Management Information System In Promoting Rational Drug Use
Rational drug use cannot be identified without a method of
measurement and a reference standard that are necessary to measure the impact
of interventions. Over the past few years, the International Network for Rational
Use of Drug (INRUD) and the WHO Action Program on Essential Drugs have closely
collaborated in developing countries to test a set of 5 prescribing indicators
to measure some key aspects of prescribing. Collecting the prescriptions data
and analyzing them is one way for measuring the above indicators. In Iran, National
Committee of Rational Use of Drug (NCRUD) and local committees affiliated to
42 universities of medical sciences were established by Food and Drug Organisation
in 1996 throughout the country to implement and promote rational use of drugs.
Here we aimed to examine all prescribing patterns in Iran in terms of irrational
use of drugs. To look at the pattern of physicians
prescription, the subcommittee of computer and data analysis of NCRUD was set
up to initiate and develop a data warehouse and application software. The intended
outcome of such efforts was to gather and analyze prescription data for measuring
RUD indicators and strategies to promote rational drug use. After development,
data ware house, called Noskhehpardaz
(RX Analyzer), was tested for
its validity and reliability in a pilot study in Mashhad University of Medical
Sciences in 1996. More than 200 million prescriptions, equaling about to 70%
of all prescriptions in the country, were collected nationally and analyzed
by RX Analyzer software. Mean items per prescription was 4. 25 in 1998 and with
the downward trend were 3.22 in 2009. Mean cost of prescriptions increased from
0.56 US$ in 1998 to 4.19 US$ in 2009. Availability of information on prescriptions
has facilitated audit and feedback suggesting that policy makers should have
to consider these data in their decisions.
One of the most important duties of health authorities is to ensure the efficacy
and cost effectiveness of health services (Soleymani et
al., 2009). Pharmaceuticals are important among essential components
in many diagnostic and therapeutic measures (Abdollahiasl
et al., 2011a, b). Promoting rationality
in drug use is a well-recognized and an important part of health policy. However,
with no method of measurement and reference standard (Le
Grand et al., 1999) it is impossible to take the step. Therefore
developing systems or methods for gathering valid and accurate data on prescribing
behavior of physicians are very important. Moreover, it is critical in planning
strategies and necessary in measuring the impact of interventions for promoting
rational drug use. It is well accepted that all medications have adverse, possibly
lethal effects, if prescribed inappropriately as shown in studies of pattern
of antibiotic use (Abdollahiasl et al., 2011c;
Ahmadizar et al., 2011) or in investigations
of self-medication. Other important factors that might increase the risks of
intervention include number of items per prescriptions and drug interactions
as well as patients sex, age and background disease. There are many examples
for that notice but the best one is our experience with the use of tramadol
(Soleymani et al., 2011). Due to the above and
also economic conditions and cultural believes of people in each society, it
is an acceptable requirement to establish and organize a framework for official
implementation of the concept of RUD in daily practice of medical professionals.
Of course this has been already proved that there are some inconsistencies with
decided strategies and those practically occurred (Nikfar
et al., 2005).
In Iran, for many years, the problem of irrational drug use have been investigated
by academic members of several universities (Cheraghali
et al., 2006). Fortunately, in 1996 those sporadic activities became
the basis for official establishment of National Committee of Rational Use of
Drug (NCRUD) in the Food and Drug Organisation and in local committees of 42
universities of medical sciences throughout the country.
The national committee has three subcommittees named policy and legislation,
computer and data analysis and consultants of medical sciences. These subcommittees,
based on their responsibilities, consist of officials and experts from different
MATERIALS AND METHODS
For looking at the pattern of physicians' prescriptions, the subcommittee of
computer and data analysis of NCRUD was formed and developed a data warehouse
and application software in order to gather and analyze prescription data for
measuring RUD indicators and to develop strategies for promoting rational drug
use. The data warehouse called Noskhehpardaz
(RX Analyzer) was tested for
its validity and reliability in a pilot study in Mashhad University of Medical
Sciences in 1996. Currently the software is in use by universities and health
services all over the country. Steps in looking at the pattern of physicians
prescriptions by local committees are as follows:
||Receiving prescriptions from pharmacies or health insurance
||Data entry by computer operators under supervision of pharmacists
||Data analysis by pharmacists using the software provided by national committee
||Preparation of the report to be reviewed by medical advisors
||Decisions about physicians practice regarding rational or irrational
use of drugs
||Preparation of reports containing the results and the decision of advisory
||Sending reports directly to physicians whose prescriptions have been analyzed
||Sending to local medical council and health insurance providers for appropriate
legal actions, a copy of profiles of physicians whose practice consistently,
after being previously informed at least twice, had major problems in terms
After above stages, a geographic information system is used to draw a comprehensive
picture and illustrate the spread of the problem at national level.
