Đánh giá thực trạng kê đơn và chăm sóc bệnh nhân điều trị ngoại trú bảo hiểm y tế tại một số cơ sở y tế công lập ở thành phố cần thơ giai đoạn 2016 2018 tt tiếng anh

MINISTRY OF EDUCATION AND TRAINING
MINISTRY OF MILITARY
MILITARY MEDICAL UNIVERSITY

HUNG NGUYEN PHUC

ASSESSMENT OF PRESCRIPTION AND CARE FOR
OUTPATIENTS WITH HEALTH INSURANCE
AT SOME PUBLIC HEALTHCARE FACILITIES
IN CAN THO CITY IN THE PERIOD OF 2016-2018

Major: Pharmaceutical management organization
Code: 9 72 02 12

SUMMARY OF PHARMACEUTICAL Ph.D THESIS

HA NOI – 2020


THE RESEARCH WORK ACCOMPLISHED AT
MILITARY MEDICAL UNIVERSITY

Scientific supervisors:
1. Assoc.Prof. Chinh Nguyen Minh

Reviewer 1: Assoc.Prof. Vu Hoang Thy Nhac
Reviewer 2: PhD. My Nguyen Huu
Reviewer 3: Prof. Binh Nguyen Thanh

The Thesis will be defended against the Council of
Military Medical University at:

o’clock day

month

year

This thesis can be referred at:
1. National Library of Vietnam
2. Library of Military Medical University


1

INTRODUCTION
Drugs have an important role in the disease treatments, but they
have various side effects. In case of incorrect use, it will cause bad
consequences that directly affect human health such as prolonging
treatment time, increasing the death rate of patients, increasing the
cost of treatment, especially increasing the drug dependence in
general and antibiotic resistance in particular. Statistically, more than
50% of drugs are used improperly worldwide. In 1985, the World
Health Organization held a large conference in Nairobi - Kenya on
rational use of drugs and developed drug use indicators.
In Vietnam, the situation of prescription is not out of the general
trend of developing countries, which is the abuse of antibiotics,
injections, vitamins, prescribing too many drugs in a prescription. In
addition, in the past time, some medical facilities have not paid
adequate attention to the conditions to serve patients and improve the
quality of medical examination and treatment; and the quality of

health services organization does not commensurate with the cost.
At the public health facilities in Can Tho receiving medical
examination and treatment with health insurance in 2015, about
6,351 outpatients visited the hospital per day and 97% of them had
health insurance cards. Therefore, the work of prescribing medical
examination and care for patients with health insurance at the
hospital should be more closely monitored. From the above practices,
the topic: "Assessment of virtual prescription and care for
outpatient with health insurance at some public healthcare
facilities in Can Tho city in the period of 2016-2018" has been
done with the following goals:
1. Assess the status of prescription and the effectiveness of some
interventions in prescribing outpatient health insurance drugs at


2

some public health facilities in Can Tho city for the period 20162018.
2. Assess the situation of patient care and the effectiveness of
some interventions in the care of patients with outpatient health
insurance at some public health facilities in Can Tho city in the
period of 2016-2018.
New contributions of the thesis:
The study was conducted to fully evaluate the prescribing
activities of physicians through evaluating the implementation of the
prescription regulations and comprehensive indicators, and at the
same time assess the satisfaction of the people about the health
facility.
The study compared the effectiveness of some interventions at 3
healthcare facilities, which serves as a basis for broad deployment of

the solutions from the experience at these 3 facilities in Can Tho
City, the largest and most developed city in the Mekong Delta with a
large number of medical examinations and treatment facilities (11
facilities). Thus, the research results will be representative and has
scientific value.
The layout of the thesis:
The content of the thesis is presented in 146 pages, including 4
chapters: Introduction: 2 pages; Chapter 1 - Overview: 34 pages;
Chapter 2 - Subjects and research methods: 25 pages; Chapter 3 Research results: 42 pages; Chapter 4 - Discussion: 40 pages;
Conclusion: 2 pages; Recommendations: 1 page. The thesis includes:
54 tables, 7 diagrams, and 120 references.


