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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 16  |  Issue : 4  |  Page : 156-159

Pattern of drug utilization at community geriatric outpatient department attached to a tertiary hospital


1 Department of Community Medicine, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
2 National Centre for Disease Control, Delhi, India

Date of Submission19-Oct-2020
Date of Decision14-Dec-2020
Date of Acceptance09-Dec-2020
Date of Web Publication23-Feb-2021

Correspondence Address:
Dr. U S Saurabha
6105, Prestige Temple Bells, Rajarajeshwarinagar, Bengaluru - 560 098, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiag.jiag_15_20

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  Abstract 


Context: Material management is a process of management; one of its essential functions is inventory control. The various inventory management types are ABC, VED, FSN, SDE, HML, XYZ, and SOS. Proper inventory control is required for the sound management of a health-care facility. Methodology: A cross-sectional descriptive study based on secondary data, conducted in the geriatric outpatient department, a peripheral health training center of a tertiary care medical college. The indent record of the pharmacy for the year 2018 was procured. The data thus obtained were tabulated and analyzed in Microsoft Excel. ABC, SDE, FSN, and XYZ analyses were carried out. Results: ABC analysis category A accounted for 67.5%, category B 20.1%, and category C 12.4% of the annual expenditure. VED analysis showed that 50% of the drugs were vital for the center's functioning; this accounts for 49.2% of the yearly expenditure. FSN, SDE, and XYZ analyses of the drug showed the more than half of the drugs. 55.7% of the drugs are fast moving; 50.8% of the drugs are easily available on indenting for them, and 63.7% of the drugs belong to X category as per XYZ analysis. Conclusion: A combined usage of the various inventory management methods, specific to the type of health-care delivery center, will help in the smooth functioning of the center.

Keywords: Community outreach, geriatric, health expenditure, health-care delivery, inventory


How to cite this article:
Bhondve AS, Saurabha U S. Pattern of drug utilization at community geriatric outpatient department attached to a tertiary hospital. J Indian Acad Geriatr 2020;16:156-9

How to cite this URL:
Bhondve AS, Saurabha U S. Pattern of drug utilization at community geriatric outpatient department attached to a tertiary hospital. J Indian Acad Geriatr [serial online] 2020 [cited 2021 Apr 20];16:156-9. Available from: http://www.jiag.com/text.asp?2020/16/4/156/309999




  Introduction Top


Materials management is the process of management which coordinates supervises and executes the task associated with the flow of materials through and out of an organization in an integrated fashion. One of the critical functions of material management is inventory control. It includes receiving items, storage, warehousing, distribution, and disposal of obsolete items. The aim of inventory control in a health-care setting is to (a) maintain the availability of item anywhere anytime in the hospital at optimum cost, (b) minimize dead stock; and (c) optimize cost by analyzing holding cost, ordering cost, and stockout cost to have minimum inventory cost.

Inventory management techniques are of various types: ABC, VED, FSN, SDE, HML, XYZ, and SOS. ABC – this type of inventory depends on the annual consumption cost of items and not on the items' unit price. This is control on a cost basis. VED analysis in inventory is based on the functional importance of the items and the necessity of the item in the health care facility; XYZ is based on the variability in the demand of the product. FSN is based on the rate of usage of the drug/turnover ratio.[1]

Approximately 35% of the annual hospital's budget is spent on buying materials, including supplies. The drugs consume about 60% of the total consumable budget.[2] Thus, pharmacy is one of the most extensively used therapeutic facilities of the hospital and a few areas where a large amount of money is spent on buying items.

The proportion of the elderly in India is 8.6% of the total population as per the report published by the Ministry of Statistics and Programme Implementation, Government of India, in 2016.[3] There has been an increase in a load of chronic morbidities among the elderly; this has affected them not only in physical, mental, and social aspects but also in the financial aspect. Among the aged living, 65% are dependent on others for day-to-day maintenance.[4] The mean monthly household consumption expenditure, as reported in India, is Rs. 6724.00. The mean out-of-pocket expenditure on health care is Rs. 854.00. On average, the health out-of-pocket expenditure is 13% of the total household expenditure.[5]

This outreach center caters to the geriatric population. The health problems for which treatment is provided comprise mostly noncommunicable diseases and musculoskeletal diseases, and communicable diseases are treated on certain occasions. This study was taken up to understand the importance of inventory management needed for an outreach center's smooth functioning, especially a geriatric clinic, wherein stockout can lead to a lot of distress among patients as many are not financially independent. The proper inventory management will also add to the reduction of out-of-pocket expenditure and reduce the fear of financial insecurity among the elderly.


