who, dept. essential drugs and medicines policy measuring use of medicines: progress in the last...
DESCRIPTION
WHO, Dept. Essential Drugs and Medicines Policy3 Criteria for inclusion of study in database Quantitative data on drug use Descriptive and intervention studies Developing and transitional countries Primary health care patients –primary health care clinics –hospital general & paeds non-specialist outpatients –pharmacies, drug sellers and households Articles in English, French, Spanish, Russian Reported/published duringTRANSCRIPT
WHO, Dept. Essential Drugs and Medicines Policy
Measuring use of medicines:progress in the last decade
Kathleen Holloway and Verica Ivanovska
Dept. Essential Drugs and Medicines PolicyWHO Geneva
ICIUM, March 30 – April 2, 2004
WHO, Dept. Essential Drugs and Medicines Policy 2
WHO database of all drug use surveys done in developing countries 1993-2003
Objectives• To provide an overview of drug use
– existing drug use patterns in primary health care settings in developing and transitional countries over time
• To identify effective interventions and trends– impact of different types of interventions on improving the use of
drugs
• To provide evidence for advocacy, planning– tool for routine monitoring nationally & internationally
WHO, Dept. Essential Drugs and Medicines Policy 3
Criteria for inclusion of study in database
• Quantitative data on drug use• Descriptive and intervention studies• Developing and transitional countries• Primary health care patients
– primary health care clinics– hospital general & paeds non-specialist outpatients– pharmacies, drug sellers and households
• Articles in English, French, Spanish, Russian• Reported/published during 1993-2003
WHO, Dept. Essential Drugs and Medicines Policy 4
Methods• Search strategy
– INRUD bibliography & WHO archives 1993-2003• Retrieval strategy
– WHO library resources• Database format
– Access, compatible with other WHO databases• Data entry
– one record per published survey divided again by country, health facility type/level, prescriber type
• Data analysis – Time series & comparisons between sectors, regions, etc– Export into excel and later into statistical packages
WHO, Dept. Essential Drugs and Medicines Policy 5
Design of the database• 1st section on demographic detail
– country, year of survey, publication reference, healthcare setting, prescriber/dispenser type, patient/disease type
• 2nd section on types of interventions – provider education, printed materials, supervision & audit,
economic strategies, regulation, essential drug programs
• 3rd section on methodological details– study design, sample sizes (prescriptions, facilities,
patients), data collection
• 4th section on drug use indicators – WHO/INRUD indicators, IMCI and specific disease
indicators, mortality rates, additional indicators
WHO, Dept. Essential Drugs and Medicines Policy 6
Current status• INRUD bibliography
– 3080 articles screened 1993-2003– 207 (7%) articles met the inclusion criteria
• WHO/Essential Drugs & Medicines archives– 67 unpublished articles/reports 1993-2003 entered
• WHO/Child Adolescent Health archives– 71 unpublished articles/reports 1993-2003 entered
• 441 data records entered in the database– about half surveys done to evaluate an intervention
WHO, Dept. Essential Drugs and Medicines Policy 8
Methodological challenges• Some surveys published in more than one
article, sometimes with inconsistent results• Standard indicators often not used• Missing data
– survey year, facility type, facility level, prescriber type• Data sometimes difficult to classify
– indicators sometimes poorly described– drug use reported for a mix of facility / prescriber type– description of study design in article descriptions not
consistent with database definitions• time series stated but 4 data points not described• “retrospective” interviews/observation described
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Facility types16%
2%
19%
63%
Don't know
Private-no profit
Private-profit
Public
WHO, Dept. Essential Drugs and Medicines Policy 14
Facility level
32%
50%
13%
5%
Hospital OPD / PHC
Primary health care
Pharmacy / drug seller
Household
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Prescriber types
24%
24%25%
6%
11%
1%9%
MDs
MDs/paramedic/nurse
paramedics/nurses
pharmacists/assts
CHWs
laypersons/self
Don't know
WHO, Dept. Essential Drugs and Medicines Policy 16
Intervention types844 interventions in 204 study sites
38.3%
10.5%25.1%
7.6%
2.2%1.1%
7.2%
7.6% 0.4% Provider education
Consumer education
Printed materials
Supervision & audit
Community case mgt
Group process
Economic strategies
Essential drug prog
Regulation
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WHO/INRUD Prescribing Indicators
0
10
20
30
40
50
60
70
80
90
100
<1992 1992-5 1996-9 2000-3
% p
atie
nts
/ % d
rugs
0
1
2
3
4
5
Av.
