Prescription pattern and its influencing factors in Chinese county hospitals: a retrospective cross-sectional study

Factors affecting the essential medicine prescribing behavior among general practitioners in Beijing, China: a cross-sectional study with structural equation model

BACKGROUND

The aim of this study is to explore the influence of GPs'information, motivation and behavior skills on EM prescribing behavior in urban and suburban districts.

METHOD

A cross-sectional study was conducted from June to November 2022 cross 3 urban districts and 4 suburban districts in Beijing. The structural equation model was used to analyze the factors influencing the essential medicine prescription behavior among general practitioners in urban and suburban districts.

RESULTS

A total of 511 valid questionnaires were collected. There was a statistically significant difference in mean scores for personal motivation and behavioral skills between urban GPs and suburban GPs. For urban GPs, the path analysis revealed that the social motivation had a direct effect on the essential medicine prescribing behavior (β = 0.225, p < 0.05). In contrast, for suburban GPs, both social motivation and personal motivation had a direct effect on the essential medicine prescribing behavior, respectively (β = 0.175, p < 0.05; β = 0.193, p < 0.01).

CONCLUSION

Social motivation of urban GPs were positively and significantly associated with essential medicine prescribing behavior. Social motivation and personal motivation of suburban GPs were positively and significantly associated with essential medicine prescribing behavior. Therefore, various corresponding policies and measures should be developed to promote the National Essential Medicines Policy in China.

Drug Prescription Indicators in Outpatient Services in Social Security Organization Facilities in Iran

OBJECTIVES

The aim of this study was to estimate drug prescription indicators in outpatient services provided at Iran Social Security Organization (SSO) healthcare facilities.

METHODS

Data on all prescribed drugs for outpatient visits from 2017 to 2018 were extracted from the SSO database. The data were categorized into 4 main subgroups: patient characteristics, provider characteristics, service characteristics, and type of healthcare facility. Logistic regression models were used to detect risk factors for inappropriate drug prescriptions. SPSS and IBM Modeler software were utilized for data analysis.

RESULTS

In 2017, approximately 150 981 752 drug items were issued to outpatients referred to SSO healthcare facilities in Iran. The average number of drug items per outpatient prescription was estimated at 3.33. The proportion of prescriptions that included an injection was 17.5%, and the rate of prescriptions that included an antibiotic was 37.5%. Factors such as patient sex and age, provider specialty, type of facility, and time of outpatient visit were associated with the risk of inappropriate prescriptions.

CONCLUSIONS

In this study, all drug prescription criteria exceeded the recommended limits set by the World Health Organization. To improve the current prescription patterns throughout the country, it would be beneficial to provide providers with monthly and annual reports and to consider implementing some prescription policies for physicians.

Prescription auditing and assessment of medication adherence patterns in patients with diabetic foot ulcer

Background

Diabetic foot ulcer (DFU) is a serious infectious disease, which can be managed very well through proper medication, but if left untreated it may lead to amputation of the affected area leading to permanent immobility which will compromise the patient's quality of life.

Objective

To carry out prescription auditing and to assess medication adherence patterns among DFU patients.

Materials and methods

A prospective interview-based study was carried out in the surgery department among inpatients aged above 18 years diagnosed with a DFU. A disease specific medication adherence questionnaire consisting of 15 questions was developed, validated and implemented among 65 patients. All the relevant data were analyzed and subjected to statistical analysis.

Results

The majority (49.2%) of the population had an intermediate adherence pattern followed by high adherence (43%) during the first visit, later the reassessment after the counseling, reports a gradual increase in adherence pattern. Prescription auditing reveals the intensity of drug burden, on an average a prescription might carry 8 drugs and more than 95.3% of prescribed drugs were in injectable form.

Conclusion

This study highlights the depth of drug burden through prescription auditing and the necessity of proper patient counseling and educating the patient about the importance of medication adherence for limiting disease progression.

Assessment of WHO core drug use indicators at a tertiary care Institute of National importance in India

Rational prescribing of medicines is an important aspect of drug prescribing which helps in safe and efficacious and cost-effective drug treatment for patients. WHO Prescription indicators are intended to evaluate the services provided to the population concerning the rational use of medicines. The study aims to study prescription practices and rational use of medicines in the department of Internal medicine, using WHO prescribing indicators in a tertiary care teaching institute of national importance. A total of 50 prescriptions were digitally photographed and analysed for prescription practices and rational drug use, using standard WHO core prescribing indicators. A total of 301 drugs with multiple and diverse diagnoses were used. Statistical analysis was done using SPSS 22 version. The average number of drugs per prescription was 3.48%. It was found that only 13.79% of prescriptions have generic names, whereas 27.58% of patient encounters had at least one drug from the National List of Essential Medicine, 6.8% of prescriptions have antibiotics and 0.7% of prescriptions were injections. The number of prescriptions with fixed drug combinations was 27.55%. Indicators such as percentage of the National List of Essential Medicine, fixed drug combinations and prescribing with a generic name are used. Hence, we will suggest regular prescription audit practices and conducting CMEs and training workshops for clinicians for the rational use of medicines in all healthcare settings to succeed in the rational use of medicine.

Determinants of the Empiric Use of Antibiotics by General Practitioners in South Africa: Observational, Analytic, Cross-Sectional Study

The overuse of antibiotics is the main driver of antimicrobial resistance (AMR). However, there has been limited surveillance data on AMR and antibiotic prescribing at a primary healthcare level in South Africa. An observational, analytic, cross-sectional study was undertaken to assess key factors associated with empiric antibiotic prescribing among private sector general practitioners (GPs) in the eThekwini district in South Africa, particularly for patients with acute respiratory infections (ARIs). A semi-structured web-based questionnaire was used between November 2020−March 2021. One hundred and sixteen (55.5%) responding GPs prescribed antibiotics empirically for patients with ARIs more than 70% of the time, primarily for symptom relief and the prevention of complications. GPs between the ages of 35−44 years (OR: 3.38; 95%CI: 1.15−9.88), >55 years (OR: 4.75; 95% CI 1.08−21) and in practice < 15 years (OR: 2.20; 95%CI: 1.08−4.51) were significantly more likely to prescribe antibiotics empirically. Three factors—workload/time pressures; diagnostic uncertainty, and the use of a formulary, were significantly associated with empiric prescribing. GPs with more experience and working alone were slightly less likely to prescribe antibiotics empirically. These findings indicate that a combination of environmental factors are important underlying contributors to the development of AMR. As a result, guide appropriate interventions using a health system approach, which includes pertinent prescribing indicators and targets.

Identifying key influences on antibiotic use in China: a systematic scoping review and narrative synthesis

INTRODUCTION

The inappropriate use of antibiotics is a key driver of antimicrobial resistance. In China, antibiotic prescribing and consumption exceed recommended levels and are relatively high internationally. Understanding the influences on antibiotic use is essential to informing effective evidence-based interventions. We conducted a scoping review to obtain an overview of empirical research about key behavioural, cultural, economic and social influences on antibiotic use in China.

METHODS

Searches were conducted in Econlit, Medline, PsycINFO, Social Science citation index and the Cochrane Database of Systematic Reviews for the period 2003 to early 2018. All study types were eligible including observational and intervention, qualitative and quantitative designs based in community and clinical settings. Two authors independently screened studies for inclusion. A data extraction form was developed incorporating details on study design, behaviour related to antibiotic use, influences on behaviour and information on effect (intervention studies only).

