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Shah R, Alam J, Minallah S, Shabbir M, Abbasi MS, Aslam K, Ahmed N, Heboyan A. Prescription writing pattern among the dental practitioners of a tertiary care hospital in Karachi. BMC PRIMARY CARE 2024; 25:273. [PMID: 39068392 DOI: 10.1186/s12875-024-02532-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/19/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To identify the frequency and types of prescription errors, assess adherence to WHO prescribing indicators, and highlight the gaps in current prescribing practices of Junior dental practitioners in a tertiary care hospital in Karachi, Pakistan. METHODS This cross-sectional study was conducted from January 2021 to March 2021. The study included the prescriptions by house surgeons and junior postgraduate medical trainees for walk-in patients visiting the dental outpatient department. A total of 466 prescriptions were evaluated for WHO core drug prescribing indicators. The prescription error parameters were prepared by studying the WHO practical manual on guide to good prescribing and previous studies. Prescription errors, including errors of omission related to the physician and the patients, along with errors of omission related to the drug, were also noted. The statistical analysis was performed with SPSS version 25. Descriptive analysis was performed for qualitative variables in the study. RESULTS The average number of drugs per encounter was found to be 3.378 drugs per prescription. The percentage of encounters with antibiotics was 96.99%. Strikingly, only 16.95% of the drugs were prescribed by generic names and 23.55% of drugs belonged to the essential drug list. The majority lacked valuable information related to the prescriber, patient, and drugs. Such as contact details 419 (89.9%), date 261 (56%), medical license number 466 (100%), diagnosis 409 (87.8%), age and address of patient 453 (97.2%), form and route of drug 14 (3%), missing drug strength 69 (14.8%), missing frequency 126 (27%) and duration of treatment 72 (15.4%). Moreover, the wrong drug dosage was prescribed by 89 (19%) prescribers followed by the wrong drug in 52 (11.1%), wrong strength in 43 (9.2%) and wrong form in 9 (1.9%). Out of 1575 medicines prescribed in 466 prescriptions, 426 (27.04%) drug interactions were found and 299 (64%) had illegible handwriting. CONCLUSION The study revealed that the prescription writing practices among junior dental practitioners are below optimum standards. The average number of drugs per encounter was high, with a significant percentage of encounters involving antibiotics. However, a low percentage of drugs were prescribed by generic name and from the essential drug list. Numerous prescription errors, both omissions and commissions, were identified, highlighting the need for improved training and adherence to WHO guidelines on good prescribing practices. Implementing targeted educational programs and stricter regulatory measures could enhance the quality of prescriptions and overall patient safety.
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Affiliation(s)
- Ruqaya Shah
- Department of Oral & Maxillofacial Surgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Jehan Alam
- Department of Oral & Maxillofacial Surgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Sheheryar Minallah
- Department of Oral & Maxillofacial Surgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Maria Shabbir
- Department of Oral & Maxillofacial Surgery, Shaheed Mohtarma Benazir Bhutto institute of Trauma, Karachi, Pakistan
| | - Maria Shakoor Abbasi
- Department of Prosthodontics, School of Dentistry, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Kashif Aslam
- Department of Prosthodontics, Dow Dental College, Dow University of Health Sciences, Karachi, Pakistan
| | - Naseer Ahmed
- Department of Prosthodontics, Altamash Institute of Dental Medicine, Karachi, 75500, Pakistan.
| | - Artak Heboyan
- Department of Research Analytics, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Saveetha University, Chennai, 600 077, India.
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Str. Koryun 2, Yerevan, 0025, Armenia.
- Department of Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, North Karegar St, Tehran, Iran.
