Evaluating antimicrobial prescribing in a Tertiary Healthcare Institution in Nigeria

Background Regular evaluation of antimicrobials prescriptions is important for optimal use. Objective This study determined the prescription patterns, class and costs of antimicrobials in the adult out-patient pharmacy of a Teaching Hospital in Nigeria. Methods A 1-year retrospective study from 1st January to 31st December 2018. The data, which included identification code, age, sex, antibiotics prescribed, number of antibiotics per prescription, number of medicines per prescription, dosage form, generic prescribing, drug on the essential drug list, and cost, were used in the analysis. The Chi-square test and Analysis of Variance were used to compare our data with the WHO–developed antimicrobial prescription Guidelines for Anatomical Therapeutic Chemical and Defined Daily Dose assignment of 2019. Results From 450 patient records, significantly more females (70%) were prescribed with antimicrobials (P = 0.0038). The prescription pattern showed that antimicrobials selection by class was significantly different (P < 0.0001) (top three being Amino-penicillin > Nitroimidazoles > Fluoroquinolone). In addition, age differed significantly (P < 0.0001) with 46–50 as the highest class. Dosage forms profile showed that the percentage of encounter with injections prescribed (1.8%) was less than WHO recommendation (13.4–24.1%). Most of the prescriptions (84.22%) were from the Essential Drug List. The average cost of prescriptions with two antimicrobials was the highest ($14.0807), then three ($10.7949), and one ($6.39858). The average number of drugs per prescription that had one (4.28), two (4.46), and three (5.55) antimicrobials, respectively, were more than double the average (2) recommended by WHO. Conclusion The study showed that most of the patterns are within limit, however, highlights the need for frequent evaluation.

WHO/INRUD Core drug use indicators and commonly prescribed medicines: a National Survey from Sri Lanka

Background Identification of internationally comparable indicators of medicines use are important for a country to implement strategies and regulations to improve usage of medicines. Sri Lanka established a new National Medicines Regulatory Authority in 2015 and this survey evaluated the medication use indicators in Sri Lanka, according to the International Network on Rational Use of Drugs (INRUD), prior to its implementation. Methods This descriptive-cross-sectional study was conducted in 80 pharmacies, representing all 25 districts of the country. Three pharmacy categories were included; privately owned pharmacies, ‘Rajya Osusala’ pharmacies operated by the State Pharmaceuticals Corporation (SPC) of Sri Lanka and SPC Franchisee pharmacy outlets. Selection of pharmacies from respective districts were done proportionate to estimated population. Data were collected to identify WHO/INRUD core drug use indicators and the commonly prescribed medicines. Results Total of 2328 prescriptions were included (‘Rajya Osusala 559; SPC Franchise 711; private pharmacies 1058). Altogether 7,255 medicines were prescribed, and the 3 most commonly prescribed medicines were atorvastatin, losartan and metformin. Average number of medicines per encounter was 3.1±1.9 (Median: 3; range 1-12) Highest average number of medicines per encounter was reported in prescriptions received at ‘Rajya Osusala’ pharmacies (3.6±2.2), significantly higher than in other categories of pharmacies (p<0.001). Percentage of medicines prescribed by generic name was only 35.5%, highest at the ‘Rajya Osusala’ pharmacies (40.6%), significantly higher than other categories of pharmacies. The overall percentage of medicines prescribed from essential medicine list (EML) was 68.8%, without any significant variation between different categories of pharmacies. The percentage of medicines actually dispensed and accurately labelled were 92.4 and 98.5% respectively. Conclusions The average number of medicines per encounter was higher than the WHO recommended value but the usage of antibiotic and injectable drugs were within recommended standards. Generic prescribing, was very much lower. The EML prescribing, labelling and percentage dispensed medicines fared much better although lower than the WHO recommended 100% compliance. This island wide study has provided national wide data before the implementation of key changes in regulation of medicines in Sri Lanka and a repeat survey will be useful to identify impact of the new legislations.