no.d
rugs
/ pa
tient
% patients pres antibiotic(n=24,63,56,29)
% patients pres injections(n=15,48,56,14)
% pres drugs on the EDL(n=3,33,41,12)
% generic drugs pres(n=11,43,40,12)
% treatments STGcompliant (n=6,11,7,6)
Av.no.drugs/patient(n=24,69,60,19)
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10-year trends in antibiotic & injection use
010203040506070
88 89 90 91 92 93 94 95 96 97 98 99 00 01 02
% patients pres AB % patients pres inj.N= 9 per year (on average)
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WHO/INRUD patient care indicators
0102030405060708090
100
<1992 1992-51996-92000-3
% d
rugs
/ %
pat
ient
s
012345678910
time
(min
s)
% pres drugsdispensed (n=3,17,27,7)
% drugs adeq labelled(n=0,12,23,6)
% patients knowingdosing (n=4,16,20,10)
Av.consultation time(n=4,19,16,2)
Av.dispensing time(n=3,15,16,2)
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WHO/INRUD facility indicators
020406080
100
<1992 1992-5 1996-9 2000-3
% key drug availability (n=9,20,25,10)% facilities with EDL (n=1,11,11,4)% facilities with STGs (n=0,3,5,2)
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Public/private prescribing for all years
020406080
100
Av.no.drugsper patient x
10
% patientsprescribedantibiotics
% patientsprescribedinjections
% presdrugs on
EDL
% genericdrugs
prescribed
Public (n=55-118) Private-no-profit (n=3-7)Private for profit (n=19-34)
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Public / private patient care for all years
020406080
100120
Av.consult(minsx10)
Av.dispensing
(secs)
% presdrugs
dispensed
% drugsadeq
labelled
% patientsknowingdosing
Public (n=25-38) Private-no-profit (n=2-3)Private for profit (n=3-7)
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Prescribing by prescriber type for all years
0 20 40 60 80 100
Av.no.drugs/Px x 10
% patients pres AB
% patients pres inj.
% pres EDL drugs
% pres generics
% STG compliance
Doctor (n=6-58) Paramedic (n=20-96)
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ARI treatment in last decade
0102030405060708090
<1992 1992-5 1996-9 2000-3
% A
RI c
ases
trea
ted
AB for viral URTI(n=7,21,13,8)
AB for pneumonia(n=3,19,7,27)
Cough syrup(n=3,6,4,2)
STG compliance(n=2,14,5,21)
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ARI treatment by region for all years
0
20
40
60
80
100
% AB use inviral URTI(n=8-25)
% AB use inpneumonia(n=11-26)
% Coughsyrup use(n=1-11)
% STGcompliance
(n=9-17)
% Key drugavailability
(n=4-15)
Africa Asia Latin America
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Diarrhoea treatment in last decade
0
10
20
30
40
50
60
70
<1992 1992-5 1996-9 2000-3
% d
iarr
hoea
cas
es tr
eate
d
ORS(n=12,24,13,25)
Antibiotics(n=10,23,12,8)
Antidiarrhoeals(n=7,19,12,7)
STG compliance(n=3,27,9,17)
WHO, Dept. Essential Drugs and Medicines Policy 28
Public/private diarrhoea treatment for all years
0
10
20
3040
50
60
70
ORS Antibiotics Antidiarrhoeals STGcompliance
% d
iarr
hoea
cas
es tr
eate
d
Public (n=24-50) Private for profit (n=5-23)
WHO, Dept. Essential Drugs and Medicines Policy 31
ConclusionsUses of WHO database of drug use surveys• track drug use over time and between countries
– plan future strategy & evaluate past strategy– identify effective interventions and policies– routine monitoring and evidence-based advocacy
Initial findings over the last decade• Few surveys and even fewer interventions done,
mostly in the public sector• Irrational drug use remains a very serious problem• Increased antibiotic use and decreased injection use• Prescribing often better in public than private sectors
WHO, Dept. Essential Drugs and Medicines Policy 32
Thank you• Prof. Dennis Ross-Degnan
– For constant support and advice throughout with regard to database design and analysis
• Jorge Hetzke– For help designing and maintaining the database
• Richard Laing and Hans Hogerzeil– Advice and support
• All authors around the world– For clarifying their studies for us