Toktobaeva B, Karymbaeva S Drug Information Centre Kyrgyzstan IMPACT OF IMPLEMENTATION OF CLINICAL PROTOCOLS ON RATIONAL DRUG USE IN KYRGYZSTAN Toktobaeva B, Karymbaeva S Drug Information Centre Kyrgyzstan Drug Information Centre

Drug Information Centre Abstract Impact of Implementation of Clinical Protocols on Rational Drug Use in Kyrgyzstan Authors: Toktobaeva B.E., Karymbaeva S. T. Institution: Drug Information Centre, Department of Drug Provision and Medical Equipment Problem Statement: Clinical protocols were implemented to improve the drug use and appropriate prescription to use drugs from country-level essential drug list and national formulary. Objectives: To evaluate criteria of rational drug prescription, to determine physical availability of drug and appropriate prescription according to clinical protocols. Design: Randomized study, retrospective study. Setting and Population: Fifty five Family Group Practitioners in outpatient facilities from 6 regions of country and fifty five pharmacies selected around the outpatient facilities, and selected 15 essential drugs from National EDL. Interventions: Study was conducted in April-June, 2003 and covered all general practitioners in outpatient facilities and assessed their activities and efficiency of introduction of family medicine. Outcome Measures: % accessibility of essential drugs, average number of drugs prescribed per patient, % of drugs prescribed from National EDL, % prescribed of injections, % prescribed of antibiotics. Results: Average physical availability of essential drug in pharmacies was higher by 18% than in 2001 and by 12% than in 2002. Average number of drugs prescribed per patient was decreased in 2 times than previous years. In comparison with 2001 number of drugs prescribed from essential drug list and formulary increased by 19%. Prescription of antibiotics was increased by 5,7%. In general prescription of injection was decreased in 2 times in comparison with 2001. Conclusions: In spite of introduction and implementation of clinical protocols prescription of antibiotics remains the major problem for general practitioners. Medical education should be continued and focused on rational antibiotic prescription. Publication of the third edition of Formulary and further introduction and implementation of clinical protocols at all level of health care system promote rational drug use and appropriate prescription. Funding Source: World Bank, ZdravPlus/USAID, WHO. Drug Information Centre

Drug Information Centre Introduction 31 clinical protocols were developed and distributed on the primary health care level for improving quality of care and promote rational drug use. According to WHO essential drug conception National EDL is regularly revised. The last fourth EDL is under the revision at present. National Formulary was published in 1997 to promote the rational drug use. Last edition was revised and published. New pharmacies are established in the remote regions of the country to serve the needs of the population and promote the physical availability. Nevertheless rational drug use remains a major problem at medical institutions in Kyrgyzstan. Drug Information Centre

Drug Information Centre Objectives To evaluate indicators of rational drug prescription To determine physical availability of drugs To evaluate appropriate prescription according to clinical protocols Drug Information Centre

Drug Information Centre Methods Randomized study. Retrospective data were collected to assess the prescribing practices. 55 Family Group Practitioners from 6 regions were selected randomly. 30 medical records were selected from each outpatient facilities. Retrospective data were collected from medical records at FGPs. 55 Pharmacies were selected around the outpatient facilities. 15 drugs selected from EDL were studied. Study was conducted in April-June, 2003 and covered general practitioners in outpatient facilities and assessed their activities and efficiency of family medicine. Drug Information Centre

Drug Information Centre Prescriptions were evaluated using INRUD indicators: Average number of drugs prescribed per patient % encounters with antibiotic prescribed % encounters with an injection prescribed % drugs prescribed from National EDL % accessibility of essential drugs % prescriptions in accordance with clinical protocols Drug Information Centre

Drug Information Centre Results The average physical availability of essential drugs in pharmacies was 77%. It was higher by 18% than in 2001 and by 12% than in 2002. The physical availability of drugs was increased (tabl.1). The average number of drugs prescribed per patient was 2. This parameter was decreased, especially, compared to the previous year (tabl.2). 1558 cases of treatment were examined and number of drugs prescribed from the National EDL was 79%. Prescription of drugs from EDL significantly increased in 2003 (79%) compared to 2001 and 2002 (59.9% and 49.2% respectively (tabl.2). Prescription of antibiotics per patient was lower in 2002 (30%). In 2001 and 2003 antibiotic use was 36% and 35.7% respectively (tabl.3). Injections used per encounters were reduced by 17% (from 34% to 17% (tabl.4). Drugs prescribed according to clinical protocols were 67.8% in 2003. It was higher in 1.5 times than in 2002 (tabl.5). Drug Information Centre

Availability of key drugs in pharmacies Drug Information Centre

Drug Information Centre Average number of drugs pre per patient and number of drugs prescribed from EDL Drug Information Centre

% of antibiotics prescribed per patient Drug Information Centre

% of injections prescribed per patient Drug Information Centre

Appropriate treatment according to clinical protocols Drug Information Centre

Drug Information Centre Conclusions Elaboration and implementation of clinical protocols and use of EDL by practitioners at the primary health care level improved the criteria of rational drug use. But prescription of antibiotics remains the major problem for general practitioners. Medical education should be continued and focused on rational antibiotic prescription. Further introduction and implementation of clinical protocols and last edition of National Formulary at all level of health care system promote the rational drug use and appropriate prescription. Drug Information Centre