Appropriateness of prescribing in selected healthcare facilities in Papua New Guinea (original) (raw)
Related papers
Health Policy and Planning, 2015
The World Health Organization (WHO) has advocated the development and use of country specific Standard Treatment Guidelines (STGs) and Essential Medicines Lists (EML) as strategies to promote the rational use of medicines. When implemented effectively STGs offer many health advantages. Papua New Guinea (PNG) has official STGs and a Medical and Dental Catalogue (MDC) which serves as a national EML for use at different levels of health facilities. This study evaluated consistency between the PNG Adult STGs (2003 and 2012) and those for children (2005 and 2011) with respect to the MDCs (2002, 2012) for six chronic and/or acute diseases: asthma, arthritis, diabetes, hypertension, pneumonia and psychosis. Additionally, the potential impact of prescriber level restrictions on rational medicines use for patient's living in rural areas, where no medical officer is present, was evaluated. Almost all drugs included in the STGs for each disease state evaluated were listed in the MDCs. However, significant discrepancies occurred between the recommended treatments in the STGs with the range of related medicines listed in the MDCs. Many medicines recommended in the STGs for chronic diseases had prescriber level restrictions hindering access for most of the PNG population who live in rural and remote areas. In addition many more medicines were listed in the MDCs which are commonly used to treat arthritis, high blood pressure and psychosis than were recommended in the STGs contributing to inappropriate prescribing. We recommend the public health and rational use of medicines deficiencies associated with these findings are addressed requiring: reviewing prescriber level restrictions; updating the STGs; aligning the MDC to reflect recommendations in the STGs; establishing the process where the MDC would automatically be updated based on any changes made to the STGs; and developing STGs for higher levels of care.
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.
A cross sectional study was conducted in Out Patient Department of Primary Care Hospital in Warangal. 502 prescriptions were randomly collected over a period of one month and recorded over a 'prescribing indicator form'. The data was analyzed using WHO indicators. Average number of drugs per encounter was 3.45. Encounter with an antibiotic prescribed was 46.21%, with a FDC was 84.66%, with an injection prescribed was 7.76%. The most common group of drug prescribed was vitamins (19.1%) followed by Antiulcer (12.34%) Antimicrobials (11.78%), Analgesics (10.22%).The findings of this study revealed that drug utilization pattern was not optimal in accordance with the standard values of WHO prescribing patterns.
2016
It is estimated by the World Health Organisation (WHO, 2004) that globally, over 50% medicines are prescribed inappropriately. In Namibia, suboptimal prescribing practices have been reported in previous medicine use surveys. Prescribing patterns in the outpatient settings have however not been evaluated in the Khomas Region. The aim of this study was to evaluate the medicine prescribing patterns in outpatient departments of public health facilities in the Khomas Region, Namibia. The study adopted the WHO descriptive cross-sectional observational design for a medicine use survey using both quantitative and qualitative methods of data collection. The study was conducted at three levels of health care: Hospital, Health Centre and Clinic. Data on prescribing indicators were collected from patient prescriptions and data on prescribers' use of treatment guidelines was also collected. The main outcome variables were the use of STGs in prescribing of medicines at OPD units and five prescribing indicators recommended by WHO. A total of 1,243 prescription records were reviewed and 37 prescribers participated in the study. Four out of the five prescribing indicators were below acceptable prescribing thresholds clearly showing that rational prescribing in Khomas Regions is suboptimal. The very high level of antibiotic prescribing (69%) is very worrying and will directly lead to increase in Anti-microbial resistance. The average of over three medicines per prescription shows that there is a degree of polypharmacy and the low level of generic prescribing only (64%) is also worrying. Adherence to STGs was found to be 73%, which is better than found in some other studies but still below the acceptable level. The main factors driving the use of STGs were access to STGs and/or training; access to STG recommended medicines at the health facility and the simplicity in indexing of the STG. The study recommends implementation of a prescribing performance management system iii to standardize, continuously monitor and improve on the prescribing of medicines at OPD units in Khomas Region.
Jurnal Kefarmasian Indonesia
Prescribing indicator is an easy core indicator to evaluate drug utilization as stated in WHO guideline. Rational prescribing pattern is important to improve rational use of drugs whereas irrational prescribing pattern can lead to irrational drug use. This study aimed to assess the prescribing pattern in public and private primary healthcare facilities which were included in the National Health Insurance Program in Indonesia. This study has been conducted using the cross sectional research design, quantitative and retrospective method in four provinces in Java island (West Java, Banten, DIY and Central Java provinces) from May to July 2014. The method of retrospective data collection were collected 757 prescriptions from 26 PHCs and 900 prescriptions from 30 clinics or General Practitioners (GPs). All data in the prescribing form were analyzed manually using Microsoft Excel 2007. The average number of item in public and private facilities was 3.31 and 3.06 respectively. The percentage of generic prescribing was 93.3% and 62.0%, the percentage of drugs in accordance with the 2013 national formulary was 89.0% and 64.5%, the percentage of antibiotic per total number of encounter was 42.8% and 39.4%, while the percentage of injection per total encounter was only 0.7% and 2.2%. Paracetamol and dexamethasone were the most frequently prescribed drugs while for antibiotic group were amoxicillin, ciprofloxacin, cotrimoxazole and cefadroxil.The average number of items per encounter and antibiotic were not met the WHO standard(≤3 for average number and less than 30% for antibiotic percentage). Suitable interventions are needed to improve the prescribing practices in Indonesia.
