Estimating Drug Requirements
Effective Healthcare !!! <ul><li>To be effective, healthcare requires a judicious balance of preventive & curative service...
Effective Healthcare !!! <ul><li>This presentation deals with a crucial & deficient input to curative services:  AN ADEQUA...
Effective Healthcare !!! <ul><li>This requires an effective drug supply management system </li></ul>
Components of An Effective Drug Supply Management  <ul><li>Selection:   </li></ul><ul><li>Deciding what drugs are needed <...
Components of An Effective Drug Supply Management   <ul><li>Quantification:  </li></ul><ul><li>Estimating how much of each...
Components of An Effective Drug Supply Management   <ul><li>Procurement:  </li></ul><ul><li>Selecting suppliers, placing &...
Components of An Effective Drug Supply Management   <ul><li>Distribution:  </li></ul><ul><li>Reception, storage, stock con...
Components of An Effective Drug Supply Management   <ul><li>Use:  </li></ul><ul><li>Prescription, dispensing & use of drug...
QUANTIFICATION <ul><li>Quantification should  NOT  be regarded as a purely computational procedure </li></ul><ul><li>Effec...
Symptoms of  Poor Quantification
Symptoms of Poor Quantification <ul><li>Chronic & widespread shortages of commonly used drugs, despite adequate funding, p...
Symptoms of Poor Quantification <ul><li>Surpluses of a significant number of commonly used drugs or large surpluses of a s...
Symptoms of Poor Quantification <ul><li>Inequity of supply between different levels of health services; urban based facili...
Symptoms of Poor Quantification <ul><li>Inadequate cost-effectiveness by failure to use cheaper but equally effective drug...
Symptoms of Poor Quantification <ul><li>Irrational adjustment to budgetary constraints, which leads to inadequate irration...
Symptoms of Poor Quantification <ul><li>Irrational or ineffective prescribing </li></ul><ul><ul><li>Prescribers faced with...
Symptoms of Poor Quantification <ul><li>Suppression or distortion of demand  </li></ul><ul><ul><li>An overall shortage of ...
Preparing an Action Plan
Preparing an Action Plan <ul><li>The Preparatory Phase </li></ul><ul><li>The Quantification Phase </li></ul>
<ul><li>The Preparatory Phase </li></ul><ul><li>………………………………………… . </li></ul>
<ul><li>The Quantification Phase </li></ul><ul><li>Data collection, quantification, costing, reconciliation to budget, cal...
Methods of Quantification
The Two Methods of Quantification <ul><li>The Patient Morbidity- Standard Treatment Method </li></ul><ul><li>(Morbidity Me...
Advantages  <ul><li>Morbidity Method </li></ul><ul><li>Does NOT require drug consumption data; useable for new services wh...
Disadvantages  <ul><li>Morbidity Method </li></ul><ul><li>Detailed morbidity data & agreed standard treatment schedules ma...
The Patient Morbidity- Standard Treatment Method (Morbidity Method) <ul><li>This method starts from  FOUR  basic sets of d...
<ul><li>This method starts from  FOUR  basic sets of data: </li></ul><ul><ul><li>The number of episodes of each health pro...
Morbidity Method <ul><li>The  quantity  of drugs given as a standard treatment for each health problem, multiplied by the ...
Morbidity Method Quantity of the drug  specified for a  standard course  of treatment X Number of  treatment  episodes of ...
<ul><li>This calculation is repeated for each health problem & its corresponding drugs </li></ul><ul><li>Where a drug is g...
<ul><li>To give the average drug requirements per 1,000 treatment episodes, the total quantity of each drug is divided by ...
<ul><li>The Quantification Phase Using Morbidity Method </li></ul><ul><li>Draw up average standard drug treatment schedule...
<ul><li>The Quantification Phase Using Morbidity Method </li></ul><ul><li>Calculate quantities required of each drug </li>...
<ul><li>The Quantification Phase Using Morbidity Method </li></ul><ul><li>Calculate drugs required per 1000 treatment epis...
<ul><li>The Quantification Phase Using Morbidity Method </li></ul><ul><li>Provide prescribing control guidelines & stock m...
<ul><li>Preparing Average Standard Treatment Schedules </li></ul><ul><li>The following steps are described assuming that  ...
<ul><li>Preparing Average Standard Treatment Schedules </li></ul><ul><li>Clinical Treatment Schedule </li></ul><ul><li>Int...
<ul><li>Preparing Average Standard Treatment Schedules </li></ul><ul><li>Average & clinical drug treatment schedules are o...
<ul><li>Preparing Average Standard Treatment Schedules </li></ul><ul><li>The schedules will  only  be effective if prescri...
