Transcript impact of implementation of clinical protocols on

IMPACT OF
IMPLEMENTATION OF
CLINICAL PROTOCOLS ON
RATIONAL DRUG USE IN
KYRGYZSTAN
Toktobaeva B, Karymbaeva S
Drug Information Centre
Kyrgyzstan
Drug Information Centre
1
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
2
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
3
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
4
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
5

-
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
6
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
7
Availability of key drugs in
pharmacies
table 1
80%
70%
60%
50%
40%
30%
20%
10%
0%
59%
2001
65%
2002
Drug Information Centre
77%
2003
8
Average number of drugs pre
per patient and number of
drugs prescribed from EDL
table 2
100
79
80
59,9
60
45,2
40
20
0
3
4
2
number of drugs
2001
2002
% from EDL
2003
Drug Information Centre
9
% of antibiotics prescribed per
patient
table 3
36%
36
35,7%
34
32
30%
30
28
26
2001
2002
Drug Information Centre
2003
10
% of injections prescribed per
patient
table 4
35
34%
30
25
18%
20
17%
15
10
5
0
2001
2001
Drug Information Centre
2003
11
Appropriate treatment
according to clinical protocols
table 5
80
70
60
50
40
30
20
10
0
67,8
42,2
2002
2003
Drug Information Centre
12
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
13