Transcript Poster presentation

INDICATORS FOR MEDICINES
INFORMATION SERVICES IN
DEVELOPING COUNTRIES
Ball DE1, Tagwireyi D2
1Dept
of Pharmacy Practice, Kuwait University, Kuwait
2Drug & Toxicology Information Service, Dept of
Pharmacy, University of Zimbabwe, Zimbabwe
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Indicators For Medicines Information Services In Developing Countries
Ball DE1, Tagwireyi D2; 1Dept of Pharmacy Practice, Kuwait University, Kuwait
2Drug & Toxicology Information Service, Dept of Pharmacy, University of Zimbabwe, Zimbabwe
Problem Statement: Medicines information centres (MICs) in developing countries need
to be able to assess and plan their development and function.
Objective: To develop & field-test indicators for monitoring MICs.
Method: Structure, process and outcome indicators were developed with input from
INDICES electronic forum. Tested on six MICs in Africa (Botswana, Eritrea, Ghana,
Kenya, South Africa, and Zimbabwe).
Results:
Structure indicators generally deficient except S. Africa, Ghana, Eritrea.
 Constitution, budget, dedicated telephone line, full-time staff only all at SA, Gh
 Funding varied from 0% to 100% public funding
Process indicators generally well met
 SOPs, reference sources in place, access to library
 Two centers did not have good MI filing systems
Outcome indicators results variable
 Only one offered a 24-hour service; one able to accurately state the level of use
 QA measures not commonly implemented
 Participation in DTCs and health care training activities was high
One MIC had operated >20yrs despite deficiencies in indicators suggesting other factors
are important in sustaining a MIC.
Conclusions: The indicators differentiated between MICs and provide a resource for
rapid assessment of the growth and effectiveness of MICs. However, other less easily
quantifiable factors e.g. staff enthusiasm, are also important in sustainability in resource2
poor settings.
Background
 WHO recognises medicines information (MI) to health care
workers (HCWs) & public as component of rational drug use (RDU)
 MI in WHO Medicines Strategy but emphasis is on consumers
 Promote RDU; integrate into training for HCWs [WHA 52.19/99]
 WHO Medicines Formulary, Bookshelf, EM Library, publications
 But need the MI to reach the consumer/HCW in situ
 Medicines Information Centres or services (MICs) are one avenue
 Development of national MICs in anglophone Africa slow:
 3 in 1980  6 in 2003; Two of initial 3 still operating
 Two more planned in 2004; also local/regional centres
 Some constraints have been described (Kasilo et al. 1989; 1991)
 Funding, staffing, training, resources
 For existing services
 Monitor efficiency and efficacy – improve & support
 Learn about sustainability - what works, what doesn’t
 Adapt functions to priority needs – planning and self-audit
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Objectives & Methods
 AIM: Develop indicators to monitor the development and
effectiveness of MI services in developing countries
 Field-test & refine the indicators and make available for wider use
 Indicator development
 previous work e.g. UK MI Group; DSE/WHO workshop report
 input from INDICES (International Network of Drug Information
Centres) electronic discussion forum
 Draft indicators surveyed through e-mailed self-administered
questionnaires to MI services in Africa:
 Local/regional: Botswana (est. 2003), Kenya (2000)
 National: Eritrea (1994), Ghana (2003), South Africa (1980),
Zimbabwe (1979)
 No response from Tanzania and Amayeza (S. Africa)
 Indicators refined and development ongoing
 To be used alongside DSE/WHO workshop report
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Results
 Structure, process and outcome indicators developed with
assistance of INDICES - see following slides
 Indicator field test results:
Structure indicators (Table 1)
 Generally deficient except Eritrea, Ghana, South Africa
 Funding varied from total reliance on public sources to mixed
income from consultancy and training services
Process indicators (Table 2)
 Generally well met with “deficiencies” due to MIC being proactive
with limited reactive role
Outcome indicators (Table 3)
 Variable results from MICs
 Only one centre offered 24 hour service; only one able to
accurately state the level of use
 Quality assurance measures almost non-existent
 Most produced bulletins; participation in DTCs and healthcare
training was high
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Structure indicators
1. Presence of a constitution (operating document):
2. At least one full-time professional staff e.g. doctor, pharmacist, nurse:
3. Total number of professional staff (full-time equivalents):
4. At least one secretarial support person:
5. Separate institutional budget for MI activities:
6. The MI service is based in: (i) academic institution, (ii) health institution,
(iii) government department
7. Percentage of the budget (incl. salaries) from: (i) Gvt., (ii) NGOs, (iii)
pharmaceutical companies, (iv) other
8. Dedicated office space (MI room), including basic furniture needs:
9. Present for MI activities: (i) dedicated telephone line, (ii) fax machine, (iii)
working photocopier, (iv) working computer, (v) MIC e-mail address
10. (a) The latest edition of 10 specified key reference sources present
(b) Percent of key references above which are present
Answer: Yes/No/Don’t know [DK]/number as appropriate
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Process indicators
1. Presence of standard operating procedures (SOPs) for handling requests:
2. Standard enquiry record forms are immediately available for use:
3. Systematic method of filing records which facilitates future access:
4. Easy access to consultant physicians if required for information:
5. SOPs for induction of new staff are present and reviewed in past 5 years:
6. At least 1 staff member received MI-related training in the past year:
7. Access to a medical library or other source of biomedical journals:
8. Staff participate in hospital ward rounds:
9. Staff are involved in teaching undergraduate/postgraduate HCWs:
10. MI service has hosted international MI colleagues for training/
exchange in the past year:
Answer: Yes/No/Don’t know [DK]/number as appropriate
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Outcome indicators
1. Total number of MI requests in the previous calendar year:
2. No. of MI requests for past year was 90% or greater than previous year:
3. At least 1 issue of a MI bulletin or newsletter published in the past year:
4. Participation in local/national therapeutic committee in the past year:
5. At least 1 presentation given to a professional or public body in the past year:
6. Annual report from previous calendar year available:
7. A 24 hour service is offered:
8. Self-audit exercise has been conducted & documented in the past year:
9. Percentage of callers satisfied with their contact/response from the MIC:
10. Percentage of enquiries related to poisonings/ toxicology information:
Answer: Yes/No/Don’t know [DK]/number as appropriate
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Table 1: Structure indicator results
Indicator
Bo
Er
Gh
Ke
SA
Zi
Constitution?






