İLAÇ HARCAMALARININ ETKİN KONTROLÜ: ÜÇÜNCÜ BASAMAK BİR HASTANEDE UYGULAMA

Yıl 2022, Cilt: 8 Sayı: 1, 18 - 33, 30.04.2022

İsa Gül , Vahit Yiğit

Öz

Bu araştırmanın amacı, üçüncü basamak bir hastanenin 2020 yılı ilaç stoklarının ticari isim, etken madde ve ATC (Anatomik Terapötik Kimyasal Sınıflandırma) grupları baz alınarak stok kontrol yöntemleri ile analiz etmektir. Araştırma Ege Bölgesi’nde bulunan 626 yataklı bir üniversite hastanesinde gerçekleştirilmiştir. Araştırmanın evrenini hastanenin 2020 yılında eczane depodan çıkış işlemi gerçekleştirilen 742 kalem ilacı oluşturmaktadır. Araştırmada stok kontrol yöntemlerinden ABC (Always, Better, Control), VED (Vital, Essential ve Desirable) ve ABC-VED matrisi analiz yöntemleri kullanılmıştır. Araştırma kapsamında 742 ilaç miktar açısından sırasıyla %7,7 (57), %12.5 (93) ve %79.8 (592) A, B ve C kategori maddeleri olduğu tespit edilmiştir. Yıllık ilaç stok maliyetinin %6, 50’sini merosid ıv 1 gr enj. 1 flk (1.076.717-TL) ticari isimli ilaç, ilaç stok maliyetinin %6,52’sini (1.079.235-TL) bu ilacın etken maddesi olan meropenem 1000 mg/ıv flakon’un oluşturduğu saptanmıştır. Toplam ilaç stok maliyetinin %49,79’unu 27 kalem ticari isimli ilaç oluştururken, ilaç stok maliyetinin %49,93’ünü 20 kalem etken madde oluşturmaktadır. Benzer biçimde toplam ilaç stok maliyetinin %81,08’i antienfektifler (sistemik), kan ve kan yapıcı organ ve antineoplastik ilaçlar olmak üzere 3 ATC grubuna aittir. ABC-VED matrisi analizinde kategori I’de bulunan ticari isimli ilaçların toplam stok maliyetinin %77,34’ünü, etken maddelerin ise toplam stok maliyetinin %79,15’ini oluşturduğu saptanmıştır. Hastaneler, ilaç stoklarını ticari isim, etken madde ve ATC grupları bazında hem maliyet hem de hayati öneme haiz olup olmama kriterlerine göre rutin olarak stok kontrol yöntemleri ile analiz etmelidir. Bu sayede etkili bir hasta bakımı tedavisi ve ilaç yönetimine tahsis edilen kaynakların optimal kullanımı sağlanmış olacaktır.

Anahtar Kelimeler

Stok yönetimi, ATC, ABC-VED

EFFECTIVE CONTROL OF DRUG EXPENDITURES: AN APPLICATION IN A TERTIARY HOSPITAL

Öz

The purpose of this study was to analyze the 2020 medicine stocks of a tertiary hospital on the basis of trade names, active ingredients and ATC (Anatomic Therapeutic Chemical Classification) groups via stock control methods. We conducted the study in a university hospital with 626 beds in the Aegean Region. The target population of the study comprised 742 items of medicine which were discharged from the pharmaceutical warehouse of the hospital in 2020. The study used the ABC (Always, Better, Control), VED (Vital, Essential and Desirable) and ABC-VED matrix analysis methods, which are among stock control methods. Within the scope of the study we determined that there are 7.7% (57), 12.5% (93) and 79.8% (592) A, B and C category items in terms of 742 amounts of drugs, respectively. 81.08% of the total medicine stock expenditure belong to three ATC groups as anti-infectives (systemic), blood and blood-forming organs and antineoplastic medicine. Hospitals should routinely analyze their medicine stocks on the basis of trade names, active ingredients and ATC groups according to the criteria of expenditure and state of having vital importance via stock control methods. 

