Percentage Of Encounters Research Articles

IRRATIONAL DRUG USE;

Objectives: To evaluate drug prescribing practices at Medical Unit, ICU andNephrology Unit, using WHO prescribing indicators, in order to promote rational drug use.Study Design: A retrospective cross sectional study. Place and Duration of Study: BolanMedical Complex Hospital Quetta, Pakistan, from July to December 2015. Methodology: Drugprescribing trends in 218 prescriptions were scrutinized thoroughly. Data was collected bywell-trained pharmacy personals by using prescriptions and prescription registration booksof patients. Descriptive statistics were calculated on SPSS version 16.0. Results: The averagenumber of drugs prescribed per prescription were 4.11 whereas, WHO recommends that itshould be 2.00 or less. Alternatively, percentage of drugs prescribed by generic name and froman essential drug list were 14.73% and 78.35% while, in accordance with WHO it must be 100%and 70% correspondingly. On the other hand, percentage of encounters having antibiotics orinjections prescribed were 18.33% and 32.79% but according to WHO it should be20% or lessand 10%respectively. Nevertheless, proper diagnosis was stated in 89.44% of prescriptionsand 72.11% prescriptions had complete relevance between treatment and diagnosis. Alongwith, appropriate drug dosage and their administration was instituted in 65.16% of prescriptionsand 73.21% of prescriptions had accurate duration of therapy. Conclusion: The prescribingpatterns in Bolan Medical Complex Hospital Quetta reflect the practice of polypharmacy, whichis more of an irrational type in contrast to WHO recommendations. Thus, there is an urge tobring about some interventions to improve the pharmacotherapy.

English

Objectives: To evaluate drug prescribing practices at Medical Unit, ICU andNephrology Unit, using WHO prescribing indicators, in order to promote rational drug use.Study Design: A retrospective cross sectional study. Place and Duration of Study: BolanMedical Complex Hospital Quetta, Pakistan, from July to December 2015. Methodology: Drugprescribing trends in 218 prescriptions were scrutinized thoroughly. Data was collected bywell-trained pharmacy personals by using prescriptions and prescription registration booksof patients. Descriptive statistics were calculated on SPSS version 16.0. Results: The averagenumber of drugs prescribed per prescription were 4.11 whereas, WHO recommends that itshould be 2.00 or less. Alternatively, percentage of drugs prescribed by generic name and froman essential drug list were 14.73% and 78.35% while, in accordance with WHO it must be 100%and 70% correspondingly. On the other hand, percentage of encounters having antibiotics orinjections prescribed were 18.33% and 32.79% but according to WHO it should be20% or lessand 10%respectively. Nevertheless, proper diagnosis was stated in 89.44% of prescriptionsand 72.11% prescriptions had complete relevance between treatment and diagnosis. Alongwith, appropriate drug dosage and their administration was instituted in 65.16% of prescriptionsand 73.21% of prescriptions had accurate duration of therapy. Conclusion: The prescribingpatterns in Bolan Medical Complex Hospital Quetta reflect the practice of polypharmacy, whichis more of an irrational type in contrast to WHO recommendations. Thus, there is an urge tobring about some interventions to improve the pharmacotherapy.

Prescribing Pattern Along With Pharmacoeconomic Evaluation In Primary Health Care Facilities Nepal

To assess the drug use pattern in Primary Health Care (PHC) facilities of Nepal and pharmacoeconomic evaluation of drug prescribed. A prospective cross-sectional descriptive study was conducted in 11 PHC facilities of Kaski district using WHO core drug use indicators A total of 301 prescriptions were analyzed. The average age of patients visiting PHC was 33.11 years (female 35.79; male 30.40). The average number of drugs prescribed was 2.29. Percentage of encounters with at least one antibiotic prescribed was 57% whereas encounters with at least one injection prescribed was low 3%. The total percentage of drugs prescribed using generic names was found to be 59.02% and percentage of drugs prescribed from EDL was 85.19% respectively. The average consultation and dispensing time of 109 patients was 2.02 minutes and 42.52 seconds. Only 30% of patients had adequate knowledge of drug whereas none of the drugs were adequately labeled. Percentage of drugs actually dispensed was 89.63%. All health facilities had availability of Essential Drug List (EDL). The total percentage of availability of key drugs in PHCs was 89.69%. Irrational practice mainly on antibiotics use and non- generic prescribing in most facilities studied were noticed. Patient care provided by health facilities studied was insufficient and thus effective intervention program for promotion of rational drug use practice is recommended in PHC facilities in Nepal.

