Factors Impacting Prescription Practice in Primary Healthcare Setting in India: A Case Study in Rajasthan

Abstract

Objective: To assess the prescription practices in the Indian state of Rajasthan with a view to demonstratethe effect of provider and system level factors, and their interactions on good prescription practices. Thestudy analysed two major dimensions of good prescription practice; first, the completeness of prescription, ameasure of adequacy; and second, the appropriateness of prescription, a measure of quality of care.Design: A retrospective cross-sectional study with a mixed method approachSetting: 24 rural and 7 urban government Primary Health Centres of Rajasthan, IndiaParticipants: Audit of 2801 prescriptions from health facility and the service providers in these facilities,including doctors, and nursesPrimary and Secondary Outcomes: The study outcome testified the study objective that provider levelfactor is critical to assure adequacy and appropriateness of good prescription practice. The secondarylevel outcome revealed that the system level factors are equally important to ensure compliance to goodprescription practiceResult: We found that the documentation of patient complaint, examination findings largely dependedon system level factors, such as availability of space in the piece of paper used for writing prescription;because for the doctor documenting diagnosis, and prescribing medicines and investigations were of greaterimportance. Ownership compliance of doctors, measured in terms of their signature on the prescriptions,emerged as an important factor determining both adequacy and accuracy of prescriptions. Further, thetreatment appropriateness, measured in terms of QoC, depends on both provider & system level factors.Conclusion: There is a need to focus on provider and system level factors to improve prescription practicesin primary health care. We recommend that institutional strengthening at systemic & provider level usinginnovative ways; such as task shifting to nurses as ‘physician assistants’, and reducing administrativeactivities of physicians to enhance focus on clinical work can propel better prescription practice.