  Methodology Top


Study design

This was a cross-sectional study.

Study type

This was a descriptive study based on secondary data.

Study site

This study was conducted in the geriatric outpatient department (OPD), a peripheral health training center of a tertiary care medical college of a metropolitan city, Naigaon. This OPD caters to the elderly population living the Naigaon areas who are above 60 years of age.

Study duration

The duration of this study was 3 months.

Data collection

The pharmacy's indent record for the year (2018) was procured after obtaining necessary permissions. A detailed list of drugs indented by the geriatric OPD department in 2018 was used to verify against the records maintained in the pharmacy. The cost of the drugs was obtained from the pharmacy. The data thus obtained were tabulated in Microsoft Excel and analyzed to understand the annual indent, annual cost incurred, and usage pattern. Based on this ABC analysis, SDE, FSN, and XYZ analyses were carried out. For VED analysis, the drug was classified based on the judgment of the center in charge.

Data analysis

Data obtained will be entered in Microsoft Excel and analyzed using Microsoft Excel.


  Results Top


A total of 31 drugs were procured from the drug store in the year 2018. All drugs procured were included in the study. The annual cost involved in the procurement of these drugs was Rs. 67,376.00. A bulk indent was placed at the beginning of the year and then whenever the stock was reduced. The 31 drugs were grouped into eight classes: oral hypoglycemic agents, antibiotics, antihypertensive, antacid, supplements, antihistamine, blood thinning, and pain killer.

The ABC analysis of the drugs revealed that the drugs belonging to category A accounted for 67.5% (Rs. 45,475.00), category B 20.1% (Rs. 13,526.00), and category C 12.4% (Rs. 8375.00) of the annual expenditure. The drugs in the categories A, B, and C constituted 23.7% (9), 50.18% (13), and 26.3% (9), respectively, of the annual quantity [Figure 1].
Figure 1: A graph representing the ABC analysis

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The VED analysis showed that 50% of the drugs were vital for the center's functioning, which accounts for 49.2% of the annual expenditure, and 22% of the drugs belonged to the essential. The remaining 28% belonged to the desired category. The combined ABC and VED analysis was inferred that 62.8% of the drugs in the annual indent belonged to category 1 (AV, AE, AD, BV, and CV); 22% of the drugs belonged to category II (BE, BD, and CE); and 15.2% of the drugs belonged to category III (CD). The drugs' annual expenditure in category I is 81.6%, category II 10.2%, and category III 8.2% [Table 1].
Table 1: Combined ABC and VED analysis

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The FSN, SDE, and XYZ analyses of the drug showed that more than half of the drugs (55.7%) of the drugs are fast moving; 50.8% of the drugs are easily available indenting for them, and 63.7% of the drugs belong to X category as per XYZ analysis [Table 2].

A combined VED and SDE analysis showed that 72% of the drugs belonged to vital and essential category and it was also observed that 10.9% of the drugs which were categorized as vital were scarce- not readily available. This group of drug accounts for 35.8% of the annual expenditure [Table 3].
Table 2: Inventory analysis by FSN, SDE, and XYZ analyses

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Table 3: Combined VED and SDE analysis

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  Discussion Top


The improvement in health care has improved individuals' life expectancy, and this increased life expectancy has come with the price of an increase in the burden of chronic diseases. Preventive medicine/healthy leaving is not the demand of many, unlike curative medicine. Thus, the inventory management of a drug store is of utmost importance in any health-care facility. The outreach centers, unlike the larger health-care facility carter to a specific group of the society and the availability of treatment, are for specific diseases. Our study tried to identify the most suitable inventory management methods for such a center for the bare minimum of 31 drugs indented. The drugs most commonly used in the geriatric OPD was antidiabetic and antihypertensive medications. It was also observed that these drugs on certain occasions were not available as per necessity.

ABC analysis of our study reveals that 23.65% of the drugs in category A amount to 67.5% of the annual expenditure and 26.3% of the drugs in category C amount to 12.43% of the yearly drug expenditure. These findings of our study are not coherence with studies conducted by Mani et al. and Chethana et al. These studies like ours have also been conducted in smaller health-care delivery units.[6],[7] The variation in the findings of our study and the above studies is probably due to the geriatric centric nature of our health facility. the two studies were conducted a full-fledged hospital.