English

Geriatric is potentially vulnerable to drug related problems. Inappropriate prescribing to these patient groups causes substantial morbidity and has become an important public health issue.  The purpose of this study was to evaluate prescription practice in geriatrics patients attending medical ward of Dessie Referral Hospital (DRH). A cross sectional study design was used to collect data from patient cards aged more than or equal to 65 years old that visited DRH in south wollo zone over the last one year period from September 11/09/2014 to September 10/09/2015. Assessment of the prescription pattern was done by using Beers criteria and WHO core indicators. A total of 244 charts were evaluated. 868 drugs were prescribed to the study population. Number of encounters with antibiotic prescription was 155 (63.5%). The percentage of encounters in which an injection was prescribed was 82.4%. Analysis of the prescribed medications using the 2012 Updated Beers Criteria showed 56 patients with at least one potentially inappropriate medication prescribed giving a prevalence of 23%. The study indicates the prescribing practices in the hospital associated with greater poly-pharmacy and inappropriate medication use. Key words: Elderly, Dessie referral hospital, beers criteria, WHO core indicators.

Study of drug utilization pattern in emergency medicine ward at a tertiary care teaching hospital

Background: The emergency department represents an important platform for conducting drug utilization studies as patients present with a wide spectrum of diseases in acute form. An irrational prescription adversely affects the prognosis and recovery of patients. Hence, the objective of our study was to evaluate the drug utilization pattern and to determine the rationality of prescription using WHO prescribing indicators in emergency medicine ward.Methods: After obtaining Institutional Ethical Committee approval, a prospective observational study was conducted over 2 months. The case records of 150 patients admitted to the emergency medicine ward, with a hospital stay of more than 24hrs were reviewed to analyze the prescription pattern during the initial 48hrs of admission. Case records of patients irrespective of age, sex and diagnosis were included in the study. Descriptive statistics were used to analyze the results (SPSS version 20).Results: A total of 1014 drugs were prescribed from 150 case records with a mean age of 47±18 years. An average of 6.76 drugs was prescribed per prescription; percentage of encounters with at least an antimicrobial was 115 (76.66%). Injections were prescribed in all patients (100%) and only 416 (41.02%) drugs were prescribed by generic name and 657 (64.79%) drugs abided to the WHO essential drug list. Majority of patients received anti-ulcerogenic drugs followed by antimicrobials.Conclusions: There was a tendency of polypharmacy with overuse of PPIs and antimicrobials. There is need to rationalize the drug therapy in terms of increasing prescription of drugs from essential drug list by generic name.

A STUDY OF DRUG UTILIZATION PATTERN OF THE GERIATRIC PATIENTS IN THE DEPARTMENT OF GERIATRIC MEDICINE IN A TERTIARY CARE HOSPITAL IN ASSAM, INDIA

Objective: To investigate the drug utilization pattern and the prevalence of potentially inappropriate medications (PIMs) using updated AGS Beers criteria 2012 among the elderly patients who attended the geriatric outpatient departments as well as admitted indoor patients ina tertiary care Hospital at Guwahati, Assam, India.Method: A hospital based prospective, observational and cross sectional study, involving patients aged 65 years and above was planned and conducted over a period of 6 months from January 2016 to June 2016. Patients were visited daily, interviewed and case records were collected. Data were analyzed using Microsoft Office Excel Sheets.Results: A total of 150 patients aged 65 years and above were analyzed. 97 patients (65%) were males and 53 (35%) were females. Majority of the patients (61 numbers, 41%) belonged to the age group of 65-70 years, and least were in the age group of 86-90 years (13 numbers, 9%). Prescription of five or more medications (polypharmacy) was observed in 117 (78%) patients. Majority of the patients presented with diseases of cardiovascular system (25.7%). Using WHO drug use indicators, the average number of drugs per prescription was found to be 5.6. The percentage of drugs prescribed by generic name was 86%. The percentage of encounters in which antibiotics were prescribed was 61%. Injection was prescribed was 65% cases and the percentage of drugs prescribed from the NLEM (National List of Essential Medicines of India) was 96%. 43 patients received PIMs from Beers list; majority were belonging to category 1. Spironolactone was most commonly prescribed PIM.Conclusion: Irrational prescribing practices and polypharmacy were detected in our study.Prescribers should be educated about rational use of drugs and Beers criteria for elderly. Keywords: Beers criteria, WHO prescribing indicators, Potentially inappropriate medications, Elderly patients, Polypharmacy

Establishment of Personalized Pain Goals in Oncology Patients to Improve Care and Decrease Costs.