RESULTS

Intervention studies increased markedly from 2014, and largely focused on the impact of national policy and practice directives on antibiotic use in secondary and tertiary healthcare contexts in China. Most studies used pragmatic designs, such as before and after comparisons. Influences on antibiotic use clustered under four themes: antibiotic prescribing; adherence to antibiotics; self-medicating behaviour and over-the-counter sale of antibiotics. Many studies highlighted the use of antibiotics without a prescription for common infections, which was facilitated by availability of left-over medicines and procurement from local pharmacies.

CONCLUSIONS

Interventions aimed at modifying antibiotic prescribing behaviour show evidence of positive impact, but further research using more robust research designs, such as randomised trials, and incorporating process evaluations is required to better assess outcomes. The effect of national policy at the primary healthcare level needs to be evaluated and further exploration of the influences on antibiotic self-medicating is required to develop interventions that tackle this behaviour.

Longitudinal Association of Salaries for Medical Staff With Medical Service Utilization and Expenditure in China, 2007-2016

Objectives: To test the hypothesis that higher salary levels of the medical staff are associated with lower medical service utilization and expenditure. Methods: Using longitudinal data from 31 Chinese provinces for the period 2007-2016, we constructed fixed effects models to analyze the association between the salary of medical staff and medical service utilization, medical expenditure, medication expenditure, and medication proportion. Results: A 10,000 CNY increase in medical staff's salaries was associated with a 0.89% decrease in the average number of annual inpatient admissions per person; 1.88 and 1.59% decreases in average expenditures per outpatient visit and inpatient admission, respectively; 3.05 and 2.66% decreases in drug expenditures per outpatient visit and inpatient admission, respectively; 0.58 percent point and 0.39 percent point decreases in the share of drug expenditure in outpatient and inpatient, respectively. When medical staff's salaries increased by 450,000 CNY, the turning point was reached when the maximum medical expenditure savings offset the medical staff salary increases, yielding a 634 billion CNY surplus from medical expenditure. Conclusions: Our results supported the hypothesis that higher salary levels of the medical staff are associated with lower medical service utilization and expenditure. Further studies are requested to test whether higher medical staff's salaries will attenuate over-treatment and that savings from reduced prescriptions and service charges will offset the increased salaries of medical staff.

Association Between Physicians' Workload and Prescribing Quality in One Tertiary Hospital in China

BACKGROUND

Alarming increasing trends in physician workload have attracted much attention in recent years. Heavy workload may compromise the quality of medication use. Previous studies have identified a series of factors contributing to inappropriate prescribing; however, there is no demonstrated evidence supporting an association between workload and the appropriateness of physicians' prescriptions in China. This study aimed to investigate the relationship between physician workload and prescription quality in a tertiary hospital in Beijing, China.

METHODS

Our study was a single-center, retrospective study, with all outpatient electronic health records extracted from hospital information system of a tertiary hospital in Beijing from July 1 to November 30, 2015. We used outpatient volume in each 5-hour shift as the measure of physician workload. The evaluation of prescribing quality was based on the Rational Drug Use System. Generalized linear models with a γ distribution and a log link were used to explore factors associated with inappropriate prescribing, and we undertook a series of robustness tests with respect to different exclusion criteria.

RESULTS

A total of 457,784 prescriptions from 502 physicians were included in the study. Physicians had an average workload of 34.3 (±19.8) patients per shift, and the mean rate of inappropriate prescribing per shift was 14.1% (±14.6%). Higher rates of inappropriate prescribing were associated with heavier workloads (P < 0.001). Physicians who worked in the afternoon, chief physicians, those working in surgical department, males, and those with more than 20-year experience had higher rates of inappropriate prescribing with increasing workload.

CONCLUSIONS

Heavier workload was associated with higher risk of prescribing inappropriately. It requires great efforts to determine optimal physician workloads and mitigate the potential adverse effects on the prescription quality.

Potentially inappropriate prescriptions of antipsychotic and anticholinergic drugs in patients with Parkinson's disease

Aim: The objective was to determine the prevalence of the potentially inappropriate antipsychotics and anticholinergics used in patients with Parkinson's disease. Materials & methods: A cross-sectional study identified the prescription of antipsychotics, anticholinergics and drugs for the treatment of Parkinson's disease. The anticholinergic burden was evaluated, and quetiapine and clozapine were considered to be adequate antipsychotics. Results: 2965 patients with Parkinson's disease were identified. The presence of psychiatric disorders and other neurological pathologies was associated with a greater probability of receiving potentially inappropriate antipsychotic prescriptions. The presence of greater number of comorbidities was associated with a greater probability of receiving anticholinergics. Conclusion: Older age and associated comorbidities, especially psychiatric and neurological comorbidities, increase the likelihood of patients with Parkinson's disease being prescribed antipsychotics and anticholinergics.

Assessment of Drug Use Practices Using Standard WHO Indicators in Lumame Primary Hospital

BACKGROUND

Irrational use of drugs has been one of the major problems around the globe. However, the degree of the problem is higher in developing countries like Ethiopia. The WHO has developed several indicators to evaluate the practices of drug use. This study aimed to assess the overall drug use practices using standard WHO indicators in Lumame Primary Hospital.

METHODS

Hospital-based retrospective cross-sectional study was employed to investigate the overall drug use practices at the hospital. Six hundred prescriptions were selected from a total of 19,242 prescriptions by systematic sampling technique over one year from July 1, 2019, to June 30, 2020, in a retrospective review. For the patient care study, 100 patients were selected for collecting the required information. Facility indicators were assessed by checking the availability of STG/formularies and essential drugs. The results were interpreted according to the standard values of WHO.

RESULTS

All 600 sampled prescriptions were 100% standard. Weight, dosage form, and quantity were written in 1.5-13.3% of the prescriptions. Patient address was recorded in 51%, while qualification of prescriber and dispenser were recorded in 71.5% and 56% of the cases, respectively, but all other information were complete in 88.5-100% of the prescriptions. The mean number of drugs per encounter, generic prescribing, prescribing from essential drug list, encounters with antibiotics and injectable drugs were 2.3, 97.9%, 99.8%, 48.8%, and 11.2%, respectively. The average dispensing time was found to be 171.9 seconds. Percentage of actually dispensed drugs, adequacy of labeling, patient knowledge, and patient satisfaction were 95.3%, 22.6%, 83%, and 88%, respectively. About 92% of tracer drugs and all reading materials, except national drug list and facility-level drug formulary, were available in the study period.

CONCLUSION

Generally, appreciable results were obtained for most of the indicators but improvement in antibiotic prescribing, polypharmacy and labeling practice is recommended.

Outpatient prescribing trends, rational use of medicine and impact of prescription audit with feedback at a tertiary care centre in India

BACKGROUND

Rational use of medicines (RUM) is highly desired worldwide yet many shortcomings are found. This study aims to evaluate prescription pattern and RUM using World Health Organisation (WHO) prescribing indicators. The impact of audit and feedback has also been studied, along with comparison with published data.

METHODS

A cross-sectional observational study was conducted in the outpatient department setting of a tertiary care centre in central India. Data were collected from 2719 prescriptions across different departments from hospital pharmacies from 2016 to 2018 at different time periods. The data was analysed using WHO core prescribing indicators.