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Chapter 1.
OVERVIEW
1.1. Rules of prescriptions for outpatient treatment, indicators of
drug use, the factors affecting drug use
1.1.1. Rules of prescriptions for outpatient treatment
According to Article 6 of Circular No. 05/2016 / TT-BYT of the
Ministry of Health, general requirements for prescription drug
contain:
* Complete, clear and correct writing of the items that are
printed on the prescription.
* Exact written address of permanent or temporary residence.
* For children under 72 months of age, the number of months
and the name of the father must be recorded.
* Write down the drug names according to the international
generic name, except for drugs containing many active ingredients. In

case of additional drug names according to trade names, trade names
must be put in parentheses after the international nonproprietary
name.
* Note the drug name, concentration / content, quantity, dose,
route of administration, time of use of each drug.
* Number of addictive drugs must be written in letters and the
first letters are capitalized.
* Number of medicine: write the number 0 beforehand if the
number only has one digit (less than 10).
* In case of amendment of the application, the prescriber must
sign next to the corrected content.
* Cross the blank paper from the bottom of the prescription
contents to the signature of the prescriber; Sign, write (or stamp) the
full name of the prescriber.
1.1.2. Indicators of drug use


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1.1.2.1. Objective
Studies to assess the use of drugs will vary widely from place to
place, depending on many factors such as the specific information
needs of health managers, the type of record keeping system
available on-site, service providers with the described routines,
resources to conduct research. In general, drug use studies are based
on indicators that fall into the following four broad groups:
* Description of prescription practice.
* Comparing the implementation of drug use indicators between
health facilities or prescribers or between health care groups.
* Supervise and monitor each specific period of the year on drug

use habits.
* Evaluation of intervention effectiveness.
1.1.3. Factors affecting drug use
1.1.3.1. According to the World Health Organization
* Simple, short-term training strategies are often ineffective and
their effects are not sustainable.
* Using printed materials is usually not effective.
* Cooperation strategies, especially various strategies such as
training combined with management often give better results.
* Workshops focused on small groups and face-to-face
discussions have proven to be effective, especially with competent
trainers and coordinators.
* Monitoring, feedback and evaluation are very effective
strategies, but it requires consistency in the use of certain standards to
evaluate prescription (e.g. standard treatment guidelines).
* The reward bracket is an effective way of changing behavior;
however, there are disadvantages that can lead to undesirable
behaviors and promote inappropriate use of drugs.


5

* Legal interventions may have an adverse effect worse than
originally anticipated (e.g. replacing prohibited drugs with
inappropriate drugs).
1.1.3.2. According to the US Center for Medical Management
Science (MSH: Management Sciences for Health)
Many factors affect drug use: the health system; prescriber;
medicine dispensers; patients and the community. MSH recommends
intervention strategies to improve drug use: education strategy;

Management strategy; economic strategy; regulatory strategy.
1.2.4. Summary of several studies on patient prescription and
care in the world and in Vietnam
* Limitations of the topics:
+ Studies are cross-sectional studies, so the results are
representative for one time of the year, not completely representative
of the establishment's use of drugs in the most comprehensive way.
+ Limited mention of possible interventions as well as
recommendations to the state management agencies for monitoring
and evaluating.
+ The sample size of the studies is quite small, so the indexes
are not fully evaluated.
+ Studies in Vietnam are often conducted at one healthcare
facility, so it has not appreciated the situation of drug use when
comparing between different health facilities or between different
areas at the same time. Therefore, the results of some studies do not
represent an entire region or country.
+ A number of studies were conducted at a third-class hospital
and therefore it is necessary to further study these parameters at the
central level.


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+ Studies have investigated the economic aspects of drug use.
However, they have not assessed the relationship between rational
safety and economy.
+ Researchers have not comprehensively assessed the causes of
rational and safe use of drugs. Overcrowding in healthcare facilities
requires assessments and solutions.

