Medicine Storage and Dispensing Facilities in Public Healthcare Pharmacies of Puducherry, India.

Background Large amounts of medicines are wasted during procurement, storage, distribution, and utilization. Proper procurement, storage, dispensing, and documentation of medicines are important aspects of pharmacy management. The World Health Organization (WHO) and the Indian Pharmaceutical Association (IPA) have developed guidelines for the storage and dispensing of medicines by pharmacists. This study was conducted to assess the storage and dispensing facilities of medicines in public healthcare pharmacies of Puducherry province in south India. Methodology A one-time survey was conducted in 10 public healthcare pharmacies by filling the checklist which was prepared based on the WHO and IPA guidelines. Results Facilities such as adequate surface area, storage area, reception area, and availability of water supply in dispensing area were available in 90% of surveyed pharmacies. The most common system used for the arrangement of medicines was alphabetical order (70%). In 80% of pharmacies, a sufficient number of shelves was available for storage of medicine, and in 90% of pharmacies, shelves were properly labeled. None of the pharmacies had separate storage facilities for expired medicines and narcotic drugs. Conclusions In Puducherry, pharmacy services are provided by qualified and experienced pharmacists. Although most of the surveyed pharmacies had all the required infrastructure and equipment facilities, few pharmacies need to improve their facilities to promote good drug-dispensing practices.

Assessment of medicine use based on WHO drug-use indicators in public health facilities of the South Indian Union Territory.

OBJECTIVE: To assess medicine use based on World Health Organization (WHO) core drug-use indicators in selected public health facilities of the South Indian Union Territory. METHODS: A prospective cross-sectional study was conducted for period of one year (from March 2019 to February 2020) in 10 selected public health facilities based on the WHO document How to investigate drug use in health facilities. Total 900 prescriptions were analysed to study prescribing, patient care and health facility indicators. The results were compared with the WHO standard measures. RESULTS: The overall average number of drugs per prescription was 3.2. Percentage of prescriptions with antibiotics and injections were found to be 36.6 and 11.4%, respectively. Percentage of drugs prescribed by generic name was 74.6%. Percentage of drugs prescribed from the National List of Essential Medicine was 93.3%. Average consultation and dispensing time were found to be 3.9 minutes and 49.3 seconds, respectively. The percentage of drugs dispensed in this study was 98.5 and 61.6% of medicines were properly labelled; 76.7% of patients had correct knowledge of each medicine dispensed to them. Mean availability of key essential medicine was 73.4%. CONCLUSION: Indicators such as percentage of drugs prescribed from the National List of Essential Medicine, availability of copy of essential medicine list and percentage of drugs dispensed were found to be as per WHO optimal value. Indicators such as average number of drugs per prescription, average consultation and dispensing time and percentage of medicines labelled were found below optimal value and need to be improved.

Availability of Key Essential Medicines in Public Health Facilities of South Indian Union Territory: One of the Crucial Components of Universal Health Coverage.

Introduction The supply of essential medicines is one of the vital components of primary health care. One of the important objectives of Indian health policy is to provide all the essential medicines at an affordable cost for the public. The performance of healthcare facilities is directly affected by the supply of essential medicines. This study was conducted to check the availability of key essential medicines in selected public healthcare facilities of the South Indian Union Territory. Methods A snapshot survey was conducted between March 2019 and February 2020 in 10 selected public health facilities to assess the availability of 50 key essential medicines. Percentage availability for all surveyed medicines for the individual facility as well as percentage availability of individual medicines in all surveyed health facilities was calculated. Results Percentage availability of 50 key essential medicines in 10 surveyed public health facilities was found in a range of 66 to 80%. Out of 50 medicines, 26 (52%) medicines were available in more than 80% of health facilities while six (12%) medicines were available in less than 30% of surveyed facilities. Conclusion This study reported the high availability of essential medicines in public health facilities as compared to similar studies done in other parts of India but the availability of some essential medicines was found sub-optimal and needs to be improved.

Monitoring Antibiotic Use in Public Health Care Facilities of South Indian Union Territory: A Step to Promote Rational Use of Antibiotics.