Anahtar Kelimeler

Inventory Management, Hospital, ATC, ABC Analysis, VED Analysis

Kaynakça

• Cho, Do‐Yeon, Juhee Park, ve Dong‐Sook Kim. 2021. “The impact of expanding health insurance coverage for anti‐cancer drugs on cancer survival in Korea”. Cancer Medicine.
• Chu, Ching-Wu, Gin-Shuh Liang, ve Chien-Tseng Liao. 2008. “Controlling inventory by combining ABC analysis and fuzzy classification”. Computers & Industrial Engineering 55(4):841–51.
• Deshpande, Vivek A. 2008. “Optimal inventory control using ABC, VED & SDE analysis for Indian industries”. S. 29 içinde National Conference on Emerging Trends in Mechanical Engineering (ETME-2008). C. 28.
• Dora, Susmita, Arvind Kumar Singh, Prem Sagar Panda, ve Jitendra Kumar Sahoo. 2020. “Inventory management of drugs at a secondary level health-care center in Odisha”. Indian Journal of Community and Family Medicine 6(2):104.
• Doshi, Riddhi Prakash, Nilam Patel, Nayan Jani, Maitraye Basu, ve Simy Mathew. 2007. “ABC and VED analyses of drug management in a government tertiary care hospital in Kerala”. içinde iHEA 2007 6th World Congress: Explorations in Health Economics Paper.
• Gupta, RKGR, K. K. Gupta, B. R. Jain, ve R. K. Garg. 2007. “ABC and VED analysis in medical stores inventory control”. Medical Journal Armed Forces India 63(4):325–27.
• Hofmarcher, Thomas, Peter Lindgren, Nils Wilking, ve Bengt Jönsson. 2020. “The cost of cancer in Europe 2018”. European Journal of Cancer 129:41–49.
• Işıkçelik, Ferda, Okan Özkan, ve İsmail Ağırbaş. 2019. “Hastane İlaç Stoklarının ABC, VED VE ABC-VED Yöntemleri İle Analizi”. Hacettepe Sağlık İdaresi Dergisi 22(2):305–18.
• K. Ingle, J. Kishore, ve R. Kumar. 2013. “ABC-VED analysis of a drug store in the department of community medicine of a medical college in Delhi”. Indian journal of pharmaceutical sciences 75(1):113.
• Kant, Shashi, Partha Haldar, Arvind Singh, ve Ankita Kankaria. 2015. “Inventory management of drugs at a secondary level hospital associated with Ballabgarh HDSS-An experience from North India”. Journal of Young Pharmacists 7(2):113.
• Kastanioti, Catherine, George Mavridoglou, Haralampos Karanikas, ve Nikolaos Polyzos. 2016. “ABC analysis: a tool of effectively controlling pharmaceutical expenditure in Greek NHS hospitals”. Journal of Pharmaceutical Health Services Research 7(3):173–79.
• Kheder, Salah I., Mousnad Mohamed Awad, ve Khalid Hamid. 2020. “Prioritization of medicine importation by the private sector in Sudan: evidence from a data analysis, 2012-2015”. Value in Health Regional Issues 22:27–34. Khurana, Sarbjeet, Neelam Chhillar, ve Vinod Kumar Singh Gautam. 2013. “Inventory control techniques in medical stores of a tertiary care neuropsychiatry hospital in Delhi”. Health 5(01):8.
• Kumar, Sushil, ve A. Chakravarty. 2015. “ABC–VED analysis of expendable medical stores at a tertiary care hospital”. Medical journal armed forces india 71(1):24–27.
• Kumar, Yogesh, Veneshwar Sahu, Devprakash Sahu, Rupesh Kumar Khaparde, Jalam Singh Dhiwar, Komal Dewangan, ve Gautam Kumar Dewangan. 2017. “XYZ Analysis for Inventory Management–Case Study of Steel Plant”. International Journal for Research in Applied Science & Engineering Technology 5(2):46–52.
• Lazarova, Biljana, Biljana Eftimova, Lidija Mihailova, Sanja Filkova, Zorica Naumovska, ve Zoran Sterjev. 2020. “Evaluation of antibiotic consumption in Clinical hospital in Stip for the period 2017-2019”. Macedonian Pharmaceutical Bulletin 66((Suppl 1)):77–78.
• Lomnicky, Yossef, Daniel Kurnik, Ronen Loebstein, Itzhak Katzir, Janet Vesterman-Landes, ve Nava Siegelmann-Danieli. 2016. “Trends in annual drug expenditure–a 16 year perspective of a public healthcare maintenance organization”. Israel journal of health policy research 5(1):1–6.
• Manhas Anil, K., Malik Aubid, R. Haroon, A. Sheikh Mushtaq, ve A. T. Syed. 2012. “Analysis of inventory of drug and pharmacy department of a tertiary care hospital”. Analysis 25(3):183.