+ Interventions and supervision in drug use have not been
thoroughly implemented. Researchers have not boldly intervened and
impacted the prescription system of drug use. Research is therefore
limited to warning levels for healthcare regulators.
* Regarding the research scope:
+ The problem that needs to be researched and resolved here is:
How do medical examination and treatment facilities operate, comply
with the regulations and guidelines, and effectively affect the
prescription and how to dispense drugs by healthcare workers
through information and counseling activities on drug use.
+ The medicine and treatment council has not been promoted in
hospitals, most of the activities are still faint and of a coping nature,
have not gone into analyzing the use and dispensing of drugs in
hospitals to propose remedies. No studies have analyzed the
interventions on the activities of the hospital medicines and treatment
Council and then re-evaluate the indicators of drug use as well as
rational use of drugs.
+ The main research topics on the subject are doctors,
pharmacists, while not evaluating and analyzing prescription.
CHAPTER 2.
SUBJECTS AND RESEARCH METHODS
2.1. Subjects
* 11 facilities that meet the research conditions.


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* Outpatient health insurance prescriptions during the study
period.
2.1.1. Patient selection criteria

* Public health facilities with health insurance holders; patients
and their relatives agree to participate in the study and fully answer
questions in the interview.
* Outpatient prescription with health insurance who encountered
common disease in the community.
2.1.2. Exclusion criteria
* Medical facilities, doctors at examination departments,
pharmacists dispensing drugs, patients and/or their family members
disagree to participate in the study.
* Patients who come for outpatient examination but are
transferred inpatient or emergency at a hospital.
2.2. Methods
2.2.1. Research designs
* Direct observation of prescription and dispensing activities.
* Direct interview of patients.
* Descriptive method with analysis before - after intervention.
2.2.2. Sample sizes
Based on the guidelines on survey of drug used index of WHO,
for each healthcare facility, at least 100 prescriptions were chosen,
according to the 2015-statistical table of Can Tho Social Insurance.
Can Tho University of Medicine and Pharmacy Hospital had the
lowest average number of daily outpatient visited, thus the sample
size wes 100 prescriptions. According to the corresponding ratio, the
number of prescriptions and insurance patients to be interviewed at
each facility is as follow:


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Table 2.2. The number of samples to be divided according to

11 healthcare facilities
No.
1
2
3
4
5
6
7
8
9
10
11

Healthcare Facilities

No. of
prescriptions

No. of
patients

Binh Thuy
136
136
Co Do
249
249
O Mon
681

681
Thot Not
630
630
Cai Rang
163
163
Phong Dien
303
303
Thoi Lai
377
377
Vinh Thanh
304
304
Can Tho Central General
218
218
CTUMP
100
100
Can Tho City General
885
885
Total
4,046
4,046
After intervention, samples with disease patterns, age group,
gender, education level are similar to those of before intervention.

The number of samples that needs to be collected at 3 healthcare
facilities after intervention is equal to that of before intervention.
2.2.4. Research content
2.2.4.1. Prescribing state in outpatient treatment with health
insurance at some public healthcare facilities in Can Tho city in the
period of 2016-2017
* Determining prescriptions to comply with the Minister of
Health's prescriptions for outpatient treatment.
* Prescription indicators: average number of prescriptions per
one prescription, percentage of drugs prescribed by generic or
international generic names (except for multi-ingredient medicines


9

that can be prescribed under trade names), the proportion of
prescriptions with antibiotics, injectable drugs, vitamins,
corticosteroids, the proportion of prescription drugs included in the
list of essential drugs and the list of mainly drugs issued by the
MOH, and the proportion of drug interactions.
* Comprehensive drug use indicators: the average cost for each
prescription, ratio of antibiotics cost, ratio of injection cost, ratio of
vitamin cost, ratio of corticosteroids cost, prescription rates
consistent with the treatment regimen.
* Survey the validity of outpatient prescription practice:
The rationality in the practice of prescribing drugs is built
according to the definition in chapter 27.2 of the US Center for
Management of Health Sciences: reasonable indications, reasonable
doses (correct prescription dosage: single dose, 24-hour dose and
divided into the correct number of times – based on the medication

guide or the drug information online), reasonable route (based on the
medication guide or research online information about drugs),
appropriate treatment duration (not more than 30 days), reasonable
information for patients (full prescription information on instructions
for use, dosage, special notes) .
2.2.4.2. Evaluate the effectiveness of some interventions in
prescribing outpatient treatment with health insurance at some
public healthcare facilities in Can Tho city
* Interventions: educational solutions, enhancing knowledge
and promoting the rational dispensing of drugs.
* Evaluation of SCT:
Review the status of prescription: the compliance with
regulations on drug prescriptions, prescription indexes, rational use
of drugs have not been achieved at 3 healthcare facilities.


