This study evaluated drug use and patient care practices at a referral hospital in Nigeria using WHO indicators. Several prescribing indicators were assessed from 2450 prescriptions, including average number of drugs per encounter (3.4), percentage prescribed by generic name (62%), encounters with antibiotics (35.5%) and injections (22.4%). Patient care indicators like consultation time (11.5 minutes) and dispensing time (5 minutes) were also evaluated. The results showed high rates of polypharmacy and antibiotic prescription compared to standards. Patients' knowledge of their medications was inadequate. Overall, the indicators suggested room for improvement in rational drug use and care at this facility.
FACTORS ASSOCIATED WITH UNNECESSARY DRUG THERAPY AND INAPPROPRIATE DOSAGE IN ...Jing Zang
To assess factors associated with unnecessary drug therapy and inappropriate dosage in hospitalized patients. A hospital based cross-sectional study design was employed. The study was conducted in Jimma University Specialized Hospital, Jimma, which is 345 Km from South west of Addis Ababa. All patients who were admitted to medical ward from February 5 – March 21, 2011 were included in the study. Data on socio-demographic variables, past medical history, past medication history, current diagnosis, current medications, vital signs and relevant laboratory data were collected by using bed side patient interview guided semi-structured questionnaire and data abstraction formats for card review. The data were analysed by using SPSS version 16 for windows. Descriptive statistics, cross-tabs, chi-square and logistic regression were done. Out of 257 study participants 140(54.5%) had unnecessary drug therapy or inappropriate dosage. The only independent factors which predicted the unnecessary drug therapy in study population was polypharmacy while not considering organ function test, polypharmacy and clinically significant potential drug-drug interaction were independent factors associated with inappropriate dosage . The prevalence of unnecessary drug therapy or inappropriate dosage is significantly high.
Preliminary study of Prescription audit for evaluation of prescribing pattern...SriramNagarajan16
Prescription audit is necessary to know the art of prescription practices to improve rational pharmacotherapy.
Present study is an observational study and was undertaken from August 2018 to October 2018 for which data
was collected from Medical OPD. Prescribing is a technique with an expert academic pharmacological
knowledge.
Irrational prescribing leads to diminished therapeutic outcome. The present study is the first preliminary one at
Pandit Jawaharlal Lal Nehru Govt. Medical College and Hospital, Chamba- HP Before July 2016, it was a
district hospital College. It is a hilly district and caters the need of 5 Lakh people. A total of 420 prescriptions
were analyzed. These prescriptions comprised of 3000 drugs. Average drugs prescribed per patient were 7.3 .
male and female ratio was 40% and 60% respectively. More prescription were carried out in the age group of 51
- 60 yrs. Prescriptions in generic were only 3.65% fixed dose combination was used in 300 prescriptions and
comprised of 71.4% drugs. Oral prescriptions were used maximally and intravenous medication was minimally
used. Multivitamin prescriptions were observed in bulk.
When a psychiatric patient is diagnosed, the practitioner selects a medication therapy from a variety of therapeutic approaches and according to the severity and condition of a patient; through peer evaluation. This requires the writing of a prescription. Prescribing accounts for a large proportion of errors [1]: Medication errors, problems related to strength and frequency of medication, quantity per dose, instructions for use, total quantity to be dispensed, dosage form etc; if absent, can cause great deal of patients’ harm. Medicines are a key component of healthcare and errors relating to medication, may impact on patient’s safety [1-4].
Human errors can be understood through a lot of suggested models and frameworks but the findings vary from country to country [5,6]. Prescribing errors are harmful to the patients and in worst cases they may lead to fatality. To avoid errors in prescriptions and its amelioration at the time of writing; is the easiest way of prevention of prescription errors [6-10]
Theories of human error states that, “a series of planned actions may fail to achieve their desired outcome because the plan itself was inadequate or because the actions did not go as planned. The definition reflects this distinction, including failures both in the prescribing decision and the prescription writing process” [5]. In 2005, Department of Health in the United Kingdom planned to reduce prescribing errors by 40% [10]. Such initiatives are also required in a developing country like Pakistan. Apparently, psychiatrists know a little about prescribing errors. Irrational drug therapy can cause patient’s harm by exacerbation or prolongation of illness, distress and higher costs [8] in some cases. Irrational prescribing is a global problem and may also be regarded as "pathological" prescribing [9].
All prescriptions must include the name, address, specialty and signature of the prescriber as well as the name, sex, and age of the patient and the strength, quantity, dose, frequency, dosage form and instructions for use of the medication [11–15]. The dispensing system of Pakistan is different than some other countries. The medication is available in already packed in containers etc by the pharmaceutical industries, to be dispensed. There is no option of refill instructions to the pharmacist etc. Adherence by the physician to good quality prescribing will minimize errors and ultimately improve patient’s care. Prescribing errors can occur as a result of errors in haste, poor concentration to the patient or attendant (in case the patient is unable to deliver the correct information), decision-making or the prescription-writing process. Incorrect prescribing habits are common unfortunately [16-20].