• Mohammed, Solomon Ahmed, ve Birhanu Demeke Workneh. 2020. “Critical Analysis of Pharmaceuticals Inventory Management Using the ABC-VEN Matrix in Dessie Referral Hospital, Ethiopia”. Integrated Pharmacy Research & Practice 9:113.
• Nigah, R., M. Devnani, ve A. K. Gupta. 2010. “ABC and VED analysis of the pharmacy store of a tertiary care teaching, research and referral healthcare institute of India”. Journal of young pharmacists 2(2):201–5.
• Pandya, Bijal, ve Hemant Thakkar. 2016. “A review on inventory management control techniques: ABC-XYZ analysis”. REST Journal on Emerging trends in Modelling and Manufacturing 2:15.
• Reddy, V. Venkat. 2008. “Hospital Materials Management”. Managing a Modern Hospital Edited by:126. Resmi Gazete. 2017. “Beşeri Tıbbi Ürünlerin Ambalaj Bilgileri, Kullanma Talimatı ve Takibi Yönetmeliği”.
• Singh, Sukhbir, Anil Kumar Gupta, ve Mahesh Devnani. 2015. “ABC and VED analysis of the pharmacy store of a tertiary care, Academic Institute of the Northern India to identify the categories of drugs needing strict management control”. Journal of young pharmacists 7(2):76.
• Skrbo, A., I. Zulić, S. Hadzić, ve I. D. Gaon. 1999. “Anatomic-therapeutic-chemical classification of drugs”. Medicinski arhiv 53(3 Suppl 3):57–60.
• Song, Yan, Zhiyan Han, Kuimeng Song, ve Tianmin Zhen. 2020. “Antibiotic consumption trends in China: evidence from six-year surveillance sales records in Shandong Province”. Frontiers in pharmacology 11:491.
• Taddele, Biruk Wogayehu, Ayalewu Adinewu Wondimagegn, Mulugeta Asfaw Asaro, Mende Mensa Sorato, Bisrat Gissila Gedayi, ve Anidinet Assefa Hailesilase. 2019. “ABC-VEN matrix analysis of the pharmacy store in a secondary level health care facility in Arbaminch Town, Southern Ethiopia”. Journal of Young Pharmacists 11(2):182.
• Taylor, D. (2015). The Pharmaceutical Industry and the Future of Drug Development. Pharmaceuticals in the Environment,Volume 41, 41, 1.
• Uygun, Sabit, ve Vahit Yiğit. 2016. “Hastane işletmelerinde etkin ilaç stok kontrolü: Pamukkale Üniversitesi Hastanesinde bir uygulama”. Balkan Sosyal Bilimler Dergisi 742–51.
• Vaz, F S, A. M. Ferreira, I. Pereira-Antao, M. Kulkarni, ve D. Motghare. 2008. “Application of inventory control techniques for drug management at a rural health centre”. Indian Journal Of Preventative And Social Medicine 39(3):120–23.
• Vaz, Federick S, A. M. Ferreira, M. S. Kulkarni, D. D. Motghare, ve I. Pereira-Antao. 2008. “A study of drug expenditure at a tertiary care hospital: An ABC-VED analysis”. Journal of Health Management 10(1):119–27.
• Wandalkar, Poorwa, P. T. Pandit, ve A. R. Zite. 2013. “ABC and VED analysis of the drug store of a tertiary care teaching hospital”. Indian Journal of Basic and Applied Medical Research 3(1):126–31.
• WHO. 2003. “WHO International Working Group for Drug Statistics Methodology, WHO Collaborating Centre for Drug Statistics Methodology, WHO Collaborating Centre for Drug Utilization Research and Clinical Pharmacological Services: Introduction to drug utilization resea”. Introduction to drug utilization research. Geneva: World Health Organization.
• WHO. 2012. “Guidelines for ATC classification and DDD assignment 2013”. Norwegian Institute of Public Health. Oslo. Yeşilyurt, Özgür, Harun Sulak, ve Mustafa Bayhan. 2015. “Sağlık Sektöründe Stok Kontrol Faaliyetlerinin ABC ve VED Analizleriyle Değerlendirilmesi: Isparta Devlet Hasanesi Örneği”. Süleyman Demirel Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi 20(1):365–76.
• Yiğit, A,, Yiğit V. (2019). “Tıbbi Malzeme Stok Kontrolünde ABC ve VED Analizi: Sağlık Bakanlığı Hastanelerinde Bir Araştırma”. Süleyman Demirel Üniversitesi Vizyoner Dergisi 10(24):254–63.
• Yiğit, Vahit. 2014. “Hastanelerde stok kontrol analizi: Akdeniz Üniversitesi Hastanesinde bir uygulama”. Sayıştay Dergisi 93:105–28.
• Yu, Min-Chun. 2011. “Multi-criteria ABC analysis using artificial-intelligence-based classification techniques”. Expert Systems with Applications 38