Analyzing some factors related to the task of drugs assurance at military hospital 105 from 2015 to 2018

T¹p chÝ y - d−îc häc qu©n sù sè 8-2020 129 ANALYZING SOME FACTORS RELATED TO THE TASK OF DRUGS ASSURANCE AT MILITARY HOSPITAL 105 FROM 2015 TO 2018 Ho Canh Hau1,2, Nguyen Minh Chinh3, Hoang Hai2 Nguyen Thi Lan Huong1, Le Viet Binh1 SUMMARY Objectives: To analyze some factors related to drugs assurance at Military Hospital 105 from 2015 to 2018. Subjects and methods: Using retrospective method about the results of examination and treatment at Military Hospital 105 from 2015 to 2018. Results: The incidence of patients who come for medical examination and treatment from 2015 to 2018 increased about 10%/year, the rate of enrollment accounted for about 17%. The number of hospital bed increased from 250 beds in 2015 to 600 beds in 2018. The rate of using a hospital bed was 189.6% in 2015, 107.7% in 2018. Disease model: There were 21 in a total of 22 disease chapters, of which Chapter 19 accounted for the highest rate. There were sufficient 27 drugs group in the list of hospital drugs in all the years but the year 2016 only had 26 drug groups (no group of cancer treatment and immunomodulating drugs). The number of pharmaceutical ingredients and the number of drugs in the hospital drug list increased from 50% in 2015 to 80% in 2018. Conclusion: The percentage of patients coming for examination and treatment increased by about 10%/year, the rate of registry accounted for about 17%. The number of hospital beds increased from 250 in 2015 to 600 beds in 2018. There were 21 chapters in a total of 22 ones, of which Chapter 19 accounted for the highest rate, and the lowest was Chapter 16. Under ATC code, the list of hospital drugs have sufficient 27 groups in all years but the year 2016 in which there were 26 drug groups. The number of pharmaceutical substances increased from about 50% in 2015 to over 80% in 2018. * Keywords: Drug assurance; Related factors; Military Hospital 105. INTRODUCTION In health care, drugs play an important role to treatment outcome. Therefore, the pharmacy department of the hospital must promptly meet the needs of medical examination and treatment for the people, and at the same time ensure the criterion "Reasonable, safe and effective". In order to ensure that the drug is adherent to the needs of medical examination and treatment, it must be based on the analysis of the drug users such as the number of visits for examination and treatment, the hospital bed capacity, the disease model... and other related factors such as the results of building a list of hospital drugs. 1Military Hospital 105 2Department of Organization and Management of Military Medical Services, Vietnam Military Medical University 3Pharmacy Training Institute,Vietnam Military Medical University Corresponding author: Ho Canh Hau (Dshocanhhau@gmail.com) Date received: 23/9/2020 Date accepted: 01/10/2020 T¹p chÝ y - d−îc häc qu©n sù sè 8-2020 130 Military Hospital 105, a first-class hospital under the General Department of Logistics - Ministry of Defense is responsible for examination and treatment for many subjects (Military, civilian policy, health insurance, health service). Therefore, analysis of some factors related to drug assurance at Military Hospital 105 from 2015 - 2018 is of practical significance in drugs assurance, aiming to satisfy the needs of examination and treatment. MATERIALS AND METHODS 1. Materials The reports on the hospital's medical examination and treatment and the results of developing a hospital drug list from 2015 to 2018. 2. Methods Using retrospective research on examination and treatment results of the hospital over the years, thereby making a statistic sheet of number of patients examined and treated, hospital beds capacity, disease model and compare the hospital's drug list according to current circular. RESULTS 1. Proportion of patients coming for medical examination and treatment from 2015 - 2018 Over the years, the number of the visits for examination and treatment at Military Hospital 105 has rapidly increased. Survey results of the number of patients admitted and treated in the hospital's "Annual work plan report" data from 2015 to 2018 [1] are shown as belows: Table 1: Survey of the number of patients examined and treated. Number of visits