Impact evaluation of self monitoring of drug use indicators in health facilities
Experiences from Gunungkidul, Indonesia
Sunartono, Darminto, Suryawati S, Prawitasari J, Bimo, Santoso B
INRUD - INDONESIA
Self monitoring of drug utilization has been implemented for 3 years in Gunungkidul District, to improve the quality use of medicine in health facilities.
The activities of this program are still maintained so far.
Its impact on prescribing pattern, however, has not been evaluated.
To evaluate the impact of drug use monitoring on prescribing practices in health facilities.
Quantitative data: prospective data collection of drug use indicators in health facilities every month from 1992 to 1996.
Qualitative data: interview with district staff, prescribers and dispensers in health facilities.
Development & implementation of self monitoring program
1. Initial workshop at district health office to introduce WHO drug use indicators to district personnel.
2. Quantitative study to collect data to measure the drug use indicators in health centres.
3. Identification of priority drug utilization problems.
4. Qualitative studies involving prescribers, dispensers and consumers to explore the underlying motivating factors of drug utilization problems.
5. Workshop at district health office to analyze the quantitative and qualitative findings.
6. Establishment of district team assigned as supervisory team for drug use in health facilities.
7. Development monitoring tools (qualitative and quantitative).
8. Field testing of the monitoring activities at 4 selected health centres for 3 months.
9. Dissemination of field testing results.
10. Implementation in health facilities throughout the district.
Drug use monitoring activities
Monthly data collection of drug use indicators in health facilities.
Review and feedback of drug indicator data by all prescribers in health facilities.
Review data at district levels and comparison between health facilities by the assigned district team.
Feedback and supervision by district team to health facilities at least every 3 months.
Drug use monitoring indicators
Drug use indicators are monitored utilizing a Local Area Monitoring format:
Average number of drug per encounter.
Percentage of encounters with an antibiotic prescribed.
Percentage of encounters with an injection prescribed.
Economic implication & qualitative findings
Economic and supply implication:
Reduction of drug items procured by 17% and increased coverage of drug supply from 9 months to 12 months in average.
Willingness to improve skills and knowledge for better treatment.
Improve the drug planning processes.
Improve relationship between district team and health centres.
The monitoring program has been proven feasible to be implemented at the district health management system.
The program has been proven effective in reducing inappropriate use of drugs.
There is also evidence that the program has improved procurement efficiency in terms of
improved supply and the number of drug items being procured.