1 Implementing a Drug Use Indicators Study. 2 Implementing a Drug Use Indicators Study: Objectives Identify the importance of drug use indicatorsIdentify

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Implementing a Drug Implementing a Drug Use Indicators StudyUse Indicators Study

Implementing a Drug Use Indicators Study 2

Implementing a Drug Use Implementing a Drug Use Indicators Study: ObjectivesIndicators Study: Objectives

• Identify the importance of drug use Identify the importance of drug use indicatorsindicators

• Know the steps to implement an indicators Know the steps to implement an indicators studystudy

• Understand different methods of sampling Understand different methods of sampling and data collectionand data collection

• Understand how to analyze a situation using Understand how to analyze a situation using indicatorsindicators

• Present the results of an indicators studyPresent the results of an indicators study


Types of Drug Use StudiesTypes of Drug Use Studies

• Descriptive: Cross-sectional Descriptive: Cross-sectional

(basic)(basic)

• Comparative: Stratified cross-Comparative: Stratified cross-

sectionalsectional

• Monitoring: To assess change Monitoring: To assess change

over timeover time

• Evaluation: To evaluate Evaluation: To evaluate

intervention impactintervention impact


Types of IndicatorsTypes of Indicators

• Prescribing Prescribing

• Patient CarePatient Care

• FacilityFacility


Prescribing IndicatorsPrescribing Indicators

• Average number of Average number of drugsdrugs

• Percentage antibioticsPercentage antibiotics• Percentage injectionsPercentage injections• Percentage genericPercentage generic• Percentage prescribed Percentage prescribed

from Essential Drugs from Essential Drugs List or FormularyList or Formulary


Patient Care IndicatorsPatient Care Indicators

• Average consultation Average consultation timetime

• Average dispensing Average dispensing timetime

• Percentage drugs Percentage drugs dispenseddispensed

• Percentage drugs Percentage drugs adequately labeledadequately labeled

• Patient's knowledge of Patient's knowledge of correct dosagecorrect dosage


Facility IndicatorsFacility Indicators

• Availability of Availability of national Essential national Essential Drugs List or Drugs List or FormularyFormulary

• Availability of key Availability of key drugsdrugs


Steps in an Indicators StudySteps in an Indicators Study

• Select geographic areaSelect geographic area• Select sample of facilitiesSelect sample of facilities• Retrospective prescribing Retrospective prescribing

data available?data available?• Simple vs. detailed data Simple vs. detailed data

form?form?• Define criteria for core Define criteria for core

indicatorsindicators• Define complementary Define complementary

indicatorsindicators

• Describe study proceduresDescribe study procedures• Select and train personnelSelect and train personnel• Pilot test and revise Pilot test and revise

proceduresprocedures• Collect dataCollect data• Feedback to facilities and Feedback to facilities and

managersmanagers• Decide on follow-up Decide on follow-up

studiesstudies


Scope of the Indicators StudyScope of the Indicators Study

• Depends on—Depends on—– Information needs of managersInformation needs of managers– Capabilities of record systemCapabilities of record system– Types of providersTypes of providers– Resources availableResources available

• Minimum sampleMinimum sample– 20 facilities and 30 prescriptions / 30 patients per facility for 20 facilities and 30 prescriptions / 30 patients per facility for

cross-sectional studycross-sectional study– 100 prescriptions per facility if facilities will be compared100 prescriptions per facility if facilities will be compared


Indicator Sampling MethodsIndicator Sampling Methods

• Selection of Facilities– Simple Random / Systematic– Useful to Stratify

• Urban / Rural• Doctor / Non-doctors• Health Center / Dispensary• Government / Mission

• Retrospective Prescribing Data– Systematic– Stratified by prescriber?

• Prospective Patient Encounters– Convenience– Quota by Health Problem?