Cancer-related pain is common, negatively affects quality of life and survival, and often requires treatment with opioid analgesics. Patient-reported data that describe the incidence and severity of pain, medication use, and patient satisfaction with care are lacking. We analyzed 18 months of outpatient oncology clinic encounters from the electronic medical record to obtain data on pain levels and opioid and nonopioid treatments. In June 2014, we instituted a pain intervention by creating a pain management information handout for patients, educating clinicians on opioid cost-effectiveness, and implementing a nursing protocol to document personalized pain goals (PPGs). Moderate to severe pain was reported in nearly 15% of patient encounters. We observed an increase in the percentage of encounters with a documented PPG of 16% to 71% ( P < .001). On average, PPG was achieved in 84% of patients. Rates of high-cost long-acting opioid prescriptions (oxycodone controlled release and fentanyl patches), as a total of all long-acting opioids, declined from 45% preintervention to 33% postintervention ( P = .005). Our intervention improved rates of PPG documentation and decreased the number of prescriptions for high-cost long-acting opioids. Oncology clinics can implement simple quality improvement methods, such as asking patients about their PPG and educating clinicians about opioid costs, to improve outcomes and lower treatment costs.

WHO core prescribing indicators in patients with allergic contact dermatitis in a coastal town of South India

Background: Prescribing pattern analysis utilizing WHO core drug prescribing indicators can be helpful for the assessing the beneficial and adverse impacts of the prescribed drugs. Even though many drugs are commonly used in treatment of Allergic contact dermatitis (ACD) they are least studied in terms of prescribing patterns. Hence the present study was planned to analyze the prescribing pattern and study the WHO core prescribing indicators in patients with ACD in our institute. Methods: A prospective observational study was carried out with prescriptions of 81 outpatients who attended the dermatology OPD with the diagnosis of ACD over a period of six months. Details such as basic demographics, specific drugs prescribed with their dose and dosage forms were recorded and WHO core prescription indicators analysed. Results: Overall, corticosteroids both topical and systemic were the most commonly prescribed drugs (45.54%) followed by antihistamines (30.69%) and antimicrobials (13.86%). The most commonly prescribed topical corticosteroid was desonide (58.82%), systemic corticosteroid was prednisolone (47.61%), antihistamine was cetirizine (54, 83%) and antimicrobials were cephalosporins (42.86%). Average drugs per prescription for patients of ACD were 6.8. Percentage of drugs prescribed by generic name was 22.77%. Percentage of encounters with antibiotic prescribed was 13.86% whereas injection prescribed was 9.90%. Percentage of drugs prescribed from National list of essential medicines (NLEM) was 53.57%. Conclusions: Corticosteroids remain the mainstay of treatment in ACD. The percentage of encounters with an injection and the use of systemic steroids were low and were according to the guidelines. But drugs prescribed by generic name and those prescribed from NELM were found to be satisfactory but can further be improved.

Geriatric Prescription in a Nigerian Tertiary Hospital.

Objectives:To assess the medications prescribed for elderly inpatients on specific days during hospital admission with a view to detecting areas of irrational prescription.Methods:It was a prospective study of all patients aged 65 years and above admitted to the medical wards of a Nigerian tertiary hospital over a 12-month period. The World Health Organization/International Network of Rational Use of Drugs (WHO/INRUD) drug use indicators were used to assess drug prescriptions on various days of admission.Results:A total of 1513 patient encounters involving 345 patients aged between 65 and 92 years were assessed on hospital days 1, 3, 5, 7, 14, and 28. The average number of medicines per encounter ranged from 6.1 ± 2.5 on hospital day 1 to 7.8 ± 2.4 on hospital day 28. This difference was statistically significant (F = 14.42; P < 0.05). The percentage of encounters with an antibiotic prescribed ranged from 50.4% on hospital day 1 to 62.9% on hospital day 28 while the percentage of encounters with an injection prescribed decreased from 72.8% on hospital day 1 to 50.0% on day 28.Conclusions:This study suggests some degree of irrational prescribing as evident by the high average number of medicine per encounter and the high percentages of encounters with an antibiotic or injection prescribed. However, there is a need to develop standard values for the WHO/INRUD indicators based on the recently published national treatment guidelines for common elderly diseases which will serve as yardsticks to assess elderly inpatients prescriptions using WHO/INRUD core indicators in future studies.