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Ag Ahmed MA, Ravinetto R, Diop K, Trasancos Buitrago V, Dujardin C. Evaluation of Rational Medicines Use Based on World Health Organization Core Indicators: A Cross-Sectional Study in Five Health Districts in Mauritania. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2024; 13:17-29. [PMID: 38566890 PMCID: PMC10984847 DOI: 10.2147/iprp.s447664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction The rational use of medicines is essential for preventing adverse medicine reactions, achieving therapeutic outcomes, and optimizing treatment costs. While the irrational use of medicines is frequently reported in sub-Saharan Africa, to the best of our knowledge no formal studies have taken place in Mauritania thus far. The main objective of this study was therefore to analyze the rational use of medicines in public and private not-for-profit health facilities, in five health districts in Mauritania. Methods We conducted a cross-sectional study to assess the rational use of medicines. We used the standard indicators derived from the methodologies of the World Health Organization (WHO) and International Network for Rational Use of Drugs (INRUD). Data were prospectively collected from 1050 prescriptions/patients, in thirty-one public and private not-for-profit health posts/centers in 5 health districts. The data were analyzed using the Statistical Package for the Social Sciences. P value less than 0.05 at 95% confidence interval considered for significance of relationships for associations in statistical test. Results The average number of medicines per prescription was 2.21; 83.1% (1931/2325) of medicines were prescribed by generic name, but only 54% (1253/2325) were on the National Essential Medicine List (NEML). Antibiotics were prescribed in 62.4% (655/1050) of the consultations, and injectable medicines were prescribed in 15.6% (164/1050) of the consultations. The average consultation time was 16.32 minutes, and the average dispensing time was 97 seconds. Dispensed medicines were correctly labeled, and 83% (871/1050) of patients met the correct administration schedule. The NEML, and the "restricted NEML" for 76 commonly-used medicines, were available in all surveyed health facilities, but the National Therapeutic Guidelines were available in only 60.26% of them. Conclusion Our findings indicate a possible excess of antibiotics prescriptions, and a likely lack of knowledge of the National Therapeutic Guidelines. There is a need to investigate in more detail the prescription patterns versus disease-specific therapeutic guidelines, and to qualitatively investigate the factors that contribute to the observed irrational prescribing. Moreover, training local staff in the rational use of medicines seems important.
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Affiliation(s)
- Mohamed Ali Ag Ahmed
- Sherpa University Institute, Montreal, Québec, Canada
- Management, Evaluation and Health Policy Department. University of Montreal, Montreal, Québec, Canada
| | - Raffaella Ravinetto
- Department of Public Health. Institute of Tropical Medicine, Antwerp, Belgium
- University of the Western Cape, Cape Town, South Africa
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Manirakiza A, Gitonga Nyamu D, Maru SM, Bizimana T, Nimpagaritse M. Evaluating drug use patterns among paediatric outpatients in Burundi. J Pharm Policy Pract 2024; 17:2312369. [PMID: 38444527 PMCID: PMC10914302 DOI: 10.1080/20523211.2024.2312369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Background Rational prescribing is key to optimising therapeutic outcomes and avoiding risks associated with irrational use of medicines. Using WHO drug use indicators, this study evaluated drug use patterns among paediatric outpatient encounters at Primary Healthcare Centers (PHCs) in Bujumbura Mairie, Republic of Burundi. Methods Descriptive cross-sectional research assessed paediatric medicine use in 20 PHCs. From 8 February to 7 April 2023, 800 randomly selected paediatric encounters' 2022-year data were retrospectively collected. Data for specific facility indicators were prospectively collected. SPSS 23 was used to analyse data. Results 800 outpatient child encounters were analysed, 48.4% female and 51.6% male. The mean number of medicines per encounter was 2.4(±0.99). The injection rate was 9.9%. Overall, 78.8% of generics and 85.2% of essential medicines were prescribed. Results show drug prescribing differences between private and government PHCs (p < 0.001). All PHCs studied had no standard treatment guidelines (STGs), while 50% had an essential medicine list (EML) and 85% of key medicines were available. Conclusion Poor prescribing practices were found indicating the need for interventions to promote good drug use practices. A large study at a national scale is required to provide a more comprehensive understanding of the overall drug use practices.
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Affiliation(s)
- Audace Manirakiza
- Master of Health Supply Chain Management at the East African Community Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - David Gitonga Nyamu
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, Faculty of Health Sciences, University of Naïrobi, Nairobi, Kenya
| | - Shital Mahindra Maru
- Faculty of Health Sciences, Department of Pharmaceutical Chemistry, Pharmaceutics and Pharmacognosy, University of Naïrobi, Nairobi, Kenya
| | - Thomas Bizimana
