**Determination of Five Indicators For Drug Utilization at 20 pharmacies in Bandung**

Sriana Azis, S.R. Muktiningsih, Max J. Herman

National Institute of Health Research and Development

Ministry of Health, Indonesia

## Abstrak

Telah dilakukan penelitian tentang lima indikator penggunaan obat, yaitu jumlah rata-rata obat dalam resep, persentase preskripsi obat generik, injeksi dan antibiotika serta persentase resep yang diracik pada 20 apotek di Bandung, Jawa Barat, Indonesia selama bulan September 1997.

Tujuan penelitian ini adalah mendeskripsikan praktek peresepan, mengetahui penerimaan cara kontrol biaya obat, mendukung pengembangan kebijakan antibiotika sebagai bagian dari kebijakan obat nasional dan mengukur kemampuan apotek memenuhi kebutuhan farmasi.

Dalam bulan September 1997 ditemukan pada 20 apotek di Bandung bahwa rata-rata 3,1 obat diresepkan dalam satu lembar resep dengan rentang antar apotek 2,0-4,6 obat, 14,6% obat dituliskan dengan nama generik dengan rentang 2,9-27,6%, 36,2% resep mengandung antibiotika , 0,1% resep mengandung injeksi serta 91,7% resep yang benar diracik di apotek.

*Kata kunci*: indikator penggunaan obat, apotek

## Abstract

A study on five indicators for drug utilization, i.e. the average number of drugs prescribed, the percentage of generic drug, injection and antibiotic prescription as well as the percentage of prescriptions that are actually dispensed has been carried out at twenty pharmacies in Bandung, West Java, Indonesia during September 1997.

The primary objective of this study is to describe prescribing practices, to investigate the practical acceptance of important means in controlling drug cost, to enhance the development of strict antibiotic policies as a part of national drug policy and to measure the ability of pharmacies to meet the pharmaceutical needs.

During September 1997, it was found that from twenty pharmacies in Bandung an average of 3.1 drugs were prescribed per prescription with a range of 2.0 to 4.6 among pharmacies , 14.6 % of drugs were prescribed by generic name and the range among pharmacies varied from 2.9 % to 27.6 %. For the same twenty pharmacies an average of 36.2 % of prescriptions contained antibiotic with a range of 20.0 % to 66.7 % among pharmacies and 0.1 % for injection with a range of 0.0 % to 3.3 %,while an average of 91.7 % of prescriptions were actually dispensed, with a range of 80.0 % to 96.7 % among pharmacies.

*Key word*: drug-use indicators, pharmacy

### Background

Pharmaceutical supply systems in many developing countries have several problems, including ineffective procedures in selection, poor quality control and economically inefficient procurement. This has been documented in numerous reports and publications.

The World Health Organisation, through the Action Programme on Essential Drugs, have recognized the need for formal indicators that would facilitate comparative analyses of pharmaceutical systems in developing countries. In 1988 WHO published the “World Drug Situation”, which presented an impressive amount of useful information, organized into an indicator format. These indicators were, in most cases, not presented in a quantitative format but this work stimulated widespread interest in the concept of pharmaceutical system indicators. The Indonesian government has not adopted the WHO indicator format yet to develope its own set of drug policy indicators for use in Indonesia.

A study carried out at twenty pharmacies in Bandung, Indonesia, on September 1997 has revealed that drugs were prescribed by either generic or brand names. Percentage of drugs prescribed by generic name reflects a rough measure of practical acceptance of this means in drug-cost control, whereas percentage of antibiotic and injection prescription may reflect indiscriminate overuse of them which results in high cost and ineffective therapy. Too high ( or too low ) an average number of drugs prescribed can indicate poor prescribing practices.

The primary objective of this study is to describe prescribing practices, to investigate the practical acceptance of important means in controlling drug cost, to enhance the development of strict antibiotic policies as a part of national drug policy and to measure the ability of pharmacies to meet the pharmacutical needs.

### Sample design, data collection and computation

As samples, twenty pharmacies in Bandung were taken, ten from the main population centre and the other ten from suburban areas. From each pharmacy 30 prescriptions during September 1997 were selected retrospectively at random.

