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Prescription practices, Tororo district, Uganda, August 1996
HEALTH
CARE POLICY
“PRESCRIPTION PRACTICES, TORORO DISTRICT, UGANDA, AUGUST 1996.” A. R. Ario, D. Kyamanywa, J. Mudusu, G. W. Pariyo, 0. Okui, and M. E. White. Uganda Public Health Schools
Without
Walls,
Kampala,
Uganda.
Introduction:
In Uganda, after years of civil strife, health services are improving, but drugs are still in short supply and they are sometimes irrationally prescribed. A study was done in Tororo, a rural district in eastern Uganda, the goal of which was to provide information for designing a strategy to improve prescription practices. The objective was to measure indicators of rational drug use and compare them with standard targets of usage and conformity to Essential Drugs List of Uganda (EDLU) and National Standard Treatment Guidelines (NSTG). Methodology: Records were reviewed in a stratified sample of 12 of 32 health units. In each health unit, the first 100 prescriptions which fulfilled certain criteria were reviewed. The criteria included readable first attendance records complete for age, date and drugs, with a clear diagnosis of any one of the diseases: malaria, diarrhea and acute respiratory infection.
Results Average number of drugs Drugs prescribed as generic Antibiotic prescribed Injection prescribed Drugs from EDLU Overall conformity to NSTG
Health units average
National standard
2.3 72% 48% 49% 96% 50%
cl.6 100% <15% <150/o 100% 100%
“EVALUATION OF DRUG USE PRACTICES IN GOVERNMENT HEALTH UNITS, KABAROLE DISTRICT, WESTERN UGANDA.” Sarah D. Kasewa, G. W. Pariyo, 0. Okui, G. Kubugambe, and M. White. Uganda Public Health Schools Without Walls, Makerere University, Kampala, Uganda. Introduction: A survey done in I992 revealed irrational use of drugs in the health units. Corrective measures through training and support supervision were taken. The district health authorities requested that the current situation on drug use be reassessed. Kabarole District has 40 government health units and a population of 846,529. Goal: To improve rational use and management of drugs in Kabarole District. Objectives: To assess the prescribing and dispensing practices of the health workers. To assess patients’ ability to recall dispenser’s instructions and to suggest strategies f&r improved drug use. Design: A cross sectional study. A stratified random sample of 11 health units selected out of 40. Records reviewed retrospectively to assess prescribing habits. One hundred new encounters from l/3/96 were reviewed from each sampled unit. Dispensing practices and patient care were assessed on 15 new encounters at each of the sampled units. Main Outcome Measure(s): Prescription and patient care practices and patients’ ability to recall dispenser’s instructions. Availability of key essential drugs and treatment guides.
Results: Outcome
Conclusion:
Prescribing by generic names and from Essential Drugs List of Uganda was close to standard. Average number of drugs, use of antibiotics and injections and conformity to National Standard Treatment Guidelines were far from standard which put patients at risk of adverse reactions and wastes scarce resources. Continuing education and support supervismn on rational drug use with emphasis on prescription indicators would be beneficial. Intermittent evaluation on prescriptions should be undertaken.
Average number of drugs/ encounter Antibiotic rate Injection rate Percentage of drugs form essential drug list Percentage of drugs actually dispensed Average consultation time Average dispensing time Ability to recall dispenser’s instructions Availability of key essential drugs
Conclusion: injection
Polypharmacy,
of the Health Care System for the IX region, in Chile. In August 1991, a fiveyear plan for the program was designed using a strategic planning approach. Evaluation was needed to determine plans for the next five years. Design: The evaluation was multifaceted. First, a logic model of the program that identifies overall goals, implementation objectives, outputs, and short- and long-term objectives was developed and discussed with stakeholders. Next, an evaluation matrix was developed and priorities for evaluation defined. Finally, data were gathered or reviewed about pertinent areas. Setting: The program covers the entire population of women (350,000) who access the health system. Participants: Stakeholders of the health care system were involved in the evaluation process. Main Outcome Measure(s): Epidemiologic measures (e.g. Pap smear rates), measures of staff and patient satisfaction, administrative data (e.g. number of visits) pertinent to measuring program objectives. Results: The evaluation focused mainly on the extent to which the objectives for the five-year period were met. Most of the b&medical and many managerial objectives were achieved. Psycho-social objectives were not met as well. The evaluation identified considerable variation across the region on some outcome measures. It developed plans to explore reasons for this variability to allow for local program adjustments to improve attainment of goals. A new five-year plan was developed based on evaluation results. Client satisfaction and quality of team work are issues to be addressed in the fiveyear period. Conclusion: Program evaluation is useful to planning adjustments to a health care program and improving program management. Clear operational definitions of objectives are needed to allow evaluation to proceed easily. On-going use of evaluative information by managers is planned. 44s
2.3
Desired national standard cl.6
66% 26% 93%
<20% <15% 100%
65%
100%
5 minutes 3 minutes 65%
>lO minutes > 5 minutes >70%
85%
100%
inappropriate
medications,
high antibiotic
and
rate.
Recommendations: “WOMEN AND INFANT HEALTH PROGRAM EVALUATION: DEVELOPING A CONTINUOUS MANAGERIAL INFORMATION LOOP.” Wilftied Diener, G. San Miguel, L. Sanhuezu, A. Irazoqui, J. Neirn, I. Pasche, rind N. Segura. CEU, Universidad de La Frontera, Temuco, Chile. Objective: The objective is to evaluate the women and perinatal program
(mean)
Recruit trained ment charts, notify staff of changes, the dispensing insrructions.
staff, better supervision, provide treatand ensure that the patients have got
CARE POLICY
“PRESCRIPTION PRACTICES, TORORO DISTRICT, UGANDA, AUGUST 1996.” A. R. Ario, D. Kyamanywa, J. Mudusu, G. W. Pariyo, 0. Okui, and M. E. White. Uganda Public Health Schools
Without
Walls,
Kampala,
Uganda.