Antibiotic use pattern at dental clinic: a cross-sectional, retrospective study

Aim: Irrational use of antibiotics leads to the development of antibiotic resistance. Hence, the objective of this study was to assess antibiotic use pattern at Dental Clinic in Nekemte Referral Hospital. Materials and Methods: A cross-sectional retrospective study was conducted by reviewing prescription cards of dental patients from February to January, 2016. The sampling frame of the study was the list of prescription cards at the dental clinic during the last one year period (from January 1 to December 31, 2015). Results: Within 386 prescriptions /medical record cards reviewed, a total of 634 medications were prescribed for patients of which 61.04% drugs were antibiotics. Amoxicillin (69.25%) was the most commonly used antibiotics. All drugs were prescribed by generic name. The average number of antibiotics per prescription and the percentage of encounters with an injection prescribed were 1.64% and 0.04%, respectively. The analysis of antibiotic prescriptions showed that a total of 85 prescription errors were detected and the majority of errors were identified to be omission errors. Conclusion: All the antibiotics were prescribed by generic names, but there were a significant number of prescribing errors of antibiotics. Therefore, prescribers should regularly check completeness of prescription and pharmacists should provide continuous drug information on rational use of antibiotics and of course should work in a team sprit with prescribers.

Assessment of antibiotic prescribing pattern in pediatric patients: A cross-sectional hospital-based survey

Background: Irrational usage of antibiotics increases the risk for the antimicrobial resistance, leads to increase morbidity, mortality, and economic burden for health care. India is a lower-middle income developing country in south Asia that has high potential for overuse and misuse of antibiotics and has less public awareness of antimicrobial resistance. The World Health Organization (WHO) developed the prescribing indicators to measure the rational usage of drugs in primary care and to assess the prescribing pattern of antibiotics. Aim: The aim of the study was to assess the prescribing pattern of antibiotics in pediatric patients of Anantapur district, Andhra Pradesh, India. Subjects and Methods: A cross-sectional and prospective study was carried out in private pediatric specialty hospitals in urban areas of Anantapur district. Sample size was calculated using single population proportion formula. A total number of 845 pediatric in-patients were included for the study. Patients' demographic characters, diagnosis, and drugs prescribed were recorded in a prestructured and validated data collection form. Results: An average of 3.53 drugs prescribed per patient encounter, which was higher than WHO prescribed indicator standard value 2. The present study reveals that the percentage of encounters with antibiotics was 50.05% (423), which was higher than WHO standard (20.0-26.8%). Among 423 antibiotic prescriptions, 23.43% (198) prescribed with generic names and 91.48% antibiotics were prescribed from essential drug formulary list. Conclusion: Prescription patterns and usage of antibiotics in this study was inappropriate in comparing our results with WHO prescribing indicators. Effective interventions are required to reduce inappropriate antibiotic prescriptions.

Prescribing pattern and WHO core prescribing indicators in post-operative patients of Gynaecology department of a Tertiary Care Teaching Hospital