The purpose of this study was to investigate drug prescriptions of Psychiatry for the essential elements of prescriptions mentioned above, and to study the prescribing trends in psychiatric practice in Peshawar area, Pakistan.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
FACTORS ASSOCIATED WITH UNNECESSARY DRUG THERAPY AND INAPPROPRIATE DOSAGE IN ...Jing Zang
To assess factors associated with unnecessary drug therapy and inappropriate dosage in hospitalized patients. A hospital based cross-sectional study design was employed. The study was conducted in Jimma University Specialized Hospital, Jimma, which is 345 Km from South west of Addis Ababa. All patients who were admitted to medical ward from February 5 – March 21, 2011 were included in the study. Data on socio-demographic variables, past medical history, past medication history, current diagnosis, current medications, vital signs and relevant laboratory data were collected by using bed side patient interview guided semi-structured questionnaire and data abstraction formats for card review. The data were analysed by using SPSS version 16 for windows. Descriptive statistics, cross-tabs, chi-square and logistic regression were done. Out of 257 study participants 140(54.5%) had unnecessary drug therapy or inappropriate dosage. The only independent factors which predicted the unnecessary drug therapy in study population was polypharmacy while not considering organ function test, polypharmacy and clinically significant potential drug-drug interaction were independent factors associated with inappropriate dosage . The prevalence of unnecessary drug therapy or inappropriate dosage is significantly high.
Preliminary study of Prescription audit for evaluation of prescribing pattern...SriramNagarajan16
Prescription audit is necessary to know the art of prescription practices to improve rational pharmacotherapy.
Present study is an observational study and was undertaken from August 2018 to October 2018 for which data
was collected from Medical OPD. Prescribing is a technique with an expert academic pharmacological
knowledge.
Irrational prescribing leads to diminished therapeutic outcome. The present study is the first preliminary one at
Pandit Jawaharlal Lal Nehru Govt. Medical College and Hospital, Chamba- HP Before July 2016, it was a
district hospital College. It is a hilly district and caters the need of 5 Lakh people. A total of 420 prescriptions
were analyzed. These prescriptions comprised of 3000 drugs. Average drugs prescribed per patient were 7.3 .
male and female ratio was 40% and 60% respectively. More prescription were carried out in the age group of 51
- 60 yrs. Prescriptions in generic were only 3.65% fixed dose combination was used in 300 prescriptions and
comprised of 71.4% drugs. Oral prescriptions were used maximally and intravenous medication was minimally
used. Multivitamin prescriptions were observed in bulk.
When a psychiatric patient is diagnosed, the practitioner selects a medication therapy from a variety of therapeutic approaches and according to the severity and condition of a patient; through peer evaluation. This requires the writing of a prescription. Prescribing accounts for a large proportion of errors [1]: Medication errors, problems related to strength and frequency of medication, quantity per dose, instructions for use, total quantity to be dispensed, dosage form etc; if absent, can cause great deal of patients’ harm. Medicines are a key component of healthcare and errors relating to medication, may impact on patient’s safety [1-4].
Human errors can be understood through a lot of suggested models and frameworks but the findings vary from country to country [5,6]. Prescribing errors are harmful to the patients and in worst cases they may lead to fatality. To avoid errors in prescriptions and its amelioration at the time of writing; is the easiest way of prevention of prescription errors [6-10]
Theories of human error states that, “a series of planned actions may fail to achieve their desired outcome because the plan itself was inadequate or because the actions did not go as planned. The definition reflects this distinction, including failures both in the prescribing decision and the prescription writing process” [5]. In 2005, Department of Health in the United Kingdom planned to reduce prescribing errors by 40% [10]. Such initiatives are also required in a developing country like Pakistan. Apparently, psychiatrists know a little about prescribing errors. Irrational drug therapy can cause patient’s harm by exacerbation or prolongation of illness, distress and higher costs [8] in some cases. Irrational prescribing is a global problem and may also be regarded as "pathological" prescribing [9].
All prescriptions must include the name, address, specialty and signature of the prescriber as well as the name, sex, and age of the patient and the strength, quantity, dose, frequency, dosage form and instructions for use of the medication [11–15]. The dispensing system of Pakistan is different than some other countries. The medication is available in already packed in containers etc by the pharmaceutical industries, to be dispensed. There is no option of refill instructions to the pharmacist etc. Adherence by the physician to good quality prescribing will minimize errors and ultimately improve patient’s care. Prescribing errors can occur as a result of errors in haste, poor concentration to the patient or attendant (in case the patient is unable to deliver the correct information), decision-making or the prescription-writing process. Incorrect prescribing habits are common unfortunately [16-20].
