E-drug: E-DRUG: Indicators of optimum prescribing (cont'd)
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These contributions reflect an ongoing debate about the WHO Drug
Use indicators. I have ordered the book and will comment in more
detail when I have the chance to read it. It appears to me that the
author used an earlier draft of the indicators when they were
WHO/INRUD indicators. I say this because he mentions dropping the
ORS for diarrhea indicator which was also dropped from the final set
of indicators adopted by WHO.
The issue remains "Are these indicators prescriptive or descriptive?"
When we started work on the indicators we were challenged with the
question "What is your standard?" and various very knowlegable
people particularly in the WHO CDD program suggested that we
should set standards of acceptable practice and then measure
adherance to these standards. In the many field tests that were done
we tried both approaches and found that it was too difficult to define
universal standards. So we defined descriptive indicators and broke
these into two groups - Core and complementary indicators. We also
recognized that other indicators could be developed for specific
circumstances.
The 12 core indicators have been used in hundreds of surveys and
except for a minor problem with the dispensing time indicator have
been found to be reliable and useful. Their major value I would
suggest is in comparing facilities in an area at the same time of year.
What is usually found is that a few facilities are outliers and that these
health units can benefit substantially from focussed interventions. The
indicators have also been used very effectively to measure the impact
of interventions.
The complementary indicators on the other hand have not been used
much and I would encourage people to try to use them. One of these
indicators could have been used in India. This is the indicator
"Percentage adherence to Standard Treatment Guidelines".
I am pleased to hear that the indicators have been used in India and I
would encourage the autors to publish their results internationally
either in INRUD News or the Essential Drugs Monitor or on E-Drug.
Unfortunately much of the research that is done in India is only
published locally and outsiders do not get to hear about these results.
To try to address this problem the next Drug Policy Issues course will
be held in Mumbai, India November 28th to December 10th 1999. The
course will be jointly organized by the Department of International
Health, Boston University School of Public Health and the Department
of Pharmacology and Therapeutics at King Edward Memorial Hospital,
Mumbai in collaboration with WHO/EDM. I will post more information
about this course soon,
I hope that we can hear more comments on the value of the WHO
Drug Use Indicators.
Richard Laing
Richard Laing M.B. Ch.B. M.Sc. M.D. Tel 1-617-414-1444
Associate Professor, Fax 1-617-638-4476
Department of International Health, E-mail richardl@bu.edu
Boston University School of Public Health,
715 Albany Street, T4W
Boston MA 02118 USA
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