Investigating Medicine Use in Healthcare Facilities

Dr Vijay ThawaniProfessor & Head, Pharmacology Department,

VCSG Govt Institute of Medical Science & Research,Srikot, Pauri-Garhwal, Uttarakhand.

vijaythawani@rediffmail.com

Objectives

• To find common medicine use practice

• To study if these practices are rational • To plan intervention • Methods to collect data on medicine use

Need of Studying Medicine Use

• Consumers commonly use medicines without HW advice

• Have subjective experience in medicine use

• Multiple sources for obtaining medicines

• Important to understand consumer behavior with medicine use and problems from their view

Basic Research Questions in Medicine Use Pattern

• What are common medicine use practices, which medicines are used, for what ills, how procured, how long used, who advices ?

• To what extent are the medicine use practices rational ?

• What are perceived to be medicine use problems by people and health workers in the community ?

Medicine Use Encounters Investigating medicine use problem involves

collecting data from medicine use encounters to find exact problem and underlying causes.

• Physician • Nurse • Traditional healer • Injectionist • Dresser / Attendant • Pharmacist • Shopkeeper • Relative / friend • Patient

MEDICINE USE INDICATORS

Prescribing Indicators

• Average no. of medicines per encounter

• % of medicines prescribed by generic name

• % of encounters with AM prescribed

• % of encounters with inj. prescribed

• % of medicine prescribed from EML / Institutional Formulary / STGs

Patient Care Indicators

• Average consultation time

• Average dispensing time

• % of medicines dispensed

• % of medicines adequately labeled

• Pts knowledge of correct dosage

Facility Indicators • Availability of copy of EML / Formulary,

STG

• Presence of vital medicines

• Cost of medicines and markup

• Generic substitution

• Info to buyer on medicine use

Other Analysis

• ABC Cost analysis

Unit price x Total consumption = Value, Total value, % of total value, Descending order, Rank, Cumulative %, 60 : 80 : rest

• Regression analysis for forecasting

Excel function

• VED (VEN) Criticality analysis

• ABC-VED matrix

AccessIndicator Public

facilitiesPrivate facilities

Availability of key medicines

% prescribed medicines actually dispensed

Stock-out duration of key medicines

Adequate record keeping of stock record

Affordability of key treatments

Price / cost of key medicines

Geographic accessibility of dispensaries 11

Quality

Indicator Public facilities

Private facilities

% key medicines expired Adequate storage conditions

12

Rational Use of MedicinesIndicator Public

facilities

Private facilitie

s

% medicines adequately labelled

% knowledge how to take medicines

Ave. # of medicines / prescription

% antibiotics, injections

% on EML, generic,

Availability of STGs, EML

% cases treated according to STG

% POM bought without prescription 13

Planning Interventional Project

• Study medicine use• Identify problems• Prioritize problems• Analyze problem• Identify solution • Plan intervention• Pretest intervention• Implement intervention• Monitor • Evaluate

Research Methods Useful in Studying Medicine Use

Quantitative Methods• Number based• Frequency of use• Representative

picture• Instrument

preparation important• Careful selection of

variables and indicators

Qualitative Methods• Text based• Ideas and perceptions

of people• In-depth understanding • Identification of

dimensions to be probed - important

Structured Interview

• Close-ended questions for large survey

• Selected through pilot study

• Sequence and language same for all respondents

• To learn about frequency of use and opinions

• Easy to analyze for comparison and hypothesis testing

Structured Observation in Health Facility / medicine shop

• To investigate medicine use pattern and cost / quality of HW prescribing

• Observe behavior of client - seller; pt - HW

• Info can be quantified and statistically processed

• Time consuming

• Ethical dimension

Patient Record Review

• Quick and cheap method to collect data • Quality of prescription can be investigated

• Data can be quantified and statistically processed

• Comparison and generalization possible

• Ethical : consent of data owner needed

Exit Interviews

• Quick way to collect data

• Study of actual / recent prescriptions

• Data can be quantified / analyzed

• Can be used in combination with observation

• Reliability of information?

Sales Statistics

• Useful for investigating public / pvt expenditure, commonly sold medicines, availability and cost

• Helps in medicine supply planning

• Data can be quantified and statistically treated

Semi-structured Interview

• Open ended questions for long answers

• Useful in investigating perceived need for medicine, quality of care, medicine use problem, opinions on medicine use practice and medicine source.

• Can generate in-depth data with new and unexpected dimensions

• Difficult to analyze, compare and generalize

Key Informant Interview

• Conducted with experts, leaders, health policy makers

• Have interview guide, lead questions, probing questions

• Can modify on spot • Generates rich information - depending on

expertise and experience • Tape record and transcribe• Time consuming and difficult to analyze• Problem in getting appointment

Free Listing

• Useful in exploration of commonly used medicines, sources, prescribers

• Generates exhaustive data

• Can help in identifying salient features

• Requires less time

• Reliability questionable

Focus Group Discussion

• Useful in investigating medicine use practices, problems, quality of care, sources of medicines, evaluation and probable solutions

• Highly skilled, requires efficient researchers

• Quicker and cheaper than individual interviews

• Problems can be identified and solutions arrived

• Great expertise can be tapped

Which method to use ?• Best methods depends upon:

- Nature of the problem

- Objectives

- Resources

- Time

- Capacity and experience

• Use Multiple methods

- Quantitative + Qualitative

- ‘Triangulate’ findings

- Different aspects of the problem