Implementing a Drug Use Indicators Study · Web viewImplementing a Drug Use. Indicators Study Implementing a Drug Use Indicators Study. SESSION GUIDE. PURPOSE AND CONTENT. The purpose

Session Guide

Implementing a Drug UseIndicators Study

IMPLEMENTING A DRUG USE INDICATORS STUDY SESSION GUIDE

Implementing a Drug Use Indicators Study

SESSION GUIDE

PURPOSE AND CONTENT

The purpose of this session is to train participants how to describe the drug use situation in a particular setting. Experience from many countries has encouraged the development of a standard method of measuring drug use practices, based on drug use indicators. This unit will expose you to the process of implementing a drug use indicator study.

The three activities will help you to gain experience in carrying out the basic steps of a real study through simulation exercises.

[VA1]OBJECTIVES

By the end of the session, you will be able to:

1. Identify the importance of drug use indicators.

2. Identify steps to be taken in preparing and implementing a drug use indicators study.

3. Understand the strengths and weaknesses of different methods of sampling and data collection.

4. Understand how to analyze drug use practice in a given setting using the drug use indicators.

5. Present the results of a drug use indicator study.

PREPARATION AND MATERIALS

1. Read the Session Notes.

2. Become familiar with the WHO Manual, "How to Investigate Drug Use in Health Facilities." WHO/DAP 93.1

3. Read Hogerzeil H.V., et al. Field-tests for rational drug use in twelve developing countries. The Lancet, 4 December 1993; pp 1408-1410. (See Annex)

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Implementing a Drug Use Indicators Study

SESSION NOTES

A. OVERVIEW

Researchers and need to understand drug use problems so that they can work to improve performance. (see Introduction to "How to Investigate Drug Use in Health Facilities").

"Drug Use" involves not only the actual prescribing of drugs but also a wide range of behaviors that occur during the drug use encounter, the interaction between the prescriber (provider) and the patient. These behaviors include the processes of making a diagnosis, prescribing, dispensing, and use of drugs by the patient.

[VA 2]Drug use indicator studies can be used for four main purposes. (See Table 4, P. 26 of the WHO Manual). These purposes are:

1. A descriptive cross-sectional study -- this measures drug use in a representative group of facilities.

2. A comparative cross-sectional study -- this compares facilities, providers, or groups at a single time.

3. Supervision (monitoring) -- to identify whether a facility is above or below a set norm of practice.

4. An assessment of the impact of an intervention (evaluation) -- to assess the impact of an intervention in an intervention group and a control group, by measuring indicators before and after.

For each different purpose, different sampling methods may be required.

In assessing drug use, you would ideally want to know about the whole process of care, but unfortunately this is not always possible. A set of limited indicators, namely the Drug Use Study Indicators, has been developed to assist in such an assessment. These indicators have been selected through a process of discussion, field testing, and revision, involving a wide range of people coordinated by INRUD, with support from WHO/DAP.

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Other indicators may be used when different needs arise.

[VA 3]The WHO/DAP indicators are divided into three groups: Prescribing Indicators; Patient Care Indicators; and Facility Indicators. The list of the indicators follows:

PRESCRIBING INDICATORS

1. Average Number of Drugs per Encounter

2. Percentage of Drugs Prescribed by Generic Name

3. Percentage of Encounters with

an Antibiotic Prescribed

4. Percentage of Encounters with an Injection Prescribed

5. Percentage of Drugs Prescribed from Essential Drugs List or Formulary

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[VA4]PATIENT CARE INDICATORS

6. Average Consultation Time

7. Average Dispensing Time

8. Percentage of Drugs Actually Dispensed

9. Percentage of Drugs Adequately Labeled

10. Patients' Knowledge of Correct Dosage

[VA 5]FACILITY INDICATORS

11. Availability of Copy of Essential Drugs List or Formulary

12. Availability of Key Drugs

[VA 6]B. DESIGNING A DRUG USE INDICATORS STUDY

The design of a drug use indicators study will vary from setting to setting. The nature and scope will depend on many factors, such as:

• the information needs of health managers • the capabilities of the record systems• the types of providers whose behavior is to be described• the resources available to carry out the work

The purpose of the study will determine which indicators to use and how the study should be designed. Possible purposes of drug use indicators studies are:

• Describe current treatment practicesUseful for problem identification or for collecting baseline information at the beginning of a project. Usually more general/basic indicators are used to describe the situation.