<ul><li>Remember: </li></ul><ul><li>Morbidity method estimates  </li></ul><ul><li>ONLY   the quantities needed </li></ul><...
<ul><li>N.B. </li></ul><ul><li>It is important that physicians &  </li></ul><ul><li>other higher level health service staf...
Examples!!
<ul><li>Preparing Average Standard Treatment Schedules </li></ul><ul><li>Examples: </li></ul><ul><ul><li>Suppose that the ...
<ul><li>Preparing Average Standard Treatment Schedules </li></ul><ul><li>Examples: </li></ul><ul><ul><li>The average stand...
Items of Average Drug Treatment Schedule <ul><li>The name of the health problem, and the ICD-10 number(s) of diagnosis it ...
Items of Average Drug Treatment Schedule <ul><li>The average dose </li></ul><ul><li>The average number of doses per day </...
Items of Average Drug Treatment Schedule <ul><li>The average number of days these doses are to be given </li></ul><ul><li>...
Items of Average Drug Treatment Schedule <ul><li>In general; two age groups should be distinguished (below five years, & f...
Before You Start; <ul><li>Selection of drugs is based on Essential Medicines List; bearing in mind the diagnostic & treatm...
Before You Start; <ul><li>Consider the  physical feasibility  of administering the proposed average treatment, e.g. inject...
Ideally, reviewing average treatment schedules requires cooperation from: <ul><li>Experienced health service staff from th...
Ideally, reviewing average treatment schedules requires cooperation from: <ul><li>Experienced senior clinicians in differe...
Ideally, reviewing average treatment schedules requires cooperation from: <ul><li>Pharmacists & administrators who can poi...
Illustrative Standard Treatment for Quantification of Drug Requirements Based on Average Doses
Examples in this presentation are hypothetical  and NOT based on systematic search 6 3 2 1 tab Co-trimoxazole tab Children...
ICD-10 Code
<ul><li>Preparing Number of Treatment Episodes of Each Health Problem </li></ul>Watch the  difference !!!!!!!!
<ul><li>Treatment Episode: </li></ul><ul><ul><li>A patient contact for which a standard course of drug treatment is requir...
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Estimating drug requirements

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Estimating drug requirements

  1. 1. Estimating Drug Requirements
  2. 2. Effective Healthcare !!! <ul><li>To be effective, healthcare requires a judicious balance of preventive & curative services </li></ul>
  3. 3. Effective Healthcare !!! <ul><li>This presentation deals with a crucial & deficient input to curative services: AN ADEQUATE SUPPLY OF APPROPRIATE DRUGS </li></ul>
  4. 4. Effective Healthcare !!! <ul><li>This requires an effective drug supply management system </li></ul>
  5. 5. Components of An Effective Drug Supply Management <ul><li>Selection: </li></ul><ul><li>Deciding what drugs are needed </li></ul>
  6. 6. Components of An Effective Drug Supply Management <ul><li>Quantification: </li></ul><ul><li>Estimating how much of each drug is needed </li></ul>
  7. 7. Components of An Effective Drug Supply Management <ul><li>Procurement: </li></ul><ul><li>Selecting suppliers, placing & monitoring orders, checking delivery quantities & quality, & paying suppliers </li></ul>
  8. 8. Components of An Effective Drug Supply Management <ul><li>Distribution: </li></ul><ul><li>Reception, storage, stock control, transportation, & record keeping for monitoring & control </li></ul>
  9. 9. Components of An Effective Drug Supply Management <ul><li>Use: </li></ul><ul><li>Prescription, dispensing & use of drugs, & patients’ compliance with prescriptions </li></ul>
  10. 10. QUANTIFICATION <ul><li>Quantification should NOT be regarded as a purely computational procedure </li></ul><ul><li>Effective quantification requires specific data concerning morbidity & drug use, & fundamental decisions about drugs which are to be available & how they are to be prescribed </li></ul>
  11. 11. Symptoms of Poor Quantification
  12. 12. Symptoms of Poor Quantification <ul><li>Chronic & widespread shortages of commonly used drugs, despite adequate funding, procurement, & distribution </li></ul>
  13. 13. Symptoms of Poor Quantification <ul><li>Surpluses of a significant number of commonly used drugs or large surpluses of a smaller number of drugs </li></ul><ul><li>This may be due to: </li></ul><ul><ul><li>Overestimation of certain drugs </li></ul></ul><ul><ul><li>Poor selection </li></ul></ul><ul><ul><li>Drugs are NOT appropriate to the morbidity pattern of the population </li></ul></ul><ul><ul><li>Drugs are NOT in the form or dosage preferred by prescribers or by patients, and therefore remain unused </li></ul></ul>