Pola Peresepan Anak dengan Infeksi Saluran Pernapasan Akut (ISPA) Non Pneumonia di Klinik

Acute respiratory infection (ARI) is a common disease in the community. Riskesdas 2018 stated that ARI prevalence was 4.4% and the highest was in 1-4 years old children (8%). The capitation payment system in clinics collaborated with BPJS Kesehatan demands the physician to prescribe as effective and as efficient as possible. On the other hand, the capitation tariff obtained by clinics is considered as too low, thus constrains of the prescription leading to irrational prescribing is likely to occur. This study analyses further the prescribing pattern for ARI children in clinics and its rationality based on the difference in source of funding. A cross sectional research using retrospective method was conducted. Data were gathered from 409 medical records and or patients’ prescription of children between 1-12 years old and diagnosed as having non pneumonia ARI during 1st January to 30th November 2019. Result showed that non pneumonia ARI patients were mostly boys (54,3%) aged 1-5 years old (6.0%). The average number of items for BPJS patients was 3,45, the percentage of generic prescribing was twofold higher for BPJS group (63.94%), the percentage of essential medicine prescribing was 63.96% while the percentage of antibiotic use was lower (48.50%). Dosage propriety for BPJS patients was 70.80% which was slightly higher than non-BPJS group. Overall, the prescribing indicators and dosage properness for BPJS patients were better than non-BPJS patients.

Generic prescribing in India: a stumbling block

In India, there is 62% out-of-pocket health expenditure per capita and only 15% are covered by health insurance. The use of generics can save a lot of money which can be used for other health issues. But lack of knowledge about cost effectiveness of generic medicines among various health-care professionals had led to a low rate of generic medicine prescription in India. This review aims to identify the barriers in adoption of generic prescribing in clinical practice in India. A systematic literature review was conducted using various healthcare databases such as PubMed and google scholar. The literature search using various combination of keywords retrieved 2360 articles. After excluding duplicates, articles in languages other than English and based on relevance to subject only 15 articles were selected. The barriers to generic prescribing identified from reported literature can be broadly classified based on stakeholders of healthcare setting such as physicians, patients, pharmacist and government policies. The major barriers to generic prescribing identified were negative perception of various stakeholders, lack of awareness of regulatory standards, maturity of health care system, vulnerability of patients, lack of standard guidelines in brand substitution, incentives and influence of drug advertisements. In Indian set up, studies on impact evaluation of generic prescription, emphasizing the quality and cost saving by their use in clinical practice should be conducted. This evidence will help to build the confidence of various stakeholders towards implementing generic prescribing in clinical practice.

Assessment of Drug Prescription Pattern in Mekelle General Hospital, Mekelle, Ethiopia, Using World Health Organization Prescribing Indicators

Introduction. Irrational prescribing is a major cause for irrational drug use. Bad prescribing habits lead to ineffective and unsafe treatment, exacerbation or prolongation of illness, distress and harm to the patient, and higher costs. Incidence of irrational prescribing practice cannot be reduced without a critical intervention by assessing the causes. Objectives. The objective of this study was to assess drug prescription pattern, using WHO prescribing indicators, in OPD at Mekelle General Hospital (MGH) Methodology. The study was conducted at Mekelle General Hospital (MGH), Mekelle, Northern Ethiopia, from December 2016 to April 2017. A descriptive cross-sectional, retrospective hospital-based study design was used to assess prescriptions at OPD in MGH from 01 January to 31 December 2016. A systematic random sampling technique was used to select prescriptions at the time of data collection. Result. 384 prescriptions were analyzed. 751 medications were prescribed from which 679 (90.4%) were with their generic name, 225 (58.6%) prescriptions contained antibiotics, 162 (42.2%) prescriptions were encountered with injection, and 648 (86.3%) encountered from the hospital list of medicine. Conclusion. In general, average number of drugs per encounter, generic prescribing, and the use of EDL/formulary of the hospital to prescribe drugs reviewed in this study were totally out of the recommended values and hence inappropriate. The study also revealed overprescribing of both antibiotics and injections.

Impact of a sensitization program on prescription order writing skills of second year MBBS students: a prospective study

Background: Incomplete and erroneous prescriptions affect the effective management of patients. The undergraduates of today are the physicians of tomorrow. Hence, the need for inculcating good prescription writing practice from undergraduate level to improve quality of healthcare. The objective of this study was to assess the impact of a sensitization program on the effective prescription writing skills of second year MBBS students.Methods: This prospective study was conducted between January and November 2017 among 149 second year medical students. The prescriptions by students were assessed prior to and after a sensitization program which emphasized on the importance of each component of the prescription, need for generic prescribing and rational use of drugs.Results: After the sensitization program, there was significant improvement in mentioning of all components (p<0.05) except for route of administration, instructions, and health advise which were still deficient. The rationality in prescribing was analyzed by scoring vital drug related information on a scale of 12. Majority of inscriptions (72%; n=107) were rational after the program. There existed a weak positive correlation (r=0.15) between students’ knowledge of drugs assessed by theory examinations and scores of prescriptions assessed in practical examinations.Conclusions: The sensitization program served as an effective strategy in improving knowledge regarding every component of the prescription and enhanced the prescription writing skills at the undergraduate level. This could help prevent deficiencies in health care arising from errors in prescribing.