Five indicators are computed as follows:

1. Average number of drugs prescribed per prescription.

For each pharmacy in the sample, the indicator is recorded as an average, calculate by dividing the number of different drug products prescribed by the total number of prescriptions surveyed. The overall indicator is an average of these pharmacy-specific averages.

total of drugs prescribed in all prescriptions

Average number of drugs = -------------------------------------------------------

prescribed per prescription total of prescriptions studied in all pharmacies

For example, assumed that the data collected from 30 prescriptions at one pharmacy showed that 75 drugs had been prescribed. Results for that one pharmacy are calculated as follows:

75

Average number of drugs = ------ = 2.5 drugs per prescription

prescribed per prescription 30

For a sample of 20 pharmacies surveyed, a total of 1859 drugs were prescribed, the average number of drugs prescribed for pharmacies is calculated as follows :

1859

Average number of drugs = -------- = 3.1 drugs per prescription.

prescribed per prescription 600

2. Percentage of drugs prescribed by generic name.

For each pharmacy in the sample, the indicator is recorded as a percentage, computed by dividing the number of drugs prescribed by generic name by the total number of drugs prescribed and multiplying this quotient by 100. The overall indicator is an average of these pharmacy-specific percentages.

total number of drugs prescribed by generic name

% of drugs prescribed = -------------------------------------------------------------x 100

by generic name total number of all drugs prescribed

For example, results for one pharmacy are calculated as follows :

4

% of drugs prescribed = -----------x 100% = 6.79 %

by generic name 60

For a sample of 20 pharmacies surveyed, a total of 1859 drugs were prescribed, 271 were prescribed by generic name,then the percentage for all pharmacies are calculated as follows :

271

% of drugs prescribed by generic name = --------- x 100% = 14.6 %

for all pharmacies 1859

3. Percentage of antibiotic-containing prescriptions.

For each pharmacy in the sample, the indicator is recorded as a percentage, computed by dividing the number of antibiotic-containing prescriptions by the total number of prescriptions surveyed and multiplying by 100.

total number of antibiotic-containing prescriptions

% of antibiotic-containing = ------------------------------------------------------------x100 %

prescriptions total number of prescriptions surveyed

For example, results from one pharmacy are calculated as follows :

10

% of antibiotic-containing = -------x 100% = 33.3 %

prescriptions 30

If, for 20 pharmacies surveyed, data for a sample of 600 prescriptions showed that a total of 217 prescriptions contained antibiotic, then the average for all pharmacies would be calculated as follows :

217

% of antibiotic-containing = -------x 100 % = 36.2 %

prescriptions for all pharmacies 600

4. Percentage of injection-containing prescriptions.

For each pharmacy in the sample the indicator is recorded as a percentage, computed by dividing the number of injection-containing prescriptions by the total number of prescriptions surveyed and multiplying by 100.

total number of injection-containing prescriptions

% of injection-containing = ------------------------------------------------------------x 100%

prescriptions total number of prescriptions surveyed

For example, results from one pharmacy are calculated as follows :

1

% of injection-containing = ------x 100% = 3.3 %

prescriptions 30

For 20 pharmacies surveyed, data showed that it was just the only one injection-

containing prescription such that the average for all pharmacies are calculated as follows

1

% of injection-containing = -------x 100 % = 0.1 %

prescriptions for all pharmacies 600

5. Percentage of prescriptions that are actually dispensed.

For each pharmacy in the sample, indicators are recorded as percentages, computed by dividing the number of prescriptions actually dispensed by the total number of prescription surveyed and multiplying this quotient by 100.

# Number of prescriptions actually dispensed

% of prescriptions = ------------------------------------------------------x 100

that are dispensed Total number of prescriptions surveyed

The results for one pharmacy are calculated as follows :

28

% of prescriptions = ------ x 100 % = 93.3 %

that are dispensed 30

If, for 20 pharmacies surveyed, data for a sample of 600 prescriptions showed that

a total of 547 prescriptions actually dispensed, then the average for all pharmacies would be calculated as follows :

547

# Average % of prescriptions = --------x 100 % = 91.7 %

that are dispensed for all pharmacies 600

### Results and discussion

The results of data computations can be summarized in Table 1.

The results obtained showed that there is an average of 3.1 drugs per prescription

which is greater than the results of WHO surveillance in some developing countries, i.e. 2.1 drugs per prescription. To improve prescribing practices is advisable to reduce the number of drugs prescribed.

The percentage of drugs prescribed by generic name for pharmacies in Bandung, 14.6 %, is justifiable as generic drug production in Indonesia only covered 13.92 % of national drug production in the year of 1996/1997 (2).

The percentage of antibiotic-containing and injection-containing prescriptions are 36.2 % and 0.1 % respectively, that is smaller than the results of WHO surveillance ,viz. 43 % for antibiotic-containing prescriptions and 25 % for injection-containing prescriptions.

These percentages may reflect how properly the use of these drugs is which can influence the cost and effectiveness of therapy.

The percentage of prescriptions that are actually dispensed for all pharmacies in Bandung found, 91.7 %, is greater than the results of WHO surveillance, 77 %. This percentage may reflect the capability of pharmacies to meet the public pharmaceutical needs or the buying-power of the community.

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