General Physicians and Prescribing Pattern in Isfahan, Iran

Abstract

Prescription is one of the principle issues in the rational treatment. Irrational use of medicines has become a global problem in many countries. The World Health Organization (WHO) has suggested several indicators for evaluating the quality of drug use at health facilities. Some prescribing Indicators included; average number and type of prescribed drugs, percentage of antimicrobial and injectable drugs, percentage of drugs prescribed by generic name and from essential drugs list and mean cost of prescriptions. 1,2 In Iran, national drug policies and regulatory systems have been developed to govern the process of prescription. In a regular drug-use survey, the prescriptions data from all physicians around the country are collected. These data are analyzed by the Rational Use of Drugs (RUD) Committee in Food and Drug Deputy of the Ministry of Health and Medical Education. In a regional setting, this process is done by medical sciences universities and health services. The activities of these Committees would provide potential quantitative and qualitative sources of data about drug use in a variety of local health facilities. The data would be helpful in defining problems in drug use patterns and also in identifying motivating factors and underlying causes including informational, economical, social, cultural and regulatory factors. During the last decade, various intervention approaches have been used for improving the prescribing practice. In Isfahan University of Medical Sciences, the committee of RUD was established by Food and Drug Deputy in 1996. The prescriptions data from all general and specialist physicians are collected from 20 cities of Isfahan province and analyzed using a computer software program (Rx Analyzer). Isfahan province is situated 400 km from Tehran in the center of Iran. In 2010, 4463710 prescriptions from Social Security Insurance Organization (an Iranian public insurance organization) issued by general practitioners were analyzed. Then the RUD Committee reported the results of survey to each physician for subsequent interventions. Table 1 shows the prescribing pattern of general physicians in Isfahan province of Iran which is very similar to the pattern of the country. 3 The mean item of drugs per prescription (3.34) shows high rate of polypharmacy. There is no universal or standard for the number of drugs prescribed per client and it is variable from 1.4-3.8 in developing countries and 1.3-2.2 in developed countries. 4 Pharmacological complexity of new drugs, ageing of population and lack of confidence resulted in increasing use of polypharmacy. Inappropriate and unnecessary drug prescribing may lead to higher adverse drug reactions (ADRs) and also higher costs. Although during the last decade, the quality of prescription has been improved in Iran, 3 the results of this survey showed that antibiotics, corticosteroids and injectable drugs are still prescribed frequently and probably inappropriately. About half of patients (51.25%) received an antibiotic. The pattern of antibiotic prescribing showed that penicillins were the most frequently prescribed antibiotics including amoxicillin (5.9%) and penicillin 6-3-3 (5.53%), followed by cefixime (3.62%) and azithromycin (2.74%). The rate of antibiotic prescription is variable in developing