Transcript Poster presentation

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 3.37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
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.