Drug Inventory Control Analysis at a Primary Level Health Care Facility in Bengaluru Urban, India

Introduction

One of the hospital's most utilised therapeutic areas is the pharmacy, where significant sums of money are regularly spent on purchases. This highlights the need for organising the pharmacy's planning, design, and layout to produce effective clinical and administrative services.¹

The major aim of hospital supply system is to ensure that adequate quantities of each item is available so as to maintain a continuous supply of all the essentials. A research study showed that fluctuated and also fell short when it was required. In that way patients can be effectively managed and treated.

On employing rational drug utilization methods for management and supply of drugs, the task of manager becomes easier as well as sustainable, thereby the overall health services in the community is improved. Even basic medications are frequently unavailable and remain out of stock for a considerable period.²

In a developing nation like India, hospital pharmacy inventory control is crucial. As resources are limited, it is critical to make maximum use of what is already available. Primary Health Centres (PHC’s) form the backbone of healthcare system, and drugs are readily available and accessible to all sections of the society. Considering this rationale, the following study was performed. Health managers must employ scientific techniques to increase investment returns at the lowest possible cost.

Materials and Methods

The study was conducted at H. Siddaiah UPHC in Bangalore urban. Drugs catalogued under Karnataka Drug Logistics Warehousing Society [KDLWS] supplied to H Siddaiah UPHC from January 2022 to August 2023 records were studied. We conducted (Always, Better, Control (ABC), Valuable, Essential, Desirable (VED), and ABC-VED matrix analyses of a drugstore in UPHC Doddamavalli for this study. The yearly cost and the use of drugs were obtained from the pharmacy database and applied to each medication.

(a) The drugs were categorized based on cost and consumption - [STEP-1]

(b) After that, VED analysis was done based on opinion from two medical officers - [STEP-2] 

(c) ABC-VED analysis was done after the STEP-1 and STEP-2 (Table 1)

The collected information contained 140 medications, and it was recorded in Microsoft Excel spreadsheet format for the quantitative calculations. The database offered five characteristics -prescription number, date of expiration, and other (attributes) prescription, brand/ generic name of a medication on a prescription, cost and quantity of the recommended medications.

Operational Definitions

ABC analysis is a technique for categorizing things or actions based on their relative significance.

A-B-C analysis which is the abbreviation of “Always Better Control” is an important tool widely used to classify the items of trivial importance.³

The items are divided into the following three categories with the analysis:

• 10-15% are category A items accounting for approximately 70% of cumulative cost

• 20-25% are category B items that account for a further 20%

• 65-70% are category C items that are mere 10% of the total value

VED analysis

The V-E-D analysis is to go through discussions and arrive at a common consensus among the experts or the users of the drug items. In the given list also, the same exercise was done by some of the doctors working at that hospital according to their priority for each drug item. VED analysis, consisting of the initials of ‘vital, essential and desirable’, divides items into three classes according to their level of significance.³

ABC-VED matrix analysis

As noted above, only the use of the ABC method will not be adequate and appropriate. Since the items analyzed in health institutions are drugs, it is necessary to take into consideration the great importance of all drugs, even if they are not in group A. This method is implemented by creating a crosstab of two analyzes (Table 1).⁴ 

Annual unit consumption

To identify all the drug items given in the list and check the estimated quantity to be consumed during a year and also for the unit cost of each of these items, the annual consumption cost of each item is required.

The total annual expenditure for each drug was calculated by multiplying the annual unit consumption.³

Annual consumption cost = Unit cost of item X Total quantity consumed per annum

Results

The total drugs formulated in UHTC, Doddamavalli were 140. Annual indent of drugs issued for 2021-2022: Rs. 10,23,566.35

ABC analysis

On ABC analysis, 31.4% (44), 26.4% (37) and 42.14% (59) items were found to be A, B and C category items amounting to 86.5% (Rs. 885,739.2), 9.08% (Rs. 93,000) and 4.37% (Rs. 44,827.25) of ADE of the pharmacy, respectively (Table 2). The above values matched with 70%, 20% and 10% expenditure criteria.