Number of treatments Index Year n % n % 2015 140,713 100.0 23,858 17.0 2016 157,496 111.9 27,081 17.2 2017 172,042 109.2 28,278 16.4 2018 186,447 108.4 31,288 16.8 Mean 164,175 109.8 27,626 16.9 - The number of visits increased rapidly over the years: from 140,713 visits in 2015 increased to 186,447 visits in 2018. T¹p chÝ y - d−îc häc qu©n sù sè 8-2020 131 - The number of patients receiving treatment also increased from 23,858 visits in 2015 to 27,081 visits in 2016 and from 28,278 visits in 2017 and 31,288 visits in 2018. - The number of patients receiving annually physical examination and treatment has steadily increased: the number of visits increased by about 10%/year, the rate of enrollment accounted for about 17%. Thus, the number of patients increased stably (about 10%), which facilitates making plan for annual drug procurement. * Hospital bed utilization: The number of patients receiving medical examination and treatment has increased with the time, directly affecting the indicator of using hospital beds. Table 2: Demand for hospital beds over the years. Year Index 2015 2016 2017 2018 Number of planned beds 250 250 550 600 Increase  0 300 350 Bed utilization rate 189.6 208.9 94.5 107.7 Increase (%)  19.3 18.3 68.9 - The number of planned beds increased from 250 beds in 2015 - 2016 to 600 beds in 2018, which improved the overload of hospital beds utilization: the rate of using hospital beds in 2015 was 189.6%, in 2016 it was 208.9% down to 94.5% in 2017 and 107.7% in 2018. - Compared to 2015 (250 planned beds), the rate of using beds increased to 19.3% in 2016, 18.3% in 2017 and 68.9% in 2018, which reflects the hospital's reputation in examination and treatment (regardless of the number of planned beds to increase over the years). 2. Disease model The ICD 10 disease model is an international statistical classification of diseases and related health problems. The entire list is divided into 22 chapters, each chapter contains one or more related groups of diseases: Chapter I - Infections and Parasites; Chapter II - Neoplasm; Chapter III - Blood diseases, blood-forming organs... [2]. Survey results on the number of inpatients according to the hospital's reported data (the hospital has not listed the disease pattern of outpatients) of the disease chapters from 2015 to 2018 are shown in figure 1. T¹p chÝ y - d−îc häc qu©n sù sè 8-2020 132 Figure 1: Survey of the number of inpatients under the Disease Chapter - The hospital's disease model had 21 chapters out of 22 disease chapters from 2015 to 2018 (Chapter XXII - Code for special purposes: no patient to be treated). - There was a great discrepancy of patients in all chapters in the year, of which Chapter 19 (Wounds, poison) accounted for the highest percentage. Chapter 16 (some pathologies originating in the perinatal period) accounted for the lowest percentage. - In the same disease chapter, there was little change in the percentage (%) of patients from 2015 to 2018. This result is favorable for procurement planning during the year and helps identify the patient group that needs to prioritize medical funds. Table 3: Surveying 10 disease chapters with the highest percentage (%) of patients. (Sort by X̅) Percentage of patients treated from 2015 - 2018 (%) Group Chapter name 2015 2016 2017 2018 X̅ ± SD 19 Injury, poison 22.13 19.14 19.67 19.77 20.18 ± 1.15 11 Diseases of the digestive system 16.30 17.07 15.15 14.73 15.81 ± 0.93 9 Circulatory system disease 10.33 11.01 10.95 11.30 10.90 ± 0.35 10 Respiratory system diseases 6.92 6.62 6.84 6.09 6.62 ± 0.32 15 Pregnancy, childbirth 7.02 6.17 6.87 6.23 6.57 ± 0.38 The number of patients calculated according to the disease chapter 2015 2016 2017 2018 N u m be r o f p at ie nt s T¹p chÝ y - d−îc häc qu©n sù sè 8-2020 133 13 Diseases of the muscles, bones, and joints 6.98 4.84 6.84 7.60 6.56 ± 1.04 1 Infections 6.35 6.64 4.59 6.10 5.92 ± 0.79 14 Genital and urinary system diseases 6.18 4.26 5.17 5.67 5.32 ± 0.71 2 Neoplasm 3.58 5.62 5.38 6.24 5.20 ± 0.99 6 Nervous system disease 4.09 4.61 5.15 4.87 4.68 ± 0.39 Total 89.88 85.98 86.60 88.60 87.76 ± 1.56 The disease chapter on trauma and poison accounted for the highest rate, 20.18 ± 1.15% on average in 4 years, followed by the digestive system disease chapter (accounting for about 15.81 ± 0.93%), chapter of circulatory system diseases... In 10 chapters, with nearly 90% of the total number of patients in the whole hospital. 