• Compare performance among health facilities or regionsMore specific indicators usually are used; the choice of which indicators to use is

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made on the basis of previous findings or knowledge of the practices in an area.

• Assess the impact of an interventionIn this case certain key outcome indicators have been determined at the beginning of an intervention project. This study is meant to measure whether the objectives of the intervention have been met by measuring changes in these indicators.

• Periodic monitoring of drug use.Supervisors can select important performance indicators to monitor over time in a set of health facilities, so that their supervision can be more focussed and targeted at specific improvements.

[VA 7]C. SAMPLING ISSUES

A great deal of work has been done to determine the optimum sampling arrangement to assess a drug use situation. (See Session Guide, Sampling for Drug Use Studies and the Annex to the WHO Manual)]

When an assessment of the drug use situation in a region or a set of health facilities is required, a sample of 30 prescriptions from each of 20 sites is the optimal arrangement. If the number of sites can be increased this should be done.

When a survey is undertaken to measure impact of an intervention or to assess practices in individual facilities, at least 100 prescriptions per site should be studied.

The basic design for an indicator study carried out to characterize drug use practices in a region would call for a sample of at least 20 health facilities, with at least 30 encounters being recorded in each facility. Studying 20 facilities, or more if possible, will increase the reliability and generalizability of indicators.

If you have identified fewer that 20 health facilities of interest, clearly all facilities should be included, and the number of encounters studied in each facility should be increased to ensure that 600 observations or prescriptions are included. However in this case, because the number of facilities studied is low, conclusions about practices in other facilities that were not studied should be advanced cautiously.

If there are more than 20 facilities in the study areas that will be included in the prescribing survey, it may be necessary to draw a sample of facilities for the study from the larger population. There is danger of introducing error into the results of the prescribing analysis at this step by selecting facilities for the sample which share a certain bias that might

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influence their prescribing patterns. One example would be only selecting and collecting data from facilities that are easier to reach; because they are more accessible, such facilities might also have more reliable drug supply and because of this, their prescribing practices might be different.

[VA 8]D. PRESCRIBING INDICATORS

The first five indicators record information about how many and what type of drugs are prescribed. These indicators include:

Average number of Drugs Prescribed

Percent Prescribed by Generic Name

Percent of Patients Receiving Antibiotics

Percent of Patients Receiving Injections

Percent of Drugs Prescribed on the EDL

Two forms for collecting these indicators (the Simple Prescribing Indictors Form and Detailed Prescribing Indicators Form) included in Annex 1. The following steps describe the process for measuring the prescribing indicators.

1. Decide on Source of Data for Prescribing EncountersOne of the basic decisions to be made in designing an indicators study is whether to use retrospective data extracted from historical records, or prospective data collected from current patients as they are treated. There are advantages and disadvantages to both types of data collection.

Retrospective treatment records exist in many facilities, although often in different forms. These records are typically kept as part of the normal morbidity or drug consumption recording and reporting systems, or else as part of a facility-based system of medical or pharmacy records.

Retrospective data are usually easier to collect than prospective data, and suffer fewer potential biases. If they are well-maintained, it is often possible to define a retrospective study period of a year or longer, and spread cases throughout this period. This serves to minimize any possible bias due to seasonal variations in health problems. It also means that treatment is observed at many points in the drug supply cycle. If practices tend to change during periods of drug shortage, this will be reflected in the data sampled from

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these different periods. The major weakness of retrospective data is that they are often incomplete. Individual or entire series of records can be missing, either because they were misplaced or because they were simply not recorded in the first place. The validity of retrospective data is often difficult to verify. Since retrospective records are usually kept for a different purpose than prescription analysis, key data elements such as an exact identification of the pharmaceutical prescribed, health problem, or even whether a drug was dispensed as prescribed, can be consistently missing or of uncertain accuracy.

