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Prasidayani Nurita 1 , Bambang Saparyono 2 , Sri Suryawati 3

MONITORING AND ASSESSING PHARMACEUTICAL SITUATION A Comparison of Two Indicator-based WHO Instruments. Prasidayani Nurita 1 , Bambang Saparyono 2 , Sri Suryawati 3 Center for Clinical Pharmacology and Medicine Policy Studies Gadjah Mada University. ABSTRACT.

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Prasidayani Nurita 1 , Bambang Saparyono 2 , Sri Suryawati 3

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  1. MONITORING AND ASSESSING PHARMACEUTICAL SITUATIONA Comparison of Two Indicator-based WHO Instruments Prasidayani Nurita1, Bambang Saparyono2, Sri Suryawati3 Center for Clinical Pharmacology and Medicine Policy Studies Gadjah Mada University

  2. ABSTRACT Problem Statement: It is widely known that the quality of pharmaceutical services may vary among countries, as well as among health care institutions within a country. In 1994, the World Health Organization (WHO) established an indicator-based instrument (WHO, 1994) to evaluate the implementation of a national drug policy. However, there was some criticism that the indicators did not provide enough detailed information, especially on the quality of medicine use. In 2002, the WHO Department of Essential Drugs and Medicines Policy (EDM) developed a new instrument, with Indonesia among the countries that participated in field-testing the new instrument. Objective: To evaluate the new indicator-based instrument (WHO, 2002) in monitoring and assessing the pharmaceutical situation in Indonesia. Method: In March–April 2002, a survey was conducted in three provinces (Bengkulu, Yogyakarta, and Nusa Tenggara Barat) covering 20 health centers, 20 private pharmacies, and 3 district pharmaceutical warehouses. Twenty indicators of the new instrument (WHO, 2002) were collected, and the data were compared to the data collected with the original instrument (WHO, 1994). Results: In general, there was no difference in the components of information between the old and the new instruments-that is, information on background, structure, process, and output. In describing inappropriate prescribing, however, the new instrument provided more details. For example, in assessing treatment for acute respiratory infection (ARI), the data described the percentage of patients receiving antibiotics (63%) and furthermore described the percentage of ARI patients treated without antibiotics (12%), the percentage treated with antibiotics (38%), and the percentage treated with medicine other than antipyretic/analgesic or cough and cold (51%). In assessing the treatment of pneumonia, the new instrument provided more in-depth data, including whether the treatment is considered appropriate (87%) as well as whether the treatment includes uncertain (3%) or inappropriate (10%) use of antibiotics. In evaluating the treatment of diarrhea, the instrument provides data on appropriateness (6%) and inappropriateness (95%). Appropriate treatment means that the diarrhea was treated with ORS only; inappropriate treatment means that ORS is not prescribed, with or without other drugs, such as antibiotics, antidiarrheals, or antispasmodics. Such detailed data are very useful in developing more focused interventions to improve prescribing. Conclusions: The new instrument offers more advantages if one wants to concentrate on assessing the quality of medicine use for the most prominent diseases (ARI and diarrhea) among children. Source of Funding: WHO, contract numbers SE/01/201167 and HQ/01/821128

  3. BACKGROUND • In 1994, the World Health Organization (WHO) established an indicator-based instrument (WHO, 1994) to evaluate the implementation of a national drug policy. • There was some criticism that the indicators did not provide enough detailed information, especially on the quality of medicine use. • In 2002, the WHO Department of Essential Drugs and Medicines Policy (EDM) developed a new instrument.

  4. OBJECTIVE • To evaluate the new indicator-based instrument (WHO, 2002) in monitoring and assessing the pharmaceutical situation in Indonesia. • To compare the finding with the finding of the old-indicator-based instrument (WHO,1994) which were collected at the same period of time.

  5. METHOD • Surveys were conducted in Bengkulu, Yogyakarta, and Nusa Tenggara Barat (NTB) involving 20 healthcenters, 20 private pharmacies, and 3 district pharmaceutical warehouses. • Twenty indicators of the new instrument on accessibility, quality, and rational use of medicine were implemented in the survey • The results were compared to the results of the original instrument (WHO, 1994), which were collected at the same period of time.

  6. ACCESSIBILITY Note: *: the indicators were not available in the instrument • The availability of key medicines in HCs (99%) was higher than in the District Pharmaceutical Warehouses (93%). This condition may because the drugs for HCs were distributed by the District Pharmaceutical Warehouses monthly • Affordability measurement was based on the standard treatment of pneumonia. • All drugs in HCs were subsidized by the government.

  7. QUALITY Note: *: the indicators was not available in the instrument

  8. RATIONAL USE OF MEDICINES (1) • The average number of drugs per prescription is 3.07, which were consist all drugs received by the patients per encounter. • The District Health Offices allowing health facilities to use brand name as supplement of generic drugs that is not included in EML

  9. RATIONAL USE OF MEDICINES (2) • None of HCs has STG for sexual transmitted infection. Most of HCs have STGs for pneumonia, malaria, diarrhea and tuberculosis. • EML only produced in the National level. Provincial and District level then make drug selection from the National EML.

  10. ADHERENCE TO RECOMMENDED TREATMENT • The first line antibiotic mentioned in the indicator were procaine penicillin or amoxycillin or co-trimoxazole. • The use of first line antibiotic for pneumonia treatment was 96.84% out of total pneumonia patients. • 37.5% of non-pneumonia ARI patients were treated with antibiotic.

  11. COMPARISON BETWEEN OLD AND NEW INSTRUMENTS Note: *: the indicators were not available in the instrument

  12. COMPARISON BETWEEN OLD AND NEW INSTRUMENTS Note: *: the indicators were not available in the instrument

  13. CONCLUSIONS • The new instrument could indicate more weaknesses, such as • % drug adequately labeled (26%) • % patients who know the doses of drugs they take (69%). Most patients remember what the dispensers’ said, but the patient-dispenser communication was not intensive • The average duration of Stock out of key drugs was quite long (22 days). • The low availability of STGs in the health facilities (60%). This is a necessity, since STGs are the core guideline for the medical practices. • The new instrument offers more advantages if one wants to concentrate on assessing the quality of medicine use for the most prominent diseases (ARI and diarrhea) among children. • The new instruments provided more details and more in-depth data in assessing treatment for ARI and diarrhea. This detailed data are very useful for designing focused intervention to improve prescribing.

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