To investigate the indicators of outpatient care, thereby contributing to the treatment and guidance for patients to use medicine appropriately, safely and economically.
Trang 1ASSESSMENT OF OUTPATIENT CARE INDICATORS
AT ELEVEN HEALTH STATE ESTABLISHMENTS IN CANTHO CITY
DURING THE PERIOD OF 2016 - 2017
Nguyen Phuc Hung 1 ; Nguyen Minh Chinh 2 ; Vo Thi My Huong 1
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
1 Cantho University of Medicine and Pharmacy
2 Vietnam Military Medical University
Coresponding author: Nguyen Phuc Hung (phuchung275@yahoo.com)
Date received: 04/10/2019
Trang 2Therefore, 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
SUBJECTS AND METHODS
1 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
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
2 Methods
Following the prospective method: directly observe the prescribing and dispensing activities at the outpatient department and outpatient medicine dispensing department Every day, 5 - 15 patients who are registered for outpatient medical examination with health insurance who met the condition of sampling criteria 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 5 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
1 Average time of medical examination
Table 1:
Name of medical facilities
The average time of medical examination (min)
The lowest medical examination time (min)
The highest medical examination time (min)
Trang 3Binh Thuy district Health Center 1.95 1.02 3.62
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
2 The average time to dispense medicine
Table 2:
Name of medical facilities
The average time to dispense medicine (min)
The lowest time to dispense medicine (min)
The highest time to dispense medicine (min)
Cantho University of Medicine & Pharmacy
Trang 4Co Do district Healthcare Center 7.21 2.85 11.58
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,
4 minutes 4 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 (> 3 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
3 Proportion of drugs dispensed in practice
Table 3:
Name of medical facilities
Number of prescription drugs
Number of dispensed drugs
The ratio of actual drugs dispensed (%)
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
Trang 517.5% 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
4 Proportion of proper labeling drugs
Table 4:
prescription
Number of prescription labeled
Proportion of proper labeled drugs (%)
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
Trang 65 The patient's understanding of the correct dosage
Table 5:
Percentage of understanding of correct dosage (%) The period
of treatment time
The usage
of all type of drugs
Using dosage of each drug
Times or point of time using drug
Name of medical
facilities
Number of patients interviewed
Cantho Central
General Hospital of
Cantho University of
Medicine & Pharmacy
Hospital
Thot Not district
O Mon district
Binh Thuy district
Co Do district
Cai Rang district
Phong Dien district
Thoi Lai district
Vinh Thanh district
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
Trang 7CONCLUSION
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
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