Evaluation of outpatient prescriptions in a University-based healthcare facility in Ibadan
Main Article Content
Abstract
Background: Appropriate drug utilization has a huge contribution to global reduction in morbidity and mortality. Periodic review of prescriptions at all levels of care is therefore essential.
Objective: To evaluate drug prescription pattern and practice in a university-based healthcare facility using the WHO-core prescribing indicators.
Method: A retrospective review of randomly selected outpatient prescriptions in the pharmacy unit of the University of Ibadan Health Services between 2012 and 2014 was done. Pre-piloted data collection form was used to retrieve data based on standard prescription specifications including socio-demographics, drug name and dosage regimen, and prescriber identity. Descriptive statistics were used to summarize the data.
Results: A total of 4,121 medicines were reviewed in 1200 encounters. Of these, 589 (49.1%) were prescribed for males and 611 (50.9%) for females. Patients' ages were indicated in 388 (32.3%) prescriptions (mean age =17.7years). Summary of WHO-core prescribing indicators showed the average number of medicines per encounter as 3.4, medicine prescribed by generic name (2,533; 61.5%), encounter with one or more antibiotics and injections (427; 35.6%) and (150; 12.5%), respectively.
Conclusion: Polypharmacy, low generic prescribing and overuse of antibiotics is common underscoring the need for ongoing enlightment and training of healthcare providers on rational prescribing practice and drug use.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Phillips MS, Gayman JE and Todd MW (1996). ASHP Guideline on medication-use evaluation. American Society of Health-System Pharmacists. American Journal of HealthSystem Pharmacists 53: 1953-1955.
Pollock M, Bazaldua VO and Dobbie AE (2007). Appropriate Prescribing of Medications: An Eight-Step Approach. American Family Physician 75(2): 231-236.
Academy of Managed Care Pharmacy (AMCP) (1999). Concepts in Managed Care PharmacyD r u g U s e Ev a l u a t i o n . Av a i l a b l e a t
http://www.amcp.org/WorkArea/DownloadAsset.aspx?id=9299 Accessed February 21, 2015.
World Health Organization (1993). Action Program on Essential Drugs. How to investigate drug use in health facilities: selected drug use
indicators. Available at http://www.who.int/medicinedocs/en/d.../3.html. Accessed December 20, 2014.
Erah PO, Olumide GO and Okhamafe AO (2003). Prescribing practices in two health-care facilities in Warri, Southern Nigeria: A comparative study. Tropical Journal of Pharmaceutical Research 2 (1): 175-182.
Dean B, Barber N and Schacter M (2000). What is a prescribing error? Quality health care 9(4): 232-237.
Desalegn AA (2013). Assessment of Drug Use Pattern using WHO Prescribing Indicators at Hawassa University Teaching and Referral Hospital, South Ethiopia: A cross-sectional study. BioMed Central (Health Services Research) 13:170.
Akande TM and Ologe MO (2007). Prescription pattern at a secondary health care facility in Ilorin, Nigeria. Annals African Medicines 6(4):186–189.
Isah AO, Liang R, Quick J, Mabadeje AFB, Santoso B, Hogerzeil H, and Ross-Degnan D (2001). The Development of Reference Values for the WHO Health Facility Core Prescribing Indicators. West African Journal of Pharmacology and Drug Research 18. Available at http://www.ajol.info/index.php/wajpdr/article/view/14718. Accessed January 3, 2015
Patel V, Vaidya R, Naik D, and Borker P (2005). Irrational drug use in India: A prescription survey from Goa. Journal of Postgraduate Medicines 15: 9-12.
Sunil K, Punam M and Madhuri K (2005). Pattern of prescription and drug dispensing. Indian Journal of Peadiatrics 72 (2):117-121.
Babalola CP, Awoleye SA, Akinyemi JO & Kotila OA (2011). Evaluation of prescription pattern in Osun State (South-west), Nigeria. Journal of
Public Health and Epidemiology 3 (3): 94–98.
Adisa R, Fakeye TO and Aindero VO (2014). Drug prescription pattern and knowledge of dispensing process among health workers in
primary health care facilities in Ibadan, Southwestern, Nigeria. International Journal of Pharmacy Practice 22 (Suppl 1):28 – 53.
Tamuno I & Fadare JO (2012). Drug Prescription Pattern in a Nigeria Tertiary Hospital. Tropical Journal of Pharmaceutical Research 11 (1):146 -152.
Teferra A, Zeruesenay D, Asfawossen GY (2002). Prescribing pattern of drugs in medical wards of three hospitals in northwest Ethiopia. Journal of Ethiopia Medical Practice 4:8-13.
