Transcript To asses patient drug use practices at the Free

ASSESSING DRUG USE PRACTICES
IN FREE MEDICAL CAMPS IN KENYA - II
Orwa J, Ombogo J, Ojoo M, Oluka M, Ogaja E,
Wanyanga W, Thuo M, All authors: INRUD KENYA,
P.O. Box 8700, Nairobi 00100, Kenya
Abstract
 Problem statement: Free medical camps are an important mechanism for delivering drug
donations and free medical services to the economically disadvantaged communities in
Kenya. However drug donations to these camps are not always appropriate and may result in
irrational drug use.
 Objective: To establish the role of public private sector interface in access to and rational use
of drugs.
 Design: Cross-sectional study.
 Setting and Population: Six hundred prescribing encounters were sampled retrospectively
by drawing randomly from historical medical records of Kenya Medical Association. Two
hundred encounters were sampled prospectively from two medical camps in Nairobi.
 Outcome measures: Average number of drugs per prescription, percentage of generics
prescribed, percentage of prescribed drugs from National Essential Drugs List (EDL),
percentage of antibiotics, percentage of injections prescribed, percentage of patients knowing
how to use their drugs, percentage of drugs prescribed actually dispensed and percentage of
drugs dispensed adequately labelled.
 Results: The average patient received 2-3 drugs, with an average of 46 % of patients
receiving antibiotics. Prescribing in accordance with the EDL was found to be about 77 % and
generic prescribing 32 %. Adequacy of labelling and patient knowledge was 65% and 74 %
respectively. The percentage of drugs prescribed actually dispensed was 79 %.
 Conclusion: This preliminary study has provided meaningful insights into drug use at free
medical camps in Kenya. More prospective evaluation is to be carried out to obtain a
representative measure of drug use and patient care at free medical camps.
Introduction
c Individual drug use problems take place within a
system of drug supply and within a network of
beliefs and motivations.
c To change a problem behaviour we must learn
about the behaviour itself and also about the
determinants which underline it.
c Evaluation of drug use practices at free medical
camps is necessary to monitor and design
changes in public -private roles that can promote
drug accessibility and rational drug use at these
camps .
Study goal
c The goal of this study was to obtain baseline
information on current treatment practices
encountered in free medical camps, so appropriate
interventions to improve drug use may be defined.
Study objectives
c To asses prescribing practices at Free Medical
Camps in Kenya.
c To asses dispensing practices at Free Medical
Camps.
c To asses patient drug use practices at the Free
Medical Camps.
Methodology
c This was a cross -sectional study.
c Data was collected using structured questionnaires.
c Prescribing encounters were sampled
retrospectively by drawing random encounters from
historical medical records of Kenya Medical
Association. 30 encounters from 20 camps covering
Nyanza , Western, Central and Rift Valley provinces,
were sampled giving a total of 600 encounters.
c Drug use indicators were also obtained
prospectively (200 encounters) from free medical
camps in Nairobi.
Results
c Table 1 shows a summary of the results of the drug
use indicator study
cThe average patient received 2-3 drugs, with an
average of 46 % of patients receiving antibiotics.
cPrescribing in accordance with Kenya EDL was
found to be about 77 % and generic prescribing
was 32 %.
cAdequacy of labelling was 65%.
cPatient knowledge on how to take their medicines
was 74 %.
cThe percentage of drugs prescribed actually
dispensed was 79 %.
Results
c The variability on the overall level of use of
antibiotics at different medical camps is shown on
Fig. 1.
c There is a general tendency to over prescribe
antibiotics.
c There is a low tendency to prescribe by generic
name in most medical camps (Fig.2).
c In most cases however, most medicines prescribed
are from Kenya EDL (Fig. 3).
c Injection was only prescribed for chronic
conditions.
Results
c Observational evaluation of donated drugs revealed
presence of:
cmedicines not on Kenya EDL
cmedicines for alternative therapy
cshort expiry (1 month)
cnon-essential medicines donated in large
quantities
c This is an indication of violation of guidelines for drug
donations.
Table 1. Information on patient care at
free medical camps in Kenya
VARIABLE
VALUE
Prospective Retrospective Average
Av. no. of drugs prescribed
2.1
2.9
2.5
Drugs prescribed by INN (%)
32
31
31.5
Encounters with antibiotics
(%)
Encounters with inj. (%)
52
40
46.0
0
1
0.5
Drugs on Kenya EDL (%)
79
76
77.5
Drugs actually dispensed (%)
79
-
79
Drugs adequately labelled (%)
65
-
65
Adequate patient knowledge
(%)
74
-
74
Fig.1. Camp-specific percent receiving
antibiotics
80
70
% of patients
60
50
40
30
20
10
0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20
camp site
Fig. 2. Camp-specific % prescribed
by INN
90
80
% by INN
70
60
50
40
30
20
10
0
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20
camp site
Fig.3. Camp-specific % drugs on EDL
100
90
80
% on EDL
70
60
50
40
30
20
10
0
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20
camp site
Conclusion
c This preliminary study has provided meaningful
insights into drug use pattern and prescribing
behaviour at free medical camps in Kenya.
c However, more prospective evaluation are to be
carried out to be able to have representative
measure of patient care practices at free medical
camps.
c Though free medical camps provide important
mechanism for improving access to essential
medical care, there is need to enforce standards for
drug donation in order to promote rational drug use.