To investigate the indicators of outpatient care, thereby contributing to the treatment and guidance for patients to use medicine appropriately, safely and economically.
Journal of military pharmaco-medicine no9-2019 ASSESSMENT OF OUTPATIENT CARE INDICATORS AT ELEVEN HEALTH STATE ESTABLISHMENTS IN CANTHO CITY DURING THE PERIOD OF 2016 - 2017 Nguyen Phuc Hung1; Nguyen Minh Chinh2; Vo Thi My Huong1 SUMMARY Objectives: To investigate the indicators of outpatient care, thereby contributing to the treatment and guidance for patients to use medicine appropriately, safely and economically Subjects and methods: Research subjects were doctors who directly participated in medical examination and treatments, pharmacists who distributed outpatient insurance drugs, outpatient visits, outpatient prescriptions with health insurance, and medicine dispensed Following the prospective method, the sample size was 4,046 patients who were measured at the time of medical examination, dispensing drug, interviewed equally during the study at 11 medical facilities Results and conclusion: Indicators of outpatient care in 11 public health facilities in Cantho: The average time of medical examination 2.64 minutes (the lowest was Cai Rang district General Hospital with 0.2 minutes, the highest was O Mon district General Hospital with 33.1 minutes) and the average time of drug dispension 8.08 minutes (the lowest was General Hospital of Cantho City: 0.35 minutes and the highest was Cantho City Hospital with 80.57 minutes); the rate of actual drugs dispensed at 11/11 facilities reached 100% Proper labeling 47.0%; the patient's understanding of the correct dosage: patient's understanding of the correct dosage: the knowledge of the period of treatment time was 77.1%, the knowledge of the usage of all type of drugs was 76.4%, the knowledge of using dosage of each drug was 75.3%, the knowledge of times or point of time using drug was 76.7% * Keywords: Patient care; Outpatients; Medical quality INTRODUCTION Outpatient care indicators mentioned about how the outpatient have been through at medical center and how they were guided to use prescribed drugs appropriately In Cantho city, there have been previous studies on some drug use indicators in the group of patients care indicators such as: the average time of distribution, rate of dispensing, proportion of proper labeling medication, patient’s understanding of the legitimate dosage It describes methods for calculating indicators and emphasizes their feasibility as well as limitations in assessing drug use models However, most of the studies on these indicators were collected only in certain hospitals, most of them were kind of central hospitals, so that the assessment was not comprehensive Cantho University of Medicine and Pharmacy Vietnam Military Medical University Coresponding author: Nguyen Phuc Hung (phuchung275@yahoo.com) Date received: 04/10/2019 Date accepted: 25/11/2019 195 Journal of military pharmaco-medicine no9-2019 Therefore, we carried out a broader study from central to districts hospitals located in Cantho city to draw a better overview of the outpatients care, then building up to a more complete health care system outpatient insurance drug distribution, patients going to outpatient visits at medical establishments, outpatient prescriptions with medical insurance during the study period and drugs are given SUBJECTS AND METHODS Following the prospective method: directly observe the prescribing and dispensing activities at the outpatient department and outpatient medicine dispensing department Every day, - 15 patients who are registered for outpatient medical examination with health insurance who met the condition of sampling criteria Subjects The study was implemented in 11 public health clinics practicing medical outpatient examination in Cantho city, namely Cantho Central General Hospital, General Hospital of Cantho city, Cantho University of Medicine & Pharmacy Hospital, O Mon district General Hospital, Thot Not district General Hospital, Vinh Thanh district General Hospital, Thoi Lai district General Hospital, Cai Rang district Health Center, Phong