Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology...
-
Upload
russell-chandler -
Category
Documents
-
view
232 -
download
0
Transcript of Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology...
![Page 1: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/1.jpg)
Investigating Medicine Use in Healthcare Facilities
Dr Vijay ThawaniProfessor & Head, Pharmacology Department,
VCSG Govt Institute of Medical Science & Research,Srikot, Pauri-Garhwal, Uttarakhand.
![Page 2: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/2.jpg)
Objectives
• To find common medicine use practice
• To study if these practices are rational • To plan intervention • Methods to collect data on medicine use
![Page 3: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/3.jpg)
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
![Page 4: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/4.jpg)
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 ?
![Page 5: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/5.jpg)
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
![Page 6: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/6.jpg)
MEDICINE USE INDICATORS
![Page 7: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/7.jpg)
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
![Page 8: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/8.jpg)
Patient Care Indicators
• Average consultation time
• Average dispensing time
• % of medicines dispensed
• % of medicines adequately labeled
• Pts knowledge of correct dosage
![Page 9: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/9.jpg)
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
![Page 10: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/10.jpg)
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
![Page 11: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/11.jpg)
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
![Page 12: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/12.jpg)
Quality
Indicator Public facilities
Private facilities
% key medicines expired Adequate storage conditions
12
![Page 13: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/13.jpg)
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
![Page 14: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/14.jpg)
Planning Interventional Project
• Study medicine use• Identify problems• Prioritize problems• Analyze problem• Identify solution • Plan intervention• Pretest intervention• Implement intervention• Monitor • Evaluate
![Page 15: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/15.jpg)
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
![Page 16: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/16.jpg)
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
![Page 17: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/17.jpg)
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
![Page 18: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/18.jpg)
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
![Page 19: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/19.jpg)
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?
![Page 20: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/20.jpg)
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
![Page 21: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/21.jpg)
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
![Page 22: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/22.jpg)
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
![Page 23: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/23.jpg)
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
![Page 24: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/24.jpg)
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
![Page 25: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/25.jpg)
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
![Page 26: Investigating Medicine Use in Healthcare Facilities Dr Vijay Thawani Professor & Head, Pharmacology Department, VCSG Govt Institute of Medical Science.](https://reader033.fdocuments.in/reader033/viewer/2022061616/5697bfb81a28abf838c9f53f/html5/thumbnails/26.jpg)