Background: Prescription pattern analysis is an essential tool to provide an insight regarding the existing drug usage and to ensure rational drug therapy. Even though drugs used for gynecological disorders are one of the commonly used, they are least studied in terms of prescribing patterns. Hence the present study was planned to analyze the prescribing pattern and WHO core prescribing indicators among post-operative patients of Gynaecology department in our institute. Methods: A prospective observational study was conducted in 76 post-operative patients of Gynaecology department for a period of six months. Each prescription was analyzed for demographic data, total number and various categories of drugs prescribed, the percentage of individual drugs prescribed in each category, the dosage forms and the percentage of drugs prescribed by generic name, and from essential drug list were also analyzed. Results: A total of 990 medications were prescribed among which anti-microbial agents (32.52%) were the most commonly prescribed category followed by analgesics (19.60%) and Intravenous fluids (13.53%). Metronidazole (27.02%) was the most commonly prescribed antimicrobial, Diclofenac (68.04%) was the commonly prescribed analgesics and Ringer lactate (38.81%) was the commonly prescribed Intravenous fluid. Most commonly prescribed antiulcer drug was ranitidine (75.0%), antiemetic was Ondansetron (76.39%). Majority of drugs (72.54%) were prescribed by generic name. Average number of drugs per prescription was 13.03. Percentages of encounters with antibiotics were 32.52%. The percentage of drugs prescribed from the National List of Essential Medicines (NLEM) was 82.16%. Injection (57.78%) was the most common drug formulation. Conclusions: Antimicrobial agents and analgesics were the most commonly prescribed drugs. Prescription by generic name was high, usage of antibiotics and injections were also high and Poly-pharmacy was common, especially among antimicrobial agents. Prescribing according to the national essential list of medicines was high, which indicates rational prescription.

An observational prospective study on prescribing pattern of drugs among pregnant women admitted in antenatal ward of a tertiary care teaching hospital in coastal town of South India

Background: Pharmacoepidemiological studies may provide an insight regarding the existing drug use pattern and in planning appropriate interventions to ensure rational drug therapy. Aims and Objectives: This study is aimed to evaluate the prescribing pattern of drugs among pregnant women admitted in antenatal ward of our hospital. Materials and Methods: An observational prospective study was conducted in 72 pregnant women for a period of 6 months. Each prescription was analyzed for demographic variables, various categories of drugs prescribed, individual drugs prescribed in that category, their dosage forms, the World Health Organization core prescribing indicators, and their teratogenic risk. Results: Overall 358 medications were prescribed among which vitamin and mineral supplements (57.26%) were the most commonly prescribed category followed by intravenous fluids (IVFs) (12.57%) and antiemetics (8.38%). Among vitamin and mineral supplements, folic acid (30.24%) was the most commonly prescribed drugs. Ringer lactate (46.67%) was the most commonly prescribed IVF. Ondansetron (66.67%) was the commonly prescribed antiemetics. Most commonly prescribed antimicrobial agents were metronidazole and mebendazole (27.59% each), antiulcer drug was ranitidine (87.5%), analgesic was paracetamol (58.33%), and tetanus toxoid was the only vaccine prescribed. Majority of drugs (75.69%) were prescribed by generic name. Average number of drugs per prescription was 4.97. Percentages of encounters with antibiotic prescribed were 8.10%. The percentage of injections prescribed was 22.91% and that of drugs prescribed from the National List of Essential Medicines (NLEM) was 95.53%. Tablet (43.58%) was the common drug formulation. According to teratogenic risk, category B (56.25%) was highest. Conclusion: On the whole, vitamin and mineral supplements were the most commonly prescribed drugs in our study. Prescription by generic name was high, usage of antibiotics and injections was less, and nearly all drugs were prescribed from NLEM, which indicates rational prescription. Usage of category B drugs must be reduced, and complete avoidance of category D drugs is advised.

Assessment of Drug Use Pattern by Using WHO Core Drug Use Indicators at Public Hospitals in Ethiopia

Background: Drug use is a complex subject involving the prescriber, the dispenser, the patient and pharmaceutical institutions. It is influenced by factors such as drug availability, prescriber’s experience, and knowledge of dispensers, health budget, cultural factors and many more. Inappropriate drug use is the problem of the whole world; however the degree of the problem is higher in developing countries like Ethiopia. Objective: To assess drug use pattern by using who core drug use indicators at public hospitals in Gamo Gofa Zone, Southern Ethiopia September 2013. Methods: Retrospective and prospective cross sectional study were used to collect data from prescriptions dispensed through the general outpatient pharmacies and Information for patients respectively. A pretested structured questionnaire was employed to collect information from prescription papers and respondents after obtaining a verbal consent. Data was entered, cleaned, edited and analysed using SPSS Version 16.0 statistical software package. Results: The average number of drugs per prescription was 1.77 in Arba Minch General Hospital and 1.95 in Chencha District hospital ranging from 1-5. Percentage of encounter with antibiotics was 292 (48.67%) and 360 (60.20%) respectively. The Percentage of drugs prescribed by generic name and from an essential drug list was 100%. The mean consultation time spent between the prescriber and patient was 3.82 minutes and 3.66 minutes respectively and the mean pharmacy dispensing time was 1.18 minutes and 1.33 minutes respectively. More than half Patients had knowledge on drug dispensed to them 60.0% and 52.0% respectively and none of drugs dispensed were adequately labelled. Conclusion: In our study the labelling status of prescribed medicines was very poor and needs special attention. Dispensing time is very short and it could have influenced patient’s knowledge on dispensed drugs. Furthermore designing strategies to improve availability of key essential drugs; establishing antimicrobial stewardship committee in both hospitals and improving drug and therapeutics committee by responsible bodies.

