estimating drug requirements

Estimating Drug

Requirements

Effective Healthcare !!!

To be effective, healthcare requires a judicious balance of preventive & curative services


This presentation deals with a crucial & deficient input to curative services: AN ADEQUATE SUPPLY OF APPROPRIATE DRUGS


This requires an effective drug supply management system

Components of An Effective Drug Supply Management

1.Selection:

Deciding what drugs are needed


2.Quantification:

Estimating how much of each drug is needed


3.Procurement:

Selecting suppliers, placing & monitoring orders, checking

delivery quantities & quality, & paying suppliers


4.Distribution:

Reception, storage, stock control, transportation, &

record keeping for monitoring & control


5.Use:

Prescription, dispensing & use of drugs, & patients’

compliance with prescriptions

QUANTIFICATION

Quantification should NOT be regarded as a purely computational procedure

Effective quantification requires specific data concerning morbidity & drug use, & fundamental decisions about drugs which are to be available & how they are to be prescribed

Symptoms of Poor Quantification


1. Chronic & widespread shortages of commonly used drugs, despite adequate funding, procurement, & distribution


2. Surpluses of a significant number of commonly used drugs or large surpluses of a smaller number of drugs

This may be due to: Overestimation of certain drugs Poor selection Drugs are NOT appropriate to the morbidity pattern of the population Drugs are NOT in the form or dosage preferred by prescribers or by patients, and therefore remain unused


3. Inequity of supply between different levels of health services; urban based facilities & hospitals are better supplied than rural based facilities

For example, certain levels of service have regular surpluses whereas others have chronic shortages

This leads patients to by-pass the appropriate primary health care level to higher levels; because primary levels are ill-supplied


4. Inadequate cost-effectiveness by failure to use cheaper but equally effective drugs or dosage forms

For example, expensive broad spectrum antibiotics are used when much cheaper penicillin would be just as effective for most patients, the more expensive broad spectrum drugs reserved for resistant cases

Similarly, injectables & other expensive forms are often used where cheaper tablet forms would suffice


5. Irrational adjustment to budgetary constraints, which leads to inadequate irrational order quantities


6. Irrational or ineffective prescribing

Prescribers faced with inadequate or inappropriate drug supplies usually either shorten treatments in an attempt to stretch their insufficient drug supplies as far as possible, or substitute alternative drugs for those in scarce supply

In extreme cases, the treatments are shortened to the point of ineffectiveness, and the alternative drugs used are inappropriate


7. Suppression or distortion of demand

An overall shortage of drugs discourages patients from seeking care & suppresses overall demand

Preparing an Action Plan

Preparing an Action Plan

A. The Preparatory Phase

B. The Quantification Phase

A. The Preparatory Phase

………………………………………….

B. The Quantification Phase

1. Data collection, quantification, costing, reconciliation to budget, calculation of final quantities per 1000 cases

2. Feedback results to managers for placing orders & allocating drugs to individual facilities

3. Provide training in prescribing & stock management

4. Evaluate the quantification process & make any necessary improvements

Methods of Quantification

The Two Methods of Quantification

1. The Patient Morbidity- Standard Treatment Method

(Morbidity Method)

2. The Adjusted Consumption Method(Consumption Method)

Advantages

Morbidity Method

• Does NOT require drug consumption data; useable for new services where such data are NOT available

• Based on rational prescribing; provides a systematic basis for reviewing drug use & prescribing

• Motivates reliable morbidity recording

Consumption Method

• Does not require detailed morbidity data or standard treatment schedules

• Requires less detailed calculations

• Useful in hospitals where health problems are numerous & drug treatments are complex

• Reliable if consumption is well-recorded & stable

• Identifies stock management problems & encourages improvements

Disadvantages

Morbidity Method

• Detailed morbidity data & agreed standard treatment schedules may both present difficulty

• Requires more detailed calculations

• Results may differ significantly from actual drug supply

• Supply will not match use if standard treatments are NOT observed

• Estimates only the quantities needed to dispense to patients

Consumption Method

• Reliable drug consumption data may be difficult to obtain

• Does NOT provide a detailed & systematic basis for reviewing drug use & improving prescribing

• Unreliable if there have been long stock-outs (over 3 months)

• Does NOT encourage good morbidity recording

The Patient Morbidity- Standard Treatment Method

(Morbidity Method)

This method starts from FOUR basic sets of data:

1. Essential drug lists with packaging & price data

2. Pharmaceutical budgets”إدارة التوريد بالمنطقة“ بعد إتمام تحديد الكميات يتم

إعادة ضبطها علىالميزانية المتوفرة

!! متوفرة

This method starts from FOUR basic sets of data:

3. The number of episodes of each health problem treated by the type or types of facilities for which drug requirements are to be estimated (Patient Morbidity Profile)

4. Average standard treatment schedules agreed for each health problem defined

يتم تحديد كل منها على مستوىملفات الوحدة

The Patient Morbidity- Standard Treatment Method

(Morbidity Method)

Morbidity Method

The quantity of drugs given as a standard treatment for each health problem, multiplied by the number of treatment episodes of that problem, gives the total quantity of drugs required for it