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2.2.4.3. Evaluate the effectiveness of some interventions in
prescribing and taking care of outpatient at some public healthcare
facilities in Can Tho city
* 3 healthcare facilities: Can Tho university of Medicine and
Pharmacy hospital, O Mon district general hospital, Phong Dien
healthcare center.
* Subjects of intervention: council of medicines and treatment,
doctors prescribing outpatient drugs, pharmacists dispensing drugs
for outpatient treatment of health insurance.
* Observe the intervention solutions of state management
agencies in charge of health at 3 establishments.
* Assessing after intervetion: using T-test and Chi-square test to

compare differences of before intervetion and after intervetion.
2.2.4.4. Evaluate the effectiveness of some interventional solutions in
caring for outpatients who have health insurance at some public
healthcare facilities in Can Tho city
* Interventions: educational solutions, enhancing knowledge and
promoting the rational dispensing of drugs.
* Evaluation of SCT:
Review the status of patient care: patient care index, patient
satisfaction with outpatient services have not been achieved at 3
healthcare facilities.
2.2.5. Methods of processing and analyzing data
Data were processed using SPSS 20.0 software.
Chapter 3.
RESULTS
3.1. Results of assessing the status of prescription and the
effectiveness of some interventions in prescribing outpatient


11

health insurance drugs at some public health facilities in Can
Tho city in the period of 2016- 2018
3.1.1. Results of assessing the situation of prescribing for
outpatient health insurance at some public health facilities in
Can Tho city in the period of 2016-2017
3.1.1.1. Survey results on compliance with outpatient prescriptions
* Regarding compliance with administrative procedures
regulations: the implementation of the provisions on administrative
procedures needed in a prescription is quite well implemented (4/5
requests reach 100%), although there are still errors in recording

patient's home address, only reaching average overall 88.3%, the
error is usually due to missing address details or sometimes writing
the name of the patient's work agency.
* Regarding the compliance with the prescriptions: the
percentage of correct implementation of regulations on compulsory
contents in a prescription: 89.8% have correct full contents of the
prescription, 96% have correct number of medicines.
3.1.1.2. Assessment results in prescription index
* The average number of prescription drugs in a single
prescription: The average for all survey samples is 5.00.
* The proportion of drugs prescribed by the generic name and
international common name: Cai Rang district general hospital is the
only facility that does not achieve absolute success with 85.32%. In
which, 3 most pharmaceuticals were listed without the active
ingredient names are Apitim (amlodipine) (12.55%), Domitral
(nitroglycerin) (11.63%), and Detracyl (mephenesin) (6.36%).
* The proportion of applications with antibiotics: The average
number of applications with antibiotics is 31.1%. Antibiotics was
initially selected for the treatment of gastrointestinal, respiratory,
urology, mainly the β-lactam group.


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* The ratio of applications having injections: the general
percentage is 0.9%.
* The ratio of applications vitamins: the rate is 24.7%.
* The proportion of applications with corticosteroids: the
general rate for 11 health facilities is 12.1%. Phong Dien district
healthcare center accounted for the highest rate of 22.8% and the

lowest rate belonged to Can Tho University of Medicine and
Pharmacy Hospital with 4.0%. Prednisolone and Methyl
prednisolone are 2 corticosteroids usually used by doctors.
* The percentage of prescription drugs included in Essential
drug list and Main drug list: the average percentage of Essential drug
used is 41.98% and Main drug is 63.07%.
3.1.2. Evaluate the effectiveness of some interventions in
prescribing for outpatient at some public healthcare facilities in
Can Tho city in the period of 2017-2018
3.1.2.1. Compliance with regulations in prescribing for outpatient
After the intervention, the percentage of compliance with the
regulations on correct addressing in O Mon district general hospital
was increased but it was not significant. This index in Can Tho
university of Medicine and Pharmacy hospital and Phong Dien
healthcare center had a significant increase with p < 0.05 when Can
Tho university of Medicine and Pharmacy hospital increased from
85.0% to 100.0% and Phong Dien district healthcare center increased
from 90.8% to 100.0%. Requirements on recording drug quantity less
than 10 compliance rate after intervention at Can Tho university of
Medicine and Pharmacy hospital has changed but not significant with
p > 0.05. Particularly, Phong Dien district healthcare center had a
statistically significant increase with p < 0.05 in the regulation on
drug name, concentration/content, quantity, dose, route, time of use
of each drug from 62.7% to 93.2%.


