In a previous message Richard Laing stated:
The WHO indicators of drug use in health facilities are for out
patients not inpatients and they do not work so well for
inpatients. They are affected by disease mix and duration of
admission.
The problem I am having is that the inpatients' drug usage can be very
(and unecessarily so) expensive expensive. For example the use of a
cephalopsorine at 10.75 $NA per shot instead of
Ampicillin/Metronidazol for 0.75 $NA per shot and 0.50 $NA per
suppository in cases such as human bites, pelvic inflammatory disease,
puerperal sepsis, and before a pus swab has been done for culture.
[This is a very good and important point. When I was in Harare recently I
heard of IV metronidazole being used when suppositaries or IV
chloramphenicol could have been used for gynaecological infections.
Hospital costs are often the major portion of drug expenditure and so far
there has been very little effort to apply Essential Drug principles to
hospitals R Laing (Co-Moderator)]
So I think we need to try other measures. My suggestions include:
Frequency of D&T meetings, attendance rates, studies undertaken,
success of interventions, changes in consumption of targetted drugs.
We should not measure input (frequency, attendance etc) but
output. And that's what I find so difficult, though if we take
intervention success which equals to some extent changes in
consumption, our local committee seems to be on the right track.
[I agree but I am at a loss at the moment to suggest robust indicators that
can be used in different hospitals and countries and at difffering points
in time. RL]
However we need to field test these indicators and so I think the
proposed WHO manual will be very useful for these tests.
Agreed.
More output indicator suggestions please...
[This is a key point, ideally we can get field tested suggestions as well.
The work being done in Zimbabwe by Juliet Manyemba and Cephas Dzuda may
answer some of these questions. I appreciate these thoughtful and
constructive comments and look forward to further discussion of these
issues Richard Laing (Co-Moderator)]
el
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Dr. Eberhard W. Lisse\ / Swakopmund State Hospital
<el@lisse.NA> * | Resident Medical Officer
Private Bag 5004 \ / +264 81 1246733 (c) 64 461005(h) 461004(f)
Swakopmund, Namibia ;____/ Domain Coordinator for NA-DOM (el108)
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