  14. 14. Symptoms of Poor Quantification <ul><li>Inequity of supply between different levels of health services; urban based facilities & hospitals are better supplied than rural based facilities </li></ul><ul><ul><li>For example, certain levels of service have regular surpluses whereas others have chronic shortages </li></ul></ul><ul><ul><li>This leads patients to by-pass the appropriate primary health care level to higher levels; because primary levels are ill-supplied </li></ul></ul>
  15. 15. Symptoms of Poor Quantification <ul><li>Inadequate cost-effectiveness by failure to use cheaper but equally effective drugs or dosage forms </li></ul><ul><ul><li>For example, expensive broad spectrum antibiotics are used when much cheaper penicillin would be just as effective for most patients, the more expensive broad spectrum drugs reserved for resistant cases </li></ul></ul><ul><ul><li>Similarly, injectables & other expensive forms are often used where cheaper tablet forms would suffice </li></ul></ul>
  16. 16. Symptoms of Poor Quantification <ul><li>Irrational adjustment to budgetary constraints, which leads to inadequate irrational order quantities </li></ul>
  17. 17. Symptoms of Poor Quantification <ul><li>Irrational or ineffective prescribing </li></ul><ul><ul><li>Prescribers faced with inadequate or inappropriate drug supplies usually either shorten treatments in an attempt to stretch their insufficient drug supplies as far as possible, or substitute alternative drugs for those in scarce supply </li></ul></ul><ul><ul><li>In extreme cases, the treatments are shortened to the point of ineffectiveness, and the alternative drugs used are inappropriate </li></ul></ul>
  18. 18. Symptoms of Poor Quantification <ul><li>Suppression or distortion of demand </li></ul><ul><ul><li>An overall shortage of drugs discourages patients from seeking care & suppresses overall demand </li></ul></ul>
  19. 19. Preparing an Action Plan
  20. 20. Preparing an Action Plan <ul><li>The Preparatory Phase </li></ul><ul><li>The Quantification Phase </li></ul>
  21. 21. <ul><li>The Preparatory Phase </li></ul><ul><li>………………………………………… . </li></ul>
  22. 22. <ul><li>The Quantification Phase </li></ul><ul><li>Data collection, quantification, costing, reconciliation to budget, calculation of final quantities per 1000 cases </li></ul><ul><li>Feedback results to managers for placing orders & allocating drugs to individual facilities </li></ul><ul><li>Provide training in prescribing & stock management </li></ul><ul><li>Evaluate the quantification process & make any necessary improvements </li></ul>
  23. 23. Methods of Quantification
  24. 24. The Two Methods of Quantification <ul><li>The Patient Morbidity- Standard Treatment Method </li></ul><ul><li>(Morbidity Method) </li></ul><ul><li>The Adjusted Consumption Method </li></ul><ul><li>(Consumption Method) </li></ul>
  25. 25. Advantages <ul><li>Morbidity Method </li></ul><ul><li>Does NOT require drug consumption data; useable for new services where such data are NOT available </li></ul><ul><li>Based on rational prescribing; provides a systematic basis for reviewing drug use & prescribing </li></ul><ul><li>Motivates reliable morbidity recording </li></ul><ul><li>Consumption Method </li></ul><ul><li>Does not require detailed morbidity data or standard treatment schedules </li></ul><ul><li>Requires less detailed calculations </li></ul><ul><li>Useful in hospitals where health problems are numerous & drug treatments are complex </li></ul><ul><li>Reliable if consumption is well-recorded & stable </li></ul><ul><li>Identifies stock management problems & encourages improvements </li></ul>
  26. 26. Disadvantages <ul><li>Morbidity Method </li></ul><ul><li>Detailed morbidity data & agreed standard treatment schedules may both present difficulty </li></ul><ul><li>Requires more detailed calculations </li></ul><ul><li>Results may differ significantly from actual drug supply </li></ul><ul><li>Supply will not match use if standard treatments are NOT observed </li></ul><ul><li>Estimates only the quantities needed to dispense to patients </li></ul><ul><li>Consumption Method </li></ul><ul><li>Reliable drug consumption data may be difficult to obtain </li></ul><ul><li>Does NOT provide a detailed & systematic basis for reviewing drug use & improving prescribing </li></ul><ul><li>Unreliable if there have been long stock-outs (over 3 months) </li></ul><ul><li>Does NOT encourage good morbidity recording </li></ul>
  27. 27. The Patient Morbidity- Standard Treatment Method (Morbidity Method) <ul><li>This method starts from FOUR basic sets of data: </li></ul><ul><ul><li>Essential drug lists with packaging & price data </li></ul></ul><ul><ul><li>Pharmaceutical budgets </li></ul></ul>” إدارة التوريد بالمنطقة“ بعد إتمام تحديد الكميات يتم إعادة ضبطها على الميزانية المتوفرة متوفرة !!