RESULTS

Average number of drugs per prescription was found to be 2.53 ± 1.23 (WHO optimal value ≤ 2). The mean values of prescribing indicators for antibiotics (19.82% vs. ≤ 30%) and injection prescribing (1.98% vs. ≤10%) were within optimal values. Generic prescribing (15.96% vs. 100%) and prescribing from National List of Essential Medicines (NLEM; 37.37% vs. 100%) were found to be significantly lesser. Annual audit and feedback showed improvement in generic prescribing and prescribing from NLEM, but the other trends continued to be similar.

CONCLUSION

While use of antibiotics and injections among outpatients was found to be rational, there is scope of improvement in most domains that can be addressed with appropriate interventions.

Lack of antibiotic knowledge and misuse of antibiotics by medical students in Mali: a cross-sectional study

Objectives: Misuse of antibiotics, especially in low-and-middle-income countries is a major contributor to antimicrobial resistance. Medical students are antibiotic consumers and prescribers in the future. This study aimed to assess antibiotic knowledge and utilization among medical students in the Republic of Mali, and to determine the relationship between knowledge and health-seeking behavior in relation to antibiotic use.Methods: A cross-sectional survey was conducted in the only public medical university in Mali. The questionnaire explored knowledge about antibiotics of medical students, and health behaviors for self-limiting illness. Data were analyzed in SPSS.Results: A total of 446 medical students completed the questionnaire. The average knowledge score was 4.12 out of 10. Students with clinical experience performed higher (4.79 vs 3.74, p< 0.01); 391(87.7%) medical students reported experience of self-limiting diseases in the past year. Of these 197(50.4%) went to see a doctor, 160 (81.2%) of whom were prescribed antibiotics: 151 medical students self-treated, with 121(80.1%) using antibiotics.Conclusions: This study shows poor knowledge and massive misuse of antibiotics among medical students in Mali. Promoting education on the mechanism of antibiotics, antimicrobial resistance and rational antibiotic use among medical students should be a priority in the medical school curriculum.

Quality of medical prescriptions in diabetes and hypertension management in Kerala and its associated factors

BACKGROUND

Kerala is facing challenges in the secondary prevention efforts of non-communicable diseases (NCDs). In spite of being the top performer in health parameters among Indian states, the burden of NCDs, especially diabetes mellitus (diabetes) and hypertension, is higher in Kerala. This research endeavours to identify the role of quality of medical prescriptions in secondary prevention of diabetes and hypertension and suggest corrective measures.

METHODS

This cross-sectional study involved collection of prescription data and other details from consenting doctors across seven districts in Kerala. After the quality of prescription was assessed using a checklist, scores were generated, and cutoff points were used to classify the prescriptions. PASW version 18 software, was used for data analysis which included univariate and bivariate analyses and logistic regression. The proportion of quality prescriptions was estimated after adjusting for clustering, and the proportion of doctors writing quality prescriptions was also estimated. Prior to the study, ethical clearance from Independent ethics committee in Health action by People (HAP) and informed consent from all the study participants were obtained.

RESULTS

After assessing 9199 prescriptions from 344 doctors, it was found that about 37.2% (95% CI: 34.9-39.4%) of the prescriptions were of good quality, and 48.2% (95% CI: 42.9-53.7%) of the doctors provided quality prescriptions. Factors associated with quality prescriptions were found to be knowledge about NCD guidelines, quality certifications of hospitals and usage of patient data management software.

CONCLUSIONS

In the context of rising prevalence of NCDs and the challenges in the secondary prevention efforts, this is one of the first studies in Kerala to evaluate the quality of prescriptions to manage NCDs as prescriptions often reflect the quality of medical management. The study also addresses other factors associated with quality medical management. The findings indicate that the scope for improvement is more than 50%, when considered for the overall quality of prescriptions in diabetes and hypertension management. Further, it was found that appropriate training of doctors, adherence to treatment guidelines and the use of technology may improve the overall quality of prescriptions.

Influencing factors of physicians' prescription behavior in selecting essential medicines: a cross-sectional survey in Chinese county hospitals

Background

To explore the key factors affecting prescription practices of essential medicines in Chinese county hospital. National essential medicine policy (NEMP) plays important roles in health care system, especially in developing countries. As a fundamental component in the Chinese health system reform, NEMP was implemented in primary health care institutions during the first stage of reform. As it is rolled out, priority usage and zero-mark-up policy of essential medicines are to be applied in every government-run healthcare institution. However, the intention and influence factors of physicians on priority selecting essential medicine remains unclear.

Methods

Based on the theory of planned behavior, a cross-sectional questionnaire survey was conducted to analyze physicians’ intention, attitude, subjective norms (SNs) and perceived behavioral control (PBC) on prescrictions and their actual behavior on selection of essential medicines.

Results

Two hundred eighty-two physicians participated in the structural questionnaire interview. The final structural equation model reflected influencing factors affecting physicians’ prescribing behavior (χ²/df = 1.32, GFI = 0.99, IFI = 0.99). Structural equation model analysis showed that attitude, other influencers and institutional environment, and PBC significantly affected behavioral intention. However, the control extent of cognition behavior of physicians prescribing had no significant positive effect on the priority usage of essential medicines.

Conclusion

Investigation results demonstrate physicians are unaware of NEMP design and implementation plans. To help enhance rational use of essential medicines we suggest educating physicians on the value of NEMP, and integrating the drug shortage report into the essential medicine (EM) bidding system seamless communication with pharmaceutical manufacturers’ credit information system.

Prescribing patterns of encounters in fourteen general practice clinics in rural Beijing: a cross-sectional study

Background

General practice clinics are the main primary care institutions providing ambulatory care in the rural areas of Beijing, rational use of medicines is crucial for the rural primary care system. This study investigated the prescribing patterns of general practice clinics in rural Beijing to provide a baseline for monitoring and promoting the rational use of medicines.

Methods

We performed a cross-sectional study at 14 rural community health service centers in 6 non-central districts of Beijing sampled through a multistage approach, 85 general practitioners were selected from the 14 centers. Total 8500 prescriptions were derived by recording 100 consecutive patients of each the general practitioner. The World Health Organization drug use indicators and an additional indicator were adopted to assess the prescribing patterns.

Results

The median number of medicines per encounter was 2.0 (1.0, 2.0); the percentage of generics and essential medicines prescribed were 97.0 and 58.2%, respectively; the percentage of encounters with antibiotics prescribed was 15.1%; the percentage of encounters with injections prescribed was 3.7%; the percentage of encounters with traditional Chinese patent medicines prescribed was 52.5%; the median duration of consultation time was 6.0 (4.0, 10.0) minutes. The most frequently prescribed medicine was aspirin (low dose, 4.6%). The prescribing indicators were influenced by different patient characteristics, patients with new cooperative rural medical scheme were less likely to be prescribed with ≥3 medicines (OR 0.865), essential medicines (OR 0.812) and traditional Chinese patent medicines (OR 0.631), but were more likely to be prescribed with injections (OR 1.551) in the encounter. Patients with ≥3 problems were more likely to be prescribed with ≥3 medicines (OR 6.753), antibiotics (OR 2.875) and traditional Chinese patent medicines (OR 2.926) in the encounter.

Conclusions

Most indicators in this study showed similar or fair performance in comparison with World Health Organization and domestic reports, except the percentage of medicines prescribed from the essential medicine list. Regular monitoring on the prescription quality of general practice clinics in rural Beijing should be maintained.

Assessment of prescription pattern and prescription error in outpatient Department at Tertiary Care District Hospital, Central Nepal

Background

The rational use of medicine improves patient’s quality of life. Excessive and inappropriate prescriptions result in severe consequences. The study of drug use patterns and prescription errors is necessary to promote rational drug use in developing countries. The aim of the study was to evaluate prescription practice and help to the quality use of medicine.

