Estimating Drug Requirements - A Practical Manual: PART III: THE CONSUMPTION METHOD: MODULE 8: The adjusted consumption method: calculation procedure: 1. INTRODUCTION

Estimating Drug Requirements - A Practical Manual
(1995; 158 pages) [French] [Spanish]

Table of Contents

PREFACE
PART I: INTRODUCTION
	MODULE 1: Objectives and use of the manual
		1. INTRODUCTION
		2. THE TWO METHODS OF QUANTIFICATION
			2.1 The patient morbidity-standard treatment method
			2.2 The adjusted consumption method
		3. TARGET GROUP OF THE MANUAL
		4. OBJECTIVES OF THE MANUAL
		5. USING THE MANUAL
			5.1 Use for self tuition
			5.2 Use for courses
	MODULE 2: Assessing the need for better quantification
		1. SYMPTOMS OF POOR QUANTIFICATION
			1.1 Chronic and widespread shortages
			1.2 Surpluses
			1.3 Inequity of supply
			1.4 Inadequate cost-effectiveness
			1.5 Irrational adjustments to budgetary constraints
			1.6 Irrational and ineffective prescribing
			1.7 Suppression or distortion of demand
	MODULE 3: Preparing an action plan
		1. INTRODUCTION
		2. TASKS IN PREPARING AN ACTION PLAN
			2.A THE PREPARATORY PHASE
				TASK 1: Name the person responsible
				TASK 2: Form a working group for coordination
				TASK 3: Agree specific objectives
				TASK 4: Choose the quantification methods
				TASK 5: List tasks, estimate budget and obtain resources
				TASK 6: Programme tasks
				TASK 7: List health problems to be treated at facilities covered
				TASK 8: Select appropriate drugs for each health problem, in order to draw up essential drug list(s) for the facilities covered, and add packaging and price data
				TASK 9: Train staff in quantification methods
			2.B THE QUANTIFICATION PHASE
				TASKS 10-15: Data collection, quantification, costing, reconciliation to budget, calculation of final quantities per 1,000 cases
				TASK 16: Feed back results to managers for placing orders and allocating drugs to individual facilities
				TASK 17: Provide training in prescribing and stock management
				TASK 18: Evaluate the quantification process and make any necessary improvements
	MODULE 4: DRAWING UP AND REVIEWING ESSENTIAL DRUG LISTS BY TYPE OF FACILITY
		1. INTRODUCTION
		2. TASK 7-8: DECIDING LEVELS OF CARE AND ESSENTIAL DRUG LISTS BY TYPE OF FACILITY
		3. ADD PACK SIZE AND PRICE PER PACK
PART II: THE MORBIDITY METHOD
	MODULE 5: Data requirements: standard drug treatment schedules for quantifying requirements, based on average doses
		1. INTRODUCTION
		2. TASK 10: STANDARD DRUG TREATMENT SCHEDULES FOR QUANTIFYING DRUG REQUIREMENTS, BASED ON AVERAGE DOSES (AVERAGE DRUG TREATMENT SCHEDULES)
		3. GUIDELINES FOR DRAWING UP AVERAGE DRUG TREATMENT SCHEDULES
		4. ILLUSTRATIVE AVERAGE DRUG TREATMENT SCHEDULES FOR THE MIDDLE (HEALTH CENTRE) LEVEL OF CARE
	MODULE 6: Data requirement: morbidity data
		1. THE DATA REQUIRED - TREATMENT EPISODES
		2. TASK 11: DATA COLLECTION
			2.1 Estimates from centrally assembled patient morbidity data
			2.2 Estimate from morbidity data from a sample of health facilities
			2.3 Prospective sample survey
	MODULE 7: The patient morbidity/standard treatment method: calculation procedures
		1. INTRODUCTION
		2. TASK 12: CALCULATING QUANTITIES REQUIRED OF EACH DRUG
		3. TASK 13: ESTIMATING THE COST OF THE DRUG QUANTITIES REQUIRED
		4. TASK 14: RECONCILING DRUG QUANTITIES TO BUDGET
		5. TASK 15: CALCULATING AVERAGE DRUG REQUIREMENTS PER 1,000 TREATMENT EPISODES OR PER 1,000 PATIENT CONTACTS
PART III: THE CONSUMPTION METHOD
	MODULE 8: The adjusted consumption method: calculation procedure
		1. INTRODUCTION
		2. METHOD OF CALCULATION
		3. TASK 10: SELECT THE “STANDARD” FACILITIES WHOSE CONSUMPTION IS TO SERVE AS THE NORM FOR THE DRUG QUANTITIES TO BE SUPPLIED TO ALL FACILITIES OF THE SAME TYPE
		4. TASK 11: ESTIMATE THE NUMBER OF PATIENT CONTACTS AT ALL FACILITIES OF THE TYPE(S) CONCERNED
		5. TASK 12: CALCULATE THE AVERAGE DRUG USE PER 1,000 PATIENT CONTACTS AND THE QUANTITY REQUIRED OF EACH DRUG
ANNEXES
	Annex 1: Model record form for the community health worker
	Annex 2: Calculation sheet for drug quantities by health problem
	Annex 3: Calculation sheet for total quantities of each drug, number of order packs and cost
	Annex 4: Calculation sheet for total drug quantities and cost after reconciliation to budget, and quantities per 1000 treatment episodes
	Annex 5: Calculation sheet for recording drug quantities (consumption method)

1. INTRODUCTION

The adjusted consumption method estimates drug requirements on the basis of actual drug use per 1,000 patient contacts in a sample of “standard” facilities, where the pattern and level of consumption are considered acceptable. In some cases an adjustment upwards or downwards may be needed for drug quantities where consumption is considered inappropriate.

In other words, the adjusted consumption in the “standard” facilities is considered to be a reasonable approximation of the need for drugs in other facilities of the same kind. This requires that:

(a) prescribing patterns in the “standard” facilities are considered to be broadly reasonable; and

(b) that the pattern of morbidity treated is representative of the pattern in the rest of the country or region concerned.

When compared with the morbidity method, this method offers less scope for systematic development to improve drug supply and prescribing practice. Its advantages are that it does not require either detailed data on patient morbidity, or standard treatment schedules. However, users of this method should pay particular attention to the fact that any irrational consumption patterns in the “standard” facilities, which are not corrected in the adjustment process, will be included in the drug estimates for all facilities of the type covered by the calculation.

It is important to realize that drug use is not identical to drug need. For example, high consumption of antibiotics because of indiscriminate prescribing, or the use of sophisticated or expensive forms might be interpreted as a need, whereas simpler or cheaper preparations would suffice.

In addition, it must be emphasized that also for the adjusted consumption method to be successful, it is crucial to improve prescribing in order to bring it into line with the drug need estimates. One means to do this is to use standard treatment schedules.