WHO/INRUD drug use indicators at primary healthcare centers in Alexandria, Egypt

Appropriate use of drugs is one essential element in achieving quality of health and medical care for patients and the community. The study aims to measure the performance of 10 primary health care centers [PHCCs] in Alexandria, Egypt regarding the use of drugs using the WHO/INRUD drug use indicators: prescribing, patient care and facility-specific indicators. One-thousand prescribing encounters were investigated for a period from January to December 2010. Three-hundred patients and 10 pharmacists were interviewed. Data entry and analysis were conducted using SPSS version 19. Mean, median and SD were measured. An ANOVA test was applied. Prescribing indicators were within optimal or slightly below the optimal value except encounters with antibiotics prescribed that were higher than the optimal value. The difference between PHCCs was statistically significant for all prescribing indicators [P = 0.000]. Concerning patient care indicators, average consultation and dispensing times were short, and there was no drug labeling at all. The difference between PHCCs was significant for all patient care indicators except the percentage of drugs labeled and patient's knowledge of correct dosage. Both facility-specific indicators were below the optimal value. Prescribing indicators were below optimum except average drugs/encounter and encounters with injection prescribed. Patient care indicators were below the optimal level especially for average consultation dispensing times and drug labeling. Facility-specific indicators were below optimum.

Effect of adopting integrated management of childhood illness guidelines on drug use at a primary health care center: a case study from Egypt

Integrated Management of Childhood Illness [IMCI] is a cost- effective strategy that improves the quality of care through the use of evidence- based management protocols for the most common causes of childhood death and illness. Evidence- based clinical guidelines are critical to promoting rational use of medicines. Despite the large number of studies that assessed process and outcome of care delivered to children utilizing IMCI protocol, there is a scarcity of studies that assessed the effect of adopting IMCI on the drug use. To examine the impact of adopting IMCI guidelines on drug use at one of the primary health care [PHC] centers, Alexandria, Egypt. Retrospective cohort study, conducted in clinic "A" not adopting IMCI guidelines and clinic "B" adopting IMCI guidelines at one of the PHC centers in Alexandria, Egypt for the period from January-- end of June 2010. A data collection sheet was designed to collect the required variables [based on WHO/ INRUD selected drug use indicators] from the medical records of children under five years. Statistical Analysis Used: SPSS version 16 was used. Percentages, means, and standard deviations were measured. Chi square, t, and Fisher's exact tests were applied. Correct drug choice, dose, dosage form, route of administration were significantly higher in the clinic adopting IMCI [clinic B] [89.3%, 87.3%, 91.3%, and 91.3%, respectively] than in the clinic not adopting it [clinic A] [78% each]. Non pharmacological remedies prescribed were significantly higher in clinic B than A [64.7% vs 4.6%]. Average no of drugs/ encounter was lower in clinic B than A [0.93 +/- 0.2 vs 1.37 +/- 0.6] and the difference between clinics was statistically significant. Difference between clinics regarding percentages of drugs prescribed by generic name, antibiotics prescribed, drugs prescribed from essential drug list, and drugs prescribed out of stock was significant. Adopting IMCI strategy improved prescribing performance and treatment regimen

Health sector reform and equity: a study at a family health center affiliated to health insurance organization in Alexandria

The 1990's witnessed a wave of reform in health systems of many countries. Health sector reform [HSR] initiatives aimed at improving health status, utilizers' satisfaction, as well as equity and accessibility of care. This study aims at exploring the question of whether there is a socioeconomically based differential access to services provided by a family health center applying HSR. A total of 248 utilizers were randomly selected and interviewed. An access index comprised of eight elements was developed to measure access and its corollary equity. Results demonstrated that the majority belonged to the low middle socioeconomic class and one- quarter belonged to the low class. Approximately 9/10 of utilizers had high access to the services offered. Mean access index score for all utilizers was above the 90% mark. ANOVA analysis of mean access index according to socioeconomic class revealed that there is no statistically significant disparity among various socio-economic classes regarding their access to care. However, it was demonstrated that higher classes had a higher opinion concerning the completeness of physical examination during the initial visit than lower classes. It was recommended to establish an appropriate policy framework to assure optimal standards of equity, preferably a 100% of high access as measured through the access index devised in this study