Methods

A retrospective, cross-sectional and quantitative study was conducted at Bharatpur District Hospital in central Nepal. The outpatient prescriptions retained at the pharmacy from November to December 2017 were used to evaluate prescription patterns and errors. The total of 770 prescriptions were reviewed. The stratified random sampling method was used.

Result

The total of 2448 drugs were prescribed in 770 prescriptions or patients. The average number of drugs per encounter was 3.2. The percentage of encounter with antibiotic and injection was 37.9% (n = 292) and 0.7% (n = 5), respectively. The percentage of drugs prescribed by generic and from an essential medicine list of Nepal was 2.9% (n = 72) and 21.3% (n = 521), respectively. The most common 32.5% of prescriptions contain three drugs and 24.7% of prescriptions contain four drugs. The average prescription errors per prescription were 3.4. Among total errors, omission errors related to prescriber were 1.5 (n = 1135), omission errors related to the drug were 1.5 (n = 1189) and commission errors were 0.3 (n = 269). The total of 249 drug interactions were found in 19.1% (n = 147) prescriptions. The common prescription errors were due to failure to mention prescriber name 87.5% (n = 674), failure to mention prescriber signature 19.2% (n = 148) and failure to mention diagnosis 39.2% (n = 302).

Conclusion

The study shows low compliance with WHO prescribing indicators and high prescription errors. The prescribing practices were not confirmed to the standard recommended by WHO. Prescribing from the Essential Drug List (EDL), low rates of generic prescribing, high antibiotic prescribing and polypharmacy were a major problem. The study found major errors in prescriber and prescribed medicine details. Remarkable drug interactions were seen in prescribed medicines. The study recommended necessary practices and policy formulation and implementation by DTC and regulatory bodies to promote the rational use of medicine.

Pattern of medication use in geriatric patients at primary health care facilities in Karawang, Indonesia

Background

Rational drug use is a critical component in patient care, particularly among the elderly who often have multiple medical problems. The aim of this study was to assess the pattern of medication use among the elderly visiting primary health care facilities.

Methods

A retrospective cross-sectional study was conducted at 25 primary health care facilities in Karawang District, Indonesia, and patients aged ≥60 years visiting the facilities from January to December 2014 were included. A systematic random sampling technique was used to select the study samples. Each prescription was assessed using the WHO prescribing indicators.

Results

A total of 10,118 prescriptions with 31,927 drugs were assessed. The average number of drugs prescribed was 3.15 (range: 1–7). Drugs prescribed by generic name comprised 98.09% (n=31,318) of the total number of drugs. Medical appointments wherein an antibiotic was prescribed constituted 23.45% (n=2373) of the total number of prescriptions. No injections were prescribed in this study setting. Drugs prescribed from the essential drug list comprised 83.07% (n=26,522). Paracetamol (13.44%), vitamin B complex (8.05%), and aluminum–magnesium hydroxide (7%) were the most frequently prescribed drugs, whereas amoxicillin (44.03%), chloramphenicol (13.10%), and ciprofloxacin (12.00%) were the most frequently prescribed antibiotics.

Conclusion

Our findings highlight that polypharmacy and prescription of essential drugs remain subjects of concern in geriatric health care. Regular medication review and promoting the use of the essential drug list among health care professionals are encouraged in primary care settings.

Antibiotic prescribing in paediatric inpatients in Ghana: a multi-centre point prevalence survey

BACKGROUND

Excessive and inappropriate use of antibiotics in hospitalised patients contributes to the development and spread of antibiotic resistance. Implementing a stewardship programme to curb the problem requires information on antibiotic use. This study describes a multicentre point prevalence of antibiotic use among paediatric inpatients in Ghana.

METHODS

Data were extracted from a multicentre point prevalence survey of hospital acquired infections in Ghana. Data were collected between September 2016 and December 2016 from ten hospitals through inpatient folder and chart reviews using European Centre for Disease Control (ECDC) adapted data collection instrument. From each site, data were collected within a 12-h period (8 am to 8 pm) by a primary team of research investigators and a select group of health professionals from each participating hospital.

RESULTS

Among 716 paediatric inpatients, 506 (70.6%; 95% confidence interval (CI): 67.2 to 74.0%) were on antibiotics. A significant proportion of antibiotics (82.9%) was prescribed for infants compared to neonates (63.9%) and adolescents (60.0%). The majority of patients (n = 251, 49.6%) were prescribed two antibiotics at the time of the survey. The top five classes of antibiotics prescribed were third generation cephalosporins (n = 154, 18.5%) aminoglycosides (n = 149, 17.9%), second generation cephalosporins (n = 103,12.4%), beta lactam resistant penicillins (n = 83, 10.0%) and nitroimidazoles (n = 82, 9.9%). The majority of antibiotics (n = 508, 61.0%) were prescribed for community acquired infections. The top three agents for managing community acquired infections were ceftriaxone (n = 97, 19.1%), gentamicin (n = 85, 16.7%) and cefuroxime (n = 73, 14.4%).

CONCLUSION

This study points to high use of antibiotics among paediatric inpatients in Ghana. Cephalosporin use may offer an important target for reduction through antibiotic stewardship programmes.

An Investigation of Prescription Indicators and Trends Among General Practitioners and Specialists From 2005 to 2015 in Kerman, Iran

Background: The World Health Organization (WHO) aims to promote strategies that ensure efficacy, safety, suitability, and cost-effectiveness of medicine prescription. Health systems should design effective mechanisms to monitor prescription and rational use of medicines at all healthcare settings. This study aimed to determine and analyze prescription patterns of general practitioners and specialists in Kerman/Iran from 2005 to 2015.

Methods: This is an explanatory mixed method study. Data were gathered during two phases. At the first phase, prescriptions issued by physicians during 2005-2015 were reviewed to extract information required to develop eight main prescription indicators. In the second phase, the indicators trends were presented to experts participating in expert panel to have their opinions and analyses on the data obtained in the first phase. Experts were selected based on their experience and expertise in medicine and/or health policy and/or experience in implementation of polices to promote rational use of medicines. Some experts attending the panel were a sample of physicians whose prescriptions were included in the first phase.

Results: Findings revealed that two indicators of the average price of prescriptions and the maximum number of medicines in each prescription had an increasing trend over the study period. Reasons including unprecedented devaluation of the Iranian Rial and willingness of young physicians to prescribe more medications were proposed as the primary contributors to the observed increasing trends. However, other indicators including types of prescribed medicines, average number of medicines per prescription, the percentage of prescriptions with more than four medications, a percentage of encounters with a corticosteroid prescribed, a percentage of encounters with an antibiotic prescribed, and a percentage of encounters with an injection prescribed decreased in the study period. Reasons of controlling initiatives adopted by the Ministry of Health, the higher responsibility of physicians, adoption of continued medical education (CME) programs, and improved knowledge of pharmacists, physicians, and patients about irrational use of medicines were proposed by participants as the main reasons for the decreasing trend.

Conclusion: Findings indicated that prescription indicators were better in Kerman than those of country average over the study period based on comparing the results of this study and others in Iran. However, they were non-desirable when compared to the international average. The number of factors contributes to the irrational use of medicines, including lack of knowledge among healthcare providers and patients, patients’ misunderstanding about the efficacy of some particular medicines, the high cost of drug development and manufacturing, and unavailability of effective medicines.

