Abstract
Background: Inappropriate use of medicines is a global concern with serious consequences related to prescribing, dispensing, and use. WHO estimated that 50% of medicines are not used correctly on their journey from the facility to home. Objective: To assess medicines use using WHO drug core indicators regarding prescribing, patient, and facilities. Setting: Outpatients, Health centers in Wadmadani locality (Urban area) in Gezira State, Sudan. Method: A cross-sectional, prospective, analytical study was conducted in 30 health centers and 60 patients from each center were selected using a simple random sampling technique. WHO indicators form was used to collect data containing different variables. T-test at a level of confidence of 95% was used to test differences between indicators. Statistical Package for Social Science (SPSS) was used for data analysis. Results: The main prescribing indicators were 2.5 ± 0.6 for drugs per encounter, 44.1% ± 14.2%. Generic 54 ± 18.0 antibiotics, 12.0% ± 9.3% injectable, and 95.2% ± 11.5% of drugs were prescribed according to the NHIF-EML. The main patient’s indicators were, 2.9 ± 0.8 minutes for consultation time, 99.5 ± 36.8 seconds for dispensing time, and 72.5% ± 16.0% for medicines actually dispensed, 49.0% ± 18.0% for medicines adequately labeled, and 22.5% ± 7.3% of the patient’s knowledge about the correct dose. The Facility specific indicators were 66.7% for the availability of a copy of EML, while the percentage of key drugs in the stock was 75.3% ± 11.6%. No statistically significant differences were found between direct and indirect facilities except in generic prescribing. Main Outcome Measure: • Interventions to improve Generic and antibiotics prescribing indicators. • The patient-to-physician ratio should be revised to optimize consultation time. • The availability of key drugs should be improved to make sure effective treatment. • The pharmacy cadre should be oriented and trained to improve patients’ compliance. Conclusion: The study concluded that there was irrational use of medicines when investigated by WHO drug core indicators. So, the study recommended interventions to improve the rationale prescribing, dispensing, and use of medicines.
Highlights
Medicines play a crucial role in improving, restoring, and maintaining health
Two studies were conducted by Muhammed Atif and others in two areas of Pakistan, Bahawalpur, and Punjab, and the results showed a remarkable deviation from the standard [18] [19]
Independent sample t-test was carried out to compare between direct health facility and indirect, for numerical indicators, while chi-square test was done for categorical indicators to test whether there was a statistical difference at the level of confidence of 95%
Summary
Availability, as well as the appropriate use of medicines, had become a global concern to achieve the desired outcomes [1]. The rational drug use as defined by the World Health Organization (WHO) “patients receive medications appropriate to their clinical needs, in doses that meet their individual requirements, for an adequate period of time, and at the lowest cost to them, and their communities” [2]. More than 50% of all medicines are prescribed, dispensed, or used inappropriately [3]. The common problems of inappropriate use of medicines include polypharmacy (use of too many medicines/prescription), overuse of antibiotics and injections, failure to prescribe according to clinical guidelines, and poor patient adherence and compliance [3]. The dramatic increase in medicines expenditure due to irrational use can affect the quality of medical services delivered by the national health insurance fund (NHIF).
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