Full-time staff?






Secretary?






All office requirements?






% of key references
60
80
-
80 100 80
% Gvt funding (incl. salaries)
0
50 100
0
Countries: Botswana, Eritrea, Ghana, Kenya, South Africa, Zimbabwe
0
1
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Table 2: Process indicator results
Indicator
Bo Er
Gh Ke SA
Zi
SOPs in place?






Record forms at hand?






Access to experts & library?






-



Clinical/teaching duties?
 
Hosted/trained others?


-



Received MI training this yr?


-



Countries: Botswana, Eritrea, Ghana, Kenya, South Africa, Zimbabwe
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Table 3: Outcome indicator results
Indicator
No. of requests last year
Bo
Er
Gh
Ke
SA
Zi
NA NA NA 83+ 6031 DK
Produced a bulletin issue?






DTC participation?






Annual report?
NA





Self-audit conducted?
NA





% satisfied with service
DK DK
-
DK
DK
DK
Countries: Botswana, Eritrea, Ghana, Kenya, South Africa, Zimbabwe
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Discussion
 Indicators adequately sensitive
 Differentiated between MICs
 Able to identify areas needing strengthening
 SOPs, record forms, lack of staff/equipment, no QA
 All MICs concentrated on MI to HCWs, public lesser extent
Limitations
 Certain indicators not relevant to some MICs
 Eritrea mostly a proactive service; not enquiry answering
 Clinical activities of Botswana & Kenya not captured
 Some MICs don’t need toxicology reference texts
 Real outcomes are difficult to measure/show
 User satisfaction; Improved patient health
 Surrogate process measures used which may take the focus
from the true desired outcomes
 Sustainability in poorly resourced situations often depends on not
easily quantified factors e.g. staff enthusiasm
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Implications
 The indicators provide a resource for rapid assessment of the
growth and effectiveness of MICs
 Regular use can assist in development of MICs if they are
understood and used in planning
 Further refinement and development of manual in process
 To make available through INDICES and WHO-EDM website
• Acknowledgements
•
•
INDICES e-mail discussion forum
The following in particular made valuable contributions:
–
–
–
–
–
–
–
Leesette Turner, Drug Information consultant, South Africa
Lee Baker, Amayeza Drug Info Service, Johannesburg, S. Africa
Jude Ike Nwokike, Maun Hospital, Maun, Botswana
Atieno Ojoo, Gertrude’s Garden Children’s Hospital, Nairobi, Kenya
Annoeskja Swart, Medicines Information Centre, Cape Town, S. Africa
Philip WO Anum, National DI Resource Centre, Accra, Ghana
Embaye Andom, Drug Information Unit, Ministry of Health, Eritrea
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References
• Menkes,DB. Hazardous drugs in developing countries. BMJ 1997;
315: 1557-1558
• Kasilo OJ & Nhachi FB. Recommendations for establishing a drug
and toxicology information center in a developing country. Drug Intell
Clin Pharm 1991; 25: 1379-1383
• Kasilo OJ, Nhachi FB. How to establish a drug and toxicology
information centre in a developing country. Essential Drugs Monitor,
No. 16, 1993: 8-9
• Kasilo OJ & Froese EH. A 10-year review of the Teaching HospitalBased National Drug and Toxicology Information Service in
Zimbabwe. J Clin Pharm Ther 1989;14(5): 355-371
• Barlett G, et al. Evaluating the quality and effectiveness of a drug
information centre. DSE/WHO Seminar on Drug Information
Centres, Berlin, 1997
• Funding: Self-funded
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