Drug Prescribing and Dispensing Practices in Tertiary Care Hospital of Eastern Ethiopia: Evaluation with World Health Organization Core Prescribing and Patient Care Indicators

Background: Rational prescribing, dispensing and patient use are the major components of rational drug use; however, the actual drug use pattern is not in line with World Health Organization (WHO) guidelines and is often irrational in many healthcare settings, particularly in developing countries. Therefore, this study aimed to highlight general prescribing and dispensing practices at Hiwot Fana Specialized University Hospital (HFSUH) outpatient settings. Method: Across-sectional study design was employed to determine the medication prescribing and dispensing practices at HFSUH. As per the WHO guideline for prescribing encounters, about 600 prescriptions were included in the study. Systematic random sampling was applied to obtain samples from encounters prescribed and dispensed from Jan 1-June 30, 2016. Moreover, as per the minimum requirement of the WHO guideline, 100 patient encounters were also included in the study with convenient sampling method. The data were evaluated against WHO standards for core drug use indicators. Results: From the total of 600 outpatient prescribing encounters, the prevalence of getting recorded diagnosis was almost negligible (4.67%). Only two thirds (67.60%) of prescription contain the patient name to whom the drug was prescribed. Coming to the drug related information, the prevalence of getting written dosage forms (18.5%), and the total quantity (35.34%) were found suboptimal. Duration of treatment had been documented in less than threefourth of encounters (73.00%). Regarding the WHO core prescribing indicators, the average number of drugs prescribed per encounter was found to be 1.89. The percentage of encounters that contain at least one antibiotic and injection was 304 (50.67%) and 315 (59.16%), respectively. Besides, the percentage of drugs prescribed by generic name and from an Essential Drug List (EDL) of the country was 1055 (93.04%) and 1134 (100.00%), respectively. The most commonly prescribed antibacterial agents were ceftriaxone 110 (36.20%), metronidazole 52 (17.11%), and cloxacillin 27 (8.89%). Besides, the top four prescribed injections were tramadol 214 (34.79%) ceftriaxone 110 (17.89%), furosemide 95 (15.45) and metronidazole 52 (8.46%). Looking at the patient care indicators, the percentage of drugs actually dispensed and labeled were 86% and 11%, respectively. The average dispensing time was 59.9 s and the percentage of patients knowing the entire regimen was 61.88%. Conclusion: As a tertiary care hospital, the overall completeness and rationality of prescription was found suboptimal since some of the key components were missed. The degree of polypharmacy fell within the window of WHO criteria. However, inappropriate use of antibiotics and injections was highly noticeable (significant deviation from the upper limit of the WHO standard). These are two critical but commonly misused classes of drugs given greater emphasis by WHO. Prescribing practice with generic name and from EDL is highly appreciable in this setting. However, labelling practice has been significantly poor in this setting.

