STUDY ON THE DRUG UTILIZATION AND MORBIDITY PATTERN AT A PHC

Health care is the right of every citizen and the Government is striving hard to provide quality Health Care through different levels of Health Care delivery system. Primary Health Care is aimed at bringing the Healch Services to the door steps of the needy, suffering people of the villages, so that morbidity and mortality is reduced among them.

A PHC caters to about 30,000 population with about 5-6 Health sub centres attached to it. The service provided through the PHC includes, both curative and preventive care.

Care of the Health problem in the community is one of the major area where curative services is provided along with a host of preventive services. For the curative services, the Government is providing drugs and other materials through the District ware houses as per the monthly intend, prepared and produced by the respective PHC's.

Objective

The main objective of the study is to analyse the Drug utilization at the PHC, and to analyse the morbidity pattern among the people utilising the services. An effort is made to correlate these two and to identify areas of disparity and lacunae in the services provided.

Methodology

The investigators visited the PHC daily for a month and collected relevant data from the various records from the PHC. Data were collected from the OP register, Nominal registers and drug registers (both main stock and sub stock).

Result

During the month of September 1998, about 7441 patients have attended the OPD. Nearly 80% (6164) utilized the services for the first time. The rest 20% (1277) were repeaters, who mainly came for followup or to collect drugs for continuing the treatment. Total number of male patients amounted to 1915 (25.74%) and females amounted to 2964 (39.83%), 2562(34.43%) of the patients were children.

Total number of males patients - 1915 (25.74%)

Total number of Female patients - 2964 (39.83%)

Total number of children - 2562 (34.43%)

Total 7441

Morbidity patterns

S.No. Illnesses Percentage

1. Upper Respiratory tract infection 30.7%
2. Skin disorders 18.0%
3. Myalgia 16.2%
4. Injuries 11.0%
5. Fever 7.8%
6. Ulcers in the body 6.5%
7. Lower respiratory tract infections 2.7%
8. Acid peptic diseases 2.4%
9. Obstetrics and gynaec problems 2.0%
10. Diarrhoeas & Dysenteries 2.0%
11. Bronchial Asthma 1.7%
12. Arthralgia 1.5%
13. Immunization 1.4%
14. Dog bite 1.2%
15. Filariasis 1.2%
16. Minor surgical problems 1.0%
17. Pulmonary TB 0.5%
18. Others 1.5%
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The above table shown that majority of the patients came with complaints of upper respiratory tract infection (30.7%), Skin disorder (18%), Body pain/myalgia (16.2%), Injuries (11%), Fever (7.8%) and ulcers in the body (6.5%)

This shows that patients with a wide variety of illness are utilizing the services of the PHC's. Majority of them are treated as out patients and a few are referred to near by referral hospitals for expert opinion and further management.

Drug supply to the PHC

The TNMSC is supplying all the Essential drugs through its warehouses in the District. The PHC is giving monthly indent based on their requirement and is getting the drugs through the TNMSC warehouse.

The majority of the drugs used in the PHC during the month of October 1998 is as follows.

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No. Drug Quantity
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1. Tab. Paracetamol 8017
2. Tab. Co-trimoxazole 7782
3. Tab. Chlorpheniramine Maleate 2943
4. Tab. Antacids 1974
5. Tab. B-Complex 1733
6. Tab. Diclofenac 1072
7. Tab. Ibuprofen 894
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Other drugs like Antihypertensives (Nifedipine) Bronchodilators (T.Aminophylline, T.Salbutamol), Antihelminthics etc. were also been used, but to a lesser extent.


Conclusion

The PHC is providing primary care round the clock to the needy people of its catchment area. But there are a number of defects and disexpancies which hampers the effective discrepancies functioning of the PHC. These are formed mainly in the indenting and stock procedures and also in the prescribing practices. A few examples, are discussed below.


* There is non-availability of certain essential drugs like. T.Aspirin, T.Digoxin and T.Ciprofloxacin and C.Amoxycillin, which have not been indented and received in time. This happened even in spite of the fact that Drug indent is prepared every fortnight.

Exapmles:-

1. The entire previous stock of C.Amoxycillin got exhausted on 29-09-97. But the subsequent stock was received only on 20-10-99.

2. Tablet Frusemide went out of stock on 09-02-98 and subsequent stock was received only on 31-07-98.


* There was pre-existing stock of 9000 tablets of Chlorpheniramine maleate. Even inspite of ample stock in hand, another 5000 tablets have been indented and received from the warehouse. Thus there was a surplus stock of nearly 14000 tablets of CPM at that time.

* There is found to have a disparity between the drugs that are utilized at the PHC on the day to day basis and the drugs that are actually required to treat various ailments in patients attending the PHC.

Examples:-

1. On 02-09-98, Total number of T.Ibuprofen (200 mg) used is 144 in number. But the total number of patients with complaints of myalgia, Arthralgia, injuries etc., requiring T.Ibuprofen were only 8, accounting to a maximum requirement of only 96 tablets (considering that T.Ibuprofen 400 mg is given 3 times daily for 2 days). The remaining 48 tablets is unaccounted.

2. On 09-09-98, Total number of T.Cotrimoxazole used in 336, the total number of patients with complaints requiring antibacterial drug with dosage of two tablets twice daily for two days is only 21 accounting to the need of only 168 tablets. The use of remaining 168 tablets is unaccounted.

* Non-availability of Anti Rabies vaccine

Every month about 20-25 patients with history of Dog bite comes to the PHC for treatment but they are referred to the other hospitals for management because of the non-availability of the Anti Rabies Vaccine, even though it is made available in the TNMSC warehouses.

* There is no stock of Tablet Diethyl Carbamazine Citrate (DEC) since 24-02-98, and no indent had been prepared for it. Patients coming to the PHC with signs and symptoms of filariasis is quite frequent. In September 1998 alone, nearly 15 patients with signs and symptoms of filariasis were reported.

* There is no stock of scabicidal agents, even though a number of scabies cases are reported.

* Nearly 1733 tablets of B-Complex have been used during the month of September 1998. But the number of patients reported with B-complex deficiency is very low. But it is found that BCT is used indiscriminately with analgesics and antibacterials, who do not have specific complaints of B-complex deficiency.

* Not a single case of Hypertension was recorded during the month of September 1998, But 72 tablets of Nifedipine were issued. This leads to think that there is a defect either in the registration of cases or prescription writing or distribution of the drug.

* The dosage of certain drugs prescribed were found to be inadequate. The adult dose of T. Ibuprofen is 400 mg thrice daily and that of T. Cotrimoxazole is two tablets twice daily. But many adult patients were prescribed 1 tablet of Ibuprofen (200 mg) thrice daily and one tablet of Cotrimoxazole twice daily resulting in incomplete treatment.


Thus, it is found that there is a lot of discrepancy in the prescribing practices as well as in the dispensing practices. When considering the stock position and drugs utilized and the morbidity pattern of the patients attending the PHC, it is very difficult to correlate the drug utilization and the morbidity pattern. An in depth study in this regard is necessary to find out the lacunae and to take necessary corrective measures.