Ryan C, Ross S, Davey P and Duncan EM, Franscis JJ,Fielding S, Johnston M, Ker J, Lee AJ, MacLeod MJ, Maxwell S, Mckey GA, MaLay JS,
Webb AJ and Bond C (2014). Prevalence and Causes of Prescribing Errors. The Prescribing Outcomes for Trainee Doctors Engaged in
Clinical Training (PROJECT) Study. Public Library of Science ONE 9 (1):e79802
World Health Organization (2004). Promotingrational use of medicines saves lives and money, WHO experts say. WHO 2004;10:406-415 (Press Release 29-3-2004). Available at http://www.who.int. Accessed December 20, 2014.
World Health Organization (1996). India's doctors warned on irrational prescribing. Essential Drugs Monitor 22:6
Oreagba IA, Olayemi SO, Mabadeje AFB, Nwoye E (2004). Assessment of rational prescribing of antihypertensive drug combinations in Lagos University Teaching Hospital. Nigerian Journal of Health and Biomedical Sciences 3:8-11
World Health Organization (WHO), (2015). The Anatomical Therapeutic Chemical Classification System with Defined Daily Doses
(ATC/DDD), WHO Collaborating Centre for Drug Statistics Methodology. Available at www.who.int. Accessed February 13, 2015.
World Health Organization (WHO), (2003). Drug and Therapeutics Committees - A Practical Guide: Drug Use Evaluation. Available at
www.who.int/medicines/areas/national_use/en/. Accessed December 31, 2014.
Bjerrum L, Rhosholm JU, Hallas J, Kragstrup J (1997). Methods for estimating the occurrence of polypharmacy by means of a prescription
database. European Journal Clinical Pharmacology 53 (1):7-11
Grant RW, Devita NG, Singer DE and Meigs JB (2003). Polypharmacy and medication adherence in patients with type 2 diabetes. Diabetes Care 26 (6):1408-1412.
Fraizer SC (2005). Health outcomes and polypharmacy in elderly individuals: an integrated literature review. Journal of Gerontological Nursing 31(9):4-11
Afify MA, Shahzad N, Tawfik N, Ibrahim IA, AbdulJaleel Z, Khan W, Mahfoz AM and AlGhandi SS (2015). Evaluation of drug prescription practices in private and general hospitals in Makkah, Saudi Arabia. African Journal of Pharmacy and Pharmacology 9 (39):966-973.
Patil KR, Mali RS, Dhangar BK, Bafna PS, Gagarani MB, Bari SB (2015). Assessment of Prescribing Trends and Quality of Handwritten
Prescriptions from Rural India. Journal of Pharmaceutical Sciences and Technology 5(1):54-60.
Hogerzeil HV,Bino D, Ross-Degnan D, Laing RO,Ofori-Adjei D, Santoso B, Chowdhury AKA, Das AM, Kafle KK, Mabadeje AFM, Massele AY
(1993). Field tests for rational drug use in twelve developing countries. Lancet 342:1408-1410.
Dean B, Vincent C, Schechter M and Barber N (2005). The incidence of prescribing errors in hospital inpatients: an overview of the research
methods. Drug Safety 28:891–900.
Lesar TS, Briceland L, and Stein DS (1997). Factors related to errors in medication prescribing. The Journal of the American Medical Association 277:312-17.
Giampaolo PV and Pietro M (2009). Medication errors: prescribing fault and prescription errors. British Journal of Clinical Pharmacology 67(6):624-628.
Weerasuriya K, Brudon P (1998). Essential drugs concept needs better implementation. Essential Drugs Monitor 25/26:32-33
Chedi BAZ., Abdu-AguyeI & Kwanashie HO (2004). WHO-Core Prescription Indicators: Field Experience in Public Health Facilities in Kano, Nigeria. BEST Journals 6(3):66–70.
Christensen RF (1990). A strategy for the improvement of prescribing and drug use in rural health facilities in Uganda. Ugandan Essential drugs and management program. In: How to investigate drug use in health facilities. Geneva: WHO; 1993. 74(WHO/DAP/93.1).
Wolff JM (1993). Use and Misuse of Antibiotics in Latin America. Clinical Infectious Diseases 17 (2):S346-S351.
Peche're JC (2001). Patients' Interviews and Misuse of Antibiotics. Clinical Infectious Diseases 33(3):S170 –S173.
Gonzales R, Steiner JF, Sande MA (1997). Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. Journal of American Medical Association 1997,278(11):901-4.
Carey B and Cryan B (2003). Antibiotic misuse in the community- a contributor to resistance? Irish Medical Journal 96(2):43-46.
James LP, Mayeux PR, Hinson JA (2003). Acetaminophen-induced hepatoxicity. Drug Metabolism and Disposition 31 (12):1499-506.
World Health Organization (WHO), (1994). Guide to Good Prescribing: A Practical Manual. WHO, Geneva. WHO/DAP/94.11. Available at
www.who.int. Accessed December 12, 2014.