The ultimate goal of drug utilization related studies are to figure out the actual practices on the ground, and comparison of that with set standard, so that improvement can be made to achieve maximum possible health outcome for a patient through rational prescribing. One of the players of this game to achieve this goal is prescribers on which this study spins. The objective of this study was to assess actual prescribing practice of drugs in Nekemte Health Center. This study was a descriptive cross-sectional survey which investigated the prescribing practices of prescribers using the World Health Organization (WHO) core prescribing indicators at Nekemte Health Center in west Ethiopia. 770 Prescriptions were retrospectively reviewed in outpatient pharmacy of the Health Center selected through systematic random sampling over the period from January 1, 2014 to January 1, 2015. Of all prescriptions, the mean number of drugs per prescriptions was 2.85, the generic name prescribing practices were 100%, and prescriptions carrying antibiotics were 67%, while those carrying injections were 9%. Out of all drugs prescribed in the Health Center, all were found in Ethiopian Standard Treatment Guideline (STG). But, 20% of drugs were with incorrect drug name and/or strength, 17% did not have the right doses, and 18.3% did not have the right frequency, while 23.3% of them did not have the right duration of treatment. The prescribing practices for antibiotic use and polypharmacy showed deviation from the standard recommended by WHO. These two commonly overused and high probability of drug side effect and interaction forms of drug therapy need to be regulated closely. Drug use evaluation should be done for some of the antibiotics to check whether they were appropriately prescribed or not. Injection use is high as the status of study area is health center. On the other hand, generic prescribing and prescribing from Essential Drug List (EDL) were not found to be a problem in this study. Wrong dose, frequency and duration of treatment are very high in this Health Center. Thus, especial training is required to curb these major problems to reduce the magnitude of their harm.
Drug Design, Development and Therapy, 2015
Background: Rational prescribing is a primary step to ensure rational drug use. Often, half of the medicines are prescribed irrationally and half of these are even used incorrectly as the patients fail to take their medicines appropriately. The aim of this research was to evaluate drug-prescribing patterns of four hospitals in southern Ethiopia. Methods: A retrospective cross-sectional study was conducted between May 15 and June 25, 2014, to evaluate the drug-prescribing patterns based on the World health Organization (WHO) prescribing indicators. The prescription papers, kept for the last 1 year in the outpatient departments of the four hospitals, were analyzed according to WHO guidelines. Also, prescriptions in the hospitals were analyzed to determine the most frequently prescribed drugs. All the statistical calculations were performed using SPSS ® version 20.0 software. Results and discussion: The average number of drugs per prescription ranges from 1.82±0.90 to 2.28±0.90, whereas the percentage of use of antibiotics and injections ranged from 46.7 to 85 and 15 to 61.7, respectively. The average percentages of drugs prescribed by generic name and from the essential drugs list were 95.8 and 94.1, respectively. Anti-infective and analgesic drugs are found to be the most frequently prescribed medicines. In terms of polypharmacy, there was a slight deviation in prescribing patterns from what is acceptable according to the WHO criteria. Prescribing by generic name and from essential drug list was almost optimal. There was a significant deviation in the use of injectables in two of the four hospitals (50%), whereas their use in the other two hospitals was within the acceptable range. The use of antibiotics in all the hospitals in present study was higher than the acceptable range. Conclusion: Generally, it seems that there is need for improvement of the prescribing patterns in the hospitals, although this should be consolidated with further studies to link the patient diagnosis and the prescribed medications.