Evaluation of the prescribing practice using WHO core prescribing indicators in Hiwot Fana Specialized University Hospital, Harar, eastern Ethiopia

Background: Drugs are important component of health care and play a critical role in saving life. Drug use in health facility is a complex subject involving physician, patient and dispenser and hence is directly affected by prescribing, dispensing and patient use of drugs. The study is, therefore, aimed to evaluate drug prescribing practice using WHO prescribing indicators in Hiwot Fana Specialized University Hospital (HFSUH), Harar, Ethiopia. Method: A retrospective cross sectional study was carried out to determine current prescribing practice in HFSUH outpatient pharmacy department, Harar, from January 20-February 20, 2016. As per the WHO guidelines, 600 prescription papers were selected using systematic random sampling and reviewed with the help of observational checklist. The data were entered and processed with SPSS version 16. Finally, the data were evaluated using WHO criteria. Result: The average number of drugs prescribed per encounter was 1.7. The percentage of encounters in which an antibiotic or injection was prescribed was 343 (57.2%) and 354 (59%), respectively. The percentage of drugs prescribed by generic name and from an essential drug list (EDL) was found to be 954 (92.1%) and 708 (68.94%), respectively. Conclusion: On the basis of the findings, the prescribing practices for antibiotic use; injection use; and prescribing from EDL showed a great deviation from the standards recommended by WHO. These two commonly overused and costly forms of drug therapy need to be regulated closely. In addition, prescribing practice should be limited to EDL of the country. Key words : WHO, core prescribing indicators, prescribing practice, HFSUH

Quality of drug prescription in primary health care facilities in Mwanza, north-western Tanzania

Background: Drug therapy can improve a patient’s quality of life and health outcomes if only used properly. However, data on prescription quality at primary health care facilities in Tanzania is scanty. The objective of this study was to assess the quality of drug prescriptions in selected health care facilities in two districts of Mwanza, Tanzania.Methods: This descriptive cross-sectional study was carried out in Ilemela and Nyamagana districts in Mwanza, Tanzania. The study included 20 randomly selected public and private health care facilities. A random sample of the patient records in each facility was included. From each patient record, the latest prescription was assessed. Information assessed and recorded included prescribing indicators, frequency of prescription error, various formulations and groups of drugs prescribed. Prescribers were interviewed on factors affecting prescribing practices.Results: A total of 570 prescriptions were studied. The average number of drugs prescribed per encounter was 2.8. The percentage of encounters with an antibacterial agent prescribed was 33.8% and injections constituted 7.9% of cases. Prescriptions by generic name were 85.8% while 90.6% of drugs prescribed were from the national essential drug list. Antibacterial agents, analgesics and antimalarial agents accounted for 75.3% of all drugs prescribed. Of all prescriptions, 485 (85.1%) had at least an error. A total of 1,177 errors were made. Errors of omissions accounted for the majority (99.3%) of all errors. The most commonly observed missing prescription particulars were the drug strength (23.2%) and patient weight (22.2%). The average number of drugs per encounter was higher in private facilities (3.2) than in public facilities (2.4) (P &lt;0.0001). The range of drugs per prescription was also higher in private (1-7) than in public facilities (1-5) (P&lt;0.0001). There were statistically significant differences in the distribution of various drug groups prescribed between public and private facilities and between health centres and dispensaries (P &lt;0.001 and 0.027, respectively).Conclusion: Prescribing of higher number of drugs than the WHO recommendations and overuse of antibiotics is still a problem at health care facilities in Mwanza Tanzania. The frequency of occurrence of prescription errors found during the study was considerably high.

Evaluation of Prescription Pattern and Rational Prescribing in Eastern Nepal

Background To promote rational prescribing and appropriate use of drugs, it is important to evaluate the prescription pattern using the World Health Organization (WHO) drug use indicators. The aim of this study was to evaluate the prescription patterns and rational prescribing at the private community pharmacies of Biratnagar, Eastern Nepal, using some of the WHO core drug use indicators.Material and Methods Five private community pharmacies were selected using systemic random sampling. Nine hundred patient encounters from these pharmacies were assessed prospectively for four months from September 2015–December 2015. Data was collected from each patient encounter and were recorded directly into a prescription indicator form.Results Average number of drugs prescribed per encounter was 2.14 (n=1930). Percentage of drugs prescribed by generic name and from essential drug list was 45.18% (n=872) and 76.11% (n=1469) respectively. Percentage of encounters in which antibiotic and injection was prescribed were 40.44% (n=364) and 3.44% (n=31) respectively.Conclusion Prescribing practices in Eastern Nepal are not up to the standards recommended by WHO. Drug use evaluation can help to ensure whether the antibiotics are appropriately prescribed or not. Poly-pharmacy, excessive use of antibiotics was quite common and concept of generic prescribing and National Essential Medicine List (NEML) was not appreciable. Standard guidelines should be recommended and strictly followed by the prescribers and National Formulary and NEML should be made available in every health institution. Physicians should be emphasized to prescribe medicines from NEML.Journal of Nobel Medical CollegeVolume 5, Number 1, Issue 8, January-July 2016, 32-36

Prescribing indicators at primary health care centers within the WHO African region: a systematic analysis (1995-2015).

