[e-drug] Policy research

[John Chalker <jchalker@msh.org>]

E-drug: Policy research
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Dear all,
 
On behalf of the Joint Research Initiative on Improving the Use of
Medicine (JRIIUM), I ask your help to investigate the effect of policy
implementation on drug use. We are looking for locations where
policies have been implemented and where there are drug use
records for both before and after the policy implementation.

The Joint Research Initiative on Improving the Use of Medicine was
established after a conference in 1997 to find evidence on the
success of different interventions to improve drug use. The
organizations involved in this initiative include the International
Network for the Rational Use of Drugs (INRUD), WHO/EDM, and the
USAID funded Applied Research for Child Health (ARCH) and the
Rational Pharmaceutical Management Plus Programs as well as a
number of research teams throughout Africa and Asia.

The types of drug use records that may be useful are either
aggregated records of procurement, consumption or distribution for
a country, region, district or hospital or disaggregated data such as
prescription or clinical records in a hospital or insurance system.
These records need to have been in existence before and after the
policy intervention.

The types of policy that may have been implemented are listed
below, but the crucial thing is the availability of retrospective data
on drug use which can be analyzed.

If you have any ideas or knowledge on where there may be existing
drug use data that can be collected or sampled, to assess the
impact of a policy implementation, please let us know at once. We
would like to get several studies underway in the next three or four
months. 

Thank you in advance.

John Chalker, on behalf of INRUD, WHO/EDM, ARCH, RPM Plus of
the Joint Research Initiative on Improving the Use of Medicine

Please contact us through John Chalker, whose E-Mail is
<jchalker@msh.org>.

Types of Policy Interventions:

A. Economic interventions
   1) Changes in reimbursement arrangements for individual
   services or drugs (e.g., levels of user fees, tiered copayments
   for drugs) 
   2) Implementation of capitated payment arrangements (instead
   of fee for service)
   3) Change in regulations regarding dispensing prescribers
   4) Changes in practice/institutional budget arrangements (e.g.,
   fixed/capped prescribing budgets
   5) Change in degree of financial autonomy of institutions or
   administrative areas

B. Administrative/managerial policies
   1) Change in national treatment policy or drugs of choice for
   defined condition
   2) Programs to implement specific standard treatment
   guideline(s) within a country or system of care
   3) Implementation of a generic prescribing or dispensing policy
   4) Change in policies regarding patient referral to higher levels
   of care
   5) System-wide audit and feedback program
   6) System-wide implementation of improved supervision 
   7) Implementation of system-wide policy requiring Drugs and
   Therapeutics Committees

C. Infrastructure changes
   1) Introduction or improvement in laboratory services
   2) Changes in drug supply system (e.g., kit systems, pooled
   procurement)
   3) Changes in programs for human resource
   management/provision/training
   4) Decentralization or devolution of decision making about
   health or pharmaceutical services
   5) Shifts in service provision/organization between public and
   private sectors (e.g. drug supply, health worker training,
   employment, private pharmacies or beds in hospitals)

D. Regulatory interventions
   1) Banning unsafe or undesirable drugs from the market or
   removing them from a drug supply system
   2) Changes in drug registration policy (e.g., level of use status,
   OTC/Rx-only status, controlled status), 
   3) Changes in licensing of drug outlets (e.g., criteria for
   licensing, policies pertaining to dispensing), 
   4) Changes in licensing health professionals (includes
   revalidation, policies pertaining to prescribing)
   5) Accreditation of health institutions

E. National Drug Policies
   1) NDPs are often diffuse programs and evaluating effects on
   specific drug use practices may be difficult, but there might be
   some opportunities

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