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3.1.2.2. Prescription indicators
* Average number of drugs in a prescription after intervention:

Table 3.24. The average number of drugs in a prescription
after intervention
No.
Quartile
No.
Health facility
of
p
Q25 Q50 Q75
pres.
Before 100
3
4
5
1
CTUMP
> 0.05
After
100
3
4
5
Before 681
4
4
4
2
O Mon
< 0.05
After

681
4
4
5
Before 303
5
6
6
Phong
3
> 0.05
Dien
After
303
5
6
6
The average of total number of drugs prescribed by O Mon
district general hospital increased significantly after intervention
from 4.00 to 5.00 drugs in a single prescription with p < 0.05 and
Q75, however this increase is not clinically significant.
3.2. Results of assessing the situation of patient care and the
effectiveness of some interventions in taking care of patients with
outpatient health insurance at some public health facilities in
Can Tho city in 2016 -2018
3.2.1. Results of the assessing the situation of taking care of
patients with outpatient medical insurance in some public health
facilities in Can Tho city in the period of 2016-2017
3.2.1.1. Patient care indicators
* Average medical examination time: the lowest and highest

medical examination time in each hospital was 0.2 minutes and 33.10
minutes, respectively. The overall average for this study is 2.64
minutes.


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* Average dispensing time: this research result is high, however,
in our opinion, it is mainly the waiting time at the health insurance
dispensing office due to the large number of patients rather than the
direct communication time between allocation staff and patients.
* The percentage of drugs actually distributed: the average
percentage of actually distributed at 11/11 health facilities is almost
absolute, reaching 99.96%.
* The percentage of fully labeled applications: the percentage of
labeled drugs is as low as 47%.
* The patients' understanding of using dose: knowledge about
the duration of treatment is 77.1%, how to use the medicine is 76.4%,
the dosage of each type of medicine is 75.3%, the time to use
medicine is 76.7%.
3.2.1.2. Patient satisfaction in healthcare service
Regarding accessibility, the average of level 4 and level 5 at 11
health facilities was quite high, at 71.58%. Information transparency
and procedures to achieve satisfaction level of 4 or more with the rate
of over 80% in 3 health facilities: Phong Dien district healthcare
center, Cai Rang district healthcare center, Thoi Lai district
healthcare center. The average percentage of 11 medical facilities
was 71.77%. The attitude and professional capacity of health workers
at the survey facilities is assessed to be quite high.
3.2.2. Evaluate the effectiveness of some interventions in

outpatient care in some public health facilities in Can Tho city in
the period of 2017-2018
3.2.2.1. Patient care indicators
* Average time of examination: after intervention, time of
examination in all 3 hospitals increased significantly with p < 0.05.
Can Tho university of Medicine and Pharmacy increased from 2.50
minutes to 5.09 minutes, O Mon district general hospital increased


15

from 2.25 minutes to 4.62 minutes and Phong Dien district healthcare
center increased from 1.88 minutes to 3.93 minutes. It can be said
that the interventions are somehow effective.
* Average delivery time:
Table 3.37. Average drug delivery time after intervention
Quartile
No. of
No.
Health facility
p
pres. Q25 Q50 Q75
Before
100
5.24 5.8 6.33
1 CTUMP
< 0.05
After
100
5.77 6.29 6.53