The purpose of this study was to investigate drug prescriptions of Psychiatry for the essential elements of prescriptions mentioned above, and to study the prescribing trends in psychiatric practice in Peshawar area, Pakistan.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Inappropriate drug use in hospitalized elderly patients of medicine and cardi...Apollo Hospitals
National committee on quality assurance, USA convened an expert consensus panel and identified the list of drugs which should be avoided in the elderly people. This resulting list of drugs after 2003 beers criteria were added to the 2006 Health Plan Employer Data and Information Set (HEDIS) to assess the drug prescribing in elderly people.
“The Value of Drug Monitoring in Chronic Opioid Therapy Patients”Fred Jorgensen
“The Value of Drug Monitoring in Chronic Opioid Therapy Patients” delivered by Dr. Harry Leider, M.D., MBA, and Chief Medical Officer of Ameritox, Inc. This presentation was delivered during the ”Managing a Patient’s Pain in Today’s Regulated Environment” portion of the 2009 ASPMN Annual Conference.
Tingkat Kepuasan Pasien dalam Pelayanan Konseling Kefarmasian Berbasis Al-Qur...Aji Wibowo
Konseling kefarmasian merupakan salah satu pelayanan apoteker yang komprehensif. Untuk itu, diperlukan partisipasi aktif apoteker melalui konseling di apotek yang mudah ditemui oleh masyarakat
untuk memberikan terapi farmakologi berupa pemberian obat antihipertensi dan penyaranan terapi nonfarmakologi, salah satunya berupa penganjuran membaca Al-Quran pada saat melakukan konseling kefarmasian. Penelitian ini bertujuan untuk mengetahui tingkat kepuasan pasien hipertensi yang mendapatkan intervensi konseling kefarmasian berbasis Al-Quran terhadap pelayanan apoteker serta efektivitas pengobatan pasien.
A Cross Sectional Study of Ethnic Differences in Occurrence and Severity of A...iosrphr_editor
Non-steroidal anti-inflammatory drugs are the most widely used "over the counter" medication all over the world despite their complications in different major organs. Present studies envisaged for knowing the occurrence and severity of adverse drug reactions from NSAIDs in different ethnic communities of Sikkim. A cross sectional study was undertaken in the medicine outpatients department of a secondary and tertiary care hospital. The patients belonging to Nepalese, Bhutias, Lepchas ethnic communities and others community (settlers from other parts of India) were included to analyzed the data based on the age and gender, ethnicity and ADRs, drugs and ADRs. Severity assessment was done using Hartwing and Siegel scale and causality assessment by Naranjo scale. Total 109 cases of ADRs, predominating in female were detected. Nepalese were the most affected and Gastrointestinal tract (GIT) being the most affected organ in them. Diclofenac showed maximum number of ADRs in all the communities. Maximum number of cases occurred on single day use (40.36%) of drugs. All the cases were belonging to the "possible category" and the maximum being the mild (72.48%) in nature. It is advisable to consider the ethnic/racial differences equally with other factors, to improve the safety and efficacy of a drug.
Nik Nuradlina N.A,Mohd Syamir M. S. ,Noor Nashreen M.S.,Rozita M.
Pharmacy Department, National Cancer Institute, Putrajaya.
1st Clinical Audit Pharmacy Department
It is very important to incorporate clinically relevant practicals into the undergraduate pharmacology practical (UGPP) curriculum. Various medical colleges in the state of Gujarat have included clinical practicals in their UGPP curriculum. [2] Rai has recommended the inclusion of the 'P-drug' concept in the UGPP curriculum.
The conference of experts on the rational use of drugs, convened by the World Health Organization in Nairobi in 1985, stated that: "Rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, at the lowest cost to them and their community." This goal can be achieved by acquiring knowledge of the principles of rational drug usage during undergraduate training. This correspondence emphasizes the importance of this concept.
» What is a P-drug?
The drugs you are going to prescribe regularly and with which you will become familiar are called P(ersonal)-drugs. The P-drug concept includes the name of a drug, dosage form, dosage schedule and duration of treatment for a specified condition. Due to varying availability and cost of drugs, different national formularies and essential drug lists, medical culture and individual interpretation of information, P-drugs differ from country to country and between doctors.
There are four reasons that indicate why a P-drug should never be the one that has been suggested or dictated by clinical teachers, senior colleagues or by sales representatives: a) the latest and the most expensive drug is not necessarily the best, the safest or the most cost-effective, b) by developing one's own set of P-drugs, one can learn to handle pharmacological concepts and drug-related data in an effective manner, c) by compiling one's own set of P-drugs, one can prescribe alternatives when the P-drug cannot be used and d) one has the final responsibility for his / her patient's well being, which he / she cannot pass on to others. While physicians can and should draw on expert opinion and consensus guidelines, they should always think for themselves.
» Example for selecting a P-drug for acute amoebic dysentery Top
Amoebiasis is one of the common infections encountered in clinical practice and it is relatively easy to understand the pathophysiology as well as the treatment of amoebiasis. Therefore, we have selected the example of acute amoebic dysentery and analyzed it in consultation with standard textbooks of pharmacology.
