There are three principal phases of activity during a drug indicators study: planning the study, collecting the data, and data processing. Personnel requirements for each phase are discussed separately.
Planning the study
Persons planning and carrying out a drug use indicator study need a basic knowledge of pharmaceuticals, some understanding of the principles of sample surveys and an appreciation of the logistical requirements for carrying out field studies. The indicators and methods recommended in this manual have been designed to minimize as far as possible the need for a high level of sophistication in these areas. Carrying out more in-depth follow-up activities, or designing and mounting an intervention, will in many cases require a higher level of technical expertise.
Studies are most useful when they are designed to meet specific objectives. The results of an indicator study would be of most interest to managers and policy-makers responsible for administering a primary health care programme, or to health providers responsible for supervising the quality of medical care in public sector facilities. If the initiative for carrying out an indicators study does not originate with such people, they should be involved at an early stage in its design.
Data collectors should be familiar with pharmaceutical terms to be able to reliably extract information from records, and to record it accurately during observations. The most effective data collectors are persons with clinical experience such as physicians, nurses, pharmacists or paramedical staff. However, other MOH staff and temporary employees with some health-related experience hired specifically to collect and enter data can also be used.
It is possible to separate the process of collecting data from coding the specific indicators. Data collectors can be trained to record only the names of drugs and routes of delivery while in the field, and coders can later assign values to the indicators (for example, whether or not a drug is an antibiotic). In this case the detailed prescribing indicators form in Annex 2 could be used. In this way, personnel with less drug-related experience can be trained to collect data, while staff more familiar with pharmaceuticals can assign values to the indicators. This is one way to ensure that the rules for assigning codes and handling missing information will be applied uniformly. Alternatively, the indicators can be coded and recorded directly on the prescribing indicators form in Annex 2.
Data collection can be tedious work, and requires an aptitude for concentration and attention to detail. The best data collectors combine the discipline to collect data in a standardized way with the flexibility to adapt procedures to the requirements of unusual situations. People who have these traits, but lack technical knowledge, can be trained to perform effectively and will improve with experience; people without them will never perform effectively, regardless of their technical qualifications.
There are two approaches to processing the data from an indicators study: manual tabulation and computerized analysis. The drug use indicators have been designed in such a way that it is possible to collect the data and calculate the indicators without the aid of a computer. However, if computers are available, the data can be a rich source of further analyses on the use of drugs and costs of treatment. To facilitate the use of computers a special spreadsheet has been prepared to allow rapid entry and analysis of indicators data*. In addition, an X-Base compatible computer program is available to allow for the standardized data entry and analysis of the detailed prescribing indicator form. Although data in this format are more difficult to process, the possibilities exist for more complex, problem-specific secondary analyses.
* Available free of charge from INRUD, Management Sciences for Health, 165 Allandale Road, Boston, MA 02130, USA
If the indicators are coded in the field, the pharmaceutical knowledge of data collectors should be relatively high. Decisions about the coding of certain indicators, such as whether or not drugs are prescribed by generic name, are more efficiently made during data collection, but require reasonably thorough information about which names represent generic drugs. Support and supervision of the data collection process also need to be strengthened.
Many of the decisions on coding the prescribing indicators can be delayed until the data are returned to the study office. Under these circumstances an indicators study will need to have the services of one or more data coders familiar with pharmaceutical treatment and if data are to be computerized, data entry clerks to input the coded encounters.