Abstract
The objective of this project was to search for problems of drug system in Songkhla hospitals, which is major portion of drug system in terms of both expenditure and quantity. Questionnaire mailed survey was used to collect data from pharmacists who were in charge of drug system in 21 hospitals. These included both public and private owned hospitals. Also, focus group technique was used to search for the problems in the drug system. A total of ten hospital pharmacists sent the survey back and pharmacists from 19 hospitals participated in the focus group. From all data, the conclusions were as followed 1. Drug Selection An important problem in drug selection process was the problematic performance of the hospital patient and therapeutic committee (PTC). It started from the beginning process when the data was gathered for submitting to the committee and continued to the committee meeting. They had an impact on the performance of hospital drug selection. Another potential problem was the problem of non-officially listed drugs in the hospitals, which were drug products that were not selected through the PTC but they were available in the hospitals. It affected the drug system in various perspectives such as equity problems among different patient types of payment or problems of avoiding regular drug selection process. 2. Drug Procurement Various problems related to the procurement process were identified. First, the hospitals were forced to buy drug products manufactured by the Government Pharmaceutical Organization (GPO). Some of the GPO’s products were more expensive. The GPO also provided poor services such as they did not notify in advance when some products were out of stock. Second, the human and information resources were scarce for decision making in drug purchasing groups, which was a government policy. Another problem was the quality of drug products. Under resource constraint, less expensive products were procured. They were required the quality assurance at the hospital end. However, limited resources were available for the hospitals themselves and the number of analyzing agencies were also inadequate. 3. Drug Distribution An important problem regarding the drug distribution was the distribution toward the primary care units (PCU). The pharmacists’ roles at the PCU were ambiguous. Also, data of drug storage appropriation at the PCU did not exist.Drug UseOther than general drug use problems such as clinical outcomes of irrational drug use, economic efficiency and equity among the different patient types of payment were the problems in the drug system. For instance, non-essential drugs, which were usually more expensive, were likely prescribed for patients who paid out-of-pocket or were covered by the government. They eventually created unnecessary high national drug expenditures.In conclusion, this study reflected various problems in Songkhla hospital drug system. Some of them were long time problems such as the problem of PTC in drug selection process. However, there were also contemporary problems which occurred from either technological change or government policy change, such as the scarcity of information, the impact from the universal health insurance coverage (UC) and the drug purchasing group policies.