Dien district Health Center, Co Do district Health Center, Binh Thuy district Health Center from September 2016 to April 2017 Subjects of research were doctors who directly participated in medical examination and treatment, pharmacists participating in Methods The sample size was 4,046 patients who were measured the time of medical examinations, drug delivery which were interviewed equally during the study at the 11 facilities Each sample was analyzed based on indicators: Average time of medical examination, average time to dispense, Proportion of actual dispensing drugs, proportion of proper labeling drugs, patient's understanding of the correct dosage RESULTS AND DISCUSSION Average time of medical examination Table 1: The average time of medical examination (min) The lowest medical examination time (min) The highest medical examination time (min) Cantho Central General Hospital 7.28 2.17 17.35 General Hospital of Cantho city 3.45 1.43 10.67 Cantho University of Medicine & Pharmacy Hospital 2.50 0.83 4.00 Thot Not district General Hospital 2.62 1.40 5.50 O Mon district General Hospital 2.25 1.35 33.10 Name of medical facilities 196 Journal of military pharmaco-medicine no9-2019 Binh Thuy district Health Center 1.95 1.02 3.62 Co Do district Healthcare Center 3.50 1.63 10.20 Cai Rang district General Hospital 1.65 0.20 3.65 Phong Dien district Health Center 1.88 1.05 3.45 Thoi Lai district General Hospital 1.90 1.13 3.60 Vinh Thanh district General Hospital 2.42 0.30 8.93 2.64 0.20 33.10 Average Statistics of the lowest and the highest medical examination times in each hospital showed that 0.2 minutes was the lowest examination time and 33.1 minutes was the highest Overall, the average of this study was 2.64 minutes According to our observation, the lowest medical examinations were 0.2 and 0.3 minutes because in these situations, the patients had met doctors before they came to hospital, then the doctors just need to give a prescription without asking disease conditions The average time for examination was 2.64 minutes, much lower than WHO’s recommendation (10 minutes), the survey results were quite low compared to some studies in Islamabad (5.02 minutes) [2], Ghana (8 minutes) [1], Ethiopia (5.6 minutes) [5] and higher than another study in Bahawalpur (2.2 minutes) [4] The time of health examination was too short for patients to have less opportunity to ask about their illnesses, information about drugs and sharing their views on health and treatment issues Besides, the amount of information, that doctors provided for patients are still inconsiderable The average time to dispense medicine Table 2: The average time to dispense medicine The lowest time to dispense medicine The highest time to dispense medicine (min) (min) (min) Cantho Central General Hospital 20.07 5.00 33.32 General Hospital of Cantho city 28.35 0.35 80.57 Cantho University of Medicine & Pharmacy Hospital 5.80 2.12 8.02 Thot Not district General Hospital 9.57 3.02 48.63 O Mon district General Hospital 6.58 3.33 13.55 Binh Thuy district Health Center 7.89 3.45 11.58 Name of medical facilities 197 Journal of military pharmaco-medicine no9-2019 Co Do district Healthcare Center 7.21 2.85 11.58 Cai Rang district General Hospital 3.17 1.53 5.78 Phong Dien district Health Center 3.10 1.68 10.47 Thoi Lai district General Hospital 8.03 3.02 9.97 Vinh Thanh district General Hospital 6.59 3.02 15.93 8.08 0.35 80.57 Average The average time to dispense medicine amongst those hospital reported were different, with the average was 8.08 minutes The result was much higher than the study in Dhaka, Ethiopia, Pakistan, India (1.18 minutes, 2.7 minutes, 51.91 seconds, minutes seconds, respectively) [3, 5, 6, 8] In general, a too short time to dispense medication is not enough to provide information about the drug as well as a dose mapping for the patient Although the study period was in the WHO recommendation (> minutes), the time that the medical staffs observing for our patients was quite limited, because the number of health insurance visits in health facilities was truly crowded, so the waiting time to receive medicine was mainly