Background
Core drug use indicators | Optimal values |
---|---|
Prescribing indicators | |
Average number of medicines prescribed per patient encounter | 1.6–1.8 |
Percent medicines prescribed by generic name | 100 |
Percent encounters with an antibiotic prescribed | 20.0–26.8 |
Percent encounters with an injection prescribed | 13.4–24.1 |
Percent medicines prescribed from essential medicines list or formulary | 100 |
Patient-care indicators | |
Average consultation time (minutes) | ≥10 |
Average dispensing time (seconds) | ≥90 |
Percent medicines actually dispensed | 100 |
Percent medicines adequately labeled | 100 |
Percent patients with knowledge of correct doses | 100 |
Facility-specific indicators | |
Availability of essential medicines list or formulary to practitioners | 100 |
Percent key medicines available | 100 |
Methods
Study setting
Study design and outcome measures
Data collection
Prescribing indicators
Patient-care indicators
Facility-specific indicators
Statistical analysis
Results
Drug prescribing indicators
Primary Healthcare Centersa
| Prescribing Indicators | ||||
---|---|---|---|---|---|
Average number of medicines prescribed per patient encounter | Percent medicines prescribed by generic name | Percent encounters with an antibiotic prescribed | Percent encounters with an injection prescribed | Percent medicines prescribed from essential medicines list | |
1 | 3.4 (1.4) | 81.2 | 64.0 | 38.0 | 98.5 |
2 | 3.6 (1.5) | 85.1 | 63.0 | 32.0 | 87.6 |
3 | 3.4 (1.3) | 83.0 | 87.0 | 21.0 | 89.2 |
4 | 3.2 (3.1) | 43.7 | 40.0 | 18.0 | 90.7 |
5 | 3.2 (1.4) | 88.5 | 56.0 | 30.0 | 100 |
6 | 1.9 (1.0) | 50.0 | 31.0 | 25.0 | 100 |
7 | 5.0 (2.3) | 60.0 | 30.0 | 9.0 | 80.5 |
8 | 4.3 (2.4) | 76.0 | 28.0 | 28.0 | 100 |
9 | 2.9 (0.7) | 66.7 | 29.0 | 43.0 | 100 |
10 | 3.4 (1.1) | 82.0 | 61.0 | 27.0 | 87.9 |
Mean (SD) | 3.4 (0.8) | 71.6 (15.7) | 48.9 (20.2) | 27.1 (9.8) | 93.4 (7.1) |
ANOVA |
p < .0005 |
p < .0005 |
p < .0005 |
p < .0005 |
p < .0005 |
Patient-care indicators
Primary Healthcare Centers | Patient-Care Indicators | Facility-Specific Indicators | |||||
---|---|---|---|---|---|---|---|
Average consultation time (minutes) | Average dispensing time (seconds) | Percent medicines actually dispensed | Percent medicines adequately labeled | Percent patients with knowledge of correct doses | Availability of essential medicines list to practitioners | Percent key medicines available | |
1 | 2.3 (1.5) | 43.1 (34.7) | 87.3 | 100.0 | 67.0 | 100.0 | 90.0 |
2 | 2.5 (1.2) | 43.0 (17.1) | 91.1 | 100.0 | 77.0 | 100.0 | 70.0 |
3 | 2.4 (1.0) | 36.7 (10.8) | 91.2 | 100.0 | 77.0 | 100.0 | 80.0 |
4 | 0.7 (0.4) | 15.5 (7.7) | 100.0 | 100.0 | 30.0 | 100.0 | 90.0 |
5 | 2.1 (0.8) | 42.6 (16) | 85.8 | 100.0 | 67.0 | 100.0 | 80.0 |
6 | 1.3 (0.6) | 31.3 (14) | 68.3 | 100.0 | 33.0 | 100.0 | 80.0 |
7 | 2.9 (1.4) | 30.9 (10.5) | 100.0 | 100.0 | 53.0 | 100.0 | 70.0 |
8 | 2.1 (1.2) | 36.9 (25.8) | 91.5 | 100.0 | 64.0 | 100.0 | 90.0 |
9 | 3.6 (1.1) | 63.3 (50.7) | 100.0 | 100.0 | 90.0 | 100.0 | 90.0 |
10 | 2.1 (1.0) | 37.1 (20.6) | 93.6 | 100.0 | 63.0 | 100.0 | 80.0 |
Mean (SD) | 2.2 (0.8) | 38.0 (12.1) | 90.9 (9.5) | 100.0 | 62.1 (19) | 100.0 | 82.0 (7.9) |
ANOVA |
p < .0005 |
p < .0005 |
p < .0005 | ------a
|
p < .0005 | ------a
|
p < .0005 |
Facility-specific indicators
Performance Indicators | Primary Healthcare Centers | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | |
