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Chugh Y, Sharma S, Guinness L, Sharma D, Garg B, Mehndiratta A, Prinja S. Establishing national hospital costing systems: insights from the qualitative assessment of cost surveillance pilot in Indian hospitals. BMJ Open 2024; 14:e082965. [PMID: 39260852 PMCID: PMC11409349 DOI: 10.1136/bmjopen-2023-082965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
OBJECTIVE The Indian Government launched Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), the world's largest health insurance scheme, in 2018. To reform pricing and gather evidence on healthcare costs, a hospital cost-surveillance pilot was initiated among PM-JAY empanelled hospitals. We analysed the process and challenges from both healthcare providers and payer agency's perspectives and offer recommendations for implementing similar systems in lower- and middle-income countries. DESIGN We employed an open-ended, descriptive and qualitative study design using in-depth interviews (IDI) as the data collection strategy. SETTINGS The interviews were conducted in both virtual and face-to-face modes depending on the convenience of the participants. The IDIs for the National Health Authority (NHA) officials and all providers in Kerala were conducted virtually, while face-to-face interviews were conducted and in Haryana and Chhattisgarh. PARTICIPANTS Staff from 21 hospitals in three states (Haryana, Chhattisgarh and Kerala), including officials from State Health Agency (n=5) and NHA (n=3) were interviewed. RESULTS The findings highlight significant challenges in reporting cost data at the hospital level. These include a shortage of trained staff, leading to difficulties in collecting comprehensive and high-quality data. Additionally, the data collection process is resource-intensive and time-consuming, putting strain on limited capacity. Operational issues with transaction management system, such as speed, user-friendliness and frequent page expirations, also pose obstacles. Finally, current patient records data has gaps, in terms of quantity and quality, to be directly put to use for pricing. CONCLUSION Accurate cost data is vital for health policy decisions. Capacity building across healthcare levels is needed for precise cost collection. Integration into digital infrastructure is key to avoid burdening providers and ensure quality data capture.
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Affiliation(s)
- Yashika Chugh
- Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Shuchita Sharma
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Lorna Guinness
- Center for Global Development, Europe, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Deepshikha Sharma
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Basant Garg
- National Health Authority, Government of India, New Delhi, India
| | | | - Shankar Prinja
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
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Mukherjee A, Surial R, Sahay S, Thakral Y, Gondara A. Social and cultural determinants of antibiotics prescriptions: analysis from a public community health centre in North India. Front Pharmacol 2024; 15:1277628. [PMID: 38333004 PMCID: PMC10850286 DOI: 10.3389/fphar.2024.1277628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
This paper explores the socio cultural and institutional determinants of irresponsible prescription and use of antibiotics which has implications for the rise and spread of antimicrobial resistance (AMR). This study describes the patterns of prescription of antibiotics in a public facility in India and identifies the underlying institutional, cultural and social determinants driving the irresponsible use of antibiotics. The analysis is based on an empirical investigation of patients' prescriptions that reach the in-house pharmacy following an outpatient department (OPD) encounter with the clinician. The prescription analysis describes the factors associated with use of broad-spectrum antibiotics, and a high percentage of prescriptions for dental outpatient department prescribed as a precautionary measure. This paper further highlights the need for future research insights in combining socio-cultural approach with medical rationalities, to further explore questions our analysis highlights like higher antibiotic prescription, etc., Along with the recommendations for further research.
