Perceived antimicrobial dispensing practices in medicine outlets in Ghana: A maximum difference experiment design.

Abstract

Antimicrobials are consumed among patients globally, but in developing and middle-income countries, these drugs can be obtained without a prescription from pharmacies and licensed drug stores due to inadequate regulation in the pharmaceutical sector. This study aimed to assess antimicrobial dispensing practices in medicine sales outlets (i.e., pharmacies and licensed drug stores) to provide quantitative evidence for policy discussions to enhance patient safety and care quality in Ghana's pharmaceutical industry. The data for this study were obtained from a cross-sectional survey conducted in the Greater Accra region between July and August 2022. The survey was conducted through interviewer-administered questionnaires, and 200 staff members from medicine sales outlets were randomly selected using a two-stage cluster and random sampling technique. The maximum difference experiment model, rooted in random utility theory, was used to analyze their antimicrobial dispensing practices. We found that medicine sales outlet staffs were highly concerned about following the drug act and not dispensing antimicrobials without a prescription, and usually refer a patient to get a prescription from a doctor if the patient has complications (like high fever, generalized malaise, fatigue as symptoms, sinusitis). Stronger concerns were also observed for medicine outlet staff not dispensing antimicrobials without a prescription if the patient is pediatric or geriatric with a severe infection. They also evaluated patients and dispensed antimicrobials based on symptoms, not their age or gender. However, they tended not to dispense antibiotics if the patient had a mild fever and requested it without a prescription. Our results provide insight into the need for a national surveillance system for monitoring antimicrobial prescribing and dispensing practices at medicine sales outlets. Therefore, the selection of antimicrobials for treating infectious diseases may be informed by evidence-based antimicrobial prescribing and dispensing surveillance data and will help policymakers to know the pattern of commonly consumed antimicrobials in the medicine sales outlets.