Prospectively collected data have the advantage that they are usually complete. However, since prospective treatment data are often collected over a very short period of time, they can suffer biases due to seasonality, peculiarities in staffing, inconsistencies in the supply cycle, or most importantly, due to the fact that providers are aware that their behavior is being observed. Of course, in the absence of retrospective sources of data, study planners have little choice but to collect data prospectively, and try to guard against these possible sources of bias. Both sources of data have been validated in INRUD studies.

The principle question to answer in deciding to use retrospective or prospective encounter data is whether adequate sources of retrospective data exist. The useful elements for designing a retrospective sample that these historical data provide include:

• the ability to link specific health problems diagnosed with specific drugs prescribed for individual patient encounters;

• a method of selecting a random sample of patient encounters that took place within a defined period of time.

Whenever possible, use retrospective data spread over the past year. Draw a sample of records using one of the techniques described in the sampling module (usually systematic or multistage sampling.)

2. Define Types of Encounters to be Included

There are many different types of prescribing encounters that take place in an outpatient health facility. There are sometimes separate clinics for adult and pediatric cases, and even when these cases are mixed in the same clinic, prescribing practices for them will be quite different. New patients are frequently separated from re-attendances for an existing health problem, both in a record-keeping system and also in the type of care they receive. Similarly,

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cases presenting for curative care are managed differently from those who attend to receive preventive services such as vaccinations, prenatal or postnatal care, or child health services. The usual indicator study includes new patients attending for curative complaints.

EXCLUDE REPEAT ATTENDANCES AND PREVENTIVE OR PROMOTIVE CASES.

3. Define Drugs to be Included as Antibiotics

There are a number of different ways in which antimicrobial agents are classified in different settings. Sometimes drugs such as antiprotozoals, antihelminthics, or antituberculosis agents will be placed in a separate category from other antibiotics, while other systems organize all of these products under a single category of antiinfectives or antimicrobials. The indicators of antibiotic use are quite sensitive to whether or not certain groups of drugs are included as antibiotics, especially in environments where problems such as parasitic infestation or tuberculosis are common.

Another issue in the definition of antibiotics for an indicators study is whether to include antibiotic topical preparations, such as skin creams, ophthalmic ointments, or ophthalmic drops. In areas where trachoma, bacterial conjunctivitis, or bacterial skin infections are common, these products may be widely used.

Metronidazole is a problem to classify. At primary level it is used as an antiparasitic agent, though it can be effective against anaerobic bacteria. For purposes of indicator studies, we recommend that metronidazole NOT be classified as an antibiotic. See Page 15 of Manual for further explanation and for the recommended list of drug groups to include as antibiotics.

4. List Drugs to be Classed as Generic

Data collectors and coders will need to have specific lists of drugs they are to class as generic in order to be able to compute the proportion of drugs prescribed as generic products. Often an essential drug list or national formulary will be written in generic terms and can be used as the basis for such a list of generic products supplied in a health system.

There are certain drugs that are difficult to class as generic or branded. For some products, such as aspirin, it makes sense to include all generic and branded forms as generic, since they are used interchangeably and tend to have similar costs. Although most combination drugs would not be classed as generic, there are some combinations in common use that would qualify, such as co-trimoxazole (trimethoprim-sulfamethoxazole). Panadol is often thought to be a generic name though it is not. Abbreviations (e.g. CQ as chloroquin or HCT as hydrochlorthiazide may be counted as generics.)

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[VA 9]E. PATIENT CARE INDICATORS

The second category of INRUD indicators measures the adequacy of the patient care process according to minimum standards of performance. These indicators include:Average Consultation Time

Average Dispensing Time

Percentage of Drugs Actually Dispensed

Percentage of Drugs Adequately Labeled

Patients' Knowledge of Correct Dosage

The length of time that a health worker spends with a patient and the type of examination performed set important limits to the adequacy of diagnosis and treatment from both a clinical and social perspective. Patients who emerge from the clinical process with prescribed pharmaceuticals should, at a minimum, understand the timing and amount of each oral and topical medication.