Proportion of drugs dispensed in practice Table 3: Number of prescription drugs Number of dispensed drugs The ratio of actual drugs dispensed (%) 914 914 100.0 3,880 3,880 100.0 384 384 100.0 Thot Not district General Hospital 2,911 2,906 99.89 O Mon district General Hospital 2,726 2,726 100.0 Binh Thuy district Health Center 605 605 100.0 Co Do district Healthcare Center 1,308 1,308 100.0 Cai Rang district General Hospital 722 722 100.0 Phong Dien district Health Center 1,703 1,703 100.0 Thoi Lai district General Hospital 2,038 2,037 99.96 Vinh Thanh district General Hospital 1,253 1,251 99.87 18,444 18,436 99.96 Name of medical facilities Cantho Central General Hospital General Hospital of Cantho city Cantho University of Medicine & Pharmacy Hospital Average The rate of drugs dispensed practically at 11/11 facilities was 99.96%, much higher than in Daniel's study: 24.2% of prescriptions received all prescription drugs, 31.7% of prescriptions receiving more than half and 14.2% of prescriptions received half, 198 Journal of military pharmaco-medicine no9-2019 17.5% of patients received less than half of the drugs, while 12.5% did not receive the number of prescription drugs [1] or Mudenda's research: 32.6% received all prescription drugs, 18.2% received more than half, 17.7% received half, 14.6% received less than half, 16.9% did not receive prescription drugs [7] The lack of drug for dispension at that time due to a large number of patients although there was enough amount of drugs Although the number of patients coming to the hospital was absolutely high, the number of medicines given to patients was still adequate, indicating that the hospital's drug planning is reasonable and accurate, of this value is close to 100% maximum - WHO standard level But we still need to set more stringent policies in planning and delivering drugs Proportion of proper labeling drugs Table 4: Number of prescription Number of prescription labeled Proportion of proper labeled drugs (%) Cantho Central General Hospital 218 160 73.4 General Hospital of Cantho city 885 533 60.2 Cantho University of Medicine & Pharmacy Hospital 100 30 30.0 Thot Not district General Hospital 630 334 53.0 O Mon district General Hospital 681 114 16.7 Binh Thuy district Health Center 136 85 62.5 Co Do district Healthcare Center 249 201 80.7 Cai Rang district General Hospital 163 79 48.5 Phong Dien district Health Center 303 106 35.0 Thoi Lai district General Hospital 377 155 41.1 Vinh Thanh district General Hospital 304 103 33.9 4,046 1,900 47.0 Name of medical facilities Average The average proportion of appropriately labeled drugs was 47.0% This difference was statistically significant research amongst the 11 public health facilities This percentage was much more marked than only 3.3% of drugs labeled in eastern Ethiopia: [9], in Pakistan, the average had only 3.96% of the drugs fully labeled [3] or 18.5% in total number of drugs dispensed is consistent with a survey in India (2005) [10] This is also an important issue in guiding safe and rational use of drugs to avoid confusion between drugs, remind and guide patients to use drugs on dosage, usage and frequency of use correctly 199 Journal of military pharmaco-medicine no9-2019 The patient's understanding of the correct dosage Table 5: Percentage of understanding of correct dosage (%) Name of medical facilities Number of patients interviewed The period of treatment time The usage of all type of drugs Using dosage of each drug Times or point of time using drug n % n % n % n % Cantho Central General Hospital 218 186 85.3 173 79.4 166 76.1 164 75.2 General Hospital of Cantho city 885 778 87.9 758 85.6 741 83.7 771 87.1 Cantho University of Medicine & Pharmacy Hospital 100 76 76.0 73 73.0 77 77.0 76 76.0 Thot Not district General Hospital 630 466 74.0 447 71.0 459 72.9 454 72.1 O Mon district General Hospital 681 443 65.1 467 68.6 419 61.5 458 67.3 Binh Thuy district Health Center 136 88 64.7 95 69.9 85 62.5 96 70.6 Co Do district Healthcare Center 249 171 68.7 154 61.8 162 65.1 167 67.1 Cai Rang district General Hospital 163 141 86.5 137 84.0 135 82.8 140 85.9 Phong Dien district