Before
681
4.75 6.58 7.83
2 O Mon
< 0.05
After
681
6.34 7.65 9.68
Before
303
2.43 3.1
5.5
Phong
3
< 0.05
Dien
After
303
5.45 6.07 6.42
Similar to the time of examination, the time of drug dispensing
also increased to statistical significance with p < 0.05. This is also a
good sign to prove the effectiveness of interventions.
* The percentage of prescription which drugs fully labeled after
intervention: significant increase in all 3 hospitals with p < 0.05. This
improvement is significant with Can Tho university of Medicine and
Pharmacy hospital increasing from 30% to 51%, O Mon district
general hospital from 16.7% to 36.1% and Phong Dien district
healthcare center from 35% to 55.1 %.
* Patient's understanding of their treatment: the patient's
knowledge about 4 surveyed variables increased, but mostly not

statistically significant.
3.2.2.2. Patient satisfaction with health care service
Regarding the provision of medical services, there was a
decrease in the percentage of high level of satisfaction at O Mon
district general hospital, a slight increase at the two other hospitals,
but the increase or decrease mostly did not have statistical


16

significance. The majority of patients' satisfaction with accessibility
increased after intervention, Phong Dien district healthcare center
increased the highest by 12.28%, Can Tho university of Medicine
and Pharmacy hospital increased by 8% and O Mon district general
hospital increased by 3.08%. The transparency of information and
procedures with the highest satisfaction rate among patients going to
outpatient health insurance after intervention and highest at Can Tho
university of Medicine and Pharmacy hospital with all the variables
are statistically significant. In terms of facilities, this hospital also
had a statistically satisfaction in high level. In terms of attitude, the
professional competence of employees with high satisfaction rate has
decreased but not much, most of them are not statistically significant
(p > 0.05).
CHAPTER 4.
DISCUSSION
4.1. Situation of prescribing and effectiveness of some
interventions in prescribing health insurance drugs for
outpatients at public health facilities in Can Tho city during the
period of 2016-2018
4.1.1. Situation of prescribing health insurance drugs for

outpatients at public health facilities in Can Tho city during the
period 2016-2017
4.1.1.1. Compliance with regulations on outpatient prescription
* Compliance with regulations on administrative procedures:
Insufficient addressing was due to a variety of reasons. For
example, with regard to disregarded information, doctors who have
to deal with a great number of patients might think that such
administrative regulations do not affect the examination results and
thereby ignoring information about patients.
* Compliance with regulations on content of prescriptions:


17

The analysis of results showed that the processes of
disseminating and guiding the regulations on prescription for doctors
have not been synchronized. In addition, the dispensing of drugs in
the Department of Pharmacy only focused on considering the
appropriateness of prescribed drugs rather than focus on other
provisions of the prescription regulations. Therefore, doctors were
still subjective and ignored regulations on content of prescriptions.
4.1.1.2. Prescription indicators
* The average number of drugs in a prescription:
Prescriptions had a high number of drugs because most patients
suffered from many diseases. The most common ICD codes were
typical conditions of the elderly namely I10-idiopathic hypertension
(15.7%), K29-gastritis, duodenitis (9.35%), E11-Non Insulin
Dependent Diabetes Mellitus (7.29%).
* The rate of drugs prescribed under generic or international
generic names:

The application of information technology to prescriptions may
overcome the problem of prescribing with non-generic name.
Particularly, in Cai Rang district health center, the percentage of
drugs prescribed with generic name was the lowest, at 71.66%. The
reason was that the Faculty of Pharmacy did not closely follow the
regulations when sending the list of drugs to the IT department. As a
result, some single substance drugs were put on the software without
their active substance name, which led to the situation of doctors
prescribing brand names. Therefore, such rate did not meet the
WHO's recommendations.
* The rate of prescription with antibiotics:
The reason for the differences among health facilities was that
the disease patterns of prescription drugs in surveyed samples were
not the same. In-depth analysis of antibiotic combinations, cases of