  28. 28. <ul><li>This method starts from FOUR basic sets of data: </li></ul><ul><ul><li>The number of episodes of each health problem treated by the type or types of facilities for which drug requirements are to be estimated ( Patient Morbidity Profile ) </li></ul></ul><ul><ul><li>Average standard treatment schedules agreed for each health problem defined </li></ul></ul>يتم تحديد كل منها على مستوى ملفات الوحدة The Patient Morbidity- Standard Treatment Method (Morbidity Method)
  29. 29. Morbidity Method <ul><li>The quantity of drugs given as a standard treatment for each health problem, multiplied by the number of treatment episodes of that problem, gives the total quantity of drugs required for it </li></ul>
  30. 30. Morbidity Method Quantity of the drug specified for a standard course of treatment X Number of treatment episodes of the health problem Total quantity of a drug required for a given health problem =
  31. 31. <ul><li>This calculation is repeated for each health problem & its corresponding drugs </li></ul><ul><li>Where a drug is given for MORE than ONE health problem, the respective totals are added together to obtain the total quantity required </li></ul>Morbidity Method
  32. 32. <ul><li>To give the average drug requirements per 1,000 treatment episodes, the total quantity of each drug is divided by the total number of treatment episodes of all kinds, expressed in thousands </li></ul>Morbidity Method
  33. 33. <ul><li>The Quantification Phase Using Morbidity Method </li></ul><ul><li>Draw up average standard drug treatment schedule for quantification </li></ul><ul><li>Tabulate number of episodes of treatment for each health problem. Or, if data not available, conduct a sample survey & estimate total number of episodes of treatment </li></ul>
  34. 34. <ul><li>The Quantification Phase Using Morbidity Method </li></ul><ul><li>Calculate quantities required of each drug </li></ul><ul><li>Estimate cost of drug quantities required </li></ul><ul><li>Reconcile quantities to budget if necessary </li></ul>
  35. 35. <ul><li>The Quantification Phase Using Morbidity Method </li></ul><ul><li>Calculate drugs required per 1000 treatment episodes OR per 1000 patient contacts </li></ul><ul><li>Feed back reults to managers for placing orders & allocating drugs to individual facilities </li></ul>
  36. 36. <ul><li>The Quantification Phase Using Morbidity Method </li></ul><ul><li>Provide prescribing control guidelines & stock management guidelines & training </li></ul><ul><li>Evaluate the quantification process & make any necessary improvements </li></ul>
  37. 37. <ul><li>Preparing Average Standard Treatment Schedules </li></ul><ul><li>The following steps are described assuming that prescribing is rational </li></ul>
  38. 38. <ul><li>Preparing Average Standard Treatment Schedules </li></ul><ul><li>Clinical Treatment Schedule </li></ul><ul><li>Intended to help clinical staff decide on the drug treatments to be given to individual patients </li></ul><ul><li>They must therefore specify all the nuances of diagnosis which require a variation in treatment for individual patients; i.e. diagnosis, severity, age, body weight, general health status, drug resistance, etc. </li></ul><ul><li>Does NOT need elaborate description of drug dosage forms </li></ul><ul><li>Average Treatment Schedule </li></ul><ul><li>Used for quantification of drug needs </li></ul><ul><li>Need NOT be precise </li></ul><ul><li>An AVERAGE is enough </li></ul><ul><li>It is NOT specific for clinical guidance </li></ul><ul><li>It must specify selection & dosage of drugs for patients of different age & disease severity </li></ul>
  39. 39. <ul><li>Preparing Average Standard Treatment Schedules </li></ul><ul><li>Average & clinical drug treatment schedules are of course related </li></ul><ul><li>Average schedules are valid ONLY IF the represent the average treatments which will actually be used clinically </li></ul><ul><li>For the quantification method to have an actual effect, clinical staff should ( must ) be committed to the used clinical guideline </li></ul>
  40. 40. <ul><li>Preparing Average Standard Treatment Schedules </li></ul><ul><li>The schedules will only be effective if prescribers are trained in their use, and actually apply them </li></ul><ul><li>There should be continuous monitoring & feedback on what is actually happening </li></ul>
  41. 41. <ul><li>Remember: </li></ul><ul><li>Morbidity method estimates </li></ul><ul><li>ONLY the quantities needed </li></ul><ul><li>to dispense to patients </li></ul><ul><li>It does not take losses or </li></ul><ul><li>wastage into consideration </li></ul>
  42. 42. <ul><li>N.B. </li></ul><ul><li>It is important that physicians & </li></ul><ul><li>other higher level health service staff </li></ul><ul><li>should be REASSURED that </li></ul><ul><li>average treatment schedules do NOT </li></ul><ul><li>infringe on their clinical freedom </li></ul><ul><li>to adapt the drug dosages to </li></ul><ul><li>the needs of individual patients </li></ul>
  43. 43. Examples!!