A retrospective cross-sectional study of antibiotics prescribing patterns in admitted patients at a tertiary care setting in the KSA

OBJECTIVE

Little is known about the pattern of antibiotics' prescribing for hospitalized adult patients in the Kingdom of Saudi Arabia. This study explored the prescribing practices of antibiotics in a large tertiary care setting serving diverse population.

METHODS

This retrospective cross-sectional study included 1.666 antibiotic prescriptions prescribed over a period of 3 months (January 2016-March 2016) in an adult inpatient department of King Saud Medical City (KSMC). Data were collected from pharmacy electronic database. The World Health Organization (WHO) prescribing indicators were also used.

RESULTS

Of the 13.414 prescriptions in pharmacy database, percentage share of antibiotic prescriptions was 12.41. The average number of drugs per encounter was 1.2. 61% of the prescriptions contained parenteral antibiotics. The percentage of drugs prescribed from essential drug list and by generic name was 100% in each indicator. The most frequently prescribed antibiotics were cefuroxime (19.44%), piperacillin/tazobactam (16.30%), and cefazolin (13.85%). Ciprofloxacin and ceftriaxone were prescribed without stated indications in 62 prescriptions. Restricted antibiotic such as meropenem was prescribed without a diagnosis in 52 prescriptions.

CONCLUSION

This study gathered baseline data pertinent to the prudent use of antibiotics in KSMC. The diagnosis was not documented in more than one-third of the admission episodes. Majority of the antibiotics were broad spectrum. Three prescribing indicators shows deviation from the WHO's standard values while prescribing from essential drug list and by generic name was not a problem in this setting. There is a need to explore the impact of prescriptions lacked indication on patient's safety.

Multi-level analysis of bacteria isolated from inpatients in respiratory departments in China

Background

With the different situation for clinical antibiotic usage and its management in different regions and medical institutions, the antimicrobial resistance varied in different level. However, the epidemiological data of multi-drug resistant (MDR) strains from the department of respiration is limited. Thus, this study aims to investigate the epidemiology of bacteria isolated from inpatients of respiratory departments, and analyze the distribution variation of major multi-drug resistant bacteria in China.

Methods

Based on data from China Antimicrobial Resistance Surveillance System (CARSS) in 2015, 50,417 non-duplicate isolates obtained from inpatients of respiratory departments from 91 general hospitals in seven regions of China were enrolled in the study. The distribution of methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Escherichia coli (CREC) and Klebsiella pneumoniae (CRKP), carbapenem-resistant Pseudomonas aeruginosa (CRPA) and Acinetobacter baumannii (CRAB), extended-spectrum β-lactamases-producing E. coli (ESBL-EC) and K. pneumoniae (ESBL-KP), were further analyzed by geographic regions, age groups, wards and specimen types.

Results

The major specimens type were sputum (81.6%, 41,131/50,417), followed by blood (5.3%, 2,649/50,417), urine (4.5%, 2,249/50,417) and bronchoalveolar lavage fluid (BALF) (3.2%, 1,620/50,417). The top four bacteria species isolated from sputum and BALF were similar: K. pneumonia (18.9% and 14.8%, respectively), P. aeruginosa (13.6% and 22.2%, respectively), A. baumannii (11.3% and 11.9%, respectively) and S. pneumonia (11.1% and 9.6%, respectively). The four most common bacteria species were K. pneumonia (17.2%), P. aeruginosa (12.1%), A. baumannii (10.4%) and S. pneumonia (10.1%) in tertiary hospitals but K. pneumonia (20.8%), P. aeruginosa (16.3%), E. coli (11.3%) and A. baumannii (6.9%) in secondary hospitals. The top four bacteria species in respiratory intensive care unit (RICU) were A. baumannii (25.8%), P. aeruginosa (13.1%), K. pneumonia (12.2%) and S. aureus (9.2%). The prevalence of CRKP, CRPA and CRAB in tertiary hospitals was significantly higher than that in secondary hospitals (5.2% vs. 2.5%, 23.8% vs. 12.8% and 53.5% vs. 33.9%, respectively) (all P<0.05). However, the prevalence of ESBL-EC in secondary hospitals was higher than in tertiary ones (63.9% vs. 55.0%, P=0.011). The prevalence of MRSA, CRKP, CRAB, CRPA, ESBL-EC, ESBL-KP in RICU were higher than that in non-ICU respiratory departments (76.5% vs. 35.7%, 20.1% vs. 4.1%, 90.6% vs. 45.5%, 64.2% vs. 19.3%, 47.2% vs. 28.3% and 43.0% vs. 11.2%, respectively) (all P<0.01). Among seven regions in China, central area had the highest detection rates of MRSA (70.3%, 237/337), CRPA (30.9%, 376/1,218), CRAB (71.8%, 487/678) and ESBL-KP (38.8%, 241/621). The prevalence of ESBL-EC and ESBL-KP in pediatric group (68.2% and 55.3%, respectively) was higher than that in geriatric group (54.2% and 27.1%, respectively) and adult group (51.1% and 15.1%, respectively) (all P<0.001).

Conclusions

In China, the predominant bacterial pathogens in the respiratory ward were Enterobacteriaceae and non-fermentative bacteria. High prevalence of ESBL-EC and ESBL-KP isolated from lower respiratory tract (LRT) was revealed in primary hospitals and pediatric patients.

Study on essential drug use status and its influencing factors among cerebral infarction inpatients in county level hospitals of Anhui Province, China

BACKGROUND AND PURPOSE

Drug costs is one of the main components of hospitalization expenditure for cerebral infarction inpatients. In China, the National Essential Medicine System (NEMS) was created to relieve the heavy drug-cost burden for patients. The objective of this study was to investigate essential drug-use status and its influencing factors among cerebral infarction inpatients in county-level hospitals of Anhui province, China.

METHODS

Three county-level hospitals were selected through a multi-stage cluster random sampling method. The hospitalization cost data of cerebral infarction inpatients in the three hospitals were extracted from the Anhui provincial information platform of the New Rural Cooperative Insurance System (NCMS), and whether the proportion of essential drug cost in the total drug cost reached the median value of 33.05% which was set as the evaluation index for essential drug-use status. Questionnaires for hospitals and physicians were designed and given to them to assess influencing factors.

RESULTS

We retrieved the cost data of 2,189 inpatients from the NCMS platform and investigated 51 corresponding physicians in total. The drug costs accounted for 52.6% of the total hospitalization cost, and essential drug costs alone accounted for 37.0% of the total drug costs. The essential drug-cost proportion was high among physicians with a higher recognition degree on NEMS, older age, lower final academic degree, longer work experience and lower professional title. Married physicians and those with tight organizational affiliation also prescribed more essential drugs.

CONCLUSIONS

Increasing the proportion of essential drugs was an effective way to reduce the disease burden for cerebral infarction patients. Perfecting the NEMS, increasing government investment, reinforcing education and propaganda, and formulating relevant incentive and restrictive mechanisms were all effective ways to promote and increase the number of essential drug prescriptions written by physicians.

Physicians' knowledge, attitudes, and perceptions concerning antibiotic resistance: a survey in a Ghanaian tertiary care hospital

Background

Understanding the knowledge, attitudes and practices of physicians towards antibiotic resistance is key to developing interventions aimed at behavior change. The survey aimed to investigate physicians’ knowledge and attitudes towards antibiotic resistance in a tertiary-care hospital setting in Ghana.