Fifty percent of the inventory drugs amount to 49.2% of the vital group's annual expenditure. Half of the drugs essential for the geriatric clinic's functioning consume nearly half of the total drug expenditure. These findings are somewhat similar to the study conducted by Guha and Sundress which was also conducted in geriatric clinic, wherein about 28.9% of the drugs in the vital group consumed 55% of the total drug expenditure.[8] The management of this group of the drug needs to be very stringent. Stockout of drugs in this group will hamper the functioning of the center and lead to high out-of-pocket expenditure by the financially dependent geriatric population.

On combined ABC-VED analysis in the present study, 62.8% of the drugs amounting to 81.6% of the annual drug expenditure belonged to category I. Similar findings of the total drug expenditure have been reported by studies conducted in similar settings [Table 4]. The category I drugs need to be monitored carefully as they are vital for the center's functioning and consume the majority of the annual drug expenditure.[9],[10]
Table 4: Comparison of coupled ABC-VED matrix

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FSN inventory management method also plays a vital role in outreach centers, wherein a close watch on the movement of drugs is essential. The fast moving drugs which constituted 55.7% of the annual indent amounted to 54.2% of the yearly expenditure. It was also observed that most drugs in the F (fast moving)category were vital for the functioning of the clinic as per VED analysis. A study conducted bu Guha and Sundress also performs an FSN analysis on the geriatric drugs of a tertiary care hospital. An XYZ analysis showed that most center drugs are nonvariable, and the drug requirement can be predicted.[8]

A coupled VED–SDE matrix helped us understand that a drug critical for the center's functioning is scarcely available from the drug store. This form of coupled analysis can be performed in health-care delivery centers like ours so that adequate stock plus buffer stock for the whole year can be procured for the drugs in the VS group whenever the drug is available in the drug store.

This study was conducted to understand the drug requirements of a specialty OPD attached to a tertiary care hospital. Such an analysis will help improve the overall functioning and quality of care provided by peripheral health units. However, our study was conducted on data available for 1 year; the variations if any over the years could not be understood.


  Conclusion Top


A combined usage of the various inventory management methods, specific to the type of health-care delivery center, will help in the center's smooth functioning. Stockout, as well as excess indent, can be prevented with a sound knowledge of inventory management. In an outreach center, drugs throughout the year are of utmost importance to avoid out-of-pocket expenditure.

Acknowledgment

We would like to thank all faculties, staff, and residents of the Department of Community Medicine, Seth GS Medical College.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bhatnagar A. Text Book of Public Health and Community Medicine. Pune: AFMC, Pune and WHO, India Office; 2009.  Back to cited text no. 1
    
2.
Saxena R, Gokhale C, Kadam D. ABC-VED analysis of the pharmacy of an urban health centre. Int J Multidiscip Res Dev 2017;4:233-6.  Back to cited text no. 2
    
3.
Central Statistics Office, Ministry of Statistics and Programme Implementation. Elderly in India- Profile and Programmes. Delhi: Government of India; 2016.  Back to cited text no. 3
    
4.
Central Statistics Office, Ministry of Statistics and Programme Implementation. Situation Analysis of the Elderly in India. Delhi: Government of India; 2011.  Back to cited text no. 4
    
5.
Singh T, Bhatnagar N, Singh G, Kaur M, Kaur S, Thaware P, et al. Health-care utilisation and expenditure patterns in the rural areas of Punjab, India. J Fam Med Prim Care 2018;7:39.  Back to cited text no. 5
    
6.
Mani G, Annadurai K, Danasekaran R, Ramasamy J. Drug inventory control analysis in primary level health care facility in rural Tamil Nadu, India. Healthline 2014;5:36-40.  Back to cited text no. 6
    
7.
Chethana T, Rajan B, Selvaraj A, Pruthvish S ABC analysis of drugs used in health camps organised in villages of Chintamani taluk, Karnataka, India. Int J Community Med Public Heal 2017;4:186.  Back to cited text no. 7
    
8.
Guha D, Sundress J. Analysis of geriatrics patient's drugs inventory management in the outpatients pharmacy in a tertiary care hospital in West Bengal. Indian J Res 2017;6:237-8.  Back to cited text no. 8
    
9.
Anand T, Ingle GK, Kishore J, Kumar R. ABC-VED analysis of a drug store in the Department of Community Medicine of a Medical College in Delhi. Indian J Pharm Sci 2013;75:113-7.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Chakraborty N, Mandal A. Inventory control for drugs used in the urban training centre of a tertiary care hospital, Kolkata, West Bengal, India. Int J Community Med Public Heal 2016;3:2509-12.  Back to cited text no. 10
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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