Introduction Antimicrobial resistance is a serious problem to solve for the public health authorities at the global level, particularly in developing countries like India. One of the possible reasons for antimicrobial resistance could be the inappropriate or overuse of antibiotics. The Indian government started the National Action Plan on Antimicrobial Resistance to promote rational use of antibiotics in our country. This study was conducted with the objective to monitor antibiotic use in public health facilities of Puducherry which is a union territory of south India. Methods Total 900 prescriptions were prospectively collected from the 10 public health facilities (nine primary health centres and one outpatient department of tertiary care hospital) over the period of one year to analyse antibiotic use.  Results We found that 36.66 % of prescriptions contained at least one antibiotic. Our result shows that antibiotics were more commonly prescribed from the access category. Upper respiratory tract infections was the most common indication for which antibiotic was prescribed in primary health centres. In the tertiary care teaching hospital, half of the antibiotics were prescribed for cough, followed by pharyngitis (20 %). Conclusions A high proportion of antibiotics were prescribed for viral infections. Using antibiotics unnecessary can increase the cost of treatment as well as risk of antibiotic resistance. The Department of Medical Services, Puducherry should take initiative to ensure the successful implantation of the National Action Plan on Antimicrobial Resistance. Data of this study can be used to provide educational intervention for all drug stake holders such as physicians, pharmacists and policy makers to promote rational use of antibiotics.

Cost Analysis of Different Antibiotic Brands Available in Indian Market with Reference to National List of Essential Medicines.

BACKGROUND: About 60%-90% of healthcare spending in India is on medicine which is mainly out of pocket. Almost all the drugs including antibiotics are available as brands with variable cost. Indian government formulated National List of Essential Medicines (NLEM) to ensure availability of affordable medicines to the population. Prescribing drugs from NLEM and considering the cost of drug, especially antibiotics in practice, can reduce cost of treatment and patient's out-of-pocket expenditure. OBJECTIVE: The objective of the study is to analyze cost variation of different antibiotic brands available in Indian market with reference to NLEM. MATERIALS AND METHODS: List of antibiotics listed in the NLEM 2015, India, was prepared. Percentage cost variation and cost ratio of different brands of these antibiotics were calculated and compared. RESULTS: We found 17 antibiotics listed in NLEM 2015. The number of brands varied from 2 to 102. We found wide cost variations among different brands of same antibiotics. Minimum cost variation was 7.34% (for ciprofloxacin 200 mg/100 ml vial) while maximum 1049.82% (for azithromycin 500 mg tablet). CONCLUSION: There is wide cost variation in different brands of same antibiotics listed in the NLEM. Prescribers should prescribe cheaper brands of antibiotics to ensure that patients complete the course of treatment and thus reduce development of resistance to antibiotics.

Post-osteomyelitic-acquired radial club hand deformity in children treated by centralization of ulna.

INTRODUCTION: Radial club hand deformity acquired post haematogenous osteomyelitis of radius bone is a very rare disease. Resulting in functional and cosmetic deficit of upper limb which is similar to congenital cases. For a long-time various surgeons attempted to reconstruct the deformity by bone grafting, plating, Ilizarov, monorail external fixator, callus distraction and so on. Keeping in mind that creating single bone forearm we proposed centralization of ulna on wrist to correct the deformity. MATERIALS AND METHODS: In our institute, we conducted a rare study involving small number of patients ( n = 5), between February 2013 and November 2106. The study participants comprised four male children and one female child whose average age was 1.8 months. Participant inclusion criteria were no active infection, no distal end of radius (cartilage remnant) and only haematogenous osteomyelitis. Exclusion criteria were congenital radial club hand and active infection. RESULT: Decrease in the angle of radial deviation (radiologically) preoperatively from 54° to 5° and angle of volar flexion from 34° to 4° were measured. Preoperatively no ulnar angulations were observed. Length of ulna remains similar to the opposite side. No neurovascular complication noted and full range of movement regained. DISCUSSION: Our case series is unique in terms of massive bone loss, that is, distal metaphysic and epiphysis, so we followed the statement of Ono et al. and did centralization of ulna over carpus and achieved good functional and cosmetic outcome at the cost of loss of motion at the wrist, concluding that treatment is primarily considered as salvage only.

