Compliance to prescribing guidelines among public health care facilities in Namibia; findings and implications

Qamar Niaz,Dan Kibuule,Brian Godman,Stephen Campbell

doi:10.1007/s11096-020-01056-7

Abstract

Background The World Health Organization estimates that over 50% medicines are prescribed inappropriately and the main driver of antimicrobial resistance globally. There have only been a limited number of studies evaluating prescribing patterns against national standard treatment guidelines (STGs) in sub-Saharan African countries including Namibia. This is important given the high prevalence of both infectious and non-infectious diseases in sub-Saharan Africa alongside limited resources. Objective Our aim was to assess prescribing practices and drivers of compliance to National guidelines among public health care facilities in Namibia to provide future guidance. Setting Three levels of public healthcare in Namibia. Method A mixed method approach including patient exit and prescriber interviews at three levels of health care in Namibia, i.e. hospital, health centre and clinic. Main outcome measures Medicine prescribing indicators, compliance to and attitudes towards National guidelines. Results Of the 1243 prescriptions analysed, 73% complied with the STGs and 69% had an antibiotic. Of the 3759 medicines (i.e. mean of 3.0 ± 1.1) prescribed, 64% were prescribed generically. The vast majority of prescribers were aware of, and had access to, the Namibian STGs (94.6%), with the majority reporting that the guidelines are easy to use and they regularly refer to them. The main drivers of compliance to guidelines were programmatic, that is access to up-to date objective guidelines, support systems for continued education on their use, and ease of referencing. Lack of systems to regulate noncompliance impacted on their use. Conclusion Whilst the findings were encouraging, ongoing concerns included limited prescribing of generic medicines and high use of antibiotics. A prescribing performance management system should be introduced to improve and monitor compliance to prescribing guidelines in public healthcare.

Highlights

The appropriate use of medicines is critical especially in lower- and middle-income countries (LMICs) where the cost of medicines account for up to 70% of total healthcare expenditure, with potentially catastrophic implications for the family if a member becomes ill [1, 2]
There have only been a limited number of studies in subSaharan Africa evaluating compliance to standard treatment guidelines
This study shows that despite good access to standard treatment guidelines (STGs) by prescribers in Namibia, compliance to these guidelines is sub-optimal with high rates of antibiotic and brand name prescribing

Summary

Introduction

The appropriate use of medicines is critical especially in lower- and middle-income countries (LMICs) where the cost of medicines account for up to 70% of total healthcare expenditure, with potentially catastrophic implications for the family if a member becomes ill [1, 2]. In Namibia, several medicine use surveys have suggested the inappropriate use of medicines across all levels of health care [3, 4] This is a concern as currently in Namibia over 45% of the adult population have hypertension [5], with cardiovascular diseases a leading cause of death (21%) [5, 6]. There have only been a limited number of studies evaluating prescribing patterns against national standard treatment guidelines (STGs) in sub-Saharan African countries including Namibia. This is important given the high prevalence of both infectious and non-infectious diseases in sub-Saharan Africa alongside limited resources

Methods

Findings

Discussion

Conclusion