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SURVEY REPORT ON RATIONAL USE OF DRUGS

SURVEY REPORT ON RATIONAL USE OF DRUGS. In 30 Primary Health Centres of Tamilnadu, India . MURALI.R , SATHYANARAYANAN.D, & TITUS.U INSTITUTE OF COMMUNITY MEDICINE, MADRAS MEDICAL COLLEGE, CHENNAI. INTRODUCTION.

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SURVEY REPORT ON RATIONAL USE OF DRUGS

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  1. SURVEY REPORT ON RATIONAL USE OF DRUGS In 30 Primary Health Centres of Tamilnadu, India ICIUM 2004-CHIANG MAI

  2. MURALI.R, SATHYANARAYANAN.D, & TITUS.U INSTITUTE OF COMMUNITY MEDICINE, MADRAS MEDICAL COLLEGE, CHENNAI ICIUM 2004-CHIANG MAI

  3. INTRODUCTION • An efficient health care delivery system is an important requisite to achieve health for all. • Access to essential drugs is probably the most important element of health care delivery system. ICIUM 2004-CHIANG MAI

  4. The Government of Tamil Nadu, India realizing this, developed and implemented various strategies under the broad framework of Tamil Nadu Medical Services Corporation to control and monitor drug procurement, storage and distribution to the Public sector hospitals in the state. ICIUM 2004-CHIANG MAI

  5. Tamilnadu Medical Services Corporation(TNMSC) • 1994: Efforts to rationalize drug use commence and TNMSC formed; Chain of modern warehouses built • 1995: Essential drug list prepared • 1997: News Bulletin “TNMSC Times” launched • 1998: Training for Doctors and Pharmacists. ICIUM 2004-CHIANG MAI

  6. TNMSC & RUD • EDL • Pharmacist’s handbook • Training of pharmacists in inventory management • “TNMSC Times” ICIUM 2004-CHIANG MAI

  7. Quantification based on EDL • Procurement of generic drugs of good quality at competitive rates • Storage under good conditions in modern warehouses ICIUM 2004-CHIANG MAI

  8. Distribution based on indenting by medical officers • Inventory control at district warehouses ICIUM 2004-CHIANG MAI

  9. Objectives • To study the current status of essential drug use in the state • To study the prescribing behaviour and practices, dispensing practices and the quality of services rendered through primary health centers. • To identify weak areas, if any in the rational use of drugs and suggest strengthening measures. ICIUM 2004-CHIANG MAI

  10. Methodology • 2 primary health centres from each of 22 out of 23 ware house districts were chosen by simple random sampling • An orientation of all medical officers of selected primary health centres was conducted ICIUM 2004-CHIANG MAI

  11. Out patient chits as booklets with carbon copy were distributed to all selected primary health centres. • Only 30 out of the 44 primary health centres returned the chits in time. ICIUM 2004-CHIANG MAI

  12. Exit interviews were conducted by three senior medical officers during the survey. • Each interviewer visited 5 primary health centres(PHC) selected by simple random technique and interviewed minimum 10 patients in each PHC ICIUM 2004-CHIANG MAI

  13. Total prescriptions studied – 13,608 • Total exit interviews conducted- 180 5th September 2001 to 20th December 2001 ICIUM 2004-CHIANG MAI

  14. Results • Prescribing indicators • Patient care indicators • Health facility indicators • Complimentary indicators ICIUM 2004-CHIANG MAI

  15. Prescribing indicators • Average number of drugs per prescription- 2.92 • % of prescriptions with at-least one antibiotic- 54.42% • % of prescriptions with at-least one injection: 56.47% • Average cost per prescription- Rs.3.75 ICIUM 2004-CHIANG MAI

  16. % of prescriptions as per STG • Acute respiratory infection- 0.47% • Acute Diarrhea- 3.63% • Fever- 1.76% • Hook worm- 12.60% • Gastritis- 2.97% ICIUM 2004-CHIANG MAI

  17. Patient Care indicators • Average consultation time- 2.78 minutes • % of drugs actually dispensed- 96.57% • Average dispensing time- 2.94 minutes • Average time at the OP ticket counter- 14.17 minutes • Average time outside the consulting room- 13.72 minutes ICIUM 2004-CHIANG MAI

  18. Prescription counselling DOCTOR PHARMACIST DOSE 40.01% 82.02% ADMN 31.15% 78.36% FREQUENCY 38.70% 87.05% SIDE EFFECTS 2.35% 6.05% AVERAGE 28.05% 63.37% ICIUM 2004-CHIANG MAI

  19. Average time outside the pharmacy- 15.82 minutes • Average time spent by a patient at the PHC- 47.75 minutes ICIUM 2004-CHIANG MAI

  20. Health facility indicators • % of availability of Essential drugs at the PHCs- 71.63% ICIUM 2004-CHIANG MAI

  21. Complimentary Indicators • % of drug cost spent on injections- 24.96% ICIUM 2004-CHIANG MAI

  22. ICIUM 2004-CHIANG MAI

  23. Summary ICIUM 2004-CHIANG MAI

  24. Conclusion • Rational use of drugs is still a problem in Tamilnadu • Poly-pharmacy, Over- use of antibiotics, misuse of injections, short consulting time and poor patient counselling are all common patterns of irrational use of drugs in the state. ICIUM 2004-CHIANG MAI

  25. Recommendations • Develop simplified STGs that are adapted to local conditions • Improve training of health care providers • Periodic monitoring and evaluation of drug use pattern • Unbiased drug and therapeutic information to be made available to prescribers, dispensers and consumers. ICIUM 2004-CHIANG MAI

  26. Study funded by DANIDA Thank you ICIUM 2004-CHIANG MAI

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