Ten recommendations to improve use of medicines in developing countries (original) (raw)
Related papers
Quality of Drug Prescription and Dispensing Practices in a Teaching Hospital in a developing country
BackgroundThe World Health Organization recommends rational drug usage to protect patient health and quality of life. Study assessed the quality of drug prescription and dispensing in a tertiary hospital.MethodsCross-sectional study with retrospective and prospective data collection underpinned by the WHO core prescribing indicators. A cluster sample of 10 clinical units and their attached pharmacies in the hospital. Six hundred prescriptions from the pharmacy over six months were randomly selected to evaluate the prescription indicators, 330 patient encounters observed for patient care indicators, and 48 randomly selected doctors to evaluate factors influencing their prescribing practices across the 10 clinics. Descriptive analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 25 and comparison done across all indicators of rational drug use.ResultsAverage drugs per encounter was 3.4 ± 1.9 drugs. Antibiotics and injections were prescribed in 40....
Ten Recommendations to Improve Pharmacy Practice in Low and Middle-Income Countries (LMICs)
SSRN Electronic Journal, 2020
Medicines are important health interventions and their appropriate use could improve health outcomes. Throughout the globe, pharmacists play a very important role to improve the use of medicines. Though high-income countries are debating on futuristic approaches, independent prescribing of pharmacists, clinical skills, and to expand pharmacy services; a large majority of low and middle-income countries still lag behind to strengthen pharmacy practice. This paper presents a key set of recommendations that can improve pharmacy practice in low and middle-income countries (LMICs). The ten recommendations include (1) Mandatory presence of graduate-level pharmacists at community pharmacies (2) Clear demarcation of the roles and responsibilities of different categories of pharmacists (3) Effective categorization and implementation of medicines into (a) prescription medicines (b) pharmacists only medicines (c) over the counter medicines (4) Enforcement of laws and regulations for the sale of medicines (5) Prohibiting doctors from dispensing medicines (the dispensing separation between pharmacists and doctors). (6) Involving pharmacies and pharmacists in Universal Health Coverage Schemes to improve the affordability of medicines (7) Strengthening national medicines regulatory authorities to improve the quality, safety, and effectiveness of medicines (8) Training of pharmacists in clinical skills, vaccination, and minor ailment schemes (9) Promoting independent medicines information for consumers and healthcare professionals by developing national medicines information strategy (10) Mandatory Continuing Professional Development (CPD) programs for the Pharmacists.
Tropical medicine & international health : TM & IH, 2013
To assess progress in improving use of medicines in developing and transitional countries by reviewing empirical evidence, 1990-2009, concerning patterns of primary care medicine use and intervention effects. We extracted data on medicines use, study setting, methodology and interventions from published and unpublished studies on primary care medicine use. We calculated the medians of six medicines use indicators by study year, country income level, geographic region, facility ownership and prescriber type. To estimate intervention impacts, we calculated greatest positive (GES) and median effect sizes (MES) from studies meeting accepted design criteria. Our review comprises 900 studies conducted in 104 countries, reporting data on 1033 study groups from public (62%), and private (mostly for profit) facilities (26%), and households. The proportion of treatment according to standard treatment guidelines was 40% in public and <30% in private-for-profit sector facilities. Most indica...
Background: Periodic assessment of the prescribing practices in a health facility is necessary to identify specific drug use problems, sensitize practitioners on rational drug prescription and provide policy makers with relevant information. The purpose of this survey is, therefore, to analysis the prescribing practice of clinicians using world health organization (WHO) prescribing indicators at four selected public hospitals found in west Ethiopia with ultimate goal of ensuring rational drug use. Methods: This study was a descriptive cross-sectional survey which investigated the prescribing practices of prescribers using WHO core prescribing indicators at four selected hospitals in west Ethiopia. We have retrospectively reviewed 2024 prescriptions found in outpatient pharmacies of each hospital selected through systematic random sampling over one year period from July to September 2013. Results: In this work, the mean number of drugs per prescription was 2.1 ± 0.5. Generic, antibiotics and injection prescribing were found to be 79.2%, 54.7% and 28.3% respectively. Less than half (45.3%) of these sampled prescriptions had diagnosis for which drugs are indicated. Whereas drugs prescribed from essential drug list/ formulary of the country constituted 83.0% which is far less than the ideal limit. Conclusion: The findings in this study are similar to what had been reported by most of the previous studies. Generally, all the prescribing indicators studied are out of the ranges recommended by WHO implying that there is deep rooted irrational prescribing practice in hospitals of Ethiopia. Therefore, urgent and well organized interventions should be implemented by federal ministry of health and drug regulatory bodies found at different levels in order to foster rational drug use in the country.
