Post on 28-Dec-2015
Using Longitudinal Data for Evaluating Policy Changes and Other Interventions
-Information system in Tamilnadu Medical Services Corporation
MURALI .R, SATHYANARAYANAN.D, RAJ KUMAR.C, SENTHI L KUMAR.R & TI TUS.U
I NSTI TUTE OF COMMUNI TY MEDI CI NE,
MADRAS MEDI CAL COLLEGE, CHENNAI
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.
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.
Monitoring and evaluation
H.O.Server
Warehouse Information System
M.I.S.
Payroll & Personal
CT Scan System
Drug Management & Monitoring System
Financial Accounts
Automated Material Handling
Construction Management
Supplier Information
QC Monitoring System
Data collection at the facility level: Pass book of TNMSC
Stock registers
Sub-stock register
Daily token register
Doctor’s diagnosis register
PATIENT FLOW
Stock status at a central warehouse
STOCK STATUS BY MONTHAMOXYCILLIN
-20
0
20
40
60
80
100
Jan-9
7
Apr-
97
Jul-97
Oct-
97
Jan-9
8
Apr-
98
Jul-98
Oct-
98
Jan-9
9
Apr-
99
Jul-99
Oct-
99
Jan-0
0
Apr-
00
Jul-00
Oct-
00
MONTHS
ST
OC
K IN
MO
NT
HS
Desired months of stockMinimum - 10 Maximum - 21
Drugs Indented for 3 yearsin a PHC
0
10
20
30
40
50
60
70
1996-1997 1997-1998 1998-1999
No.
of D
rugs
Total no. of drugs indented No. of drugs indented from the PHC list
No.of drugs indented outside the PHC list No. of drugs not indented from the PHC list
Impact of Tamil Nadu Medical Services Corporation on Drug Prescribing in primary health care- an example1)To study the impact of the TNMSC in
primary care centres (PHCs) on a) availability of 15 core essential drugs; b) continuous availability of an adequate quantity of the core essential drugs; and c) rational use of drugs in PHCs;
2) to study the maintenance of quality of drugs by the TNMSC and
3) to study the control of drug expenditures by the TNMSC.
Study design
Longitudinal time series with control before and after various TNMSC interventions (20 PHCs Vs 20 Controls).
Time series study of government rural PHCs before and after various TNMSC interventions in 1994-8.
Feasible indicators % of key drugs available average number of days of stock-out. % cases receiving prescription; average number of drugs per prescription; % drugs prescribed by generic name; % drugs prescribed that belong to the PHC EDL
(51 drugs); % prescriptions containing an antibiotic; % prescriptions containing a vitamin % prescriptions containing an injection; average cost per prescription. % of prescriptions as per STG
10 years of data is to be preserved at every point of time
This gives sufficient longitudinal data to evaluate the policy change.
Limitations
Missing data ( the tokens of a year or a portion of the year may be missing)
Non-uniformity in writing the diagnosis
Injection tokens often not well preserved
Thank you