A Systematic Review of Main Factors leading to Irrational Prescription of Medicine

Abstract

Context: One of the serious global problems is the irrational prescribing of medicines that can be regarded as harmful or wasteful. Inappropriate use and overuse of medicines, waste resources and therefore lead to health and economic consequences in patients. The goal of this systematic review was to identify factors associated with irrational prescriptions of medicine. Evidence Acquisition: We searched the Cochrane database of systematic reviews (via Cochrane library), PubMed, Medline, Scopus, Science Direct, BMC, Scholar Google, and SID from 1980 up to October of 2016. Results: Of the 594 papers, 26 papers were finally included. The combined results of the 26 papers indicated 24 factors for unnecessary prescriptions of medicine. Factors related to the patient were expectations, demand to prescribe, and poor medical knowledge. Factors related to the physician were inaccurate diagnosis, inadequate awareness and knowledge, low experience, information asymmetry, poor medical education, and the physician’s attitude. Factors related to the institutional and political issues were fee-for-service, out-of-pocket payment, financial incentives, insurance reimbursements, insurance coverage, medicine subside, medicine advertisement, ineffective monitoring programs, regulation on prescription, prescription supervision, clinical guidance, and medicines near-expiry dates or expired. Conclusions: It can be concluded that the irrational/unnecessary prescription of medicine was influenced by many different factors, such as patient, physician, and institution. Thus to prevent irrational/unnecessary prescription, one needs to consider all the involved factors.