Inappropriate drug use in hospitalized elderly patients of medicine and cardi...Apollo Hospitals
National committee on quality assurance, USA convened an expert consensus panel and identified the list of drugs which should be avoided in the elderly people. This resulting list of drugs after 2003 beers criteria were added to the 2006 Health Plan Employer Data and Information Set (HEDIS) to assess the drug prescribing in elderly people.
“The Value of Drug Monitoring in Chronic Opioid Therapy Patients”Fred Jorgensen
“The Value of Drug Monitoring in Chronic Opioid Therapy Patients” delivered by Dr. Harry Leider, M.D., MBA, and Chief Medical Officer of Ameritox, Inc. This presentation was delivered during the ”Managing a Patient’s Pain in Today’s Regulated Environment” portion of the 2009 ASPMN Annual Conference.
Tingkat Kepuasan Pasien dalam Pelayanan Konseling Kefarmasian Berbasis Al-Qur...Aji Wibowo
Konseling kefarmasian merupakan salah satu pelayanan apoteker yang komprehensif. Untuk itu, diperlukan partisipasi aktif apoteker melalui konseling di apotek yang mudah ditemui oleh masyarakat
untuk memberikan terapi farmakologi berupa pemberian obat antihipertensi dan penyaranan terapi nonfarmakologi, salah satunya berupa penganjuran membaca Al-Quran pada saat melakukan konseling kefarmasian. Penelitian ini bertujuan untuk mengetahui tingkat kepuasan pasien hipertensi yang mendapatkan intervensi konseling kefarmasian berbasis Al-Quran terhadap pelayanan apoteker serta efektivitas pengobatan pasien.
A Cross Sectional Study of Ethnic Differences in Occurrence and Severity of A...iosrphr_editor
Non-steroidal anti-inflammatory drugs are the most widely used "over the counter" medication all over the world despite their complications in different major organs. Present studies envisaged for knowing the occurrence and severity of adverse drug reactions from NSAIDs in different ethnic communities of Sikkim. A cross sectional study was undertaken in the medicine outpatients department of a secondary and tertiary care hospital. The patients belonging to Nepalese, Bhutias, Lepchas ethnic communities and others community (settlers from other parts of India) were included to analyzed the data based on the age and gender, ethnicity and ADRs, drugs and ADRs. Severity assessment was done using Hartwing and Siegel scale and causality assessment by Naranjo scale. Total 109 cases of ADRs, predominating in female were detected. Nepalese were the most affected and Gastrointestinal tract (GIT) being the most affected organ in them. Diclofenac showed maximum number of ADRs in all the communities. Maximum number of cases occurred on single day use (40.36%) of drugs. All the cases were belonging to the "possible category" and the maximum being the mild (72.48%) in nature. It is advisable to consider the ethnic/racial differences equally with other factors, to improve the safety and efficacy of a drug.
Nik Nuradlina N.A,Mohd Syamir M. S. ,Noor Nashreen M.S.,Rozita M.
Pharmacy Department, National Cancer Institute, Putrajaya.
1st Clinical Audit Pharmacy Department
It is very important to incorporate clinically relevant practicals into the undergraduate pharmacology practical (UGPP) curriculum. Various medical colleges in the state of Gujarat have included clinical practicals in their UGPP curriculum. [2] Rai has recommended the inclusion of the 'P-drug' concept in the UGPP curriculum.
The conference of experts on the rational use of drugs, convened by the World Health Organization in Nairobi in 1985, stated that: "Rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, at the lowest cost to them and their community." This goal can be achieved by acquiring knowledge of the principles of rational drug usage during undergraduate training. This correspondence emphasizes the importance of this concept.
» What is a P-drug?
The drugs you are going to prescribe regularly and with which you will become familiar are called P(ersonal)-drugs. The P-drug concept includes the name of a drug, dosage form, dosage schedule and duration of treatment for a specified condition. Due to varying availability and cost of drugs, different national formularies and essential drug lists, medical culture and individual interpretation of information, P-drugs differ from country to country and between doctors.
There are four reasons that indicate why a P-drug should never be the one that has been suggested or dictated by clinical teachers, senior colleagues or by sales representatives: a) the latest and the most expensive drug is not necessarily the best, the safest or the most cost-effective, b) by developing one's own set of P-drugs, one can learn to handle pharmacological concepts and drug-related data in an effective manner, c) by compiling one's own set of P-drugs, one can prescribe alternatives when the P-drug cannot be used and d) one has the final responsibility for his / her patient's well being, which he / she cannot pass on to others. While physicians can and should draw on expert opinion and consensus guidelines, they should always think for themselves.
» Example for selecting a P-drug for acute amoebic dysentery Top
Amoebiasis is one of the common infections encountered in clinical practice and it is relatively easy to understand the pathophysiology as well as the treatment of amoebiasis. Therefore, we have selected the example of acute amoebic dysentery and analyzed it in consultation with standard textbooks of pharmacology.
