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![Page 1: WHO, Dept. Essential Drugs and Medicines Policy Measuring use of medicines: progress in the last decade Kathleen Holloway and Verica Ivanovska Dept. Essential.](https://reader035.fdocuments.us/reader035/viewer/2022062523/5a4d1af67f8b9ab059981c16/html5/thumbnails/1.jpg)
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
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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
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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
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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
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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
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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
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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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WHO, Dept. Essential Drugs and Medicines Policy 13
Facility types16%
2%
19%
63%
Don't know
Private-no profit
Private-profit
Public
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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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WHO, Dept. Essential Drugs and Medicines Policy 15
Prescriber types
24%
24%25%
6%
11%
1%9%
MDs
MDs/paramedic/nurse
paramedics/nurses
pharmacists/assts
CHWs
laypersons/self
Don't know
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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, Dept. Essential Drugs and Medicines Policy 17
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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WHO, Dept. Essential Drugs and Medicines Policy 18
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, Dept. Essential Drugs and Medicines Policy 19
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, Dept. Essential Drugs and Medicines Policy 20
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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WHO, Dept. Essential Drugs and Medicines Policy 21
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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WHO, Dept. Essential Drugs and Medicines Policy 22
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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WHO, Dept. Essential Drugs and Medicines Policy 23
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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WHO, Dept. Essential Drugs and Medicines Policy 24
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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WHO, Dept. Essential Drugs and Medicines Policy 26
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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WHO, Dept. Essential Drugs and Medicines Policy 27
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)
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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)
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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
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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