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Evolving Systems For Rational Drug Use In Public Health Facilities In KwaZulu Natal, South Africa By Cassimjee M , Kha

Evolving Systems For Rational Drug Use In Public Health Facilities In KwaZulu Natal, South Africa By Cassimjee M , Khan R, Ramasir K, Moolman M. Progressions in Pursuing RDU 1994 to 2004. Pre era of DTCs & Essential Medicine Programme (EMP): 1994

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Evolving Systems For Rational Drug Use In Public Health Facilities In KwaZulu Natal, South Africa By Cassimjee M , Kha

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  1. Evolving Systems For Rational Drug Use In Public Health Facilities In KwaZulu Natal,South Africa By Cassimjee M, Khan R, Ramasir K, Moolman M

  2. Progressions in Pursuing RDU 1994 to 2004 • Pre era of DTCs & Essential Medicine Programme (EMP): 1994 • Formation of a DTC: March 1996. Served 3 Hospitals and spread to the district • Production of PHC Standard Treatment Guidelines (STGs) & Essential Medicine List (EML): First Edition May 1996 • Launch of the EMP for all levels of Care: May 1999 in KZN •  5 years post EMP launch: Gaps for service provision & for practising RDU

  3. Average Monthly Usage Costs of Amoxycillin & Cephradine R e g i o n a l H o s p i t a l

  4. Microbial Resistance Numbers(Regional Hospital ) E.Coli resistant to Cephalo-sporin amongst resistant organism: 09/94.

  5. Av Monthly Usage of Long Acting ACEIs

  6. Baseline Indicators Used in OPD: August 2003 PHC Clinic District Hospital Region-al Hosp Core Concepts of the EMP - “Questionnaire” (Percent) 90 40 25 Average number of drugs per encounter 2.3 3 3.6 Percentage of drugs prescribed generically 54.4 34.8 0 Percentage of encounters with an antibiotic 53.3 36.7 6.7 Percentage of injections prescribed per encounters of sample 6.7 30 6.7 Percentage of drugs prescribed according to the STGs –EDL 14.5 13.5 6.4 Problem Areas: Percentage Score Correct Prescribing of Antibiotic (A=Amoxycillin) or Injection (I = Diclophenac sod) or a Statin (S= Atorvastatin /Simvastatin) 50 (A) 0 (I) 3.9 (S) Availability of EML Items 95 100 100 = Area of Concern

  7. Immediate Interventions • Reports of the baseline evaluations, furnished to the facility clinical manager, included:- • DURs for problematic drugs to verify usage • Recommendations with respect to all aspects of the tests • Data on how to investigate drug use in health facilities • Sought workplan strategies from district manager to monitor progress or regression

  8. Monitor’s Strategies • Top management involvement  endorsement of process & for referee function. • Communications broadened: Email, telephonic & face-to-face support. • Audits: Inputs from manager to identify possible misuse/irrational prescribing • Facility to determine the process: to follow for correction of the problems • Measure or map the outcomes

  9. Results of Pilot Sites: Baseline (8/2003) & Post (3/2004) Study = Area of Concern = Marked Improvement after intervention = Some Improvement after an intervention  = Change in person answering questions.  = to be read with compliance to STGs

  10. District Hospital Facility Monitoring Tool An audit of 50 prescriptions – randomly selected (Hardy, B: Nov 2003)

  11. Distant Support - District Hospital • Baseline DUR for the statins (from 01 Jan to July 2003)  high usage • Problems identified:- • Prescribed outside the specialist prescriber level & outside STGs. Non drug measures & biochemical monitoring not followed. • 99 units p.m.  2.34% of patients on statins • Cost per month (determined over 7 months) = R18,851. Results - Statin Usage

  12. Conclusion • Almost five years after the launch of the EMP, non-compliance was evident by the low scores atttained in the pre-test with some improvement in the post-tests. • An EMP with EML & STGs do not in themselves promote RDU • Appropriate interventions for the province & its health facilities, considering their level of development, physical accessibility, busy personnel schedules and demands are very necessary. • Therefore…........

  13. Systems Needed to Promote RDU • An EMP with EML & STGs • DTCs at all levels: National, provincial, districts and at health facilities. • Educators: Inculcation of EMP at college level and into the curriculum. • Promoters, marketers and monitors • To facilitate educational workshops within establishments  to bridge gaps and build in continuity for annual and other changes in staff. • Dedicated provincial person/s to promote, evaluate & assist district teams using an ambassadorial approach. • Finely tuned communication systems  bulletins, minutes, network groups, electronic and face-to-face. • Accountable management team within health facilities to perform audits and feedback. • Sustainable “EML” medicine supply

  14. Acknowledgements & Thanks • RPM-Plus: opportunities presented to attend workshops to learn & to network • Ramasir, K: Ugu District Pharmacy Manager – facilitator & active participator for field tests & co-monitoring. • Moolman, M: Active DTC Course Attendant & Pharmacy Manager (2003) • Khan, A R: Mentorship • Liebenberg, L: Infection Control Team of 1996 - 1998 • Hardy, B: Monitoring Tool • Management and staff of the Ugu district at a PHC clinic, a district hospital and a regional hospital. • The KZN Department of Health: Endorsement of EMP Compliance tests.

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