Preparing for a Survey (1)Preparing for a Survey (1)Prescribing IndicatorsPrescribing Indicators

• Select a sample of Select a sample of facilitiesfacilities

• Decide on a source of Decide on a source of data for prescribing data for prescribing encountersencounters

• Define types of Define types of encounters to includeencounters to include

• Define drugs to be Define drugs to be counted as antibioticscounted as antibiotics

• List drugs to be List drugs to be classified as genericclassified as generic


Preparing for a Survey (2)Preparing for a Survey (2)Patient Care IndicatorsPatient Care Indicators

• Observe logistics of patient Observe logistics of patient carecare

• Determine how consulting Determine how consulting and dispensing times will be and dispensing times will be measuredmeasured

• Define criteria for adequate Define criteria for adequate patient knowledgepatient knowledge

• Describe procedure for Describe procedure for evaluating patient knowledgeevaluating patient knowledge


Preparing for a Survey (3) Preparing for a Survey (3) Facility IndicatorsFacility Indicators

• Determine if Determine if national EDL or national EDL or Formulary existsFormulary exists

• Prepare a short list Prepare a short list of key drugs to test of key drugs to test availabilityavailability


Undertaking the Survey Undertaking the Survey PreparationPreparation

• Select and train personnelSelect and train personnel

• Conduct pilot testsConduct pilot tests

• Select and inform sample sitesSelect and inform sample sites

• Plan schedule of data collection visitsPlan schedule of data collection visits


Undertaking the Survey Undertaking the Survey Field ActivitiesField Activities

• Select a sample of encountersSelect a sample of encounters

• Fill in encounter formsFill in encounter forms

• Observe consultation and dispensing timesObserve consultation and dispensing times

• Collect patient knowledge and dispensing Collect patient knowledge and dispensing informationinformation

• Fill in facility summary formsFill in facility summary forms

• Present results to staffPresent results to staff


Simple Prescribing Simple Prescribing Indicators FormIndicators Form


Detailed Prescribing Detailed Prescribing Indicators FormIndicators Form

Location:

Investigator: Date:

ID# Date Name Age Sex Prescriber

Health Health Problem Description CodeProblems 1

23

Drugs Name and Strength Code Quantity12345678,9

Detailed PrescribingIndicators form


Prescription 1Prescription 1












Patient Care Indicators FormPatient Care Indicators Form


Health Facility Summary FormHealth Facility Summary Form


Facility Indicator Reporting FormFacility Indicator Reporting Form

Facility Indicator Reporting Form

Location:

Investigator Date

This National Facility Standard

Number of Cases PrescribingPatient Care

Average Number of drugs prescribedPercentage of drugs prescribed by generic names % %Percentage of encounters with an antibiotic prescribed % %Percentage of encounters with an injection prescribed % %Percentage of drugs prescribed on Essential Drug List % %Average Consulting Time mins minsAverage Dispensing Time secs secsPercentage of drugs actually dispensed % %Percentage of drugs adequately labelled % %Percent correct patient knowledge of dosage % %Availability of essential drug List or Formulary Yes / No %Percentage availability of key indicator drugs % %

Comments

Signatures


Indicators Consolidation FormIndicators Consolidation Form

Indicators Consolidation Form

Location: Date:

Avg. drugs Percent Percent Percent Percent Consult Dispense % Drugs % Adequate %Adequate Impartial % Drugs

Date Facility Prescribed generics antibiotics Injections on EDL time time dispensed label knowledge Information in stock

Mean MaximumMinimum


Graphs of Indicators Data (1)Graphs of Indicators Data (1)Sample-Wide Distribution of Antibiotic UseSample-Wide Distribution of Antibiotic Use

0

2

4

6

8

10

12

Under 30% 30% - 40% 40% - 60% Over 60%

Percentage Antibiotic Use

NUMBER OF FACILITIESNUMBER OF FACILITIES


Graphs of Indicators Data (2)Graphs of Indicators Data (2)Sample-Wide Distribution of Consulting TimesSample-Wide Distribution of Consulting Times

0

1

2

3

4

5

6

7

8

Under 2 2 - 3 3 - 4 Over 4

Average Consulting Time (mins)