3 chapters (chapters 19, 11 and 9) accounted for nearly half of the total number of patients. The results help identify the treatment group as the 1st list of the hospital's annual drug purchase plan. 3. Results of developing hospital drug list Hospital drug list, developed annually by the Drug and Treatment Council with a view to meeting the task of treatment and prevention according to the regional disease model and technical development in the year [3]. From 2015 - 2018, 105 Military Hospital built drug list under the guidance of 02 circulars: 2015 under Circular 31/2011/TT-BYT (Circular 31), 2016-2018 according to Circular No.40/2014/TT-BYT (Circular 40) [4, 5]. This drug list issued under the circular is classified into 27 main groups according to the ATC code (anatomy, treatment, chemistry). This survey results are shown in table 4: Table 4: Survey of results of building hospital drug list. Index Drug list Group (ATC) Number of active ingredient (DC) Number of drug (T) Ratio T/DC (%) Circulars No.31 (C) 27 900 1,143 127.00 Hospital (H) 27 464 547 117.89 2015 Ratio H/C (%) 100.00 51.56 47.86 92.83 Circulars No.40 27 845 1,064 125.92 Hospital (H) 26 468 674 144.02 2016 Ratio H/C No.40 (%) 96.3 55.38 63.35 114.37 Hospital (H) 27 504 712 141.27 2017 Ratio H/C No.40 (%) 100.00 59.64 66.92 112.19 Hospital (H) 27 676 855 126.48 2018 Ratio H/C No.40 (%) 100.00 80.00 80.36 100.45 T¹p chÝ y - d−îc häc qu©n sù sè 8-2020 134 - According to the guidance of the current circulars, there were sufficient 27 groups of drug in the hospital drug list over the years but the year 2016 with 26 drug groups (no group of cancer treatment and immunomodulate). - The number of active ingredients and drugs in this list compared to circular drug list (Circular 30 and Circular 40) rapidly increased over the years (from about 50% in 2015 to over 80% in 2018). Thus, the number of drugs and active ingredients in hospital drug list is increasing (an increase of about 30% from 2015 - 2018) to meet the needs of developing new expertise and techniques in examination and treatment, the hospital Grade II reached Grade I (recognized by the Ministry of Defense in 2017). CONCLUSION - The rate of patients coming for medical examination and treatment from 2015 - 2018: The annual number of patients coming into medical examination and treatment has increased steadily, the number of visits to medical examination increased by about 10%/year, the rate of admission was about 17%. - Number of hospital beds: The number of planned beds increased from 250 beds in 2015 - 2016 to 600 beds in 2018. In 2015, the rate of using hospital beds was 189.6%, in 2016 it was 208.9% to 94.5% in 2017 and 107.7% in 2018. Compared to 2015 (250 planned beds), the bed occupancy rate increased to 19.3% in 2016, 18.3% in 2017 and 68.9% in 2018. - Disease model: The hospital's disease model had 21/22 disease chapters from 2015 to 2018, of which Chapter 19 accounted for the highest rate, followed by Chapter 11, Chapter 9... - Results of building a hospital drug list: In 2016, the hospital drug list was built into 26 drug groups (no cancer treatment and immunomodulatory drugs group) whereas there were sufficient 27 groups of drug in the remaining years according to the guidance of the current circulars. The number of active ingredients and drugs in this list compared to circular list increased from about 50% in 2015 to over 80% in 2018. REFERENCES 1. Military Hospital 105. Annual “Hospital work” plan, from 2016 to 2019. 2. Ministry of Health. Instructions for use, The 10th International Statistical Classification of Disease and Related Health Problems (ICD 10) 205; 1. 3. Ministry of Health. Circular No. 21/2013/TT-BYT, Regulation on organization and operation of Medical Council and hospital treatment 2013. 4. Ministry of Health. Circular No. 31/2011/TT-BYT. To promulgate and guide the implementation of the list of drugs mainly used at medical examination and treatment establishments covered by the health insurance fund. November 17, 2011. 5. Ministry of Health. Circular No. 40/2014/TT-BYT. To promulgate and guide the implementation of the list of modern medicine drugs covered by the health insurance fund. July 11, 2014.