The following activities are recommended to plan data collection for the patient care indicators.

1. Observe the Logistics of the Patient Care Process

To determine how and when the data required to measure the indicators of patient care will be collected, it is necessary to become familiar with the organization of services at sample health facilities. In particular, data must be collected about both the clinical examination and drug dispensing procedures. In addition, a non-disruptive way must be found to intercept and interview patients at some convenient point after their drugs have been dispensed.

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It may be impractical to observe in advance the clinic activities in all facilities in the sample. However, health facilities in a region are often organized in a similar way, so observations in a few facilities should be sufficient to design efficient data collection processes for the patient care indicators. However, if there are different types of facilities to be studied, for example, large multi-provider polyclinics and smaller, single-provider health centers, a few facilities of each type should be observed to ensure that data collection can be organized in all. Training of data collector should prepare them for different situations.

2. Determine How Consultation and

Dispensing Times will be Measured To measure the length of time the patients are seen in the treatment and dispensing process, it is necessary to develop a method for observing the starting and ending times of these processes for individual patients. To smooth some of the variations in time that occur with different diagnoses, it is recommended that the patient care process be timed for at least ten individual patients.

Based on the logistics of care at health facilities, you will need to describe the procedures to be used to record times for ten patients. There are two basic alternatives:

• Record beginning and ending times for ten individual consultations between patients and health workers, then follow the same patients to the dispensary, and again record the beginning and ending times of their interactions with pharmacists or dispensers. This method is preferred if it is possible to observe these interactions on an individual patient basis, or if there are only a few cases awaiting treatment.

• Record the beginning time of an index patient, and keep a cumulative record of the time it takes for health workers to see ten consecutive patients; repeat this process as these ten patients see drug dispensers. This procedure is preferred if it is impossible to observe individual episodes, or if there are many patients in the queue.

An example of a form in which to enter this information is included in Annex 1. Whichever method is selected, it is resting the beginning of observations takes place at a random point in the middle of a clinic day. This way, the results will not be overly influenced by the rush to see patients at the beginning or end of a clinic, or by freshness

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or fatigue on the part of health workers.

3. Define Criteria for Adequate Patient Knowledge about Medicines

At some point during the examination or dispensing process, medications prescribed for a patient should be explained. Ideally, this explanation would include the reasons why each particular medication is being given, how each drug should be taken, and any precautions or possible side effects explained.

AT A MINIMUM, PATIENTS SHOULD BE ABLE TO DESCRIBE WHEN AND IN WHAT QUANTITY EACH SELF-ADMINISTERED DRUG IS TO BE USED.

Because of the difficulty in reliably evaluating other factors, it is recommended that the minimum criteria of timing of administration and dose be used. These criteria should be evaluated for each oral or topical medication received by the patient during the visit. Failure to know about any of the drugs prescribed should result in patient knowledge being scored as inadequate.

4. Describe the Procedures for Evaluating Patient Knowledge about Medications

A procedure must be defined for intercepting and interviewing patients after they have received their medications from the dispensary. Because such a process can disrupt patient flow as well as intimidate health workers, an effort should be made to find an area to do this that is removed from the main clinic area.

The method for recording results will differ depending on the pharmaceutical knowledge of data collectors. If data are being collected by pharmacists or physicians who are familiar with each drug, it will be possible for them to evaluate adequacy of knowledge in the field and simply record each patient interviewed as having adequate or inadequate knowledge. If this system is used, the proper dosing of all major medications should be reviewed during the training of data collectors, and the data collectors should be provided with a drug list containing this information to refer to in the field.

If data collectors are less experienced, they may simply record the information on each drug and the patient's knowledge about it during the interview, and allow these records to be evaluated for adequacy later by a single experienced person on the study team. If this method is chosen, the data collector should record, for each oral and topical drug prescribed to the patient, the drug name, strength, number of units (pills, tubes, etc) dispensed, and the patient's explanation of how and when the drug is to be taken.

