Abstract
BackgroundPrescription practices, especially in South Asian countries, have come under investigation for quality. Although there have been no studies in Nepal that have analyzed the prescription pattern of FDCs for different levels of health care centers, several studies from Nepal and other countries in the region have revealed poor medicine use practices, including irrational use of fixed-dose drug combinations (FDCs). This research aimed at assessing the utilization pattern of FDCs among primary (PHC), secondary (SHC) and tertiary health care (THC) centers in Western region of Nepal.MethodsA cross-sectional descriptive study was conducted at primary, secondary and tertiary health care centers in Western Nepal. One hundred prescriptions from each health care center were chosen through systematic random sampling. The International Network for Rational Use of Drug (INRUD) indicators were used to assess the rationality of prescribing. Both descriptive and inferential statistics were applied. The alpha level used was 0.05.ResultsAt the PHC center, 206 medicines were prescribed, of which 20.0% were FDCs. Antimicrobials were the most prescribed FDCs (57.1%). The unit prices of all FDCs were below 100 Nepalese Price Rupees (NPRs). At the SHC center, 309 medicines were prescribed, and 30% were FDCs. Vitamins, minerals and dietary supplements were the most prescribed FDCs (25.8%). The costs of 63.5% of FDCs were below 100 NPRs. At the THC center, 33.5% of 270 medicines were FDCs. As at the SHC center, vitamins, minerals and dietary supplements were the most prescribed FDCs (40.6%). The costs of 50.5% of FDCs were below 100 NPRs.ConclusionsFDCs were used extensively at different health care centers. The number of prescription in private centers, following established guidelines and the essential drug list (EDL), was much lower. The cost associated with the utilization of FDCs was higher in private sectors compared to public health care centers. In certain cases, the use of FDCs was questionable, and this study found a low use of essential medicines. Education to improve prescription practices at different healthcare levels is recommended.
Highlights
Prescription practices, especially in South Asian countries, have come under investigation for quality
Our study examined the prevalence of Fixed Dose Drug Combination (FDC) and the cost associated with their use; we can corroborate past reports of widespread irrational FDC use in the private sector [20]
Part I: Primary health care center Altogether, 100 prescriptions were encountered from the primary health care (PHC) center
Summary
Prescription practices, especially in South Asian countries, have come under investigation for quality. Rational prescription practices mean “making a diagnosis, estimating prognosis, obtaining the best possible effect with the least number of medicines in the shortest period and at reasonable cost and monitoring the effects of the treatment” [3]. In both developed and developing countries, the irrational and inappropriate use of medicines is a major concern [4]. The prescribing behavior of a practitioner depends on several factors, including commercial publicity, government regulations, academic literature, patient behaviors, and influences from pharmaceutical companies Inappropriate responses to these factors lead to prescription errors and irrational prescribing habits, both of which are very common in clinical practice
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