According to WHO, Drug utilization research is defined as ‘the marketing, distribution, recommendation and utilize of drugs in a society, with particular focus on the resulting medical, social and economic results. In many developed countries, a number of studies about utilization of drug have been conducted, which indicates a wide proof of irrational drug use. The drug use indicators are considered as objective measures that can be extended to identify practices of medicines utilization in any health facility, country or an entire region. To check the drug utilize pattern in Primary Health Care (PHC) facilities of Bhakkar district Punjab Pakistan. Using WHO core drug use indicators, a prospective cross-sectional descriptive study was carried out in health facilities of Bhakkar district. A total of 40 prescriptions were analyzed. The average age of patients visiting HC centers was 33.11 years (female 35.79; male 30.40). 3.65 was the average number of prescribed drugs. 27% was the percentage of encounters with at least one prescribed antibiotic whereas 35% was the percentage of encounters with at least one prescribed injection prescribed, which was low. 25% is the total percentage of drugs given using generic names was noticed. The average consultation and dispensing time of 40 prescriptions was 2.02 minutes and 42.52 seconds. The study demonstrates that trend toward irrational practice mainly on use of antibiotics and non-generic prescribing in most of health facilities studied. Patient care given by health facilities studied was inadequate and thus for encouragement of rational drug use practice, an effective intervention program is recommended.
Assessment of drug utilization and rational drug use on WHO indicationZaibaFathima8
This is a study done in the outpatient department for a short period of time to recognize the drug utilized and use of rational drug use based on WHO indicators under the guidance of Dr. GOPINATH S, M Pharm., Ph.D.,
by Prabhavathi S co. B Pharmacy final year project.
SELF MEDICATION PRACTICES FOR ORAL HEALTH PROBLEMS AMONG DENTAL PATIENTS IN B...iosrphr_editor
Introduction: Self‑ medication is commonly practiced all over the world. Self-medication is defined as the use
of medication by a patient on his own initiative or on the advice of a pharmacist or a lay person instead of
consulting a medical practitioner. The present study was aimed to estimate the prevalence of self-medication for
oral health problems among dental patients in Bengaluru city; to identify triggering factors that could influence
self-medication practices; to identify sources of medications used; to identify sources of information about
medications used; and to identify reasons for self-medication.Study Design: A Cross sectional Study.Methods:A
survey was conducted among 175 subjects among dental patients in Bengaluru city. Data were collected
through a specially designed proforma using a closed‑ ended, self‑ administered questionnaire containing 15
questions, in five sections.
Results: The prevalence of
Study of medication appropriateness during hospital stay and revisits in medi...iosrjce
IOSR Journal of Pharmacy and Biological Sciences(IOSR-JPBS) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of Pharmacy and Biological Science. The journal welcomes publications of high quality papers on theoretical developments and practical applications in Pharmacy and Biological Science. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
2. Ifeanyi E. Chima et al.,: Continental J. Pharmaceutical Sciences 6 (1): 10 - 16, 2012
The best way to investigate drug use in health facilities is by the usage of indicators created and validated by the
World Health Organization (WHO, 1993).
The following WHO Core drug use indicators are used to evaluate drug use and patient care practices globally:
a. prescribing indicators-
Average number of drugs per encounter, percentage of drugs prescribed by generic name, percentage of
encounters with an antibiotic prescribed, percentage of encounters with an injection prescribed, percentage of
drugs prescribed from essential drug list or formulary.
b. WHO patient care indicators: Average consultation time, average dispensing time, Percentage of drugs
actually dispensed, percentage of drugs adequately labeled, patient’s knowledge of correct dosage. Others
indicators are: Availability of a copy essential drug list or formulary and availability of key essential drugs in
the facility.
These indicators enable health care planners, managers and researchers to compare situations in different
facilities or at different times (Enato and Chima, 2011).
Several studies done on medication and patient care practices in various parts of Nigeria using the above
indicators, often show irrational drug use in the form of over prescription of antibiotics and injections, poly
pharmacy and non adherence to the principles of essential drugs (Enato and Chima, 2011). The average
numbers of drugs prescribed per patient had been found to vary from 3 to 7, the prescribing rate of injection has
a range of 40-70% and antibiotic use rate exceeds 50% (Odusanya, 2004).
OBJECTIVES OF THE STUDY:
To evaluate the pattern of drug use in the facility using WHO Core Drug Use indicators.
To assess the quality of care given to patients using WHO Patient Care indicators.
METHODOLOGY
STUDY SETTING: This study was carried out in Federal Medical Centre Yenagoa, the capital city of Bayelsa
State, South-South Nigeria. Yenagoa is a Local Government Area in Bayelsa State, Nigeria. Its headquarter is in
the town of Yenagoa (the State capital) in the south of the area at 4°55′29″N 6°15′51″E4.92472°N 6.26417°E.