Improving the use of pharmaceuticals through patient and community level interventions
Social Science & Medicine, 2001
Pharmaceuticals represent an increasing share of private and public health care expenditures. However, while most governments are interested in ensuring availability and access to drugs, the issue of adequate use of drugs remains a low priority in most third world countries. This paper summarizes the results of interventions conducted in developing countries aimed at improving patients' compliance with the advice of health professionals and/or to decrease the unnecessary use of drugs by the general population. Forty-five studies were identified through literature searches and networking; and only about a third of them fulfilled the eligibility criteria for inclusion in the review. Given the paucity of information available and the importance of the topic the authors report on all 45 studies identified. Although much remains to be explored there are several interventions that deserve to be highlighted. The authors argue that improving the use of pharmaceuticals through interventions directed only to consumers may have a small impact and suggest that in order to obtain meaningful changes it might be necessary to design interventions to modify the behavior of all the actors in the medication cycle (manufacturers, health professionals, retailers, consumers and governments). They suggest that the extraordinary therapeutic effects of antibiotics, coupled with the problems that may arise when they are inappropriately used and with the extraordinary amount of resources spent on antibiotics worldwide justify a global effort to reduce their inappropriate use and promote their adequate administration. The complexity of this type of intervention would require the support of the pharmaceutical industry, governments, private foundations, and international organizations. #
Assessing prescribing practice: A tanzanian example
International Journal of Health Planning and Management, 1993
This article presents the results of an assessment of prescribing practice, undertaken in the Morogoro region of Tanzania. As part of a wider evaluation of performance in primary level health units, retrospective data from patient registers and prospective data from observations of consultation practice were assessed using indicators proposed by the International Network of Rational Use of Drugs. Tanzanian prescribing practices compared favourably with other countries where studies using the same indicators have been undertaken. However, relatively high proportions of incorrect prescriptions were identified, with particular problems of under-prescribing. Church units were also found to perform less well than government units against the indicators used; differences between the dispensary and health centre level were few. Actions to address the problems highlighted by this study include more careful monitoring and regulation of non-government health care and identification of the root causes of under-prescribing in government units. Review of prescribing practice using appropriate indicators is important in both cases, although also requiring wider regulatory action, health provider and patient education, and action to tackle the low morale of health workers.
Advances in Pharmacological and Pharmaceutical Sciences
Irrational prescribing is common, especially in developing countries. It is important to identify the magnitude of irrational use, to take necessary steps to promote rational prescribing. We identified core prescribing indicators and commonly prescribed medicines at ward settings (IW) and outpatients’ clinics (OPC) in a tertiary care hospital in Sri Lanka. A descriptive cross-sectional study was carried out at IW and OPC settings. Prescriptions were obtained from 5 major specialties (Clinical Medicine (CM), Gynaecology and Obstetrics (GO), Paediatrics, Psychiatry, and Surgery). The WHO core prescribing indicators were used to describe the pattern of prescribing, and the most commonly prescribed medicines were identified. A total of 1,318 prescriptions were analyzed. The five most commonly prescribed medicines were paracetamol (31.0%), omeprazole (20.6%), folic acid (18.3%), atorvastatin (16.2%), and salbutamol (15.3%). The average number of medicines per encounter was 4.8 ± 3.6 (IW:...
Clinical and Experimental Pharmacology
Background: Rational prescribing, dispensing and patient use are the major components of rational drug use; however, the actual drug use pattern is not in line with World Health Organization (WHO) guidelines and is often irrational in many healthcare settings, particularly in developing countries. Therefore, this study aimed to highlight general prescribing and dispensing practices at Hiwot Fana Specialized University Hospital (HFSUH) outpatient settings. Method: Across-sectional study design was employed to determine the medication prescribing and dispensing practices at HFSUH. As per the WHO guideline for prescribing encounters, about 600 prescriptions were included in the study. Systematic random sampling was applied to obtain samples from encounters prescribed and dispensed from Jan 1-June 30, 2016. Moreover, as per the minimum requirement of the WHO guideline, 100 patient encounters were also included in the study with convenient sampling method. The data were evaluated against WHO standards for core drug use indicators. Results: From the total of 600 outpatient prescribing encounters, the prevalence of getting recorded diagnosis was almost negligible (4.67%). Only two thirds (67.60%) of prescription contain the patient name to whom the drug was prescribed. Coming to the drug related information, the prevalence of getting written dosage forms (18.5%), and the total quantity (35.34%) were found suboptimal. Duration of treatment had been documented in less than threefourth of encounters (73.00%). Regarding the WHO core prescribing indicators, the average number of drugs prescribed per encounter was found to be 1.89. The percentage of encounters that contain at least one antibiotic and injection was 304 (50.67%) and 315 (59.16%), respectively. Besides, the percentage of drugs prescribed by generic name and from an Essential Drug List (EDL) of the country was 1055 (93.04%) and 1134 (100.00%), respectively. The most commonly prescribed antibacterial agents were ceftriaxone 110 (36.20%), metronidazole 52 (17.11%), and cloxacillin 27 (8.89%). Besides, the top four prescribed injections were tramadol 214 (34.79%) ceftriaxone 110 (17.89%), furosemide 95 (15.45) and metronidazole 52 (8.46%). Looking at the patient care indicators, the percentage of drugs actually dispensed and labeled were 86% and 11%, respectively. The average dispensing time was 59.9 s and the percentage of patients knowing the entire regimen was 61.88%. Conclusion: As a tertiary care hospital, the overall completeness and rationality of prescription was found suboptimal since some of the key components were missed. The degree of polypharmacy fell within the window of WHO criteria. However, inappropriate use of antibiotics and injections was highly noticeable (significant deviation from the upper limit of the WHO standard). These are two critical but commonly misused classes of drugs given greater emphasis by WHO. Prescribing practice with generic name and from EDL is highly appreciable in this setting. However, labelling practice has been significantly poor in this setting.
Impact of an educational intervention to improve prescribing by private physicians in Uganda
East African medical journal, 2004
Private physicians in urban Uganda treat a large percentage of common adult illnesses. Improving their prescribing would not only encourage more rational drug use, but also reduce costs to patients. Interventions to improve drug use are generally more successful when face-to-face educational methods are included. To determine the effectiveness of a face-to-face educational intervention on the treatment of acute respiratory infections (ARI), malaria, and non-dysenteric diarrhoea by private physicians in three urban areas of Uganda. The study used an intervention with comparison group design to evaluate the impact of the educational intervention. A total of 108 private physicians was divided into intervention (n = 30) and control (n = 78) groups. Surrogate patients, trained to simulate presenting symptoms and signs of the target conditions, were used to collect data on the medical practices and prescribing behaviours of the physicians. Intervention physicians were invited to a one-day...