Introduction:
In Uganda, after years of civil strife, health services are improving, but drugs are still in short supply and they are sometimes irrationally prescribed. A study was done in Tororo, a rural district in eastern Uganda, the goal of which was to provide information for designing a strategy to improve prescription practices. The objective was to measure indicators of rational drug use and compare them with standard targets of usage and conformity to Essential Drugs List of Uganda (EDLU) and National Standard Treatment Guidelines (NSTG). Methodology: Records were reviewed in a stratified sample of 12 of 32 health units. In each health unit, the first 100 prescriptions which fulfilled certain criteria were reviewed. The criteria included readable first attendance records complete for age, date and drugs, with a clear diagnosis of any one of the diseases: malaria, diarrhea and acute respiratory infection.
Results Average number of drugs Drugs prescribed as generic Antibiotic prescribed Injection prescribed Drugs from EDLU Overall conformity to NSTG
Health units average
National standard
2.3 72% 48% 49% 96% 50%
cl.6 100% <15% <150/o 100% 100%
“EVALUATION OF DRUG USE PRACTICES IN GOVERNMENT HEALTH UNITS, KABAROLE DISTRICT, WESTERN UGANDA.” Sarah D. Kasewa, G. W. Pariyo, 0. Okui, G. Kubugambe, and M. White. Uganda Public Health Schools Without Walls, Makerere University, Kampala, Uganda. Introduction: A survey done in I992 revealed irrational use of drugs in the health units. Corrective measures through training and support supervision were taken. The district health authorities requested that the current situation on drug use be reassessed. Kabarole District has 40 government health units and a population of 846,529. Goal: To improve rational use and management of drugs in Kabarole District. Objectives: To assess the prescribing and dispensing practices of the health workers. To assess patients’ ability to recall dispenser’s instructions and to suggest strategies f&r improved drug use. Design: A cross sectional study. A stratified random sample of 11 health units selected out of 40. Records reviewed retrospectively to assess prescribing habits. One hundred new encounters from l/3/96 were reviewed from each sampled unit. Dispensing practices and patient care were assessed on 15 new encounters at each of the sampled units. Main Outcome Measure(s): Prescription and patient care practices and patients’ ability to recall dispenser’s instructions. Availability of key essential drugs and treatment guides.
Results: Outcome
Conclusion:
Prescribing by generic names and from Essential Drugs List of Uganda was close to standard. Average number of drugs, use of antibiotics and injections and conformity to National Standard Treatment Guidelines were far from standard which put patients at risk of adverse reactions and wastes scarce resources. Continuing education and support supervismn on rational drug use with emphasis on prescription indicators would be beneficial. Intermittent evaluation on prescriptions should be undertaken.
Average number of drugs/ encounter Antibiotic rate Injection rate Percentage of drugs form essential drug list Percentage of drugs actually dispensed Average consultation time Average dispensing time Ability to recall dispenser’s instructions Availability of key essential drugs
Conclusion: injection
Polypharmacy,
of the Health Care System for the IX region, in Chile. In August 1991, a fiveyear plan for the program was designed using a strategic planning approach. Evaluation was needed to determine plans for the next five years. Design: The evaluation was multifaceted. First, a logic model of the program that identifies overall goals, implementation objectives, outputs, and short- and long-term objectives was developed and discussed with stakeholders. Next, an evaluation matrix was developed and priorities for evaluation defined. Finally, data were gathered or reviewed about pertinent areas. Setting: The program covers the entire population of women (350,000) who access the health system. Participants: Stakeholders of the health care system were involved in the evaluation process. Main Outcome Measure(s): Epidemiologic measures (e.g. Pap smear rates), measures of staff and patient satisfaction, administrative data (e.g. number of visits) pertinent to measuring program objectives. Results: The evaluation focused mainly on the extent to which the objectives for the five-year period were met. Most of the b&medical and many managerial objectives were achieved. Psycho-social objectives were not met as well. The evaluation identified considerable variation across the region on some outcome measures. It developed plans to explore reasons for this variability to allow for local program adjustments to improve attainment of goals. A new five-year plan was developed based on evaluation results. Client satisfaction and quality of team work are issues to be addressed in the fiveyear period. Conclusion: Program evaluation is useful to planning adjustments to a health care program and improving program management. Clear operational definitions of objectives are needed to allow evaluation to proceed easily. On-going use of evaluative information by managers is planned. 44s
2.3
Desired national standard cl.6
66% 26% 93%
<20% <15% 100%
65%
100%
5 minutes 3 minutes 65%
>lO minutes > 5 minutes >70%
85%
100%
inappropriate
medications,
high antibiotic
and
rate.
Recommendations: “WOMEN AND INFANT HEALTH PROGRAM EVALUATION: DEVELOPING A CONTINUOUS MANAGERIAL INFORMATION LOOP.” Wilftied Diener, G. San Miguel, L. Sanhuezu, A. Irazoqui, J. Neirn, I. Pasche, rind N. Segura. CEU, Universidad de La Frontera, Temuco, Chile. Objective: The objective is to evaluate the women and perinatal program
(mean)
Recruit trained ment charts, notify staff of changes, the dispensing insrructions.
staff, better supervision, provide treatand ensure that the patients have got