The LGA has an area of 706 km² and a population of 353,344 at the 2006 census.
The postal code of the area is 561.
Yenagoa is the traditional home of the Ijaw people, Nigeria's fourth largest ethnic group after the Hausa, Yoruba
and Igbo. The Ijaw form the majority of the town. English is the official language, but Epie/Atissa language, one
of the Ijaw languages, is the major local language spoken in Yenagoa.
Since attaining the status of state capital in 1996, construction and other activities have accelerated appreciably.
Yenagoa's population is estimated at about 150,000 people.
Yenagoa is the heart of the oil rich Niger Delta of Nigeria. It is bounded in the east and west by Port Harcourt
and Delta States respectively linked by the east-west road; and at the south by the Atlantic Ocean. At the time of
this study, the hospital had six wards and about two hundred bed spaces. It has an average general outpatient
attendance 13,000 cases per annum. The general practice clinic has four consulting rooms with four doctors. The
Pharmacy Department of the hospital had six registered pharmacists, six intern pharmacist, four pharmacy
technicians and four pharmacy trainee on their industrial training that dispense drugs as support staff. This type
of study to the best of our knowledge has not been done in this part of the country before now. The study was
designed essentially to assess the degree of rational use of drugs in this health facility using WHO core drug use
indicators.
11
3. Ifeanyi E. Chima et al.,: Continental J. Pharmaceutical Sciences 6 (1): 10 - 16, 2012
STUDY DESIGN
The data collection process was done both prospectively and retrospectively. The pharmaceutical prescribing
pattern was retrospectively done while the patient care practices and health facility indicators were prospectively
studied. In addition, the times spent by patients to assess their prescription and make payments were also
evaluated.
DATA COLLECTION PROCESS
The prescription sheets of the previous twelve months period were collected from the pharmacy department,
sorted and systematically sampled. One in every three prescriptions was selected for the study. Three research
assistants were trained to extract the necessary information from the sampled prescriptions into data collection
forms. The information abstracted from the prescription forms are: The name of the medication, the route of
administration, the dosage form, the dose and duration of therapy.
The prescribing indicators evaluated in this study include: Total number of drugs prescribed per encounter,
percentage of drugs prescribed by generic name, percentage of encounter with an antibiotic prescribed,
percentage of encounter with an injection prescribed. The patient care indicators evaluated include: Consultation
time, dispensing time, patient’s knowledge of prescribed medications and adequacy of medication labeling.
Also, the times spent by the patients to assess their prescriptions and make payments were also evaluated. These
were all done prospectively.
The presence or absence of an essential drug list at the pharmacy unit was also noted. Classification of
antibiotics and the description of key essential drugs were based on WHO guideline.(WHO/DAP 1993)
DATA ANALYSIS
The information from the prescription forms were entered into a data collection form and sorted while data on
patient care practices were collected prospectively and entered into appropriate section of the data collection
forms.
The prescribing, patient care and facility indicators were calculated using WHO guidelines (WHO/DAP 1993).
The prescribing indicators were calculated as follows:
Average number of drugs prescribed per encounter = Total no of drugs for all encounters
Total no of encounters
Percentage of drugs prescribed by generic name = Total no of drugs prescribed as generics
Total no of drugs prescribed
Percentage of encounters with an antibiotic prescribed =
Total no patients who received one or more antibiotics
Total no of encounters
Percentage of encounters with an injection prescribed =
Total no of encounters with one or more injections
Total no of encounters
Percentage of drugs prescribed from the EDL = Total no drugs from the EDL
Total no of drugs prescribed
Also, the mean consultation time, the mean dispensing time, the mean assessment and revenue times were all
calculated by dividing the total time spent by the patient for each of the above activities by the number of
encounters assessed. Other patient care indicators that were evaluated include: percentage of drugs actually
dispensed, the percentage of drugs adequately labeled and the percentage of patients with adequate knowledge
of their medications.
12
4. Ifeanyi E. Chima et al.,: Continental J. Pharmaceutical Sciences 6 (1): 10 - 16, 2012
RESULTS
A total of two thousand four hundred and fifty (2450) prescriptions were used for the evaluation of the
prescribing pattern. A total of forty (40) patients participated in the study regarding consultation and dispensing
times. Thirty (30) persons participated in the study of revenue and waiting times while ninety (90) persons
participated in the study of the knowledge of dispensed medications.
Table 1 shows that the average number of drugs per encounter was 3.4. The percentage prescribed by generic
name was 62% and the percentage of encounter with an antibiotic prescribed was 35.5%. The percentage of
encounter with an injection prescribed was 22.4% and 87% percent of drugs prescribed from the essential drug
list.
Table 2 shows that the mean consultation time was 11.5 minutes. The mean assessment and revenue times were
48.2 seconds and 3.5 minutes respectively. The mean dispensing time was 5.0 minutes. The percentage of drugs
actually dispensed and the percentage adequately labeled were 80.3% and 84.55 respectively.
