ABSTRACT
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.
ABSTRACT
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
Subject(s)
Humans , Male , Female , Pediatrics , Practice Guidelines as Topic , Primary Health Care , Disease Management , Drug PrescriptionsABSTRACT
Provision of essential drugs is one of the eight elements of primary health care [PHC]. The aim of the present study was to investigate the quality of the provision of essential drugs in three PHC facilities in Alexandria. This involved evaluating essential drug availability relative to prevalent health problems, assessing knowledge, attitude and practice [KAP] of health personnel concerning the provision of drugs, as well as assessing KAP of the consumers regarding drug use. The results revealed the irregular availability of essential drugs and vaccines and their improper storage conditions. The absence of a drug list at the three study settings, the presence of some differences between the list of WHO and that of the Health Directorate, as well as between the types of drugs available at the three facilities were noticed. Drug records in rural facilities were incomplete and the amounts of drugs supplied were not coinciding with the number of cases or with the seasonality of diseases. The majority of health personnel and the consumers had fair knowledge, indifferent attitude and partial practice concerning drug use. Moreover, no diagnosis was found on the majority of consumers' records