Health Center 303 230 75.9 239 78.9 235 77.6 242 79.9 Thoi Lai district General Hospital 377 298 79.0 291 77.2 302 80.1 286 75.9 Vinh Thanh district General Hospital 304 244 80.3 258 84.9 265 87.2 250 82.2 4,046 3,121 77.1 3,092 76.4 3,046 75.3 3,104 76.7 Average The rate of patient’s knowledge about the right dosage studied at 11 facilities were quite high in four aspects: The knowledge of the period of treatment time (77.1%), the knowledge of the usage of all type of drugs (76.4%), the knowledge of using dosage of each drug 75.3%), the knowledge of times or point of time using drug (76.7%) This result was lower than one study in India (2005) (80.8%) [10], higher than the study in Ghana (63.2%) [1] and Pakistan (54.98%) [3] However, due to the time and overcrowding of large numbers of patients, this index is still much lower than WHO’s standard, 100% 200 Journal of military pharmaco-medicine no9-2019 CONCLUSION Patient care indicators: Average time of medical examination 2.46 minutes and average time of medicine distribution 8.08 minutes; the actual distribution of drugs 99.96% and proper labeling 47.0%; patient's understanding of the correct dosage: the knowledge of the period of treatment time was 77.1%, the knowledge of the usage of all type of drugs was 76.4%, the knowledge of using dosage of each drug was 75.3%, the knowledge of times or point of time using drug was 76.7% There is a need to design a strategy for education and arrangement medical staff properly in order to reduce burdens of higher level hospital and increase safe and suitable use of drugs in outpatients REFERENCES Atif M, Sarwar M.R, Azeem M et al Assessment of core drug use indicators using WHO/INRUD methodology at primary health care centers in Bahawalpur, Pakistan BMC Health Services Research 2016, 16, p.684 Bilal A.I, Osman E.D, Mulugeta A Assessment of medicines use pattern using World Health Organization’s Prescribing, patient care and health facility indicators in selected health facilities in eastern Ethiopia BMC Health Services Research 2016 16, p.144 Mathew B, Gadde R, Nutakki P et al Assessment of drug dispensing practices using WHO patient care and health facility indicators in a private tertiary care teaching hospital International Journal of Pharmacy and Pharmaceutical Sciences 2013, (4), pp.368-371 Mudenda W, Chikatula E, Chambula E et al Prescribing patterns and medicine use at the University Teaching Hospital, Lusaka, Zambia Medical Journal of Zambia 2016, 43 (2), pp.94-102 Afriyie D.K, Tetteh R A description of the pattern of rational drug use in Ghana Police Hospital International Journal Pharmaceutical Pharmacol 2014, (1), pp.143-148 Sayeed Ibn Elias S.M.A A study on drug use at Upazilla Health Complex, Savar, Dhaka ASA University Review 2013, (1), pp.161-168 Akhtar M.S, Shafiq M, Irshad N et al Assesment of prescribing practices of private GPS in Islamabad International Journal of Current Pharmaceutical Research 2013, (1), pp.49-53 Sisay M, Mengitsu G, Molla B et al Evaluation of rational drug use based on World Health Organization core drug use indicators in selected public hospitals of eastern Ethiopia: A cross- sectional study BMC Health Services Research 2017, 17, p.161 Aslam A, Khatoon S, Mehdi M et al Evaluation of rational drug use at teaching hospitals in Punjab Pakistan Journal of Pharmacy Practice and Community Medicine 2016, (2), pp.54-57 10 Sunil K, Sankhe P, Kulkarni M Patterns of prescription and drugs dispensing The Indian Journal of Pediatrics 2005, 72 (2), pp.117-121 201 ... Subjects The study was implemented in 11 public health clinics practicing medical outpatient examination in Cantho city, namely Cantho Central General Hospital, General Hospital of Cantho city, Cantho. .. Although the study period was in the WHO recommendation (> minutes), the time that the medical staffs observing for our patients was quite limited, because the number of health insurance visits in health. .. distribution of drugs 99.96% and proper labeling 47.0%; patient's understanding of the correct dosage: the knowledge of the period of treatment time was 77.1%, the knowledge of the usage of all type of