Table 3 shows that 66% of respondents knew the names and duration of their dispensed medications. Four out of
every respondent knew the dosage of prescribed medications. Only 2% of respondents knew the side effects of
the dispensed medications.
TABLE 1. WHO PRESCRIBING INDICATORS
S/N INDICATORS % REF.
STD
1. Average number of drugs per encounter 3.4 1.6-1.8
2 Percentage of encounter with an antibiotic prescribed 35.5% 20-25.4%
3. Percentage of encounter with an injection prescribed 22.4% 10.0-
17.0%
4. Percentage of drugs prescribed by generic name 67% 100%
5 Percentage of drugs prescribed from EDL 87% 100%
WHO- World Health Organization.
REF. STD- Reference Standard.
EDL- Essential Drugs.
TABLE 2: WHO PATIENT CARE INDICATORS
S/N PARAMETER
1. Mean Consultation time (mins) 11.5
2. Mean assessment time (secs) 48.2
3. Mean Revenue time(mins) 3.5
4. Mean dispensing time (mins) 5.0
5. Percentage of drugs actually dispensed 80.3%
6. Percentage of drugs adequately labeled 84.5%
TABLE 3 RESPONDENTS’ KNOWLEDGE OF DISPENSED MEDICATIONS
S/N PARAMETER PERCENTAGE
1. Knowledge of names of dispensed medications 66%
2. Knowledge of correct dosage of dispensed medications 80%
3. Knowledge of duration of dispensed medications 66%
4. Knowledge of side effects of dispensed medications 2%
DISCUSSION
Study of drug use patterns in health facilities is used to describe treatment practices and to assess performance of
health care providers. This allows healthcare planners, managers and researchers to make basic comparisons
between health facilities and also evaluate situations at different times in a particular health facility following
interventions.
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5. Ifeanyi E. Chima et al.,: Continental J. Pharmaceutical Sciences 6 (1): 10 - 16, 2012
The average number of drugs prescribed per encounter obtained from this study was 3.4.
The value is higher than some values obtained in Nigeria by Enato and Chima (2011) in Lokoja (2.94), Nwolisa
et al., (2005) (3.13). A similar result was obtained in a secondary health facility in Lagos, Nigeria (Odusanya,
2004) (3.5).
This value indicates a relatively high level of poly pharmacy practice in prescription pattern. This may have a
very negative effect on therapeutic outcome in patients. Among the likely negative effects this may pose are
increased incidences of side effects, drug-drug interactions, confusion where aged patients are involved, non
compliance by the patients as a result of the large number of drugs to be taken at a time (Babalola et al., 2011)
Sixty two percent of the drugs from the study were prescribed by generic name. Higher values had been obtained
in some other studies. For instance, Babalola et al.,(2011) (69.81%), Nwolisa et al. (2006) (63.8%). The value is
higher than that reported by Enato and Chima (2011) (37%). This value is low and does not comply with the
WHO recommendation that 100% of drugs should be prescribed using the International Non-proprietary Name,
INN. Prescribing by non generic name is a form of irrational prescribing (prescribing a more costly brand when
cheaper and equally effective alternatives are available). Factors that have been identified as contributing
immensely to this trend are the influence of drug promotional activities as well as pressure from pharmaceutical
manufacturers’ representatives or detail men on prescribers.
Antibiotics were prescribed in 35.5% of patient encounters. This value was lower than those obtained from
studies done in some health facilities in Nigeria. For instance, 51% was obtained in a study done by Enato and
Chima (2011), 50.1% was obtained in a study by Babalola et al (2011) and 54.8% by Odusanya (2004). Though
this value is lower than that from other studies, it still indicates overprescribing of antibiotics because it is higher
than the range given by WHO (20%-25.4%). Over prescription of antibiotics often arise from prescribing
antibiotics for presumed infections. High rate of antibiotic prescribing has a number of implications. Firstly, it
can result to non compliance when unaffordable antibiotics are prescribed. Secondly, it tends to promote
antibiotic resistance.
The prescription rate for injections from this study(22.4%) was lower than that from some previous studies. For
instance, in a study done by Babalola et al (2011) in some primary health institutions the rate of injection
prescribing was 71.74%. This relatively low rate of prescription of injection is encouraging as injection – related
hazards and infections such as HIV/AIDS, hepatitis and tissue necrosis.
Eighty seven percent of drugs in this study were prescribed from the Essential drug list (EDL). Higher values
had been obtained from other studies in Nigeria (94%) (Babalola et al, 2011). Ninety two percent and 100%
were obtained in two studies done in Edo state (Ozemoya, 1997). The value from this study, though lower than
the WHO benchmark (100%) value, is an indication that the prescribers have a fair knowledge of the drugs in
the essential drug list. Though lower than the WHO benchmark (100%). However, improvement should be made
It was observed that the pharmacy department had a copy of the EDL but none of the prescribers.
