National survey on World Health Organization/International Network of Rational Use of Drugs core drug use indicators in the outpatient setting and availability of medicines in a developing South Asian country

Abstract

Abstract Objectives To describe the availability of medicines and World Health Organization (WHO)/International Network of Rational Use of Drugs (INRUD) core drug use indicators in a nationally representative sample of outpatient department (OPD) pharmacies in government hospitals of Sri Lanka. Methods This descriptive-cross-sectional national survey was conducted in OPD pharmacies in government hospitals, representing all 25 districts of Sri Lanka. WHO/INRUD core prescribing indicators were evaluated, together with the identification of the most commonly prescribed medications. To measure the availability of medicines, a list of 103 medicines from the WHO Global Core List (GCL), WHO/South East Asia Regional Office (SEARO) Regional Core List (RCL) and a national ‘Supplementary List’ were surveyed. Key findings A total of 3055 prescriptions were evaluated. There were 88 different medications prescribed with the commonest being paracetamol (n = 578; 18.9%). The average number of medicines per encounter was 3.3 ± 1.4 (range 1–10). Overall, the percentage of encounters with an antibiotic was 43.4% (n = 1327). There were 178 prescriptions where more than one antibiotic (5.8%) has been prescribed. Overall, the percentage of encounters with an injection was only 0.5% (n = 14). The percentage of medicines prescribed by generic name and from the essential medicine list (EML) was 84.3% and 98.9%, respectively. The average availability of medicines overall was 71.8% (range 0–100%). On average, medicines from the WHO/Health Action International GCL, WHO-SEARO RCL and national supplementary list were available in 69.8%, 75.8% and 71.3% of hospital OPD pharmacies, respectively. Conclusions The major contributors to irrational prescribing and inappropriate use of medicines in this setting were polypharmacy and prescription of antibiotics. Prescribing by generic name, use of injectable preparations and use of medicines from the EML conformed to the WHO-recommended optimal levels to a great extent.