- Master of Health Supply Chain Management at the East African Community Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Goruntla N, Ssesanga J, Bommireddy BR, Thammisetty DP, Kasturi Vishwanathasetty V, Ezeonwumelu JOC, Bukke SPN. Evaluation of Rational Drug Use Based on WHO/INRUD Core Drug Use Indicators in a Secondary Care Hospital: A Cross-Sectional Study in Western Uganda. Drug Healthc Patient Saf 2023; 15:125-135. [PMID: 37727328 PMCID: PMC10506591 DOI: 10.2147/dhps.s424050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023] Open
Abstract
Purpose Rational drug use (RDU) promotes safe, efficient, and cost-effective utilization of medicines in hospital settings. The aim of this study was to assess rational drug use based on the World Health Organization (WHO) and the International Network for Rational Use of Drugs (INRUD) core drug use indicators. Patients and Methods This prospective, descriptive, hospital-based cross-sectional study was conducted among patients attending the Outpatient Department of a secondary care hospital located in the Sheema District of Western Uganda. A total of 450 prescriptions were prospectively collected from eligible patients and subjected to evaluation by using the WHO/INRUD core drug use indicators (prescribing, patient care, and health-facility indicators). Results The average number of drugs prescribed per encounter was found to be 3.2 (optimal value=1.6-1.8). The percentages of drugs prescribed by their generic name (90.48%) and from the Essential Medicine List (96.23%) were close to the WHO reference (100%). The percentage of antibiotics (66.22%) and injections (25.22%) per encounter exceeded the WHO standards (antibiotics=20.0-26.8; injections=13.4-24.1). Among the patient-care indicators, the average consultation time (5.41 minutes), average dispensing time (131.03 seconds), percentage of medicines dispensed (76.11%), percentage of medicines adequately labeled (59.74%), and percentage of patients with dosage knowledge (49.50%) did not meet the WHO reference. Facility indicators such as the percentage of key medicines available in the stock (66.67%) did not conform to the WHO optimal value. The hospital made the EML hundred percent available to all practitioners. Conclusion The study concludes that the prescribing, patient care, and health facility indicators at Sheema District Secondary Care Hospital deviate from the optimal values recommended by the WHO. Therefore, this study indicates a need for improvement on these indicators and a requirement for the ongoing educational initiatives focused on rational drug prescribing, dispensing, and patient use in order to comply with the standards set by the WHO.
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Affiliation(s)
- Narayana Goruntla
- Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, Kampala International University, Western Campus, Ishaka, Uganda
| | - Joackim Ssesanga
- Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, Kampala International University, Western Campus, Ishaka, Uganda
| | - Bhavana Reddy Bommireddy
- Research Scholar, Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research (RIPER) – Autonomous, Anantapur, Andhra Pradesh, India
| | - Durga Prasad Thammisetty
- Department of Pharmacy Practice, Sri Padmavathi School of Pharmacy, Tirupati, Andhra Pradesh, India
| | | | | | - Sarad Pawar Naik Bukke
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, Kampala International University, Western Campus, Ishaka, Uganda
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Abu Farha R, Awwad O, Abdurazaq B, Abu Hammour K, Akour A. Evaluation of drug use pattern in adults’ outpatient clinics in a tertiary teaching hospital using WHO core prescribing indicators. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2022. [DOI: 10.1093/jphsr/rmac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Abstract
Objectives
This study has evaluated the drug use pattern among adults attending the outpatient clinics of the Jordan University Hospital (JUH), by assessing the adherence of prescriptions to the World Health Organization (WHO) core prescribing indicators.
Methods
This is a cross-sectional study that was conducted during the period from October 2011 to January 2022 at JUH. Several prescriptions from 10 different adult outpatient clinics were reviewed to evaluate hospital adherence to the five WHO core prescribing indicators.
Key findings
To assess the WHO core prescribing indicators, data for 2451 prescriptions were reviewed. Around one-third of the patients (33.4%) were receiving polypharmacy (five medications or more). Results revealed that two core prescribing indicators were not following the standard values specified by the WHO; the average number of drugs prescribed per encounter (3.8 medications/prescription), and the percentage of drugs from the essential drug list (EDL) (54.1%). Endocrine clinics showed the highest average of drugs (6.3) per prescription and the highest percentage of prescriptions with injectable medicines (51.7%). On the other hand, ophthalmology clinics showed the highest percentage of prescriptions with antibiotics (29.9%) and the lowest percentage of drugs prescribed from the EDL at JUH (14.1%). Evaluating factors affecting the number of prescribed medications per encounter revealed that elderly patients (> 60 years), being female, referring to the endocrine clinic, and having insurance have a higher average number of medications per encounter compared with others (P < 0.05).
Conclusion
The proper prescribing practices in a sizable tertiary hospital in Amman, Jordan, are clarified by this study. The percentage of medications from EDL and the typical number of drugs/encounters did not comply with WHO requirements. The study findings should guide the Jordanian health policymakers in designing and implementing strategies to limit irrational prescribing practices and raise awareness of and ensure physician adherence to the national EDL.
