Prescribing Pattern of Extemporaneous Compounding in Primary Health Care Centers

Indri Hapsari,Marchaban Marchaban,Susi Ari Kristina,Chairun Wiedyaningsih

doi:10.5539/gjhs.v10n12p104

Abstract

OBJECTIVE: Compounding is one of basic competences and skills should be owned by pharmacists since ages. Shortage of licensed drug supply and patients with special needs had become the major reason for the compounding practice to be performed. Average of drug number given to patients in primary or government health centers in a sheet of prescription compounding was quite high; commonly it included more than one drug given individually or prescribed together. The WHO/ INRUD cores drug prescribing indicators were developed to be utilized as a measure of performance in areas related to rational use of medicine in health facilities. This study aimed to analyze prescribing pattern of extemporaneous compounding in primary health care centers.  METHOD: Cross sectional survey method was employed in this study which was conducted at 24 Primary Health Care Centers in Banyumas regency, Central Java Province, Indonesia by collecting data of extemporaneous compounding from the primary health care centers having the compounding percentage &ge; 5% from total prescription of each. The researchers implemented retrospective data collection which was conducted on 1200 prescription sheets in period of April to June 2017.  RESULT: The drugs used in extemporaneous compounding were 49 types, and the mostly used were chlorpheniramin maleate (22.54%), dexamethasone (18.20%), glycerol guaiacolate (15.36%), amoxicillin (9.15%) and paracetamol (7.47%). Number of drugs used in each extemporaneous compounding was various; one to six drugs per-compounding with its average 2.86 drugs per-prescription of extemporaneous compounding. Generic drugs were mostly used in extemporaneous compounding with percentage 93.88%, while percentage of antibiotic use was low; it was 11.36%. Based on conformity with national formulary in Indonesia, the proper used drug in extemporaneous compounding was 71.43 %, while based on conformity with WHO Model List Essential Medicines, it was 46.96 %.  CONCLUSION: In this study, although the drug which was used in dosage form of extemporaneous compounding was still quite high with a range between 1 to 6 drugs in one dosage form, but generally the drug use in form of extemporaneous compounding in primary health care centers was still in accordance with the WHO/INRUD cores drug prescribing indicators that were characterized by high generic drugs and low use of antibiotics in the extemporaneous compounding at the primary health care centers.

Highlights

Compounding is one of basic competences and skills should be owned by pharmacists since ages
The World Health Organization (WHO)/International Network of Rational Use of Drugs (INRUD) cores drug prescribing indicators were developed to be utilized as a measure of performance in areas related to rational use of medicine in health facilities
In this study, the drug which was used in dosage form of extemporaneous compounding was still quite high with a range between 1 to 6 drugs in one dosage form, but generally the drug use in form of extemporaneous compounding in primary health care centers was still in accordance with the WHO/INRUD cores drug prescribing indicators that were characterized by high generic drugs and low use of antibiotics in the extemporaneous compounding at the primary health care centers

Summary

Introduction

Compounding is one of basic competences and skills should be owned by pharmacists since ages. Extemporaneous compounding was known as unlicenced, unauthorized, unapproved or unregistered drugs (Giam & McLachlan, 2008). Ease of the drug use, efficiency and cheaper price were other reasons why doctors still prescribed extemporaneous compounding to the patients (Pappas, MacPherson, & Stewart, 2002). The shortage of licenced drugs caused the doctors using unlicenced or off label drugs in extemporaneous compounding; usage of unlicenced or off label drugs for pediatric patients is common in some countries (Giam & McLachlan, 2008); such as the case in Rotterdam, where the use of unlicenced drugs for pediatric patients was quite high, especially for patients with complex health cases (Conroy et al, 2000). Extemporaneous compounding remained a concern, because of unwanted cases such as polypharmacy, medication errors, quality of extemporaneous compounding and the problem of bacterial contamination that may appear in non-sterile dosage form (Allen, 2003)

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Discussion

Conclusion