As with the other two patient care indicators, it is best to sample patients from the middle of a clinic day.

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[VA 10]F. FACILITY INDICATORS

The ability of prescribers to use drugs rationally is influenced by many features of their practice environment. These include access to relevant, impartial pharmaceutical information; adequate supply of products needed to treat common health problems; and a regulatory climate that encourages the proper use of drugs in the private sector.

There are two core drug use indicators that measure factors at the facility level, including:

Availability of Copy of Essential Drugs List or Formulary

Availability of Key Drugs

The activities needed to plan for measuring these indicators are described below.

1. Determine if there is a National Essential Drug List or Formulary

One sign of the acceptance of the concept of essential drugs by national authorities and the basis for rational drug use in the public sector is the development of a national essential drug list. In order for such a list to be most effective, it should be disseminated to all health facilities at the local level to guide decisions about the purchase and therapeutic use of drugs. It should be determined before the study whether there is a national essential drug list, when the list underwent its most recent revision, and in what form the list has been distributed to health facilities. While in the field, data collectors are expected to ask prescribers in each facility to show them a copy of the list in some form. The list must be in the facility.

2. List the Key Pharmaceuticals Recommended

For prescribers to treat effectively the recommended products must be available in facilities on a regular basis.

Identify key products (name and formulation) to survey for availability in facility stores. It is important for data collectors to know all common proprietary names as well as generic names for these drugs, since from a therapeutic perspective branded and generic drugs are equivalent. Choose between 10 and 15 drugs. [See page 23 of WHO/DAP manual.]

On a summary form for each facility, data collectors should check the products on each list that are found in any amount in health facility stores. An example of such a form appears in Annex 1.

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[VA 11]

G. UNDERTAKING THE SURVEY

1. Preparation

Careful preparation for the survey is essential. After the steps listed above have been completed, the next stages in doing the survey are:

1. Select and train personnel and conduct pilot tests -- Try to recruit people who know drug names.

2. Select and inform sample sites. It may be necessary to get permission letters from local authorities.

3. Plan the schedule of data collection visits -- In general, it is possible for two data collectors to survey one facility per day.

2. Data Collection[VA12]When collecting data in the field, follow these steps:

1. Select a sample of encounters to record. If adequate records exist, use these records (retrospective data collection). If the data are inadequate, use direct observation (prospective data collection).

2. Fill in prescribing encounter forms (see Annex 1). If the field workers are skilled and you do not require diagnosis-specific data, use the short [VA 13] Simple Prescribing Indicator Form If the field workers are unskilled, or you want detailed information, use the Detailed Indicators Encounter Form.

[VA 14] [VA 15 - 20]

3. Observe patient care indicators for at least 30 patients. You can observe different patients for consultation and dispensing indicators. Fill in the data on the Patient Care Indicators Form. [VA 21]

4. Fill in the Health Facility Summary Form. [VA 22]

It is most important that the quality of data collection is supervised in the field.

[VA23]

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H. ANALYZING THE DATA

There are two levels of analysis that are done. First, at the facility itself a report should be made to the staff about the survey. Second, the data for the twenty facilities should be aggregated to produce a combined result.

1. Presenting at the Health Facility

At the end of the survey activities in each facility, add up and calculate the percentage or average results.

Then ask all the staff involved, including the registration clerk, the dispenser, and the dispensary assistant, to sit down to review the results. Always start off positively -- identifying something good that has been observed. Fill in the Facility Indicator Reporting Form(see Annex 1) and leave it with the staff.

Start with the prescribing indicators and discuss how their average drugs per consultation, percentage antibiotics, injections, and generics compare with what should be, what occurs in other facilities in their country, and other countries.

Then discuss the patient care form. Start by discussing the diagnostic process. Talk about history, examination, diagnosis, prescription, dispensing, and patient education. Point out how each of these activities takes time, and how important physical examination is, both for making a diagnosis and for patient satisfaction. Then describe their results and talk about how their results compare with other studies. A table of results from different studies is available in the WHO manual.