BackgroundRational medicine use is essential to optimize quality of healthcare delivery and resource utilization. We aim to conduct a systematic review of changes in prescribing patterns in the WHO African region and comparison with WHO indicators in two time periods 1995–2005 and 2006–2015.MethodsSystematic searches were conducted in PubMed, Scopus, Web of science, Africa-Wide Nipad, Africa Journals Online (AJOL), Google scholar and International Network for Rational Use of Drugs (INRUD) Bibliography databases to identify primary studies reporting prescribing indicators at primary healthcare centres (PHCs) in Africa. This was supplemented by a manual search of retrieved references. We assessed the quality of studies using a 14-point scoring system modified from the Downs and Black checklist with inclusions of recommendations in the WHO guidelines.ResultsForty-three studies conducted in 11 African countries were included in the overall analysis. These studies presented prescribing indicators based on a total 141,323 patient encounters across 572 primary care facilities. The results of prescribing indicators were determined as follows; average number of medicines prescribed per patient encounter = 3.1 (IQR 2.3–4.8), percentage of medicines prescribed by generic name =68.0 % (IQR 55.4–80.3), Percentage of encounters with antibiotic prescribed =46.8 % (IQR 33.7–62.8), percentage of encounters with injection prescribed =25.0 % (IQR 18.7–39.5) and the percentage of medicines prescribed from essential medicines list =88.0 % (IQR 76.3–94.1). Prescribing indicators were generally worse in private compared with public facilities. Analysis of prescribing across two time points 1995–2005 and 2006–2015 showed no consistent trends.ConclusionsPrescribing indicators for the African region deviate significantly from the WHO reference targets. Increased collaborative efforts are urgently needed to improve medicine prescribing practices in Africa with the aim of enhancing the optimal utilization of scarce resources and averting negative health consequences.

Assessment of current prescribing practices using World Health Organization core drug use and complementary indicators in selected rural community pharmacies in Southern India

BackgroundDue to the lack of clear, comprehensive, and rational drug policy, the production of pharmaceutical preparations in India is distorted for the most part. Indian markets are flooded with more than 70,000 formulations, compared to approximately 350 formulations listed in the World Health Organization (WHO) Essential Drug List. Studies have indicated that majority of prescriptions in India are of drugs of “doubtful efficacy.” To promote rational drug use in developing countries, assessment of drug use patterns with the WHO drug use indicators is becoming increasingly necessary. The aim of this study was to assess the patterns of drug use by using WHO core drug use and complementary indicators.MethodsOne thousand fifty-two patients were prospectively interviewed and their prescriptions analyzed according to WHO guideline five randomly selected busy community pharmacies in northern district of the State of Tamil Nadu, South India to analyze the WHO core drug use and complementary indicators using an investigator-administered data collection form. The main outcome measured is patterns of drug use measured using WHO core drug use and complementary indicators.ResultsThe data obtained showed that, out of total drugs prescribed (3936), only 2.5 % (100) drugs were prescribed by generic name. Mean number of drugs per encounter was 3.7. Use of antibiotics was 22 %, percentage of encounters with an injection was 7.2 %, and the percentage of drugs prescribed from formulary was 99.8 %.ConclusionsBrand name prescribing is dominated even in rural India. There is a need to improve the availability of essential guidelines and key drugs in the stock in rural areas of India. Prescriptions studied were conforming to most indicators of WHO except the number of drugs prescribed & generic name prescription practice, which deviated. In India the healthcare is dominated by private practitioners at the primary level. Prescription practices of the individual community-based clinician needs consistent monitoring with respect to generic name prescribing habits as well as the number of drugs prescribed. The WHO drug use indicator guidelines need to be promoted amidst the primary care clinicians and should not be just limited to hospitals having a formulary. The data collected by this study can be used by policymakers to monitor and improve the prescribing and consumption of pharmaceutical products in Southern India.