Frontiers in Pharmacology, 2020
Background: Ensuring rational drug use requires ongoing evaluation of drug prescribing, dispensing, and use by patients. Health care providers working in an emergency department face unique challenges, including making urgent decisions, patient overload, and limited resources, which contribute to inappropriate drug use. Rational medication use should be an important aspect of emergency care to improve patient outcomes. Thus, this study was conducted to assess medication utilization patterns using World Health Organization (WHO) prescribing indicators in the emergency department. Methods: A cross-sectional study design was implemented among patients presenting at the emergency department of Hiwot Fana Specialized University Hospital (HFSUH) from January to March 2018. The data were collected from the medical charts of a total of 342 patients using a pre-prepared structured format according to WHO recommendations. The data were analyzed using SPSS version 21 software and presented in tables and figures. Results: The most commonly reported clinical diagnosis was found to be soft tissue laceration or abrasion, in 75 patients (21.9%), followed by dyspepsia, in 50 (14.6%), and severe pneumonia, in 44 (12.9%). A total of 810 drugs were prescribed for the 342 patients. The main category of drugs prescribed were analgesics, constituting 125 (29.2%), followed by antibiotics, 120 (28.0%). Regarding WHO prescribing indicators, the average number of drugs prescribed per encounter was 2.36, the number of encounters at which antibiotics were prescribed was 127 (37.13%), and injections were prescribed at 300 (87.7%) encounters. All of the drugs prescribed were from the National Essential Medicine List (NEML) of Ethiopia, and 780 (98.1%) of the drugs were prescribed by international nonproprietary name.
Prescribing practices in two health care facilities in Warri, Southern Nigeria: A comparative study
Tropical Journal of Pharmaceutical …, 2003
Purpose: Inappropriate prescribing has been identified in many health facilities in developing countries. The purpose of this study was to evaluate the prescribing practices in two health care facilities in Warri located in south-south geopolitical region of Nigeria and identify factors influencing the practices. Method: WHO Prescribing Indicators were applied to evaluate 2000 prescription records, retrospectively, from a private and a public hospital in Warri. Factors influencing the prescribing practices in the facilities were identified through informal interviews of 10 prescribers in the facilities. Using a self-administered questionnaire administered to 40 prescribers in the facilities, we also evaluated the order of importance of the factors affecting drug prescribing. Results: Average number of drugs per encounter in the health facilities is 3.4 (3.9 in the public hospital and 2.8 in the private hospital). Generic prescribing was generally low (54% in the public hospital and 16% in the private hospital) while the percentage of encounters with antibiotics prescribed was high (75% in the public hospital and 55% in the private hospital). Antimalarials, antihypertensives, antidiarrhoeals and analgesics accounted for 47.4%, 7.5%, 1.0% and 18.2%, respectively. The overuse of drugs and generic prescribing were significantly lower in the private hospital than in the public hospital. Major factors influencing prescribing practices included drug availability, clinician's level of training, cost of drugs, feedback from patients and socio-economic status of patients. Conclusion: Polypharmacy, overuse of antibiotics and low rate generic prescribing still occur in the health facilities studied. Drug availability, clinician's level of training, cost of drugs, feedback from patients and socio-economic status of patients are major factors influencing prescribing in the facilities.
Background: The ultimate goal of drug utilization related studies are to figure out the actual practices on the ground, and comparison of that with set standard, so that improvement can be made to achieve maximum possible health out come for a patient. One of the players of this game to achieve this goal is prescribers on which this study spins. Methods: This study was a descriptive cross-sectional survey which investigated the prescribing practices of prescribers using WHO core prescribing indicators at Nekemte Referral Hospital in west Ethiopia. 770 Prescriptions were retrospectively reviewed in outpatient pharmacy of the hospital selected through systematic random sampling over the period from Abstract-Background: The ultimate goal of drug utilization related studies are to figure out the actual practices on the ground, and comparison of that with set standard, so that improvement can be made to achieve maximum possible health out come for a patient. One of the players of this game to achieve this goal is prescribers on which this study spins. Methods: This study was a descriptive cross-sectional survey which investigated the prescribing practices of prescribers using WHO core prescribing indicators at Nekemte Referral Hospital in west Ethiopia. 770 Prescriptions were retrospectively reviewed in outpatient pharmacy of the hospital selected through systematic random sampling over the period from January 2, 2015 to March 2, 2015. Results: Of all prescriptions, the mean numbers of drugs per prescriptions were 2.1, the generic name prescribing practices were 98.26%, and prescriptions carrying antibiotics were 69 %, while those carrying injections were 21.94%. Out of all drugs prescribed in the hospital, 1.74% of them were not found in Ethiopian STG. Also 18.45% of them were with incorrect name and strength, 11.82% haven't the right doses, and 6% haven't right frequency, while 20.5% of them haven't right duration of treatment. Conclusion: On the basis of the finding of this study, the prescribing practices for antibiotic use and poly Pharmacy show deviation from the standard recommended by WHO. These two commonly overused and high probability of drug side effect and interaction forms of drug therapy need to be regulated closely. Drug use evaluation should be done for some of the antibiotics to check whether they were appropriately prescribed or not. On the other hand, injection use, generic prescribing and prescribing from EDL were not found to be a problem in this study. Referral hospitals have a special responsibility to society to prescribe selectively with strong caution to save lives of patients as a final treatment facility.