Quantity of the drug specified for a

standard course of treatment

X

Number of treatment

episodes of the health problem

Total quantity of a drug

required for a given

health problem

=

Morbidity Method

This calculation is repeated for each health problem & its corresponding drugs

Where a drug is given for MORE than ONE health problem, the respective totals are added together to obtain the total quantity required

Morbidity Method

To give the average drug requirements per 1,000 treatment episodes, the total quantity of each drug is divided by the total number of treatment episodes of all kinds, expressed in thousands

Morbidity Method

B. The Quantification Phase Using Morbidity Method

1. Draw up average standard drug treatment schedule for quantification

2. Tabulate number of episodes of treatment for each health problem. Or, if data not available, conduct a sample survey & estimate total number of episodes of treatment


3. Calculate quantities required of each drug

4. Estimate cost of drug quantities required

5. Reconcile quantities to budget if necessary


6. Calculate drugs required per 1000 treatment episodes OR per 1000 patient contacts

7. Feed back reults to managers for placing orders & allocating drugs to individual facilities


8. Provide prescribing control guidelines & stock management guidelines & training

9. Evaluate the quantification process & make any necessary improvements

1. Preparing Average Standard Treatment Schedules

The following steps are described assuming that prescribing is rational


Clinical Treatment Schedule

1. Intended to help clinical staff decide on the drug treatments to be given to individual patients

2. They must therefore specify all the nuances of diagnosis which require a variation in treatment for individual patients; i.e. diagnosis, severity, age, body weight, general health status, drug resistance, etc.

3. Does NOT need elaborate description of drug dosage forms

Average Treatment Schedule

1. Used for quantification of drug needs

2. Need NOT be precise

3. An AVERAGE is enough

4. It is NOT specific for clinical guidance

5. It must specify selection & dosage of drugs for patients of different age & disease severity


Average & clinical drug treatment schedules are of course related

Average schedules are valid ONLY IF the represent the average treatments which will actually be used clinically

For the quantification method to have an actual effect, clinical staff should (must) be committed to the used clinical guideline


The schedules will only be effective if prescribers are trained in their use, and actually apply them

There should be continuous monitoring & feedback on what is actually happening

Remember: Morbidity method estimates ONLY the quantities needed

to dispense to patients

It does not take losses or wastage into consideration

N.B. It is important that physicians &

other higher level health service staff should be REASSURED that

average treatment schedules do NOT infringe on their clinical freedom

to adapt the drug dosages to the needs of individual patients

Examples!!


Examples:

Suppose that the standard treatment for iron deficiency anemia (ICD-10 ) should be 84 tablets of ferrous sulphate, if prescribers continue to give 120 tablets, then the average does NOT reflect reality


Examples:

The average standard treatment for a mild case of malaria in adults is ten 150 mg base tablets of chloroquine

This average allows for & reflects variations in the courses of drug treatments prescribed for individual patients

Items of Average Drug Treatment Schedule

1. The name of the health problem, and the ICD-10 number(s) of diagnosis it includes

2. The generic name, dosage form & strength of each drug to be used in the treatment


3. The average dose

4. The average number of doses per day


5. The average number of days these doses are to be given

6. The total average quantity of each drug used for a standard course of treatment; for acute conditions. The total quantity given per prescription for chronic conditions


In general; two age groups should be distinguished (below five years, & five years and older)

The severity of the disease should ONLY be included in the average drug treatment schedules if a more severe case would need a different drug

Before You Start;

1. Selection of drugs is based on Essential Medicines List; bearing in mind the diagnostic & treatment capabilities to administer each treatment schedule

2. More detailed clinical criteria must be applied to each health problem to determine the most appropriate average dosage form and drug quantity

Before You Start;

3. Consider the physical feasibility of administering the proposed average treatment, e.g. injection versus tablets

4. Average treatments which go against cultural preferences may be far more effective or cost-effective, but they must be explained & made acceptable to prescribers & patients

Ideally, reviewing average treatment schedules requires cooperation from:

Experienced health service staff from the type of facility for which the treatment schedules are intended, who are familiar with diagnostic possibilities & prescribing patterns, & ca advise on what is feasible in practice

1


Experienced senior clinicians in different fields, who can advise on the treatments which they consider most effective

2


Pharmacists & administrators who can point out technical requirements, such as special storage conditions & ensure that costs are also borne in mind, so that proposed treatments are not only effective but also cost-effective

3

Illustrative Standard

Treatment for Quantification

of Drug Requirements

Based on Average Doses

ICDIndicati

onDrugs Dose

Times per

Day

Number of Days

Amount per

Course of

Treatment

1- Infections & Parasitic DiseasesBacterial Infections & Zoonosis

001 Cholera

Adults Tetracycline 250 mg 2 caps 4 3 24

O.R.S.As

required

Assume 4

sachets

Children

Co-trimoxazole tab 1 tab 2 3 6Examples in this presentation are hypothetical

and NOT based on systematic search

ICD-10 Code

2. Preparing Number of Treatment Episodes of Each Health Problem

Watch the difference !!!!!!!!

Treatment Episode:

A patient contact for which a standard course of drug treatment is required

2. Preparing Number of Treatment Episodes of Each Health Problem

estimating drug requirements

Health & Medicine

placing orders

quantification process

standard treatment method

total quantity

standard treatment

health problem

morbidity method

patient morbidity