Methods

We conducted a cross-sectional respondent-driven survey using a 40-item, anonymous, voluntary, traditional paper-and-pencil self-administered questionnaire among 159 physicians at Korle-Bu Teaching Hospital. Single and multi-factor analysis were conducted to assess the study objectives.

Results

The survey was completed by 159 of 200 physicians (response rate of 79.5%). Of physicians, 30.1% (47/156) perceived antibiotic resistance as very important global problem, 18.5% (29/157) perceived it as very important national problem and only 8.9% (14/157) thought it as a very important problem in their hospital. Methicillin resistant Staphylococcus aureus was the most known about antibiotic resistant bacteria of public health importance followed by extended-spectrum beta-lactamase-producing Enterobacteriaceae, carbapenem resistant Enterobacteriaceae (CRE) and vancomycin resistant enterococci (VRE). In multiple logistic regression analysis, senior physicians were nearly 3 times more likely to know about CRE than junior physicians. The odds of knowing about VRE increased over 4.5 times from being a junior to becoming senior physician. Among junior physicians, age had no associated effect on their knowledge of VRE or CRE.

Conclusions

Physicians in this survey showed variable knowledge and perceptions on antibiotic resistance. Introducing educational programs on antibiotic resistance would be a useful intervention and should focus on junior physicians.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-2899-y) contains supplementary material, which is available to authorized users.

Drug prescription pattern of outpatients in a tertiary care teaching hospital in Tamil Nadu

Purpose:

Drug use prescribing indicators advocated by the World Health Organization (WHO) are important tools for assessing the degree of polypharmacy, use of generic medicines, and to evaluate if there is inappropriate use of antibiotics or parenteral medications besides estimating the adherence to the essential drugs list. This study aimed to assess the WHO prescribing indicators in prescriptions given at the medical outpatient department (OPD) in a private medical college hospital in South India.

Materials and Methods:

The study was done prospectively from patients when they presented for consultation at the medical OPD at our tertiary care center. Prescriptions were randomly chosen to be analyzed for the WHO prescribing indicators from September 2016 to April 2017.

Results:

A total of 700 prescriptions were analyzed and the average number of drugs per prescription was 2.955 ± 1.32. 32.57% of prescriptions had fixed drug combinations and a similar value of 36% was obtained for prescriptions containing more than one drug for the same indication. Amongst the prescribing indicators, generic prescribing was appallingly low (6.42%). In contrast, antibiotic prescribing and prescription of injections showed an appreciably rational trend with 15.42% and 8.14%, respectively. Furthermore, the prescription of the drugs enlisted in the essential drugs list was determined to be 90.67%.

Discussion:

The need for increase in generic prescribing and augmenting the adherence of prescriptions to the essential drugs list has been identified. This can be accomplished by multimodal approach that includes regulatory changes, conducting educational programs directed at attitudinal change among current doctors and imparting modifications in medical curriculum so as to inculcate the culture of abiding by the best prescription practices among budding doctors.

Conclusion:

This study has delineated the requisite for pertinent changes in current prescribing trends in a tertiary care teaching private colleges.

Pattern and Appropriateness of Medicines Prescribed to Outpatients at a University Hospital in Northwestern Ethiopia

The study assessed the pattern and appropriateness of medicines prescribed to outpatients at Gondar University Referral Hospital in northwestern Ethiopia. An institution-based cross-sectional study was employed, through interviews and prescription reviews, among 346 patients at the outpatient pharmacy, from 2nd to 20th of May 2016. Data on sociodemographic profile of patients and medicines prescribed to them were collected. A mean of 1.72 medicines per encounter was prescribed, over a third of the total being anti-infectives. Patients were able to get about 85% of these medicines. An unskilled government employee would be required to work more than one and a half day to be able to afford the average priced medicine. Among prescriptions with two or more medicines, more than a third had at least one potential drug-drug interaction (PDDI), the commonest pair containing amoxicillin and doxycycline. Being male, being older (50–59 years), and increased number of medicines were associated with higher likelihood of PDDIs. In conclusion, the number of medicines prescribed per encounter was up to accepted standard. However, their availability fell short, together with considerable cost. Regarding appropriateness, a significant proportion of potential drug-drug interactions is identified and associated with patient's sex, age, and number of medicines prescribed.

Indicators related to the rational use of medicines and its associated factors

OBJECTIVE

To evaluate indicators related to the rational use of medicines and its associated factors in Basic Health Units.

METHOD

This is a cross-sectional study carried out in a representative sample of Brazilian cities included in the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). The data were collected by interviews with users, medicine dispensing professionals, and prescribers; and described by prescription, dispensing, and health services indicators. We analyzed the association between human resources characteristics of pharmaceutical services and dispensing indicators.

RESULTS

At national level, the average number of medicines prescribed was 2.4. Among the users, 5.8% had antibiotic prescription, 74.8% received guidance on how to use the medicines at the pharmacy and, for 45.1% of users, all prescribed medicines were from the national list of essential medicines. All the indicators presented statistically significant differences between the regions of Brazil. The dispensing professionals that reported the presence of a pharmacist in the unit with a working load of 40 hours or more per week presented 1.82 more chance of transmitting information on the way of using the medicines in the dispensing process.

CONCLUSION

The analysis of prescription, dispensing, and health services indicators in the basic health units showed an unsatisfactory proportion of essential medicines prescription and limitations in the correct identification of the medicine, orientation to the patients on medicines, and availability of therapeutic protocols in the health services.

Relationship Between the Provision of Injection Services in Ambulatory Physician Offices and Prescribing Injectable Medicines

Overuse of injections is a common problem in many low-income and middle income countries. While cultural factors and attitudes of both physicians and patients are important factors, physicians› financial intensives may play an important role in overprescribing of injections. This study was designed to assess the effects of providing injection- services in physicians› ambulatory offices on prescribing injectable medicines. This cross-sectional study was conducted in Tehran in 2012 -2013and included a random sample of general physicians, pediatricians and infectious disease specialists. We collected data on the provision of injection services in or in proximity of physician offices, and obtained data from physicians› prescriptions in the previous three-month period. We analyzed the data using ANOVA, Student›s t-test and linear regression methods. We obtained complete data from 465 of 600 sampled physicians. Overall 41.9% of prescriptions contained injectable medicines. 75% of physicians offered injection services in their offices. Male physicians and general physicians were more likely to offer the services, and more likely to prescribe injectables. We observed a clear linear relationship between the injection service working hours and the proportion of prescriptions containing injectables (p-value<0.001). Providing injection service in the office was directly linked with the proportion of prescriptions containing injectables. While provision of injection services may provide a direct financial benefit to physicians, it is unlikely to be able to substantially reduce injectable medicines› prescription without addressing the issue.

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

Background

Rational 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.

Methods

Systematic 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.

Results

Forty-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.

Conclusions

Prescribing 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.

Hospital pharmacists' knowledge of and attitudes towards the implementation of the National Essential Medicines System: a questionnaire survey in western China

Background

In 2009, Chinese government launched a new healthcare reform, one of the key points of which is to establish National Essential Medicine System (NEMS). Hospital pharmacists are directly related to the implementation of NEMS. This study is to examine knowledge of and attitudes towards the implementation of the NEMS among hospital pharmacists in western China.

Methods

We conducted a questionnaire survey of pharmacists from different types of medical institutions in Shaanxi Province in November 2014. We gathered demographic information about the participants, collected the data about their knowledge of and attitudes towards the implementation of NEMS, and identified the influencing factors of cognitive level. We analyzed the data and compared public secondary/tertiary hospitals and primary healthcare institutions.

