Implementing a Drug Use Indicators Study

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Implementing a Drug Use Indicators Study
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Implementing a Drug Use Indicators Study
Objectives

• Identify the importance of drug use indicators
• Know steps to implement an indicator study
• Understand different methods of sampling and data
  collection
• Understand how to analyze a situation using
  indicators
• Present the results of a drug use study

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Types of Drug Use Studies

• Descriptive - Cross-sectional (basic)
• Comparative - Stratified cross-sectional
• Monitoring - To assess change over time
• Evaluation - To evaluate intervention impact

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Types of Indicators

• Prescribing
• Patient Care
• Facility Indicators

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Prescribing Indicators

• Average number of drugs
• Percentage antibiotics
• Percentage injections
• Percentage generic
• Percentage prescribed from Essential Drugs List
  or Formulary

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Patient Care Indicators

• Average consultation time
• Average dispensing time
• Percent drugs dispensed
• Percent drugs adequately labeled
• Patient's knowledge of correct dosage

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Facility Indicators

• Availability of national Essential Drugs List or
  Formulary
• Availability of key drugs

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Steps in an Indicator Study

• Select geographic area
• Select sample of facilities
• Retrospective prescribing data available?
• Simple vs. detailed data form?
• Define criteria for core indicators
• Define complementary indicators

• Describe study procedures
• Select and train personnel
• Pilot test and revise procedures
• Collect data
• Feedback to facilities and managers
• Decide on follow-up studies

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Scope of the Indicators Study

• Depends on
• information needs of managers
• capabilities of record system
• types of providers
• resources available
• Minimum sample
• 20 facilities and 30 prescriptions / 30 patients
  per facility for cross-sectional study
• 100 prescriptions per facility if facilities will
  be compared

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Indicator Sampling Methods

• Selection of Facilities
• Simple Random / Systematic
• Useful to Stratify
• Urban / Rural
• Doctor / Non-doctors
• Health Center / Dispensary
• Government / Mission
• Retrospective Prescribing Data
• Systematic
• Stratified by prescriber?
• Prospective Patient Encounters
• Convenience
• Quota by Health Problem?

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Preparing for a Survey (1)Prescribing Indicators

• Select a sample of facilities
• Decide on a source of data for prescribing
  encounters
• Define types of encounters to include
• Define drugs to be counted as antibiotics
• List drugs to be classified as generic

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Preparing for a Survey (2)Patient Care
Indicators

• Observe logistics of patient care
• Determine how consulting and dispensing times
  will be measured
• Define criteria for adequate patient knowledge
• Describe procedure for evaluating patient
  knowledge

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Preparing for a Survey (3) Facility Indicators

• Determine if national EDL or Formulary exists
• Prepare a short list of key drugs to test
  availability

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Undertaking the Survey Preparation

• Select and train personnel
• Conduct pilot tests
• Select and inform sample sites
• Plan schedule of data collection visits

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Undertaking the Survey Field Activities

• Select a sample of encounters
• Fill in encounter forms
• Observe consultation and dispensing times
• Collect patient knowledge and dispensing
  information
• Fill in facility summary forms
• Present results to staff

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Simple Prescribing Indicators Form
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Detailed Prescribing Indicators Form
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Prescription 1
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Prescription 2
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Prescription 3
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Prescription 4
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Prescription 5
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Prescription 6
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Patient Care Indicators Form
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Health Facility Summary Form
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Facility Indicator Reporting Form
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Indicators Consolidation Form
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Graphs of Indicators Data (1)Sample-Wide
Distribution of Antibiotic Use
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Graphs of Indicators Data (2)Sample-Wide
Distribution of Consulting Times
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Graphs of Indicators Data (3)Facility-Specific
Antibiotic Use
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Graphs of Indicators Data (4)Facility-Specific
Consultation Times
AVERAGE TIME (MINS)
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Steps in an Indicator StudySummary

• Select geographic area
• Select sample of facilities
• Retrospective prescribing data available?
• Simple vs. detailed data form?
• Define criteria for core indicators
• Define complementary indicators

• Describe study procedures
• Select and train personnel
• Pilot test and revise procedures
• Collect data
• Feedback to facilities and managers
• Decide on follow-up studies

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Conclusion

• Undertaking a Drug Use Indicators Study is
  possible in nearly all environments
• The more attention to detail the greater the
  value and accuracy of the survey.

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Lot Quality Sampling Procedure

• Set standard for adequate performance (e.g.
  antibiotic use 30)
• Choose level to be considered inadequate (e.g.
  antibiotic use gt 60)
• Accept error rates - misclassifying poor
  facilities as adequate 5.0 - misclassifying
  good facilities as inadequate 20.0
• Find necessary sample size and critical number of
  "failures" in table (e.g. sample size 16 and
  failures 6)
• Select random sample and count "failures"
• If number of failures is equal to or greater than
  the critical number, facility is inadequate

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LQAS Sampling Table
Number of Failures for Inadequate Performance