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Affiliation(s)
- Arunima Mukherjee
- Department of Informatics, University of Oslo, Oslo, Norway
- Society of Health Information Systems Programmes, New Delhi, India
| | - Rashmi Surial
- Society of Health Information Systems Programmes, New Delhi, India
| | - Sundeep Sahay
- Department of Informatics, University of Oslo, Oslo, Norway
- Society of Health Information Systems Programmes, New Delhi, India
- Centre for Sustainable Healthcare Education (SHE), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Yogita Thakral
- Department of Informatics, University of Oslo, Oslo, Norway
- Society of Health Information Systems Programmes, New Delhi, India
| | - Amandeep Gondara
- Society of Health Information Systems Programmes, New Delhi, India
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Comprehending healthcare professionals’ perspectives and expectations on drug information services at point-of-care: an online survey. DRUGS & THERAPY PERSPECTIVES 2022. [DOI: 10.1007/s40267-022-00913-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Meena DK, Mathaiyan J, Thulasingam M, Ramasamy K. Assessment of medicine use based on WHO drug-use indicators in public health facilities of the South Indian Union Territory. Br J Clin Pharmacol 2021; 88:2315-2326. [PMID: 34859476 DOI: 10.1111/bcp.15165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 10/20/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess medicine use based on World Health Organization (WHO) core drug-use indicators in selected public health facilities of the South Indian Union Territory. METHODS A prospective cross-sectional study was conducted for period of one year (from March 2019 to February 2020) in 10 selected public health facilities based on the WHO document How to investigate drug use in health facilities. Total 900 prescriptions were analysed to study prescribing, patient care and health facility indicators. The results were compared with the WHO standard measures. RESULTS The overall average number of drugs per prescription was 3.2. Percentage of prescriptions with antibiotics and injections were found to be 36.6 and 11.4%, respectively. Percentage of drugs prescribed by generic name was 74.6%. Percentage of drugs prescribed from the National List of Essential Medicine was 93.3%. Average consultation and dispensing time were found to be 3.9 minutes and 49.3 seconds, respectively. The percentage of drugs dispensed in this study was 98.5 and 61.6% of medicines were properly labelled; 76.7% of patients had correct knowledge of each medicine dispensed to them. Mean availability of key essential medicine was 73.4%. CONCLUSION Indicators such as percentage of drugs prescribed from the National List of Essential Medicine, availability of copy of essential medicine list and percentage of drugs dispensed were found to be as per WHO optimal value. Indicators such as average number of drugs per prescription, average consultation and dispensing time and percentage of medicines labelled were found below optimal value and need to be improved.
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Affiliation(s)
- Dinesh Kumar Meena
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Jayanthi Mathaiyan
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Mahalakshmy Thulasingam
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Kesavan Ramasamy
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
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Gujar A, Gulecha DV, Zalte DA. Drug utilization studies using WHO prescribing indicators from India: A systematic review. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.100547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Carriage rates and antimicrobial sensitivity of pneumococci in the upper respiratory tract of children less than ten years old, in a north Indian rural community. PLoS One 2021; 16:e0246522. [PMID: 33539406 PMCID: PMC7861412 DOI: 10.1371/journal.pone.0246522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 01/20/2021] [Indexed: 11/19/2022] Open
Abstract
Pneumococcal carriage studies are important for vaccine introduction and treatment strategies. Pneumococcal carriage rates estimated in this cohort study among children in a rural community of northern India. Between August 2012 and August 2014, trained nurses made weekly home visits to screen enrolled children aged <10 years for acute upper or lower respiratory infections (AURI/ALRI) in Ballabgarh, Haryana. Nasal swab from infants aged <1year and throat swab from children aged ≥1 year were collected. All specimens were cultured for pneumococci; isolates were serotyped and subjected to antimicrobial susceptibility testing. During the study period, 4348 nasal/throat swabs collected from children with clinical features of ARI (836 ALRI, 2492 AURI) and from 1020 asymptomatic children. Overall pneumococcal carriage was 5.1%, the highest carriage rate among children <1 year of age (22.6%). The detection rates were higher among children with ARI (5.6%; 95% CI: 4.8–6.4) than asymptomatic children (3.3%; 95% CI: 2.3–4.6). Among 220 pneumococcal isolates, 42 diverse serotypes were identified, with 6B/C (8.6%), 19A (7.2%), 19F (6.8%), 23F (6.4%), 35A/B/C (6.4%), 15B (5%), 14 (4.5%) and 11A/C/D (3.2%) accounting for 50%. Forty-five percent of the serotypes identified are included in the current formulation of 13-valent pneumococcal conjugate vaccine. Ninety-six percent of isolates were resistant to co-trimoxazole, 9% were resistant to erythromycin, and 10% had intermediate resistance to penicillin with minimum inhibitory concentration ranges (0.125 to 1.5 μg/ml). Pneumococcal detection was relatively low among children in our study community but demonstrated a diverse range of serotypes and half of these serotypes would be covered by the current formulation of 13-valent pneumococcal vaccine.
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Hambisa S, Feleke R, Zewudie A, Yimam M. Evaluation of Drug Use Based on the WHO Prescribing Indicator in Mizan-Tepi University Teaching Hospital, South Western Ethiopia: A Cross-sectional Study. CURRENT DRUG THERAPY 2020. [DOI: 10.2174/1574885515999200819092717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Rational drug use comprises aspects of prescribing, dispensing, and patient
use of medicines for different health problems. This study is aimed to assess drug prescribing practices
based on the world health organization prescribing indicators in Mizan-Tepi University teaching
hospital.