Results

Of the 704 participants (response rate = 70.2 %), the majority had positive and moderate knowledge (39.2 and 53.3 %) and attitudes (35.8 and 62.9 %) towards NEMS. The most participants were aware of the implementation time of NEMS (89.8 %) and zero mark-up policy (85.5 %) while the least learned of the adjustment time of National Essential Medicines List (NEML). Pharmacists from public secondary/tertiary hospitals tended to know more and have more positive attitudes. There was no statistical correlation between knowledge and attitude scores. The education level (p = 0.022) and number of training sessions attended (p = 0.028) were the only demographic variables linked to knowledge scores.

Conclusions

Hospital pharmacists in Shaanxi Province had moderate knowledge of and attitudes towards the implementation of NEMS. Pharmacists from public secondary/tertiary hospitals showed better understanding. The government should therefore focus on improving the understanding of pharmacists in primary healthcare institutions and also address existing problems, especially the supply and distribution systems.

A Cross-sectional Study Assessing Predictors of Essential Medicines Prescribing Behavior Based on Information-motivation-behavioral Skills Model among County Hospitals in Anhui, China

Background:

The self-consciousness and practicality of preferentially prescribed essential medicines (EMs) are not high enough in county hospitals. The purposes of this study were to use the information-motivation-behavioral skills (IMB) model to identify the predictors of essential medicines prescribing behavior (EMPB) among doctors and to examine the association between demographic variables, IMB, and EMPB.

Methods:

A cross-sectional study was carried out to assess predictive relationships among demographic variables and IMB model variables using an anonymous questionnaire administered in nine county hospitals of Anhui province. A structural equation model was constructed for the IMB model to test the instruments using analysis of moment structures 17.0.

Results:

A total of 732 participants completed the survey. The average age of the participants was 37.7 ± 8.9 years old (range: 22–67 years old). The correct rate of information was 90.64%. The average scores of the motivation and behavioral skills were 45.46 ± 7.34 (hundred mark system: 75.77) and 19.92 ± 3.44 (hundred mark system: 79.68), respectively. Approximately half (50.8%) of respondents reported that the proportion of EM prescription was below 60%. The final revised model indicated a good fit to the data (χ²/df = 4.146, goodness of fit index = 0.948, comparative fit index = 0.938, root mean square error of approximation = 0.066). More work experience (β = 0.153, P < 0.001) and behavioral skills (β = 0.449, P < 0.001) predicted more EMPB. Higher income predicted less information (β = −0.197, P < 0.001) and motivation (β = −0.204, P < 0.001). Behavioral skills were positively predicted by information (β = 0.135, P < 0.001) and motivation (β = 0.742, P < 0.001).

Conclusion:

The present study predicted some factors of EMPB, and specified the relationships among the model variables. The utilization rate of EM was not high enough. Motivation and behavior skills were crucial factors affecting EMPB. The influence of demographic variables, such as income and work experience, on EMPB should be fully appreciated. Comprehensive intervention measures should be implemented from multiple perspectives.

The influence of health insurance scheme on the drug prescribing pattern in a Nigerian tertiary healthcare facility

Introduction:

Prescription medicines constitute a significant proportion of total healthcare expenditure in many countries of the world. Nonrational prescribing by healthcare providers contributes significantly to this relatively high proportion. In many developing countries of the world, a significant proportion of the population pays “out of pocket” to access healthcare, sometimes leading to catastrophic healthcare expenditure. Healthcare insurance is a form of healthcare financing that promotes judicious use of the resources and ensuring the cost-effectiveness of interventions through the use of affordable drugs. The main objective of this study was to compare concurrently the prescribing practices in the general outpatients' clinic (noninsured patients) and the National Health Insurance Scheme (NHIS) clinic (patients with insurance coverage).

Materials and Methods:

A cross-sectional study was conducted in the general outpatients' and the “NHIS” clinics of the Ekiti State University Teaching Hospital, Ado-Ekiti, South-western Nigeria. The medical records of patients, who attended these two clinics between the 1^st March and 30^th June 2014 were retrieved and used for the study.

Results:

The average number of prescribed drugs for patients attending the general outpatients' clinic was 3.9 ± 2.0 while that from the NHIS clinic was 4.1 ± 1.6 (P = 0.24). Prescribing by generic names was done in 48.2 ± 23.8% and 45.8 ± 22.9% of prescriptions from the general outpatients' and NHIS clinic, respectively. Percentage of encounters with antibiotics was 49.4% and 33.6% of patients who attended the NHIS and general outpatients' clinics, respectively.

Conclusion:

There was a trend to having more medicines prescribed and more encounters with antibiotics among patients enrolled under the health insurance scheme.

Comparison of prescribing indicators of academic versus non-academic specialist physicians in Urmia, Iran

Objective:

As chief prescribers, physicians could have a key role in rational drug use. Core prescribing indicators of all physicians have been evaluated in the Islamic Republic of Iran for several years, but no study has assessed the effects of academic status of doctors on their prescribing behaviors. We aimed to compare prescribing indicators of two groups of academic and non-academic specialist physicians working in Urmia, Iran.

Methods:

In this cross-sectional study, prescribing indicators of the total number of 37 academic and 104 non-academic specialist physicians in six medical specialties (infectious diseases, psychiatry, otorhinolaryngology, gynecology, pediatrics and general surgery) were studied during 2012 using Rx-analyzer, a dedicated computer application. A set of five quality indicators was used based on the World Health Organization and International Network for Rational Use of Drugs recommendations.

Findings:

Totally, 709,771 medications in 269,660 prescriptions were studied. For academic and non-academic specialist physicians, the average number of medications per prescription was 2.26 and 2.65, respectively. Similarly, patients’ encounters with injectable pharmaceuticals were 17.37% and 26.76%, respectively. The corresponding figures for antimicrobial agents were 33.12% and 45.46%, respectively. The average costs of every prescription were 6.53 and 3.30 United States Dollar for academic and non-academic specialist physicians, respectively. All the above-mentioned differences were statistically significant.

Conclusion:

Better prescribing patterns were observed in academic specialist physicians. However, they prescribed medications that were more expensive, while the reason was not investigated in this study. Further studies may reveal the exact causes of these differences.

Overuse of antibiotics for the common cold - attitudes and behaviors among doctors in rural areas of Shandong Province, China

Background

Irrational antibiotic use is common in rural areas of China, despite the growing recognition of the importance of appropriate prescribing to contain antibiotic resistance. The aim of this study was to analyze doctors’ attitudes and prescribing practices related to antibiotics in rural areas of Shandong province, focusing on patients with the common cold.

Methods

A survey was conducted with doctors working at thirty health facilities (village clinics, township health centers and county general hospitals) in three counties within Shandong province. Questions were included on knowledge and attitudes towards antibiotic prescribing. Separately, a random selection of prescriptions for patients with the common cold was collected from the healthcare institutions at which the doctors worked, to investigate actual prescribing behaviors.

Results

A total of 188 doctors completed the survey. Most doctors (83%, 149/180) had attended training on antibiotic use since the beginning of their medical practice as a doctor, irrespective of the academic level of their undergraduate training. Of those that had training, most had attended it within the past three years (97%, 112/116). Very few doctors (2%, 3/187) said they would give antibiotics to a patient with symptoms of a common cold, and the majority (87%, 156/179) would refuse to prescribe an antibiotic even if patients were insistent on getting them. Doctors who had attended training were less likely to give antibiotics in this circumstance (29% vs. 14%, p < 0.001).

