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Impact of educational and managerial intervention on improving rational use of medicines- results from a tertiary care teaching hospital in Nepal Upadhyay.

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Presentation on theme: "Impact of educational and managerial intervention on improving rational use of medicines- results from a tertiary care teaching hospital in Nepal Upadhyay."— Presentation transcript:

1 Impact of educational and managerial intervention on improving rational use of medicines- results from a tertiary care teaching hospital in Nepal Upadhyay DK, 1,2 Subish P, 1,2* Mishra P, 1,2 Shankar PR, 2 Alam K, 1 Bhandari RB, 1 Bista D 2 *= presenting author 1. Department of Hospital and Clinical Pharmacy, Manipal Teaching Hospital, Pokhara, Nepal. 2. Department of Pharmacology, Manipal Teaching Hospital / Manipal College of Medical Sciences, Pokhara, Nepal

2 Background Irrational drug use is a common problem worldwide Irrational drug use is a common problem worldwide Major reasons being lack of information, promotional strategies by pharmaceutical companies Major reasons being lack of information, promotional strategies by pharmaceutical companies Work load of doctors, Pharmacists etc Work load of doctors, Pharmacists etc Lack of drug information Lack of drug information

3 Cont… Leading to Leading to Non-compliance Non-compliance Increased healthcare cost Increased healthcare cost Drug interactions Drug interactions Adverse drug reactions Adverse drug reactions In Nepal, Irrational use of drugs is a common phenomenon In Nepal, Irrational use of drugs is a common phenomenon Polypharmacy Polypharmacy Use of expired drugs Use of expired drugs Irrational combination of drugs Irrational combination of drugs Overuse of antibiotics, vitamins / herbal remedies, Overuse of antibiotics, vitamins / herbal remedies, Brand prescribing Brand prescribing Retail shop prescribing and unethical dispensing Retail shop prescribing and unethical dispensing

4 Objectives To analyze the prescriptions for rational prescribing and dispensing To analyze the prescriptions for rational prescribing and dispensing To evaluate the patients knowledge regarding use of drugs; as per the INRUD indicators To evaluate the patients knowledge regarding use of drugs; as per the INRUD indicators To evaluate the impact of educational and managerial intervention on improving rational use of medicines in a tertiary care teaching hospital To evaluate the impact of educational and managerial intervention on improving rational use of medicines in a tertiary care teaching hospital

5 Methodology Settings : Out-patient pharmacy, Manipal Teaching Hospital, a 700 bedded tertiary care teaching hospital Settings : Out-patient pharmacy, Manipal Teaching Hospital, a 700 bedded tertiary care teaching hospital Study type: Cross sectional interventional study Study type: Cross sectional interventional study Study duration: Study duration: Preintervention (June - August 2004 ) Preintervention (June - August 2004 ) Intervention Phase (Two years) Intervention Phase (Two years) Post intervention ( June – August 2006) Post intervention ( June – August 2006)

6 Cont… Study tools: INRUD encounter form Study tools: INRUD encounter form Mode of operation Mode of operation Preintervention: Patient interview and prescription review Preintervention: Patient interview and prescription review Intervention: Drug and Therapeutics Committee, detection of medication errors, continuing pharmacy education, and personnel discussion with the pharmacists Intervention: Drug and Therapeutics Committee, detection of medication errors, continuing pharmacy education, and personnel discussion with the pharmacists Post intervention: Similar to pre intervention Post intervention: Similar to pre intervention Total number of patients Total number of patients Preintervention: 247 Preintervention: 247 Post intervention: 247 Post intervention: 247 Uniformly distributed over time and departments Uniformly distributed over time and departments

7 Patient compliance aids

8 Results Patient demography SexPreintervention Post intervention Male49.842.11 Female50.257.89

9 Average number of drugs prescribed DepartmentsPreintervention Post intervention Medicine3.22.8 Dermatology2.62.8 ENT2.92.3 Psychiatry3.42.8 OBG3.42.3 Ophthalmology2.42.8 Orthopedics1.62.2 Others2.92.1

10 Therapeutic category of drugs prescribed Therapeutic classification Preinterventi on Post intervention Dermatological and other topical agents 17.216.99 Central nervous system 1413.78 Antimicrobials12.110.74 Cardiovascular, renal and blood 11.79.46 Antihistamines10.310.42 Analgesics and anti- inflammatory 7.58.97 Vitamins, minerals and dietary supplements 7.46.09

11 Cont… Gastrointestinal system 6.79.13 Respiratory system 3.81.12 Anti diabetics 2.81.76 Hormone and Hormone antagonist 1.80.16 Autonomic nervous system 1.50.32 Anti-parasites0.42.4 Others2.88.49

12 Encounters with an antibiotic prescribed DepartmentsPreintervention Post intervention Medicine5.332.08 Dermatology13.791.60 ENT23.263.04 Psychiatry2.200 OBG17.651.12 Ophthalmology2.781.44 Orthopedics4.760 Others12.202.56

13 Cost analysis Cost NRS Preintervention Post intervention 0-10027.9427.94 101-20030.3629.15 201-30017.0015.38 301-4009.3110.93 401-5004.863.24 500-6004.454.45 >6006.078.91

14 Patient knowledge on proper use of drugs DepartmentsPreintervention Post intervention Medicine59.2100 Dermatology76.5100 ENT40.0100 Psychiatry44.4100 OBG60.0100 Ophthalmology80.0100 Orthopedics69.2100 Others26.2100

15 Key INRUD indicators Indicators Pre intervention Post intervention Average number of drugs per prescription 2.92.53 Number of drugs from Hospital drug list: NA97.9 Number of fixed drug combinations 21.718.8 Number of drugs from Essential drug list of Nepal 29.438.5 Number of drugs from NNF 40.049.5

16 Cont… Indicators Pre intervention Post intervention Number of drugs from EDL WHO 29.44 32.2 32.2 Number of injectable preparations 2.10.2 Number of antibiotics 1011.9 Number of generic drugs prescribed 1517.0 Average cost per prescription 3.26 USD 23.03 USD

17 Discussion No improvement in generic prescribing No improvement in generic prescribing Reduction in polypharmacy Reduction in polypharmacy Reduction in fixed dose combination Reduction in fixed dose combination Improvement in patient understanding Improvement in patient understanding

18 Conclusion Can reduce the prescription cost Can reduce the prescription cost Can improve the patient knowledge Can improve the patient knowledge Educational and managerial intervention can be a powerful tool in developing countries Educational and managerial intervention can be a powerful tool in developing countries

19 Thank you


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