It has been noted that patient care patient care practices impact on the quality of health care delivered and
appropriate use of time influences the health seeking behavior of clientele (Isah et al, 1998) Contrary to findings
from various studies in different parts of the nation (Enato and Chima, 2011) (Isah et al, 1997), the mean
consultation time of 11.5 minutes obtained in this study was considered adequate for making appropriate
diagnosis. An important factor that affects consultation time is the number of patients to attend to. Adequate
consultation time is an indication of adequate clinical care for the clientele; which directly impacts positively on
patients’ satisfaction.
The time spent to assess their prescription for payment was so short and was considered
quite satisfactory considering the fact that sick patients are attended to almost immediately they arrive without
necessarily queuing before their prescriptions are assessed for payment. The time spent to make payment for
medications could be further reduced for the benefit of the patient.
The mean dispensing time (5 minutes) obtained was considered satisfactory and adequate for a meaningful
pharmacist- patient interaction to take place. The dispensing time is a measure of the quality of care given to
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6. Ifeanyi E. Chima et al.,: Continental J. Pharmaceutical Sciences 6 (1): 10 - 16, 2012
patients by the pharmacist in providing information about the dispensed drug. This interaction results in
appropriate use of prescribed medications and ultimately a positive therapeutic outcome. The value obtained
showed good quality of care. Inappropriate and unsuitable environment impacts negatively on dispensing time.
Overall evaluation of drugs adequately labeled showed that 84.5% of drugs dispensed were adequately labeled.
Four out of every five patients interviewed knew the correct dosage regimen of all their dispensed drugs. This
result is lower than some results obtained from earlier drug use studies (Ozemoya, 1997). However this result
was similar to results obtained in some other studies (Massele et al, 2011). Knowledge of correct dosage of
medication is a very central factor in the therapeutic process. Lack of it could jeopardize the whole process, thus
resulting in several predictable undesirable outcomes. Two out of three respondents knew the names of all their
dispensed medications. This value is unsatisfactory, though higher than values obtained in a study in UBTH and
central hospital with values as low as 33.8% and 10.8% (Ozemoya, 1997). A researcher had observed that what
is responsible for low values of respondents who knew the names of their dispensed drugs is the practice of
some pharmacists and other health care givers not to disclose the names of the prescribed drugs. Another factor
identified in that same study was the short time spent by pharmacists in counseling patients on their medications.
This results in some vital information such as name of drugs being left out. This trend has been changed by the
fact that the new health care process encourages patients to actively participate in their care process.
Two out of every three respondents in the study knew the duration of all their medications. This indicates that
34% of the patients did not know the duration of their therapies. This entails that a patient may not complete his
therapy especially in a case where a refill is necessary, the patient may not know for how long to continue the
refills. The patient may even decide to share his drugs with another sick person who is having similar symptoms
or may even decide to save the drug for another time when he feels better. A factor that has been identified as
being responsible for the pharmacist occasionally not disclosing the duration of therapy is the fact that the total
quantity of drugs dispensed is usually equal to the quantity needed. Lower values of 30.0% and 3.5% have been
obtained in study in Edo State (Ozemoya, 1997).
Only 2% of the respondents interviewed knew the side effects of their medications. A similar result was
obtained in the study done in UBTH and Central hospital in which 1% and 0% of the respondents respectively
knew the side effects of their medications (Ozemoya, 1997). Lack of information on the side effects of a drug
could result premature discontinuation of therapy when the patient experiences the side effect, resulting in non
adherence and consequently therapeutic failure.
CONCLUSION
The findings from this study showed that pharmaceutical prescribing pattern and patient care practices were
inappropriate. There was high tendency of poly- pharmacy and over prescription of antibiotics. The patients’
knowledge of vital aspects of medication management was found to be inadequate. The overall picture of drug
use suggests that the indicators at this facility are not yet at the optimal level. Thus, the need for the training of
medical and Pharmacy practitioners on rational drug use and the incorporation of same in the undergraduate
curriculum of both professions in various universities in the country.
ACKNOWLEDGEMENTS
We wish to thank the management and staff of Federal Medical Centre, Yenagoa and the staff of the Pharmacy
Department for their support during the data collection process. We also thank Pharm (Dr) Daniel Orumwense
and Dr Suleiman, both of Clinical Pharmacy Department Niger Delta University, Wilberforce Island for their
moral and technical support in the course of the research work.
Conflict of interest:
All views expressed in this paper are simply those of the authors and does not in any way represent that of the
management of the hospital. The authors declare no conflicts of interest.
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Received for Publication: 05/01/2012
Accepted for Publication: 02/03/2012
Corresponding Author
Ifeanyi E. Chima
Department of Clinical Pharmacy & Pharmacy Practice Faculty of Pharmacy, Niger Delta University,
Wilberforce Island, Bayelsa State, Nigeria.
E-mail: ifeanyimail@yahoo.com
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