Prescribing Indicators | ||||||||||
(1) Non-polypharmacy index | 0.53 | 0.5 | 0.53 | 0.56 | 0.56 | 0.95 | 0.36 | 0.42 | 0.62 | 0.53 |
(2) Generic name index | 0.81 | 0.85 | 0.83 | 0.44 | 0.88 | 0.50 | 0.60 | 0.76 | 0.67 | 0.82 |
(3) Rational antibiotic index | 0.42 | 0.43 | 0.31 | 0.67 | 0.48 | 0.86 | 0.89 | 0.96 | 0.92 | 0.44 |
(4) Injection safety index | 0.63 | 0.75 | 1.0 | 1.0 | 0.80 | 0.96 | 1.0 | 0.86 | 0.56 | 0.89 |
(5) Essential drugs list index | 0.99 | 0.88 | 0.89 | 0.91 | 1.0 | 1.0 | 0.81 | 1.0 | 1.0 | 0.88 |
IRDP | 3.38 | 3.41 | 3.56 | 3.58 | 3.72 | 4.27 | 3.66 | 4.0 | 3.77 | 3.56 |
Rank | 9 | 8 | 7 | 6 | 4 | 1 | 5 | 2 | 3 | 7 |
Patient-Care Indicators | ||||||||||
(6) Consultation time index | 0.23 | 0.25 | 0.24 | 0.07 | 0.21 | 0.13 | 0.29 | 0.21 | 0.36 | 0.21 |
(7) Dispensing time index | 0.48 | 0.48 | 0.41 | 0.17 | 0.47 | 0.35 | 0.34 | 0.41 | 0.70 | 0.41 |
(8) Dispensed drugs index | 0.87 | 0.91 | 0.91 | 1.0 | 0.85 | 0.68 | 1.0 | 0.91 | 1.0 | 0.93 |
(9) Labeled drugs index | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
(10) Patients’ knowledge index | 0.67 | 0.77 | 0.77 | 0.30 | 0.67 | 0.33 | 0.53 | 0.64 | 0.90 | 0.63 |
IRPCDU | 3.25 | 3.41 | 3.33 | 2.54 | 3.20 | 2.49 | 3.16 | 3.17 | 3.96 | 3.17 |
Rank | 4 | 2 | 3 | 8 | 5 | 9 | 7 | 6 | 1 | 6 |
Facility-Specific Indicators | ||||||||||
(11) Index of EDL | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
(12) Index of key drugs in stock | 0.90 | 0.70 | 0.80 | 0.90 | 0.80 | 0.80 | 0.70 | 0.90 | 0.90 | 0.80 |
IRFSDU | 1.90 | 1.70 | 1.80 | 1.90 | 1.80 | 1.80 | 1.70 | 1.90 | 1.90 | 1.80 |
Rank | 1 | 3 | 2 | 1 | 2 | 2 | 3 | 1 | 1 | 2 |
Grand total | ||||||||||
IRDS | 8.53 | 8.52 | 8.69 | 8.02 | 8.72 | 8.56 | 8.52 | 9.07 | 9.63 | 8.53 |
Rank | 6 | 7 | 4 | 8 | 3 | 5 | 7 | 2 | 1 | 6 |
Discussion
Performance Indicators | Study Reference | Mean | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
[54] | [55] | [6] | [41] | [28] | [48] | [42] | [36] | [49] | |||
Average number of medicines prescribed per patient encounter | 2.2 | 2.4 | 2.3 | 2.5 | 2.3 | 3.0 | 2.2 | 2.2 | 2.4 | 3.1 | 2.5 |
Percent medicines prescribed by generic name | 74.0 | 61.2 | 5.1 | 95.4 | 75.5 | 63.1 | 99.0 | 79.4 | 99.8 | 10.1 | 66.3 |
Percent encounters with an antibiotic prescribed | 37.0 | 32.2 | 60.9 | 39.2 | 35.4 | 54.2 | 43.0 | 24.9 | 66.0 | 33.0 | 42.6 |
Percent encounters with an injection prescribed | 11.0 | 2.0 | 1.2 | 9.9 | 19.0 | 38.0 | 18.0 | 10.6 | 2.4 | 2.4 | 11.4 |
Percent medicines prescribed from EML | 78.0 | 99.2 | 93.0 | 95.4 | 87.1 | 75.6 | 98.8 | 90.3 | 99.7 | 65.2 | 88.2 |
Average consultation time (minutes) | 5.8 | 7.3 | 3.9 | 7.1 | 3.6 | 6.1 | 3.7 | 6.2 | 4.4 | 2.3 | 5.0 |
Average dispensing time (seconds) | 17.0 | 100 | 28.8 | 47.4 | 39.9 | 18.1 | 37.0 | 78.0 | 234 | 258 | 85.8 |
Percent medicines actually dispensed | 66.0 | 99.6 | 81.8 | 95.9 | 91.6 | 99.1 | 84.5 | 83.4 | 100 | 81.0 | 88.3 |
Percent medicines adequately labeled | 63.0 | 10.0 | 91.4 | 0.0 | 87.6 | 55.9 | 86.2 | 70.1 | 0.0 | 99.4 | 56.4 |
Percent patients with knowledge of correct doses | 54.0 | 79.3 | 77.7 | 94.0 | 96.1 | 86.5 | 81.7 | 72.1 | 55.0 | 74.3 | 77.1 |
Availability of EML to practitioners | 50.0 | 90.0 | 100 | 80.0 | 100 | 100 | 100 | 50.0 | 100 | 100 | 87 |
Percent key medicines available | 55.0 | 59.2 | 80.0 | 78.3 | 100 | 91.7 | 86.5 | 65.0 | 86.6 | 84.0 | 78.6 |