18

using 2 or 3 antibiotics mainly combined 2 drugs with different forms
of use, mainly oral and ophthalmic eye drops antibiotic or topical
antibiotic or according to the treatment regimen of H. pylori stomach
ulcers.
* The rate of prescription with injecting medicine:
Results showed that the healthcare facilities did not abuse this
kind of drug. The reason why there were 5 medical facilities which
did not use injecting drugs in the list of outpatient health insurance
drugs was that they were graded III in the classification of healthcare
facilities. Therefore, the permissible health insurance ceilings were
lower. Injecting drugs were high-cost drugs; therefore, in 5 health
facilities, they were only in the list of inpatient medical insurance

drugs.
* The rate of prescription with vitamins:
According to WHO, this indicator does not have ideal level
which was researched by the Ministry of Health of Vietnam and a
number of countries to monitor the use of vitamins in prescription, as
well as to avoid overuse of vitamins.
* The rate of prescription with corticosteroids:
The corticosteroids in the survey were mainly used for the
treatment of inflammation, asthma or topical application in topical
products. None of the corticosteroids were abused or misused based
on diagnoses.
* The rate of prescribed drugs in essential medicine list and
main medicine list:
The percentage of prescription drugs in surveyed facilities’
essential medicine list/main medicine list was low. Doctors were only
allowed to prescribe drugs in the presented lists; therefore, it was
seen that the cause of low rate of prescribed drugs in essential
medicine list and main medicine list was not from doctors.


19

4.1.2. Effectiveness of some interventions in prescribing
medicines for outpatients at public health facilities in Can Tho
city during the period of 2017-2018
4.1.2.1. Compliance with regulations on prescribing for outpatients
Interventions such as promoting the implementation of
regulations, educating and enhancing knowledge by directly
propagandizing regulations on prescriptions, distributing materials
and regularly reminding during professional meetings has effectively

impacted on the awareness and strict adherence to the regulations
regarding prescribing.
4.1.2.2. Prescription indicators
* The average number of drugs in a prescription:
This result also highlighted the need to raise awareness of
physicians about prescription. Medical facilities should have
measures for prescribers to be able to calculate the cost of medicine
right after prescribing so that they can adjust the price of
prescriptions in accordance with the affordability of the patients as
well as the health insurance provisions.
4.2. Situation of patient health care and effectiveness of some
interventions in healthcare of outpatients with health insurance
at some public health facilities in Can Tho city during the period
of 2016-2018
4.2.1. Situation of patient health care at some public health
facilities in Can Tho city during the period of 2016-2018
4.2.1.1. Patient health care indicators:
* Average time for medical examination:
This indicator was not achieved because the state healthcare
facilities in Vietnam in general and Can Tho in particular, especially
district healthcare facilities, with relatively few facilities and the lack
of human resources, which led to overcrowding. In addition, doctors


20

who were not only in charge of medical examination and treatment,
but also had to carry out other administrative tasks, thus having a
great work pressure which partly limited the effectiveness of medical
examination and treatment.

* Average drug dispense time:
In 4,046 surveyed cases, drug dispensers mainly counselled on
special drugs or when being requested from patients. The counsel
content was dosage, usage, frequency and duration of administration.
This was partly due to the fact that the medical staffs thought that
patients had been counselled by physicians and patient prescriptions
had quite adequate instructions for using the drug, thus not paying
too much attention to such issue.
* The rate of drugs actually distributed:
Drug management software provided by Hau Giang
Pharmaceutical Joint-Stock Company was used by 11 health facilities
surveyed. Accordingly, only drugs in the warehouse were included in
the drug list. Doctors prescribed based on such software and
Pharmaceutical department did not have to notify the status of
existing drugs to the departments.
* The rate of sufficiently labelled prescriptions:
This result was low due to the pressure and workload during
hospital busiest hours when continuous drug dispenses interfered
with the preparation of adequate information on drug use instructions
in the patient medicine bags. Moreover, the majority of dispensers
believed that most of information was already on patient
prescriptions so labelling was not necessary and patients only have to
follow drug use on the prescription. Instead of writing in detail,
verbal instructions were given to patients.
* Patient understanding of medication dose:


