DRUG USE INDICATORS

Purpose of Drug use indicators

* Objective measures (Indicators) that can describe the drug use situation in a country/region/Health facility.

* These indicators will allow Health planners, Managers and Researchers, to make basic comparisons between situations in different areas or at different times.

* The indicators can be used to measure the impact of the interventions undertaken.

* The indicators can serve as simple supervisory tools to detect problems in performance of individual providers or Health facilities.

* The drug use indicators can be used as "first line measures" to stimulate further questioning and to guide subsequent action.

Type of Indicators:

Indicators are developed to be used is measures of performance in three general areas, related to the Rational use of Drugs in Primarycare.

* Prescribing practices by Health providers

* Patient care including both clinical consultation and pharmaceutical dispensing.

* Facility specific factors which support RUD.

Core Indications:-

These are highly standardised which do not need adaptation, and are recommended for inclusion in any drug use study using indicators.

Complementary Indicators:-

These are no less important, often more different to measure and cannot be collected reliably in some settings. These are less standardised and may depend on local variables.

Care Drug use Indicators

I. Prescribing indicators

* Average number of drugs per encounter

* Percentage of drugs prescribed by generic name

* Percentage of Encounters with an antibiotic prescribed

* Percentage of encounters with an injection prescribed

* Percentage of drugs prescribed from essential drug list or formulary.

II. Patient care Indicators

* Average consultation time
* Average dispensing time
* Percentage of drugs actually dispensed
* Percentage of drugs adequately labeled
* Patients knowledge of correct dosage

III. Facility Indicators
* Availability of essential drug list or formulary
* Availability of key drugs.

These indicators are of activity based measures, meant to describe practices in a representative sample of Health facilities. The drug use indicators can be collected at one time in a cross sectional survey, or otherwise. For a basic cross sectional survey about 20 health facilities can be selected to represent a larger group of facilities.

The prescribing indicators can be based on either Retrospective or prospective data.
Retrospective data describe the drug use during patient list that took place in the past. These data can be collected from medical records kept in the Health facilities.
Prospective data describes the drug use during patient visits that takes place on the day of the indicator survey.

Recommended sample size:

There should be atleast 600 encounters included in a cross sectional survey. If 20 Health facilities are included, then there should be 30 encounters per facility. The Retrospective data collection should be over the past one year which should be used for prescribing indicators. To obtain a more reliable result in one facility, a sample of 100 prescriptions should be examined to minimise the margin of error and to obtain an estimate with a 95% confidence interval of plus or minus 10%.

Complementary drug use indicators

These indicators represent measures of performance that can be used in addition to the core indicators are no less important than the core indicators, but the data to measure them may often be more difficult to obtain, or their interpretation may be highly sensitive to the local context. The required data can be collected in a drug use survey with core indications. The complementary indication are suggested as additional measures of drug use.

Complementary drug use indicators can be:-

* Percentage of patients treated without drugs
* Average drug cost per encounter.
* Percentage of drug costs spent an Antibiotics
* Percentage of drug costs spent an Injections
* Prescriptions in accordance with treatment guidelines
* Percentage of patients satisfied with the care they received
* Percentage of health facilities with access to impartial drug information.