A diagnosis of common cold was the only diagnosis reported on 1590 out of 8400 prescriptions. Over half (55%, 869/1590) of them included an antibiotic. Prescriptions from village clinics were more likely to contain an antibiotic than those from other healthcare institutions (71% vs. 44% [township] vs. 47% [county], p < 0.001).

Conclusions

Most doctors have recently attended training on antibiotic use and report they would not prescribe antibiotics for patients with a common cold, even when placed under pressure by patients. However, more than half of the prescriptions from these healthcare institutions for patients with the common cold included an antibiotic. Exploring and addressing gaps between knowledge and practice is critical to improving antibiotic use in rural China.

A cross-sectional analysis of prescription and stakeholder surveys following essential medicine reform in Guangdong Province, China

Background

An essential medicine (EM) system has been implemented in China to reduce patients’ financial burden and to make the use of drugs more rational. This study aims to evaluate the current state of the EM system in Guangdong Province.

Methods

We conducted surveys in 21 cities in 2012, covering 98 medical institutions, 1,509 doctors, 17 medicine manufacturers, and 17 distribution companies. We also reviewed outpatient prescriptions (n = 9,941) for treating hypertension, diabetes, bacterial infections and gout to measure the rational use of drugs in secondary and tertiary (upper-level) hospitals.

Results

The percentage of non-priority EM use ranged from 8.1% to 10.7% in upper-level hospitals, and this non-priority use significantly increased prescription drug costs. Other types of inappropriate medicine use were found more frequently in treating bacterial infections (7.4%) than in treating hypertension (1.6%), diabetes (1.3%) and gout (1.7%). Tertiary hospitals prescribed fewer EMs than secondary hospitals; moreover, tertiary hospitals had higher prescription drug costs. The zero mark-up policy decreased prescription drug costs in secondary hospitals. The survey revealed that forced full-prescription EM use might lead to fewer patient visits to primary hospitals. Manufacturers had halted the production of four (1, 23) types of EMs at the time of the survey.

Conclusions

Encouraging the priority use of EMs and implementation of the zero mark-up policy were effective in curtailing prescription medicine costs in upper-level hospitals. Further work should focus on the following: creating guidelines to enhance rational prescription behavior, establishing policies to support EM use in upper-level hospitals and improving the bidding system to ensure a steady supply of the lowest-priced generic drugs.

Factors affecting family physicians' drug prescribing: a cross-sectional study in Khuzestan, Iran

BACKGROUND

Rational prescription is a considerable issue which must be paid more attention to assess the behavior of prescribers. The aim of this study was to examine factors affecting family physicians' drug prescribing.

METHODS

We carried out a retrospective cross-sectional study in Khuzestan province, Iran in 2011. Nine hundred eighty-six prescriptions of 421 family physicians (including 324 urban and 97 rural family physicians) were selected randomly. A multivariate Poisson regression was used to investigate potential determinants of the number of prescribed drug per patient.

RESULTS

The mean of medication per patient was 2.6 ± 1.2 items. In the majority (91.9%) of visits a drugs was prescribed. The most frequent dosage forms were tablets, syrups and injection in 30.1%, 26.9%, and 18.7% of cases respectively. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and antibiotics were 29.7% and 17.1% of prescribed drugs respectively. The tablets were the most frequent dosage forms (38.6% of cases) in adult's patients and syrups were the most frequent dosage forms (49% of cases) in less than 18 years old. Paracetamols were popular form of NSAIDs in two patients groups. The most common prescribed medications were oral form.

CONCLUSION

In Khuzestan, the mean of medication per patient was fewer than national average. Approximately, pattern of prescribed drug by family physicians (including dosage form and type of drugs) was similar to other provinces of Iran.

Effect of publicly reporting performance data of medicine use on injection use: a quasi-experimental study

Background

Inappropriate use of prescribing pharmaceuticals, particularly injections, not only affects the quality of medical care, but also leads to an increase in medical expenses. Publicly reporting performance data of medical care is becoming a common health policy tool adopted to supervise medical quality. To our knowledge, few studies about public reporting applied to medicine use have been reported. This study intended to introduce public reporting in the field of medicine use, and evaluate the effect of publicly reporting performance data of medicine use on the use of injections.

Methods

The research sites were 20 primary healthcare institutions in Q City, Hubei. By matching, the institutions were divided into the intervention group and control group. A quasi-experimental design was applied in this study. In the intervention group, the performance data of medicine use were publicly reported. The injection prescribing rates of the two groups before and after intervention were measured and compared. Difference-in-difference method and logistic regression were employed to estimate the effect of public reporting on injection use.

Results

Public reporting led to a reduction of approximately 4% in the injection prescribing rate four months after intervention (OR = 0.96; 95%CI: 0.94, 0.97). The intervention effect was inconsistent in each month after intervention, and it was most positive in the second month after intervention (OR = 0.90; 95%CI: 0.89, 0.92).

Conclusions

In general, publicly reporting performance data of medicine use may have positive effects on injection use to some extent. Further research is needed to investigate the mechanism by which public reporting influences injection use. Comprehensive measures are also necessary to promote the rational use of injections.

Addressing Antibiotic Abuse in China: An Experimental Audit Study

China has high rates of antibiotic abuse and antibiotic resistance but the causes are still a matter for debate. Strong physician financial incentives to prescribe are likely to be an important cause. However, patient demand (or physician beliefs about patient demand) is often cited and may also play a role. We use an audit study to examine the effect of removing financial incentives, and to try to separate out the effects of patient demand. We implement a number of different experimental treatments designed to try to rule out other possible explanations for our findings. Together, our results suggest that financial incentives are the main driver of antibiotic abuse in China, at least in the young and healthy population we draw on in our study.

Evaluation of medicine prescription pattern using World Health Organization prescribing indicators in Iran: A cross-sectional study

OBJECTIVE

The objective was to quantify the specialists' prescription pattern in Iran and to point out the prescribing behavioral differences among several specialties.

METHODS

A retrospective cross-sectional study was carried out on the claim data. National prescription data were obtained on the basis of the claims that the pharmacies submitted to the insurers during 1 year period of the study. More than 85 million prescriptions were analyzed using "Rx-Analyst" software that is designed and applied by National Committee of Rational Use of Medicines in Iran. Specified medical specialties were considered and the World Health Organization prescription indicators were used to evaluate the physicians' prescribing behavior.

FINDINGS

Average items per prescription were ranged from 3.68 in cardiologists' to 2.06 in dermatologists' prescriptions. The highest and the lowest mean price were belonged to neurologists' and ophthalmologists' prescriptions, respectively. In addition, 45% of patients received antibiotics, 41% of patients received injectable form of drugs, and 23% received corticosteroids. A high tendency toward prescribing corticosteroids and antibiotics as well as an injectable form of medicines was observed among general physicians.

CONCLUSION

There is an inevitable need to improve prescription habits among different specialties, especially among general practitioners. This causes the policymakers to put more emphasis on priorities such as continuous education.

Changes in Chinese policies to promote the rational use of antibiotics

Xonghong Xiao and colleagues analyze the challenge of antimicrobial resistance in China. A government strategy to promote rational use of antimicrobials in health care reduced antibiotic sales and percentage of prescriptions for antimicrobials for both hospitalized patients and outpatients, and offers insights to shape future initiatives. Please see later in the article for the Editors' Summary.