Results of neurolysis in established upper limb Volkmann's ischemic contracture.

BACKGROUND: Treatment of established cases of Volkmann's ischemic contracture (VIC) of upper limb is very tedious. Since the period of Volkmann, various experimental works are being performed for its treatment, but none are effective. Disabilities from nerve palsy and hand muscle paralysis are more problematic than any other deformity in VIC. To solve these problems, we conducted a study to see the result of neurolysis of median and ulnar nerve and their subcutaneous placement in established cases of VIC. MATERIALS AND METHODS: Twelve cases of established VIC operated between July 2007 and August 2010 with complete records and followup were included in the study. VIC of lower limb and contracture of nonischemic etiology were excluded from the study. Their evaluation was done by the British Medical Research Council grading system for sensory and motor recovery. Followup was done for an average period of 24.3 months (range 15-30 months) (the average age was 8.3 years). RESULTS: To study the results, we divided the cases into two series. One group consisted of cases which were operated within 6 months from onset of VIC. The second group consisted of cases which were operated after 6 months from onset of VIC. Our results revealed that there was no statistically significant difference between the two groups operated, though both had significant improvement in motor and sensory recovery in both median and ulnar nerve distribution. CONCLUSIONS: Neurolysis of the nerves definitely improved the outcome for motor and sensory components of median and ulnar nerves but the timing of the surgery did not play a role in the outcome contrary to the clinical assumption. This study can serve as a template and further such studies could help us find the answer to a long standing issue.

Distraction histiogenesis for treatment of Kienbock's disease: A 2- to 8-year follow-up.

BACKGROUND: Distraction histiogenesis is known to enhance vascularity and stimulate new tissue formation. Its use in Kienbock's disease is not reported in the literature, so we proposed to study the outcome after distraction histiogenesis in treating this condition. MATERIALS AND METHODS: This prospective study comprised of six patients (two male and four female) with mean age 18.16 years (range 21-35 years) with clinicoradiologically diagnosed Lichtman stage II (n = 3) and stage III (n = 3) Kienbock's disease with a mean duration of symptoms 6.67 months. The ulnar variance was neutral in two and was negative in four patients treated with the application of Joshi external stabilization system (JESS) across the wrist. The gradual distraction was done at a rate of 0.5 mm/day. After the distraction of 5-7 mm, the distractors were kept static for 3 weeks. The wrist was mobilized by using hinged distractors for next 3 weeks. Later short cockup splint was used for further 4 weeks. At the end of minimum 2 years, an assessment was done on the basis of relief of symptoms, ability to perform activities of daily living, range of movement at wrist, grip strength, and on radiology (change in the density of bone and C:MC ratio i.e ratio of carpal height to third metacarpal height). RESULTS: The mean follow-up was of 4.5 years (range 2-8 years). The average duration of treatment was 5.3 months (range 4.5-6 months), and the duration of distraction (both static and hinged) was 8 weeks. Clinically all the patients were relieved of the symptoms with an increase in the range of wrist movement (ulnar deviation increased from 20.8 degrees to 29.5 degrees , radial deviation from 17.5 degrees to 21 degrees , dorsiflexion from 37.5 degrees to 52.5 degrees , and palmer flexion from 38.3 degrees to 47.5 degrees ). At the last follow-up, activities of daily living were not affected, and all the patients were on their previous jobs without any fresh complaints. The average grip strength increased to 73-86% of normal. Radiologically the C:MC ratio (ratio of carpal height to third metacarpal height) did not show any significant improvement, but the density of lunate decreased. CONCLUSION: Distraction histiogenesis when used in Lichtman stage II and III with negative or neutral ulnar variance gives good symptomatic relief, allowing return to normal activities. This study has also shown that reparative process is possible in avascular bone by distraction. The authors recommend further research in this modality of treatment.