Medicine usage patterns in a district hospital : a therapeutic budget model approach
Eksteen, Margaritha Johanna
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According to the National Drug Policy one of the health services objectives is to ensure the availability and accessibility of essential drugs to all citizens. An economic objective of the same policy is to promote the cost-effective and rational use of drugs (Department of Health, 1996). Currently, there is no system to scientifically determine the usage of medicines in the public sector and whether the current usage is satisfactory enough (John, 2004:2). The World Health Organization states that "good drug supply management is an essential component of effective and affordable health care services globally (World Health Organization, 1998:1). In the South African context, even though the Essential Drug List helps health care professionals to treat diseases in the public sector, it does not prescribe the minimum guidelines for medicine supply systems (Department of Health, 2006a). The general objective of this study was to develop a therapeutic medicine budget model in a district hospital in the public sector of the North-West Province to control medicine usage. This can be done after analysing the medicine usage patterns and then developing a framework for therapeutic budgeting by evaluating appropriate systems, i.e. the International Code for Disease (ICD-10) classification system, with the therapeutic budget model framework. Retrospective drug utilisation of six months (January 2007 until June 2007) was documented. A random sample population of 25% was selected (n = 1 494). After the data collection period of 9 weeks, the actual study population was only 18.67% (only 1 166 of the 1 494 patients files had a medicine history). All the medicine items prescribed were classified in the therapeutic budget model. Patient confidentially was assured by using a unique pin number on the survey form, so that no names of patients or other biographical details were collected from the patient files onto the survey form, which is in line with the requirements of the Ethics Committee approval conditions for the North-West University. The total number of medicine items dispensed during the study period was 11 768. The average cost per medicine item was R19.36 ± 86.79 for inpatients. The total number of consultations was 3 220. The average number of medicine items per consultation was 3.66 ± 1.98. The total cost of medicine items during the study period was R244 677.11. The average medicine cost per consultation for inpatients was R70.80 ± 177.72. The top three budget groups according to frequency represented 68.11% of all medicine used according to budget groups. The top three pharmacological groups according to total cost represented 61.68% of the total cost of pharmacological groups. The top three therapeutic codes according to frequency represented 18.75% of all therapeutic codes. The top three ICD-10 codes based on total cost represented 59.35% of all medical conditions diagnosed. The total hospital budget for 2007 was predicted at R3 276 750.00. Of this budget, 75% was for pharmaceuticals (R2 457 562.50). The total pharmaceutical medicine cost (excluding surgicals) from the study was R224 677.11 (this was for 18.67% of the total patient visits for six months) which can be calculated at R2 406 824.96 for all patients visits in a full year. The correlation between the actual budget and the projected budget showed a R50 737.54 surplus in the budget of the hospital. A therapeutic budget model can also help in achieving the following: • Proper preparation and planning of budgetary policies in a phased manner based on scientific evidence; • Evaluation of budgetary compliance, cost-efficiency of therapy and standard treatment guidelines (STG) / Essential Drug List (EDL) / formulary compliance; • Better procurement strategies based on demand, expenditure and inventory control; and • Better delivery and maintenance of quality health care by evaluating operational and clinical policies. The therapeutic budget model is a more appropriate manner to use in the projections of budgets and medicine usage. The scope of a therapeutic budget model to be implemented in the hospitals in the public sector of the North-West Province seems to be promising.
- ETD@PUK