Methods:
An institutional-based, retrospective, cross-sectional study was conducted to evaluate the
prescribing practices in Mizan-Tepi University teaching hospital. Data were collected based on the
World health organization's drug use indicators using prescription papers. A total of 600 prescriptions,
written for a 1-year time, dispensed through the general outpatient pharmacy of the hospital
were collected by a systematic random sampling method from Mizan-Tepi University teaching
hospital.
Results:
The present study found that the average number of drugs per prescription was 2.04 ± 0.87
in Mizan-Tepi University teaching hospital, with a range between 1 and 5. Prescribing by generic
name was 97.6%, and 47.8% of prescriptions contained antibiotics in the hospital. 27.7% of prescriptions
contained at least one injectable medication in Mizan-Tepi University teaching hospital.
From prescribed drugs, 96.7% of them were prescribed from the Ethiopian essential drug list.
Conclusion:
: Present study indicated that the average number of drugs prescribed per encounter, the
percentage of generic prescribing, and prescribing from the EDL were close to the optimal value.
However, the percentage of encounters with antibiotics and injections prescribed was found to be
very high. Thus, the study highlights some improvements in prescribing habits, particularly by focusing
on the inappropriate consumption of antibiotics and injections.
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Affiliation(s)
- Solomon Hambisa
- Department of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Rediet Feleke
- Department of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Ameha Zewudie
- Department of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Mohammed Yimam
- Department of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
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Camcioglu Y, Sener Okur D, Aksaray N, Darendeliler F, Hasanoglu E. Factors affecting physicians' perception of the overuse of antibiotics. Med Mal Infect 2020; 50:652-657. [PMID: 32046887 DOI: 10.1016/j.medmal.2020.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 07/20/2019] [Accepted: 01/17/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We aimed to determine the reasons for irrational antibiotic use, to evaluate knowledge, attitudes, and behaviors of physicians regarding such use, to find factors affecting knowledge of physicians, and to explore precautions that need to be taken to stop irrational antibiotic use. MATERIAL AND METHODS We performed the study between January 2014 and June 2014. We included 202 physicians who answered a questionnaire with 22 multiple-choice questions about knowledge (eight questions), behavior and attitudes of physicians (nine questions), and recommendations for reducing antibiotic consumption (five questions). Answers to all questions were assessed according to the physician's age, educational status, metropolitan areas, and healthcare facilities. RESULTS The effects of parents' expectations and satisfaction (7.4%-40.0%) (P<0.0001) and socioeconomical status of families (33%-62%) (P=0.007) increased as the participants' age decreased. Participants working at public hospitals (42.6%) considered expectations and satisfaction of parents more important than other participants (10.5%-26.9%; P=0.002). Rapid recovery of patients was not an essential determinant for administering antibiotics for pediatricians (25.7%) and pediatric assistants (26.9%). However, it was important for emergency physicians (55.6%) and family physicians (60%, P=0.016). Physicians working at university hospitals did not consider this determinant as important as physicians working in other healthcare facilities (P=0.001). CONCLUSION To determine the obstacles associated with promoting rational antibiotic usage, every country should assess the attitudes, behavior, and knowledge of physicians related to such use. The present study is one of the few in Turkey to address the problems associated with irrational antibiotic use.
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Affiliation(s)
- Y Camcioglu
- Istanbul University Cerrahpasa Faculty of Medicine Department of Pediatrics Division of Pediatric Infectious Diseases, Clinical Immunology and Allergy, Istanbul, Turkey
| | - D Sener Okur
- Istanbul University Cerrahpasa Faculty of Medicine Department of Pediatrics, Division of Pediatric Infectious Diseases, 1200 Evler mah 2026 sk Can Evler Sitesi C Blok Kat:4 Daire:10, 20050 Denizli, Turkey.
| | - N Aksaray
- Cukurova University Faculty of Medicine Department of Pediatrics, Division of Pediatric Infectious Diseases, Adana, Turkey
| | - F Darendeliler
- Istanbul University Faculty of Medicine Department of Pediatrics, Division of Pediatric Endocrinology, Istanbul, Turkey
| | - E Hasanoglu
- Gazi University Faculty of Medicine Department of Pediatrics, Division of Pediatric Nephrology, Ankara, Turkey
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