E-DRUG: prescribing and dispensing indicators in public health facilities
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Dear fellow E-druggers,
I am writing to ask you if you have any information related to my
dissertation proposal on ' Assessment of prescribing and dispensing
practices in the public health facilities'. Listed below are the proposal
indicators.
(a) Prescribing indicators:
All the four indicators below will be collected retrospectively from the
patient registers (they record date, name of patient, age, diagnosis and
treatment) and 30 encounters will be evaluated for each facility. The
information or data will be recorded or collected according to the following
indicators on a prescribing indicator form (See Annex 1):
(i) Average number of drugs per encounter which measures the
degree of poly-pharmacy (more than five drugs per encounter). This will be
done by dividing the total number of different drug products prescribed, by
the number of encounters surveyed.
(ii) Percentage of drugs prescribed by generic name (the
drug's official or international nonproprietary name given by WHO regardless
of who manufactures or markets it) which measures the tendency to prescribe
by generic name. This will be calculated by dividing the number of drugs
prescribed by generic name, by the total number of drugs multiplied by 100.
(iii) Percentage of encounters with
(1) an antibiotic prescribed
(2) an injection prescribed
This measures the overall level of use of two important, but commonly
overused and costly forms of drug therapy. They will be calculated by dividing the number of patient encounters during which an antibiotic or injection were prescribed, by the total number of encounters surveyed, multiplied by 100.
(iv) Percentage of drugs prescribed from essential list or
formulary, which measures the degree to which practices conform to national
drug policy. It will be calculated by dividing the number of products
prescribed which are listed on the essential drugs list by the total number
of products prescribed which are listed on the essential drugs list by the
total number of products prescribed, multiplied by 100.
(b) Patient Care Indicators:
These address key aspects of what patients experience at health facilities
and how well they have been prepared to deal with pharmaceuticals that have
been prescribed and dispensed. 30 patients will be asked during exit
interviews when they have finished and are about to go home at each
facility. All data needed to measure patient care indicators for each
facility will be recorded and summarized on the patient care form (See Annex
2)
(i) Average consultation time measures the time that medical
personnel spend with patients in the process of consultation and
prescribing. This will be observed and time recorded between when the
patient enters and leaves the consultation room. It will be calculated by
dividing the total time for a series of consultations, by the number of
consultations.
(ii) Average dispensing time, measures the average time that
personnel dispensing drugs spend with patients. This will be done by
observing and recording the time when a patient submits the prescription to
the dispenser of drugs and the time the patient leaves the dispensary. It
will be calculated by dividing the total time for dispensing drugs to a
series of patients, by the number of encounters.
(iii) Percentage of drugs actually dispensed measure the degree
to which health facilities are able to provide the drugs which were
prescribed. It will be measured by dividing the number of drugs actually
dispensed at the health facility by the total number of drugs prescribed,
multiplied by 100.
(iv) Percentage of drugs adequately labelled measures the degree
to which dispenser's record essential information such as name of patient,
description of drug, dosage regimen, strength of the drug, precautions and
total quantity dispensed on the drug packages they dispense. It will be
measured by dividing the number of drug packages containing at least patient
name, drug name and when the drug should be taken, by the total number of
drug packages dispensed, multiplied by 100.
(v) Patients' knowledge of correct dosage measures the
effectiveness of the information given to patients on the dosage schedule of
the drugs they receive. This will be measured by dividing the number of
patients who can adequately report the dosage schedule for all drugs during
exit interviews, by the total number of patients interviewed, multiplied by
100.
(c) Health Facility Indicators:
Three important components which influence the ability to prescribe drugs
rationally are the availability of prescribers and dispensers, adequate
supply of essential drugs and access to unbiased information about these
drugs. The data for the health facility indicators will be recorded on the
facility summary form (See Annex 3):
(i) Percentage availability of a copy of essential drugs
list or formulary is indicative of the extent to which copies of the
national essential drugs list or local formulary are available at health
facilities. The Essential Drugs List or formulary will be checked in the
consultation room or dispensing area or drugstore. It will be calculated by
dividing the total number of health facilities that have the Essential Drugs
List or formulary by the total number of facilities surveyed, multiplied by
100.
(ii) Percentage of available key drugs is a measure of the
availability at the health facility of key drugs recommended for the
treatment of some common ailments such as malaria, pneumonia, anaemia and
diarrhoea. This will be collected from the drugstore. This will be done by
dividing the number of available key drugs from the checklist by the total
number of drugs on the checklist multiplied by 100 (See Annex 6 for
checklist). The actual drugs that will be checked are: Paracetamol, Aspirin,
Ferrous Sulphate + Folic Acid, Albendazole, SP, ORS and Cotrimoxazole.
(iii) Percentage availability of qualified prescribers
(clinicians who write prescriptions) .This will be obtained by asking the
health workers whether they have qualified clinicians. It will be calculated
by dividing the total number of health facilities that have qualified
clinicians by the total number of facilities surveyed, multiplied by 100.
(iv) Percentage availability of qualified dispensers (pharmacy
personnel who issue out drugs to patients).This will be obtained by asking
the health workers whether they have qualified pharmacy personnel. It will
be calculated by dividing the total number of health facilities that have
pharmacy personnel by the total number of facilities surveyed, multiplied by
100.
Results will be reported at the Health Centre level, District hospital
level, Central hospital level and Ministry of Health. Both tabular and
graphic presentation will be used from the quantitative data. After the data
will have been collected from each facility, the results will be entered and
aggregated onto a facility indicator reporting form (Annex 4) and
consolidation form (Annex 5) and then transferred into a computerized
version of the form, which will be included in the spreadsheet. If this is
used, mean (average), minimum and maximum values and the standard errors for
individual indicators will be generated using Epi Info software. Bar charts
will also be created using Microsoft Excel that show the number of
facilities at different levels of each indicator and how the facilitie
Regards,
Aaron Sosola
Malawi
sosola@malawi.net
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