to essential drugs is probably the most important element of health care delivery system.

ICIUM 2004-CHIANG MAI The Government of Tamil Nadu, India realizing this, developed and implemented various strategies under the broad framework of Tamil Nadu Medical Services Corporation to control and monitor drug procurement, storage and distribution to the Public sector hospitals in the state.

ICIUM 2004-CHIANG MAI Tamilnadu Medical Services Corporation(TNMSC) 1994: Efforts to rationalize drug use commence and TNMSC formed; Chain of modern warehouses built 1995: Essential drug list prepared 1997: News Bulletin “TNMSC Times” launched 1998: Training for Doctors and Pharmacists.

ICIUM 2004-CHIANG MAI TNMSC & RUD EDL Pharmacist’s handbook Training of pharmacists in inventory management “TNMSC Times”

ICIUM 2004-CHIANG MAI Quantification based on EDL Procurement of generic drugs of good quality at competitive rates Storage under good conditions in modern warehouses

ICIUM 2004-CHIANG MAI Distribution based on indenting by medical officers Inventory control at district warehouses

ICIUM 2004-CHIANG MAI Objectives  To study the current status of essential drug use in the state  To study the prescribing behaviour and practices, dispensing practices and the quality of services rendered through primary health centers.  To identify weak areas, if any in the rational use of drugs and suggest strengthening measures.

ICIUM 2004-CHIANG MAI Methodology 2 primary health centres from each of 22 out of 23 ware house districts were chosen by simple random sampling An orientation of all medical officers of selected primary health centres was conducted

ICIUM 2004-CHIANG MAI Out patient chits as booklets with carbon copy were distributed to all selected primary health centres. Only 30 out of the 44 primary health centres returned the chits in time.

ICIUM 2004-CHIANG MAI Exit interviews were conducted by three senior medical officers during the survey. Each interviewer visited 5 primary health centres(PHC) selected by simple random technique and interviewed minimum 10 patients in each PHC

ICIUM 2004-CHIANG MAI Total prescriptions studied – 13,608 Total exit interviews conducted th September 2001 to 20 th December 2001

ICIUM 2004-CHIANG MAI Results Prescribing indicators Patient care indicators Health facility indicators Complimentary indicators

ICIUM 2004-CHIANG MAI Prescribing indicators Average number of drugs per prescription % of prescriptions with at-least one antibiotic % % of prescriptions with at-least one injection: 56.47% Average cost per prescription- Rs.3.75

ICIUM 2004-CHIANG MAI % of prescriptions as per STG Acute respiratory infection- 0.47% Acute Diarrhea- 3.63% Fever- 1.76% Hook worm % Gastritis- 2.97%

ICIUM 2004-CHIANG MAI Patient Care indicators Average consultation time minutes % of drugs actually dispensed % Average dispensing time minutes Average time at the OP ticket counter minutes Average time outside the consulting room minutes

ICIUM 2004-CHIANG MAI Prescription counselling DOCTOR PHARMACIST DOSE 40.01%82.02% ADMN 31.15%78.36% FREQUENCY 38.70%87.05% SIDE EFFECTS 2.35%6.05% AVERAGE 28.05%63.37%

ICIUM 2004-CHIANG MAI Average time outside the pharmacy minutes Average time spent by a patient at the PHC minutes

ICIUM 2004-CHIANG MAI Health facility indicators % of availability of Essential drugs at the PHCs %

ICIUM 2004-CHIANG MAI Complimentary Indicators % of drug cost spent on injections %

ICIUM 2004-CHIANG MAI

Summary NO.INDICATORSTATEIDEAL 1.Avg.Drug per prescription % Of prescriptions with injection 56.47<10% 3.% Of prescriptions with antibiotic 54.42<25% 4.No of drugs actually dispensed % Of prescription counselling by doctor % Of prescription counselling by doctor Availability of drugs

ICIUM 2004-CHIANG MAI Conclusion Rational use of drugs is still a problem in Tamilnadu Poly-pharmacy, Over- use of antibiotics, misuse of injections, short consulting time and poor patient counselling are all common patterns of irrational use of drugs in the state.

ICIUM 2004-CHIANG MAI Recommendations Develop simplified STGs that are adapted to local conditions Improve training of health care providers Periodic monitoring and evaluation of drug use pattern Unbiased drug and therapeutic information to be made available to prescribers, dispensers and consumers.

ICIUM 2004-CHIANG MAI Study funded by DANIDA Thank you