Finally, discuss the facility form, examining the availability of drugs, and the presence or absence of the essential drugs list.

[VA24]2. Aggregating Facility Results

As each facility is studied, enter the summary results into the Drug Use Indicators Consolidation Form (Annex 1). Add up and average these results. These results will then be the summary results for the survey.

It is always interesting to look at individual facilities, but with a small sample size of prescriptions, it is not possible to make accurate comparisons. Differences may be interesting, but are not conclusive and would need to be followed up with further studies.

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The data from the consolidation form can be graphed, as shown in the figures below.[VA 25, 26, 27, 28]

[VA29]CONCLUSION

It is possible to undertake a Drug Use Indicators study in nearly all possible environments. Members of the INRUD network have done a great deal of work with support from WHO to standardize the methods and to make the process as easy as possible.

When undertaking such a survey the more attention paid to detail, the greater the value and accuracy of the survey. Once reliable data are available, it is often possible to identify priority problems and to decide which problem to address first with an intervention.

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Sample-wide Distribution of Antibiotic Use

Sample-wide Distribution of Consulting Times

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Facility-Specific Antibiotic Use

Facility-Specific Consultation Times

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ACTIVITY ONEData Collection and Entry

RATIONALE

In this activity you will process the data collected from a prescribing study and do calculations and tabulations.

INSTRUCTIONS

1. Read the directions to complete the Simple Prescribing Indicator Form as provided in the WHO Drug Use Indicators Manual.

2. Fill in the data collection form using the data presented. Each member of the group should fill in the data from one of the six prescriptions on the following pages. In addition, the group should work together to draw a systematic sample of 24 prescriptions from the consultation logs (to be distributed during this exercise). Use the random number table to select these prescriptions randomly. Remember to fill in only new cases!

3. Complete the calculation of the indicators by filling in the appropriate cells in the form.

WORKSHEETS TO BE USED:

The Simple Prescribing Indicator Form will be used. In addition to the six prescriptions which follow, you will be shown pages from consultation logs from which you will select prescriptions.