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Affiliation(s)
- Rana Abu Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University , Amman , Jordan
| | - Oriana Awwad
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan , Amman , Jordan
| | - Bashar Abdurazaq
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan , Amman , Jordan
| | - Khawla Abu Hammour
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan , Amman , Jordan
| | - Amal Akour
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan , Amman , Jordan
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University , Al Ain , United Arab Emirates
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Adeosun SA, Joda AE, Aderemi-Williams RI, Oyetunde OO. Assessment of drug use in primary health centers in Lagos State, Nigeria. Pan Afr Med J 2022; 43:58. [PMID: 36578811 PMCID: PMC9755715 DOI: 10.11604/pamj.2022.43.58.36231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/24/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction rational drug use prevents wastage of resources, loss of confidence in healthcare system and drug-related morbidity and mortality. This study aims to assess drug use in Primary Health Centers (PHCs) in Lagos State, Nigeria using the World Health Organization in collaboration with the International Network of Rational Use of Drugs core drug use indicators. Methods the study was conducted between February to October 2021 as a comparative observational survey of selected PHCs. It included a retrospective and prospective cross-sectional design for prescribing and patient care indicators assessing 2640 prescriptions and clients respectively. Data were analyzed and presented as frequency with percentage or mean with standard deviation, as applicable. The performances of the types of PHCs were compared using two-sample t-test. A 2-tailed p-value < 0.05 was considered statistically significant. Results average number of drugs per prescription, drugs prescribed by the generic name, percentage of encounters with prescribed antibiotics and injections were 3.6 ± 0.9%, 76.5 ± 18.5%, 63.3 ± 19.1% and 21.1 ± 24.1% respectively with no significance difference between the comprehensive and basic PHCs. For all the facilities, the average consultation and dispensing times were 10.5 ± 6.0 minutes, 244.9 ± 179.2 seconds respectively. In this study, the percentage of patients' knowledge of the correct dosage was 72.4 ± 38.3%. There is statistically significant difference in availability of key drugs in stock between the comprehensive and basic PHCs (p-value 0.0001). Conclusion irrational drug use practices exist in comprehensive and basic PHCs. There is a need to implement interventions aimed at strengthening good prescribing and patient-care practices across the PHCs in Lagos State.
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Affiliation(s)
- Shakirat Adeshiyan Adeosun
- Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Lagos, Idiaraba, Lagos State, Nigeria,Corresponding author: Shakirat Adeshiyan Adeosun, Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Lagos, Idiaraba, Lagos State, Nigeria.
| | - Arinola Eniola Joda
- Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Lagos, Idiaraba, Lagos State, Nigeria
| | | | - Olubukola Olusola Oyetunde
- Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Lagos, Idiaraba, Lagos State, Nigeria
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Teni FS, Wubishet BL, Yimenu DK. Systematic review and meta-analysis of medicine use studies in Ethiopia using the WHO patient care indicators with an emphasis on the availability of prescribed medicines. BMJ Open 2022; 12:e054521. [PMID: 35314470 PMCID: PMC8938701 DOI: 10.1136/bmjopen-2021-054521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To collate the findings of studies on patient care indicators in Ethiopia using the WHO/International Network for Rational Use of Drugs indicators with a focus on the availability of medicines to patients. DESIGN Systematic review and meta-analysis. DATA SOURCES Embase, Global Index Medicus, Google Scholar, Medline (via PubMed) and Web of Science. ELIGIBILITY CRITERIA Medicine use studies employing the WHO patient care indicators across health facilities in Ethiopia. DATA EXTRACTION AND SYNTHESIS Descriptive summary of the indicators and a random-effects meta-analysis were performed for quantitative synthesis of findings on the percentage of medicines actually dispensed. Meta-regression was performed to assess the moderator effects of different attributes of the studies. RESULTS A total of 25 studies conducted in 155 health facilities with 11 703 patient exit interviews were included. The median value of average consultation time was 5.1 min (25th-75th: 4.2-6.6) and that of average dispensing time was 78 s (25th-75th: 54.9-120.0). The median percentage of medicines with adequate labelling was 22.4% (25th-75th: 5.6%-50.0%). A concerning trend of decreasing dispensing times and adequacy of labelling were observed in more recent studies. The median percentage of patients with adequate knowledge of dosage schedules of medicines was 70.0% (25th-75th: 52.5%-81.0%). In the meta-analysis, the pooled estimate of medicine availability was 85.9% (95% CI: 82.1% to 89.0%). The multivariable meta-regression showed that geographical area and quality of study were statistically significant predictors of medicine availability. CONCLUSION Short consultation and dispensing times, inadequate labelling, inadequate knowledge of patients on medicines and suboptimal availability of medicines were identified in health facilities of Ethiopia. Studies aimed at further exploration of the individual indicators like problems of inadequate labelling and patients' knowledge of dispensed medicines are crucial to determine the specific reasons and improve medicine use. PROSPERO REGISTRATION NUMBER CRD42020157274.
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Affiliation(s)
- Fitsum Sebsibe Teni
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Dawit Kumilachew Yimenu
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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