Abstract
ObjectiveThis study aimed to investigate prescription patterns and influencing factors in Chinese county hospitals.MethodsPrescription quality was evaluated by five indicators proposed by WHO/INRUD. A questionnaire for doctors was designed by our research group. All internists, surgeons, obstetricians, gynecologists and pediatricians from 10 county hospitals in Anhui province were asked to fill the questionnaire. Their prescriptions from May 2011 to April 2012 were analyzed.ResultsThree-hundred and thirty-seven doctors completed valid questionnaires, and 5099 prescriptions were analyzed. The average number of drugs per prescription was 3.52±2.31; the average percentage of generic drugs, antibiotic usage, injection drug usage, and drugs prescribed from the national essential drug list were 96.12%, 29.90%, 20.02% and 48.85%, respectively. Differences in final academic degree and specialty led to differences in all of the five prescription quality indicators. The older doctors tended to use more antibiotics. Doctors with more education, more training on rational drug use, and better acquisition of medicine knowledge prescribe a lower percentage of generic drugs. Moreover, the more supportive the doctor’s attitude to national essential medicine policy, the higher the percentage of generic drugs were prescribed. A higher level of medical knowledge was associated with a higher percentage of drugs prescribed from the essential drugs list.ConclusionsPromoting the education of medical knowledge on doctors, reinforcing the publicity of rational drug use to doctors, and initiating the performance evaluation for doctors are effective ways for improving prescription quality in Chinese county hospitals.
Highlights
It is estimated by the World Health Organization (WHO) that approximately 5.3 trillion U.S dollars were spent on health services, and 25% of this amount was used to pay for medicines [1,2]
Data from the WHO indicates that by 2015, over 10 million deaths per year could be avoided by effective health interventions, such as national essential medicine policies [3]
As for the quality indicators of the 5099 prescriptions, the minimum number of drugs per prescription was 1 and the maximum was 10, with an average of 3.5262.31; the average percentage of generic drugs prescribed was 96.12% (26%–100%); the average percentage of antibiotics usage was 29.90% (0%– 100%); the average percentage of injection usage was 20.02% (0%–100%), and the average percentage of drugs prescribed from the national essential drug list was 48.85%(0%–100%)
Summary
It is estimated by the World Health Organization (WHO) that approximately 5.3 trillion U.S dollars were spent on health services, and 25% of this amount was used to pay for medicines (from the WHO National Health Accounts data files for 2006) [1,2]. Data from the WHO indicates that by 2015, over 10 million deaths per year could be avoided by effective health interventions, such as national essential medicine policies [3]. ‘‘Essential medicines’’, a concept proposed by WHO in 1977, was defined as drugs with availability, safety, effectiveness and rational use [4]. The WHO guideline on essential medicines has obtained approval from its member states. In 2009, the Chinese government approved the national essential medicines system. It is common sense that doctors with prescription eligibility should be responsible for rational drug use. An inappropriate prescribing pattern by doctors often encourages inappropriate self-medication by patients because of the asymmetry of medical information [5]. Doctors’ prescription patterns are not static or standardized but dynamic and individual [6]. Studies on medicines are complicated social themes rather than medical themes [7]
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