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PRESCRIPTION 1

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PRESCRIPTION 2

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PRESCRIPTION 3

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PRESCRIPTION 4

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PRESCRIPTION 5

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PRESCRIPTION 6

24


RANDOM NUMBER TABLE

0.28181 0.36674 0.03565 0.44454 0.78345 0.55357 0.92520 0.98918 0.24985 0.90307 0.62424 0.363650.72498 0.99228 0.69909 0.54806 0.75994 0.96248 0.04732 0.49158 0.65169 0.22131 0.37949 0.486530.73725 0.97763 0.66783 0.56180 0.32292 0.59649 0.17528 0.45738 0.83446 0.56783 0.59325 0.616880.52251 0.85545 0.90832 0.56570 0.46516 0.84159 0.87197 0.43658 0.24328 0.27218 0.26475 0.851340.49285 0.47110 0.02986 0.32469 0.29774 0.02210 0.10954 0.61989 0.41650 0.79006 0.57841 0.192070.86298 0.64983 0.22192 0.24865 0.58630 0.18668 0.98299 0.63616 0.30083 0.51330 0.53154 0.124050.07287 0.65950 0.67320 0.93081 0.90772 0.73940 0.64286 0.64254 0.41456 0.72072 0.94293 0.360630.58109 0.25651 0.86713 0.83379 0.77493 0.41397 0.26476 0.12260 0.52947 0.10695 0.59005 0.660660.64009 0.45020 0.81196 0.75202 0.21989 0.84106 0.62750 0.12691 0.59728 0.46832 0.48267 0.117630.29625 0.03074 0.80469 0.18090 0.76631 0.07765 0.64289 0.80597 0.42059 0.54752 0.33931 0.203350.66929 0.27105 0.38245 0.35996 0.35466 0.95867 0.88960 0.69470 0.08680 0.42062 0.99890 0.500640.66220 0.96124 0.94346 0.13794 0.12921 0.77079 0.34320 0.89381 0.72780 0.77207 0.41183 0.536120.99302 0.82531 0.18294 0.69819 0.02041 0.19120 0.05009 0.30331 0.17830 0.92343 0.66202 0.205930.18193 0.45179 0.10796 0.12238 0.31859 0.03718 0.15801 0.62498 0.29981 0.46015 0.96907 0.457360.92831 0.91398 0.12440 0.36665 0.37045 0.69954 0.70049 0.00840 0.65694 0.25226 0.44813 0.587540.49890 0.57483 0.23352 0.72498 0.52637 0.47300 0.51270 0.58307 0.64121 0.92989 0.10240 0.536590.47829 0.04158 0.45849 0.14370 0.61276 0.51598 0.36109 0.31831 0.87283 0.39096 0.48133 0.173840.63489 0.85490 0.90048 0.69521 0.27080 0.07515 0.45412 0.04971 0.08256 0.66306 0.69020 0.976630.76565 0.23386 0.34620 0.64750 0.81381 0.14068 0.91120 0.12898 0.51521 0.54315 0.37108 0.885770.45887 0.86688 0.05729 0.92647 0.30177 0.61879 0.47596 0.20795 0.09632 0.19732 0.58334 0.042090.51128 0.32958 0.94829 0.27204 0.41056 0.38847 0.70473 0.69122 0.96991 0.93970 0.40350 0.811550.82958 0.82493 0.33323 0.74311 0.22386 0.22035 0.69698 0.17834 0.01995 0.26452 0.84116 0.967380.26826 0.80896 0.84855 0.00770 0.33997 0.60881 0.15379 0.73566 0.08538 0.01699 0.17939 0.868540.30873 0.95771 0.94886 0.79796 0.53453 0.91990 0.54472 0.86054 0.60245 0.34247 0.13269 0.685770.97455 0.26886 0.25914 0.46656 0.61351 0.84598 0.76638 0.53096 0.45925 0.40966 0.58245 0.974480.96525 0.42753 0.24674 0.09531 0.08043 0.96374 0.10933 0.19030 0.83535 0.73553 0.35246 0.163540.66284 0.31799 0.01712 0.96037 0.66141 0.08211 0.04316 0.40076 0.01621 0.07105 0.85754 0.519260.65283 0.33788 0.42879 0.67877 0.08242 0.20302 0.23775 0.37797 0.13931 0.12381 0.44455 0.839350.77644 0.03774 0.26207 0.02913 0.45106 0.40121 0.98373 0.16523 0.88096 0.22499 0.35954 0.905830.00708 0.37183 0.08147 0.98787 0.28192 0.78577 0.62209 0.37903 0.91876 0.45461 0.47513 0.011430.00456 0.03002 0.97829 0.63830 0.61149 0.17222 0.50972 0.05685 0.06729 0.89338 0.78685 0.712720.79470 0.88968 0.88756 0.42029 0.23421 0.75848 0.56497 0.42250 0.29531 0.88220 0.72963 0.305220.12438 0.23196 0.45596 0.76461 0.31418 0.03392 0.12685 0.81803 0.34718 0.32310 0.44966 0.811350.85958 0.17683 0.53436 0.49438 0.81665 0.08040 0.12228 0.68689 0.30287 0.41270 0.08484 0.477640.08906 0.96398 0.78177 0.17978 0.43712 0.05837 0.83086 0.06085 0.94694 0.27622 0.66328 0.487980.42408 0.75046 0.70243 0.36590 0.23187 0.79615 0.84285 0.85354 0.03234 0.19192 0.53813 0.945350.64120 0.28314 0.10376 0.68464 0.05931 0.29272 0.21149 0.67050 0.01685 0.14589 0.72375 0.751100.88661 0.48483 0.61636 0.01725 0.91934 0.03856 0.71091 0.53116 0.44927 0.24460 0.00377 0.720680.33995 0.94486 0.13122 0.56969 0.75016 0.66394 0.99088 0.37000 0.96743 0.90691 0.35268 0.839540.32381 0.85873 0.91718 0.12674 0.62742 0.89791 0.05220 0.90315 0.77647 0.84366 0.71415 0.147080.23257 0.84084 0.62576 0.27456 0.39834 0.55139 0.09493 0.96170 0.89795 0.00903 0.13459 0.297820.59271 0.53865 0.02111 0.09152 0.77903 0.46294 0.18544 0.76316 0.70874 0.05829 0.69961 0.812290.01073 0.66985 0.86360 0.35512 0.11711 0.10344 0.21911 0.03085 0.79766 0.96554 0.18580 0.648510.72465 0.85179 0.66843 0.32333 0.33572 0.09858 0.24681 0.12392 0.27899 0.47328 0.39052 0.429810.61465 0.90095 0.61691 0.94221 0.42376 0.83487 0.12357 0.85764 0.51682 0.71992 0.70874 0.829700.42220 0.78970 0.94477 0.32937 0.42746 0.85167 0.26155 0.79473 0.29086 0.13625 0.01537 0.530780.50486 0.87265 0.45562 0.51749 0.73458 0.38321 0.41118 0.64700 0.06674 0.20414 0.96905 0.935010.06957 0.58291 0.00920 0.22256 0.73781 0.88336 0.62699 0.05156 0.55644 0.12008 0.00905 0.007010.60827 0.50105 0.80484 0.45500 0.44204 0.49885 0.01418 0.00161 0.82617 0.62760 0.81310 0.499090.76483 0.84170 0.20412 0.52418 0.61443 0.55009 0.39623 0.34031 0.42074 0.64833 0.07091 0.040410.08029 0.99398 0.56143 0.18912 0.37379 0.88740 0.31389 0.85848 0.51122 0.32322 0.70279 0.652020.93451 0.53512 0.68958 0.60885 0.02845 0.63831 0.22487 0.37644 0.07251 0.72038 0.35562 0.88068

