1. Impact of the Tamilnadu Medical Services Corporation on Drug Prescribing in primary Health Care Murali R,Sathyanarayanan D,Rajkumar C,Senthil Kumar R,Usha T

2. Introduction  Access to essential drugs is probably the most important element of health care delivery system.  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.

3. 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.

4. TNMSC & RUD  EDL  Pharmacist’s handbook  Training of pharmacists in inventory management  “TNMSC Times”  Generic drugs of good quality at competitive rates  Storage in modern warehouses  Distribution based on indenting by medical officers  Inventory control at district warehouses

5. 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.

6. 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  Out patient chits as booklets with carbon copy were distributed to all selected primary health centres.

7.  Only 30 out of the 44 primary health centres returned the chits in time  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

8. Prescribing indicators  Average number of drugs per prescription- 2.92  % of prescriptions with at-least one antibiotic- 54.42%  % of prescriptions with at-least one injection: 56.47%  Average cost per prescription- Rs.3.75

9. % of prescriptions as per STG  Acute respiratory infection- 0.47%  Acute Diarrhea- 3.63%  Fever- 1.76%  Hook worm- 12.60%  Gastritis- 2.97%

10. Patient Care indicators  Average consultation time- 2.78 minutes  % of drugs actually dispensed- 96.57%  Average dispensing time- 2.94 minutes  Average time at the OP ticket counter- 14.17 minutes  Average time outside the consulting room- 13.72 minutes.

11.  Average time outside the pharmacy- 15.82 minutes  Average time spent by a patient at the PHC- 47.75 minutes Health facility indicators  % of availability of Essential drugs at the PHCs- 71.63% Complimentary indicators  % of drug cost spent on injections- 24.96%

12. Summary NO. INDICATORSTATEIDEAL 1.Avg.Drug per prescription 2.922 2.% Of prescriptions with injection 56.47<10% 3.% Of prescriptions with antibiotic 54.42<25% 4.No of drugs actually dispensed 96.57100 5.% Of prescription counselling by doctor 28.05100 6.% Of prescription counselling by doctor 63.37100 7.Availability of drugs71.63100

13. Conclusion and recommendations  TNMSC has ensured availability and accessibility of drugs  Rational use of drugs is still a problem inTamilnadu  Develop simplified STGs that are adapted to local conditions  Improve training  Periodic monitoring & evaluation