P1258820110HOfQS

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

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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.
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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.

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TNMSC RUD

• EDL
• Pharmacists 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

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AUTOMATED BILL PASSING
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Quality Control
Visual - Physical Defects - Packing - Including
Cartoon
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Stock Monitoring
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Warehouse Information System
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H.O.Server
CT Scan System
Drug Management Monitoring System
Warehouse Information System
Computerization
QC Monitoring System
M.I.S.
TNMSC
Payroll Personal
Financial Accounts
Integrated System
Construction Management
Automated Material Handling
Supplier Information
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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.

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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.

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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 year
• 3) drugs prescribed by generic name
• 4) drugs prescribed that belong to the PHC EDL
  (51 drugs)
• 5) Average cost per prescription

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• However no such trend is discernible in the
  following
• 1) prescriptions containing an antibiotic
• 2) prescriptions containing a vitamin
• 3) prescriptions containing an injection
• 4) average number of drugs per prescription

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Results are preliminary and have to be
interpreted with cautionwww.tnmsc.tn.nic.inwww.t
nmsc.com

• Study funded by Applied Research in Child Health
  through the United States Agency for
  International Development (USAID).
• Thank you