25


ACTIVITY TWO

DATA PRESENTATION

RATIONALE

In this activity you will review the results shown on Worksheet 2.1. You should prepare to present the results of a facility to the staff members.

INSTRUCTIONS

1.Review the results of the facility allocated to your group.

2.Identify what are good and bad results compared to other facilities and to other countries (Page 74 of the WHO Manual).

3.Decide if you want to show the results using visual aids. If so, prepare them.

4.Start off your presentation with the positive -- the "good" results.

5.Then identify the problem areas -- the "bad" results.

6.Discuss with the facility members the possible reasons for the results.

7.Make an action plan with the participants for what they will do about their problems.

NOTE: Not every group will present. Groups will be randomly selected.

26


Worksheet #2.1

EXAMPLES OF INDICATOR RESULTS FROM DIFFERENT FACILITIES

INDICATORFACILITIES

AVERAGES

# 1 # 2 # 3 # 4 # 5 # 6

# Drugs 1.5 1.9 4.7 2.7 3.5 2.1 2.7

% Antibiotics 32 64 47 37 100 24 51

%Injectables 6 44 95 54 89 14 50

%Generics 94 61 47 15 100 92 68

%EDL 100 77 84 43 89 86 80

ConsultationTime (mins.) 2:30 3:24 1:40 1:25 4:53 8:12 3:41

DispensingTime (secs.) 75 42 135 34 185 26 83

%CorrectLabeling

62 68 61 35 28 21 46

% PatientKnowledge 62 41 74 16 32 31 43

% Drugsin Stock 60 100 80 70 60 90 77

EDL Present Yes Yes Yes No Yes No Yes

ImpartialInformation No Yes No No No No No

27


Annex 1: Examples of Forms

Examples of Forms (note that there should be 2 copies of the forms in the binder)

Prescribing Indicators Form

Detailed Prescribing Indicators Encounter Form

Patient Care Form

Facility Summary Form

Facility Indicators Reporting Form

Drug Use Indicators Consolidation Form

28

Documents

Implementing a Drug Use Indicators Study · Web viewImplementing a Drug Use. Indicators Study Implementing a Drug Use Indicators Study. SESSION GUIDE. PURPOSE AND CONTENT. The purpose