VED analysis

Table 2 shows that about 22.14% (31), 45.7% (64) and 32.14% (45) items belonged to V, E and D categories and expenditure pattern came up to 55.3% (Rs. 566,955.66), 16.14% (Rs. 165,225) and 28.46% (Rs. 291,385.54), respectively.

On combining ABC and VED analysis it showed that 15% (AV, BV, CV, AE, AD) belonged to Category I which included vital and essential items. 40% (BE, CE, BD) belonged to Category II that included remaining items of E and B groups. 45% (CD) belonged to Category III that included the desirable and cheaper items. (Table 3).

Inference

ABC analysis

The ABC analysis focused only on drug inventory control of 31.4% (44) in category A items while 26.4% (37) and 42.14% (59) belonging to category B and C were not considered as important.

VED analysis

If VED analysis focused on vital items, essential and desired items (67.84%) accounting for 71.27 % of ADE cannot be given utmost importance.

ABC-VED matrix analysis

But on combining both methods, 47.14% (66) items with ADE of 74.16% can be strictly controlled and focused on. Thereby, these drugs cannot be accepted as understocked, out of stock or early expired without usage. 

Discussion

In our study, we demonstrated that the inventory analysis has a significant role in controlling the drugs inventory in pharmacies. The better use of inventory models improves the health delivery system in the hospital, patient hospital relationship, and the allocation of financial resources of the hospital. The present study examined three inventory control models: ABC, VED, and ABC-VED Matrix.

The implementation of inventory management and store keeping system in primary health care is still lagging due to lack of manpower, inadequate infrastructure and lack of co-ordination between the team members and multiple national programmes to focus on.⁵

The highest level of management was responsible for regulating the administration of Category I medications, which helped to better control yearly costs while also making Category II at middle and Category III at lower managerial levels available for use.⁶

Limitations

The drawback of ABC analysis is that it only considers the item's monetary worth and rate of consumption. An item with modest cost and consumption might be extremely important or even lifesaving in a hospital. They cannot be overlooked, even though they do not fall within the category A. 

Conclusion

Through the analysis of drug inventory, drugs were categorized based on priority and allocated to suitable management levels. This analysis aimed to enhance the efficiency of management of drug inventory using limited financial resources, while also ensuring sufficient safety stocks of critical medications and decreasing the occurrence of shortages in drug supply. The implementation of a proficient inventory management at the grassroot level will play a significant role in ensuring high-quality patient care without compromises.

It allows effective utilization of drugs and helps to reduce the chances of medicines being out of stock and manages the medications nearing expiry.

Recommendations

• All pharmacists at the level of primary health care can be trained in this technique of drug inventory management for ABC & VED analysis which can help the medical officers and staff to elicit the situation much before the stock out. Thus, it helps to improvise the efficacy of pharmaceutical management.

• Instead of only VED, it is better to add the ABC analysis so that the importance of each drug can be determined and it can also help in evaluating the drug utilization effectively. It helps to avoid stock out and expiration.

• Similar method can be applicable to plan the vaccine logistics which can be used to categorize the vaccines, like which vaccines will be utilized at what point of time and how much will be the buffer stock.

• Distribution of unused drugs to the higher centers for effective utilization: By knowing the drugs that are more utilized and those that are needed in primary health facility, it can help to re-distribute the unutilized drugs to other PHCs where there is a stock out.

• It should not be restricted only to pharmacists, as it is easy to train. Even Auxiliary nurse-midwife (ANMs), staff nurses, laboratory technicians can be trained as a backup where there is less man power and limited resources. Thus, by integrating this inventory approach, we can analyze, maintain and monitor the stock situation in a better way and also can improve the quality assurance.

Financial support & Sponsorship

Nil 

Conflict of interest

Nil