Drug Use Indicators

Rational drug
use

The rational use of drugs requires that:

patients receive medications appropriate to their clinical
needs
in doses that meet their own individual requirements
for an adequate period of time, and
at the lowest cost to them and their community.
 FACTORS THAT RAISED
THE RDU

 Drug explosion
 Efforts to prevent the development of resistance
 Growing awareness
 Increased cost of the treatment
 Consumer protection act (CPA)
 FACTORS INFLUENCING
USE OF MEDICINES

Policy,
Legal and
Regulatory
framework

Prescriber,
Dispenser RATIONAL Patient &
& their DRUG USE community
workplaces

Drug
Supply
System
 TYPES OF IRRATIONAL
USE

DIAGNOSIS

PRESCRIPTION
 DIAGNOSIS-
IRRATIONAL USE

 Inadequate examination of patient

 Incomplete communication between patient and doctor

 Lack of documented medical history

 Inadequate laboratory Resources

 PRESCRIPTION-
IRRATIONAL USE

 Under-prescribing

 Incorrect prescribing

 Extravagant prescribing

 Over-prescribing

 Multiple prescribing
 Prescribing

Extravagant prescribing: Expensive drugs are used

when less expensive equivalents are available.

Over-prescribing: Prescribed drugs are not needed, or

the dosage is too high.
 DISPENSING- IRRATIONAL
USE
 Incorrect interpretation of the prescription

 Retrieval of wrong ingredients

 Inaccurate counting, compounding

 Inadequate labeling

 Packaging:
 Poor-quality packaging materials

 Repackaging

 Unappealing package
 HAZARDS OF IRRATIONAL
USE OF DRUGS

 Ineffective & unsafe treatment

 Exacerbation or prolongation of illness.

 Distress & harm to patient

 Increase the cost of treatment

 METHODS FOR
DEVELOPMENT OF RDU
 Drug use indicators

- prescribing indicators (measures the performance of health care provider)

- patient care indicators (patients experience)

- facility indicators (features of working environment)

 Drug and Therapeutics Committee

 Standard Treatment Guidelines

 Pharmacovigilance

 Pharmaceutical care
 DRUG USE
INDICATORS

• used as measures of performance in three general areas

related to the rational use of drugs in primary care:

- Prescribing practices

- Patient care

- Facility specific factors

 Steps in an Indicators
Study

• Select geographic area • Describe study procedures

• Select sample of facilities • Select and train personnel
• Retrospective prescribing data • Pilot test and revise procedures
available?
• Collect data
• Define criteria for core indicators
• Feedback to facilities and managers
• Decide on follow-up studies
 DRUG USE
INDICATORS
Continued

Prescribing indicators
1.Average number of drugs per encounter
2. Percentage of drugs prescribed by generic name
3. Percentage of encounters with an antibiotic prescribed
4. Percentage of encounters with an injection prescribed
5.Percentage of drugs prescribed from essential drugs list
or formulary
 Simple Prescribing
Indicators
No. of Form
No. of
No. of No. of
Number of Diagnosis
Patient medicines medicines not recorded
medicines antibiotics injections
Number prescribed by in the diagnosis=1/
prescribed prescribed prescribed
generic name NEML/NNF symptoms=0
1
2
3
4
5
Total no. A B C D E
medicines = = = = =
Total no. F G H I
patients = = = =
(total meds % Patients % Patients % Diagnosis
/#patients) receiving 1 or receiving 1 or recording
= A/F more more injections = (I/F)*100
Average …………… antibiotics = (H/F)*100
=(G/F)*100 ……………. …………..
……………..
% of medicines % of medicines % of medicines % of medicines
prescribed by being being injections not in the
% generic name antibiotics =(D/A)*100 NELM=(E/A)*1
=(B/A)*100 =(C/A)*100 …………….. 00
…………….. ……………..
……………..
 DRUG USE
INDICATORS
Continued

Patient care indicators

6. Average consultation time

7. Average dispensing time
8. Percentage of drugs actually dispensed
9. Percentage of drugs adequately labelled
10. Patients' knowledge of correct dosage
 Patient Care Indicators
Form

PATIE NT CARE FORM

Loca ti on:
I nve sti ga tor Da te :

Pa ti e nt Consul ti ng Di spe nsi ng # Drugs # Drugs # Ade - Know s

Se q. I de nti fi e r Ti m e Ti m e Pre - Di s- qua te l y Dosa ge
# (i f ne e de d) (m i ns) (se cs) scri be d pe nse d La be l l e d (0/ 1)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
C ount
Total
Average XX XX XX XX XX XX XX XX XX XX XX XX
Percentage XX XX XXX X XX XX XXX X XX XX XX % % %
-
s
i
d
f
o
d
s
n
e
p d
e
k
s
a
* 0=N o 1=Yes
PATI E NT CARE FORM
Loca ti on:
I nve sti ga tor Da te :

P a ti e nt Cons ul ti ng Di spe ns i ng # Drugs # Drugs # Ade - Know s

S e q. I de nti fi e r Ti m e Ti m e P re - Di s- qua te l y Dosa ge
# (i f ne e de d) (m i ns ) (se cs) scri be d pe nsed La be l l e d (0/ 1)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
C ount
Total
Average XXXXXX XXXXXX XXXXXX XXXXXX
P ercentage XXXXXXXX XXXXXXXX XXXXXX % % %
-
s
i
d
f
o
d
s
n
e
p d
e
k
s
a
* 0=N o 1=Yes
 Preparing for a Survey Facility
Indicators

• Determine if national
EDL or Formulary
exists

• Prepare a short list

of key drugs to test
availability
 DRUG USE
INDICATORS
Continued
Facility indicators

11. Availability of copy of essential drugs list or formulary

12. Availability of key drugs
 Health Facility Summary
Form

FACILITY SUMMARY FORM

Location:
Investigator Date:

Contacts

Problems or
Complaints

# Cases From To
Retrospective covering dates
Prospective covering dates
Patient Care covering dates

Essential Drug List/Formulary available at facility? (0/1)

Key Drugs in Stock to Treat Important Conditions In Stock

(0/1)
% in stock
this facility
 DRUG AND THERAPEUTICS
COMMITTEE
* providing advice on all aspects of drug management
1. developing drug policies

2. evaluating and selecting drugs for the formulary list

3. developing (or adapting) and implementing STGs

4. assessing drug use to identify problems

5. conducting interventions to improve drug use

6. managing adverse drug reactions and medication errors

7. informing all staff members about drug use issues, policies and decisions.
 STANDARD TREATMENT
GUIDELINES

STGs may be defined as ‘systematically developed statements

to help practitioners or prescribers make decisions about
appropriate treatments for specific clinical conditions.
 USES OF
STGs
1. providing guidance to health professionals on the diagnosis and
treatment of specific clinical conditions

2. orienting new staff about accepted norms in treatment

3. providing prescribers with justification for prescribing

decisions made in accordance with STGs

4. aiding efficient estimation of drug needs and setting

priorities for procuring and stocking drugs.
 PHARMACOVIGILANC
E
• Relating to the detection, assessment,
collection, monitoring, adverse effects with
and prevention
of pharmaceutical products.
• The 4 elements of an AE case
are
(2) an identifiable reporter,
(1) an identifiable patient,
(3) a suspect drug, and

(4) an adverse event.

Its study is necessary to p r e v e n t A D R to
M. A.M . Co lleg eo f P ha rma cy
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