More than 200 million prescriptions, equal to 70% of all prescriptions in the
country with an acceptable spread were collected and analyzed by RX Analyzer
software. Table 1 is one of the possible outputs of the software
that demonstrates national level and comparative information regarding the yearly
number of prescriptions between 1998 to 2009. The software also allows calculation
of other figures such as national mean items per prescription and mean cost
of prescription in Iranian currency units (each US$ equating roughly to 10,000
Iranian Rials), the percentage of prescriptions contain antimicrobial drugs,
parenteral drugs and corticosteroids as well as the other drug categories as
shown in Table 1. To calculate the above and other indicators,
all data included information of physicians, pharmacies and patients, drug's
name, dosage form and number prescribed were all entered continuously into the
software. In this way the system give report in many forms such as:
||Reporting system for each groups of physician, pharmacy, location
||Frequency in use of different drug items and frequently used drugs
||Drug interaction according to reference database (Threlkeld
and Hagemann, 1996)
||Drug group frequency usage based of USPDI (2005)
||Drug form analyzing
According to the above data, feedback forms for physicians were developed that
is shown in Fig. 1.
|| Trend of prescriptions' indicators in Iran evaluated between
1998 and 2009
NCRUD has 14-year experience in collecting and data analyzing of physicians
prescriptions at both national and local levels. In the early years it was important
to inform policy makers about national and local drug use patterns and to indicate
and highlight gravity of problems in key areas. In the next step, different
types of interventions were implemented to improve irrationality in drug use.
More recently it has been necessary to look at the impact of those interventions
on drug use patterns.
Looking at the experiences of other countries shows such services to optimize
drug-related health outcomes by identifying and promoting drug prescribing and
use. For example National Prescribing Service in Australia has been established
to implement a quality use of medicines service as part o f the National Medicine
Policy in mid 1998 as an independent public company that was funded almost exclusively
by the Federal Government (Weekes et al., 2005)
and also the Canadian Optimal Medication Prescribing and Utilization Service
(COMPUS) which was launched in March 2004, by the Canadian Coordinating Office
for Health Technology Assessment (CCOHTA) to achieve the above goal.
Considering the mean of items per prescription as an important indicator among
rational drug use indicators, the findings of this study indicate a descending
trend for this indicator from 4. 25 in 1998 to 3. 22 in 2009. Given the large
number of medicines that prescribed in each year, even the small reduction in
prescribing would be worthwhile. For instance, a 5% reduction in prescribing
would result in a saving of 235 million pound in the United Kingdom and $A1
40 m in Australia annually (OConnell et al.,
Pattern of prescriptions is influenced by many factors and implementing interventions
for improving and promoting rational drug use is the need for corporation between
different sectors involved in the health field. One of the most important items
is cost-effectiveness studies that is rare in most of developing countries.
To make a feasible national policy decision, information on burden of expenses
to the insurance companies or the government should be also collected and paid
enough attention. Such studies would clarify which class of drugs are misused
and thus should be regulated properly. The examples are drugs like diphenoxylate
tablet (Farshchi et al., 2012) or nitroglycerine
ampule (Nikfar et al., 2011).
Availability of information on prescriptions can facilitate audit and feedback.
It is therefore recommended that decision-makers place a greater emphasis on
the use the database in evaluating the impact of corrective interventions.
This study is the outcome of an in-house non-financially supported study. Authors
would like to thank the experts of National Committee of Rational Drug Use and
the RUD committees of the universities for their assistance in collecting data.
The assistance of Ahmadali Mostoufi for his technical support is highly appreciated.
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