21

According to guidelines of WHO, pharmacists when counselling

drug use for patients need full information about name of drugs,
name of active substances, concentration, content, dosage, usage,
duration of treatment, daily time of taking medicine, drug effects,
storage. Therefore, it is important to raise pharmacist awareness
about counselling drug information to patients.
4.2.1.2. Satisfaction of the patient on healthcare services:
The research results were quite high because the Ministry of
Health had implemented solutions to improve healthcare services in
public healthcare facilities nationwide. In 2013, the Ministry of
Health approved the project of "Determining methods to measure
people's satisfaction with public health care services". In 2016, the
Ministry of Health issued a set of guidelines on measurement
methods and tools to measure people's satisfaction with each type of
public health service to be consistently performed.
4.2.2. Effectiveness of some interventions in healthcare of
outpatients with health insurance at some public healthcare
facilities in Can Tho city during the period of 2017-2018
4.2.2.1. Patient healthcare indicators
* Average time for medical examination:
It can be seen that the interventions had been effective and
contributed to improve hospital prescription practice. In O Mon
district general hospital, a significant improvement was witnessed
after implementing interventions. It was due to an increasing number
of patients with health insurance coverage. Although the hospital had
mobilized more doctors from inpatient departments to examine
outpatient, it did not meet the needs of patients in O Mon District.
* Average drug dispensing time:
The intervention solutions showed positive outcomes. At the
Hospital of Can Tho University of Medicine and Pharmacy, a

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pharmacy technician was recruited to handle medicine dispensing.
Phong Dien district healthcare center has increased the number of
staffs in the pharmacy department since some of graduates from
intermediate level have finished their course in the university and
returned to the pharmacy department.
* Rate of fully labelled prescriptions:
After intervention in the drug dispensing process including
sending WHO regulatory documents to the Hospital's Medicine and
Treatment Council, posting the on-site drug delivery process and
providing on-site training sessions, this rate was higher than that of
the previous period.
* Knowledge on the dosage of medicine:
With the multi-intervention measures used in the three
researched facilities, it can be said that the knowledge and practical
skills of health workers in charge of outpatient medicine provision
have improved significantly through the implementation of
professional and instructional work for drug usage.
Keith F. Ward's study on the intervention in quality of patient
care of 222 doctors showed that there was a 50.9% change in
patient's cognitive quality. Furthermore, there was a significant rise
from 4.7% to 13.4% (p < 0.01) in patient knowledge after the
intervention in a study in Ghana.
4.2.2.2. Patient satisfaction with health care services
It can be said that after the intervention, the majority of positive
levels of satisfaction have increased, which proved that the
intervention solutions have been effective. In addition, this result has
been brought about partly by the measures from the Ministry of

Health to improve the quality of medical examination and treatment
at public health facilities nationwide.


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CONCLUSION
1. The current situation of prescription and the effectiveness of
some interventions in prescribing outpatient health insurance
medicines in some public healthcare facilities in Can Tho city
during the period of 2016-2018 has been analysed
* Compliance with regulations on outpatient prescriptions: the
rate of sufficient, comprehensive and accurate printing items: 100%,
accurate address: 88.3%, accurate requirements for children under 72
months old: 100%; the rate of the drug name, concentration/content,
quantity, dose, form of use or time of use: 89.8%, accurate amount of
medicine below 10: 96.0%; the rate of accurately corrected
prescription and crossing out the blank paper with signature and
name of the doctor: 100%. Interventional solutions by education,
knowledge enhancing as well as promoting the implementation of
regulations at 3 hospitals are efficient. At the Hospital of Can Tho
University of Medicine and Pharmacy, the practice of accurately
recording patient addresses increased from 85% to 100% while the
number of medicines slightly decreased from 71% to 70%. At O Mon
district general hospital, the rate of accurately recording patient
addresses increased from 92.5% to 94.6%. At Phong Dien District
Health Center, this rate increased from 90.8% to 100% while the
sufficient recording of drug indications increased from 62.7% to
83.2%.
* Prescription indicators: the average number of medicines in a

prescription: 5.0; the percentage of drugs prescribed under generic
name and international generic name: 98.62%; the rate of
prescription with antibiotics: 31.2%, the rate of injecting medicine:
0.9%, vitamins: 25.4%, corticosteroids: 12.4%, essential medicines:
41.99%, main medicines: 63.07%.
2. The situation of patient healthcare and the effectiveness of
some interventions in patient healthcare for outpatients with
health insurance at some public healthcare facilities in Can Tho
city during the period of 2016-2018 has been analysed