Studies have found out that drugs are comprising 40%-50% of the total hospital revenue. The main problems related to drug management at the health care unit are drugs shortage and expired drugs. Today, I am going to talk about the problems of drugs shortage corresponding to an article that I have read recently.
According to Fox and his associations (2009), some of the contributing factors to drugs shortage in hospitals and health system are recognized as below:
1) unavailability of raw and bulk materials used in pharmaceutical.
2) manufacturing difficulties and regulatory issues,
3) changes in product formulation or manufacturers
4) manufacturer's production decisions and economic
5) lack of communication and transportation deficiency throughout the supply chain,
6) unexpected increases in demand and shifts in clinical practice
7) natural disaster
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Process for decision-making in the management of drugs shortages |
A better drug inventory management may play an important role. One of the effort taken by puskesmas in Indonesia is to develop a drug formulary. The drug formulary is a list of drug information. As what was told by Dr. Erna, Puskesmas has essential drug list, generic drugs and brand drugs list. The prescription of common drugs in puskesmas mostly refer to essential drug list, sometimes generic drug and only 10% for brand drugs . As for the essential drug list, Indonesia adopted it from WHO essential medicines & pharmaceutical policies. Besides, Dr. Erna also pointed out that there is approximately 150 types of essential drugs in puskesmas Indonesia. To develop a drug formulary, below is the VEN system that can be found in Puskesmas Indonesia.
1) Vital (V) : potentially life-saving
1) Vital (V) : potentially life-saving
2) Essential (E) : most common drug prescribed, proven beneficial
3) Non essential (N) : high cost, for minor self-limited disease
Another way to cope with the problems of drugs shortage is to manage the drug inventory. To determine a target inventory, Indonesia use ABC (activity based costing) analysis which classify drugs into 3 groups.
Another way to cope with the problems of drugs shortage is to manage the drug inventory. To determine a target inventory, Indonesia use ABC (activity based costing) analysis which classify drugs into 3 groups.
A Class : 10 - 20% of total drugs consumed , 70-80% of spendings on medication
B Class : > 20% of total drugs consumed, 10 - 20% of spendings on medication
C Class : 60 - 80% of total drugs consumed, 5 -25% of spendings on medication
For instance, drugs categorized into A class will be given the highest attention as they make most profit to the health center, around 70 - 80% of the income contributed by patients' medication bills. Let say we reduce the level of A class drugs inventory as it only comprises 10 to 20% of total drugs presribed. Doctors could presribe A class drugs more frequently and in a small amount each time. As a result, an overall inventory cost can be regulated. Since different categories of stock that need different management has been identified, workload for pharmaceutical department in controlling drugs stock level could be reduced as well.
I think that is all for what i want to share today. You can study more on lecture notes. =)
I think that is all for what i want to share today. You can study more on lecture notes. =)
References;
1) Lecture note by Dr. Erna kristin, Drug management and Policy in Primary Health Care
6) http://en.wikipedia.org/wiki/ABC_analysis
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