Rational use of medicines: prescribing indicators at different levels of health care

Maria Beatriz Cardoso Ferreira,Daisson José Trevisol,Mônica Cristina Toffoli Kadri,Teófilo Fernando Mazon Cardoso,Tatiane Da Silva Dal Pizzol,Adriana Mary Mestriner Felipe De Melo,Maria Tereza Ferreira Duenhas Monreal,Liziane Maahs Flores,Alvaro Koenig,Isabela Heineck,Aline Lins Camargo,Iraci Lucena Da Silva Torres

doi:10.1590/s1984-82502013000200015

Abstract

This multicenter study aimed to investigate prescribing patterns of drugs at different levels of health care delivery in university-affiliated outpatient clinics located in eight cities in the South and Midwest of Brazil. All prescriptions collected were analyzed for various items, including WHO prescribing indicators. A total of 2,411 prescriptions were analyzed, and 469 drugs were identified. The number of drugs prescribed per encounter, the frequency of polypharmacy, and the percentage of encounters with at least one injection or antibiotic prescribed were higher in centers providing primary health care services, compared to those where this type of care is not provided. Most drugs (86.1%) were prescribed by generic name. In centers with primary health care services, drug availability was higher, drugs included in the National and Municipal Lists of Essential Medicines were more frequently prescribed, and patients were given more instructions. However, warnings and non-pharmacological measures were less frequently recommended. This study reveals trends in drug prescribing at different levels of health care delivery in university-affiliated outpatient clinics and indicates possible areas for improvement in prescribing practices.

Highlights

METHODSThe World Health Organization (WHO) suggests a set of drug use indicators that has proven useful in the investigation of drug prescribing patterns in health care facilities (WHO, 1993)
Among those who had some level of formal education, 63.9% attended only primary school, 18% attended high school, and 6.8% attended university
All injections were prescribed at centers with primary health care services (Table I)

Summary

Introduction

METHODSThe World Health Organization (WHO) suggests a set of drug use indicators that has proven useful in the investigation of drug prescribing patterns in health care facilities (WHO, 1993). Prescribing indicators have been used in several studies, showing problems in the pattern of drug prescribing in different regions of the world (Mahfouz et al, 1997; Nikfar et al, 2005; Sharif et al, 2008; Vallano et al, 2004) These studies provide data to be used in future strategies aiming to promote rational drug use. In accordance with the Brazilian health regulations (Brasil, 1973), a medication order should carry several items, such as name and address of the patient and name, address, medical license number and signature of the prescriber. The presence of these and other data aims at a more rational use of drugs, minimizing drug-related problems and improving treatment outcomes

Objectives

Results

Conclusion