NUMBER OF FACILITIESNUMBER OF FACILITIES


Graphs of Indicators Data (3)Graphs of Indicators Data (3)Facility-Specific Antibiotic UseFacility-Specific Antibiotic Use

0

10

20

30

40

50

60

70

80

U0 U1 U3 U3 U5 U6 U7 U8 U9 R0 R1 R2 R3 R4 R5 R6 R7 R8 R9

Health Facility

Urban

Rural

Percentage of PatientsPercentage of Patients


Graphs of Indicators Data (4)Graphs of Indicators Data (4)Facility-Specific Consultation TimesFacility-Specific Consultation Times

0

1

2

3

4

5

6

7

U0 U1 U3 U3 U5 U6 U7 U8 U9 R0 R1 R2 R3 R4 R5 R6 R7 R8 R9

Health Facility

Urban

Rural

AVERAGE TIME (MINS)AVERAGE TIME (MINS)


Steps in an Indicators StudySteps in an Indicators StudySummarySummary

• Select geographic areaSelect geographic area• Select sample of Select sample of

facilitiesfacilities• Retrospective Retrospective

prescribing data prescribing data available?available?

• Simple vs. detailed data Simple vs. detailed data form?form?

• Define criteria for core Define criteria for core indicatorsindicators

• Define complementary Define complementary indicatorsindicators

• Describe study Describe study proceduresprocedures

• Select and train Select and train personnelpersonnel

• Pilot test and revise Pilot test and revise proceduresprocedures

• Collect dataCollect data• Feedback to facilities Feedback to facilities

and managersand managers• Decide on follow-up Decide on follow-up

studiesstudies


ConclusionConclusion

• Undertaking a Drug Undertaking a Drug Use Indicators Use Indicators Study is possible in Study is possible in nearly all nearly all environmentsenvironments

• The more attention The more attention to detail the greater to detail the greater the value and the value and accuracy of the accuracy of the surveysurvey


Lot Quality Sampling ProcedureLot Quality Sampling Procedure

• Set standard for adequate performance (e.g., antibiotic use = 30%)Set standard for adequate performance (e.g., antibiotic use = 30%)

• Choose level to be considered inadequate (e.g., antibiotic use > 60%)Choose level to be considered inadequate (e.g., antibiotic use > 60%)

• Accept error ratesAccept error rates- Misclassifying poor facilities as adequate = 5.0%- Misclassifying poor facilities as adequate = 5.0%- Misclassifying good facilities as inadequate = 20.0%- Misclassifying good facilities as inadequate = 20.0%

• Find necessary sample size and critical number of "failures" in table Find necessary sample size and critical number of "failures" in table (e.g. sample size = 16 and failures = 6)(e.g. sample size = 16 and failures = 6)

• Select random sample and count "failures"Select random sample and count "failures"

• If number of failures is equal to or greater than the critical number, If number of failures is equal to or greater than the critical number, facility is inadequatefacility is inadequate


LQAS Sampling TableLQAS Sampling Table

20% 30% 40% 50% 60% 70% 80% 90%

10% 10 3 2 1 1 0 0 0

20% 27 8 4 2 1 1 0

30% 47 13 6 3 2 1

40% 66 17 8 4 2

50% 80 19 8 4

60% 87 19 7

70% 80 15

80% 57

20% 30% 40% 50% 60% 70% 80% 90%

10% 83 26 13 8 5 3 2 1

20% 119 33 15 9 5 3 2

30% 143 37 16 9 5 3

40% 153 38 16 8 4

50% 151 35 13 6

60% 137 29 10

70% 109 20

80% 69

Defined Level of Inadequate PerformanceAdequate Performance

Maximum Number of Encounters to ExamineMaximum Number of Encounters to Examine

Number of Failures for Inadequate PerformanceNumber of Failures for Inadequate Performance

Documents

1 Implementing a Drug Use Indicators Study. 2 Implementing a Drug Use Indicators Study: Objectives Identify the importance of drug use indicatorsIdentify