  44. 44. <ul><li>Preparing Average Standard Treatment Schedules </li></ul><ul><li>Examples: </li></ul><ul><ul><li>Suppose that the standard treatment for iron deficiency anemia (ICD-10 ) should be 84 tablets of ferrous sulphate, if prescribers continue to give 120 tablets, then the average does NOT reflect reality </li></ul></ul>
  45. 45. <ul><li>Preparing Average Standard Treatment Schedules </li></ul><ul><li>Examples: </li></ul><ul><ul><li>The average standard treatment for a mild case of malaria in adults is ten 150 mg base tablets of chloroquine </li></ul></ul><ul><ul><li>This average allows for & reflects variations in the courses of drug treatments prescribed for individual patients </li></ul></ul>
  46. 46. Items of Average Drug Treatment Schedule <ul><li>The name of the health problem, and the ICD-10 number(s) of diagnosis it includes </li></ul><ul><li>The generic name, dosage form & strength of each drug to be used in the treatment </li></ul>
  47. 47. Items of Average Drug Treatment Schedule <ul><li>The average dose </li></ul><ul><li>The average number of doses per day </li></ul>
  48. 48. Items of Average Drug Treatment Schedule <ul><li>The average number of days these doses are to be given </li></ul><ul><li>The total average quantity of each drug used for a standard course of treatment; for acute conditions . The total quantity given per prescription for chronic conditions </li></ul>
  49. 49. Items of Average Drug Treatment Schedule <ul><li>In general; two age groups should be distinguished (below five years, & five years and older) </li></ul><ul><li>The severity of the disease should ONLY be included in the average drug treatment schedules if a more severe case would need a different drug </li></ul>
  50. 50. Before You Start; <ul><li>Selection of drugs is based on Essential Medicines List; bearing in mind the diagnostic & treatment capabilities to administer each treatment schedule </li></ul><ul><li>More detailed clinical criteria must be applied to each health problem to determine the most appropriate average dosage form and drug quantity </li></ul>
  51. 51. Before You Start; <ul><li>Consider the physical feasibility of administering the proposed average treatment, e.g. injection versus tablets </li></ul><ul><li>Average treatments which go against cultural preferences may be far more effective or cost-effective, but they must be explained & made acceptable to prescribers & patients </li></ul>
  52. 52. Ideally, reviewing average treatment schedules requires cooperation from: <ul><li>Experienced health service staff from the type of facility for which the treatment schedules are intended, who are familiar with diagnostic possibilities & prescribing patterns, & ca advise on what is feasible in practice </li></ul>1
  53. 53. Ideally, reviewing average treatment schedules requires cooperation from: <ul><li>Experienced senior clinicians in different fields, who can advise on the treatments which they consider most effective </li></ul>2
  54. 54. Ideally, reviewing average treatment schedules requires cooperation from: <ul><li>Pharmacists & administrators who can point out technical requirements, such as special storage conditions & ensure that costs are also borne in mind, so that proposed treatments are not only effective but also cost-effective </li></ul>3
  55. 55. Illustrative Standard Treatment for Quantification of Drug Requirements Based on Average Doses
  56. 56. Examples in this presentation are hypothetical and NOT based on systematic search 6 3 2 1 tab Co-trimoxazole tab Children Assume 4 sachets As required O.R.S. 24 3 4 2 caps Tetracycline 250 mg Adults Cholera 001 Bacterial Infections & Zoonosis 1- Infections & Parasitic Diseases Amount per Course of Treatment Number of Days Times per Day Dose Drugs Indication ICD
  57. 57. ICD-10 Code
  58. 58. <ul><li>Preparing Number of Treatment Episodes of Each Health Problem </li></ul>Watch the difference !!!!!!!!
  59. 59. <ul><li>Treatment Episode: </li></ul><ul><ul><li>A patient contact for which a standard course of drug treatment is required </li></ul></ul><ul><li>Preparing Number of Treatment Episodes of Each Health Problem </li></ul>
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