Impact of Tamilnadu Medical Services on drug prescribing in primary health care

MURALI .R, SATHYANARAYANAN.D, RAJ KUMAR.C, SENTHI L KUMAR.R & TI TUS.U

I NSTI TUTE OF COMMUNI TY MEDI CI NE,

MADRAS MEDI CAL COLLEGE, CHENNAI

INTRODUCTION

An efficient health care delivery system is an important requisite to achieve health for all.

Access to essential drugs is probably the most important element of health care delivery system.

The Government of Tamil Nadu, India

realizing this, developed and implemented various strategies

under the broad framework of Tamil Nadu

Medical Services Corporation to control and monitor drug procurement, storage and

distribution to the Public sector hospitals in the state.

Tamilnadu Medical Services Corporation(TNMSC) 1994: Efforts to rationalize drug

use commence and TNMSC formed; Chain of modern warehouses built

1995: Essential drug list prepared 1997: News Bulletin “TNMSC

Times” launched 1998: Training for Doctors and

Pharmacists.

TNMSC & RUD

EDL

Pharmacist’s handbook

Training of pharmacists in inventory management

Good quality Generic drugs at competitive rates

“TNMSC Times”

Storage under good conditions in modern warehouses

Distribution based on indenting by medical officers

Inventory control at district warehouses

TNMSC Web Server

H.O

Order Placement

Form Download & Submission

Suppliers

Tender MinutesGeneration

e-Tendering

TNMSC

OrderPlacement

Suppliers

Warehouses

MRC & InvoiceLinkageInvoice

MRC

Printing of Cheques

AUTOMATEDAUTOMATEDBILL PASSINGBILL PASSING

Quality ControlVisual - Physical Defects - Packing - Including Cartoon

Samples fromWarehouses

EliminatingCommon Batches

Sent to LAB

Resultsthru’ E-Mail

Intimate toWarehouses

if failed

No No Compromise Compromise on QUALITYon QUALITY

Stock Monitoring

TNMSCTNMSCH.O.H.O.

Internet

WarehousesWarehouses

Internet

Internet

TransferTransferinfo.info.

sent to H.O.sent to H.O.

Transfer info.Transfer info.to Warehousesto Warehouses

WarehousesWarehouses

MonitorMonitorthe Stocksthe Stocks

Internet

Warehouse Information System

SuppliersSuppliers

TNMSCTNMSCH.O.H.O.

Issues under Issues under BudgetaryBudgetary

ControlControl

MedicalMedicalInstitutionsInstitutions

WarehouseWarehousePassbookPassbook& Order& Order

info.info.

Submit IndentSubmit Indent

SupplySupply

H.O.Server

Warehouse Information System

M.I.S.

Payroll & Personal

CT Scan System

Drug Management & Monitoring System

Financial Accounts

Automated Material Handling

Construction Management

Supplier Information

QC Monitoring System

Impact evaluation

1) To study the impact of the TNMSC in primary care centres (PHCs) on a) availability of 15 core essential drugs; b) continuous availability of an adequate quantity of the core essential drugs; and c) rational use of drugs in PHCs;

2) to study the maintenance of quality of drugs by the TNMSC and

3) to study the control of drug expenditures by the TNMSC.

Study design

Longitudinal time series with control before and after various TNMSC interventions (20 PHCs Vs 20 Controls).

Time series study of government rural PHCs before and after various TNMSC interventions in 1994-8.

RESULTS(preliminary-5 PHCs Vs 4 Controls)

Tim e series analysis is showing a positive trend in the following indicators in the intervention facilities:

1) % of key drugs available per facility per time period 2) Average number of days of stock-out per year per facility per year3) % drugs prescribed by generic name 4) % drugs prescribed that belong to the PHC EDL (51 drugs) 5) Average cost per prescription

However no such trend is discernible in the following:1)% prescriptions containing an antibiotic;

2)% prescriptions containing a vitamin;

3)% prescriptions containing an injection4) average number of drugs per prescription

Results are preliminary and have to be interpreted

with cautionwww.tnmsc.tn.nic.in

www.tnmsc.com

Study funded by Applied Research in Child Health through the United States Agency for International Development

(USAID).

Thank you