Transcript DRUG UTILIZATION REVIEW ON PRESCRIBING PRACTICES AND

DRUG UTILIZATION REVIEW ON
PRESCRIBING PRACTICES AND
PATTERNS AT KENYATTA NATIONAL
HOSPITAL OUT-PATIENT
DEPARTMENT (PHARMACY 15)
Dr Margaret
Omuronji Ambetsa
&
Dr Nicholas Mulwa
Charles
introduction
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Inappropriate prescribing habits lead to
ineffective and unsafe treatment,exacerbation or
prolongation of illness, distress and harm to the
patient and higher costs.
They also make prescriber vulnerable to
influences which can cause irrational prescribing;
important reasons being lack of knowledge about
drugs, unethical drug promotions and irrational
prescribing habits of clinicians
Introduction…
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Monitoring of prescriptions and drug utilization
studies can identify the problems and provide
feedback to prescribers so as to create awareness
about irrational use of drugs.
Indicators of prescribing practices measure the
performance of health care providers in several
key dimensions related to the appropriate use of
drugs and are useful tools to promote rationale
prescribing.
objectives
The broad objective of the study was;
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To perform a drug ulilization review of the
prescribing practices and patterns at Kenyatta
National Hospital Out-Patient Department
(Pharmacy 15)
The specific objectives were: To determine
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the average number of drugs prescribed per
prescription
the percentage of drugs actually dispensed per
prescription
methodology
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A sample of 60 prescriptions was selected by
systematic random sampling.
Data from the prescriptions were entered into a
specially designed data collection tool
The following parameters were recorded for each
prescription:
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Patient information.
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Prescriber information.
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Drug information.
METHODOLOGY…
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The number of drugs prescribed in each
prescription was taken into account to calculate
the average number of drugs prescribed per
prescription.
The percentage of drugs actually dispensed per
prescription was calculated.
Further, the percentage of drugs prescribed by
generic name was compared to those prescribed
by brand name
Finally, the proportion of prescribed drugs which
were consistent with the hospital tender list was
calculated
RESULTS
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The average number of drugs prescribed per
prescription was three
Only about two-thirds (65%) of the prescribed
drugs were actually dispensed at Pharmacy 15
implying a 35% stock out level
Slightly more than half (52%) of the drugs were
prescribed by generic name indicating that 48%
of the drugs were prescribed by brand names
Results…
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Prescribing by brand names was common with
FDCs (70%) compared to single formulations
(30%
Almost all drugs prescribed (95%) were
consistent with the hospital tender list
DISCUSSION
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The average number of drugs prescribed per
prescription was three
Incidences of polypharmacy were few, usually
occurring when it was inevitable, for example in
the management of comorbidities
Polypharmacy increases chances of drug
interactions, cost of drugs and promotes nonadherence.
Discussion…
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Only about two-thirds (65%) of the prescribed
drugs were actually dispensed at Pharmacy 15
implying a 35% stock out level.
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Reasons for the stock out were majorly:
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Inadequate funds for procurement of medicines
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Prescribing by brand names
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Inadequate record keeping (for example, bin card
indicates adequate stocks but physically there
are no stocks)
Inefficient distribution (for example, placing
orders late)
Discussion…
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Slightly more than half (52%) of the drugs were
prescribed by generic name.
Prescribing by brand names posed several
challenges, for instance:
It contributed to an increase in waiting time for
the patients.
It also lead to unwarranted out-of-stock
situations especially if the branded product was
new in the market.
DISCUSSION…
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Almost all drugs prescribed (95%) were
consistent with the hospital tender list
However, consistency with the hospital formulary
would have been a better indicator, but this could
not be established since compilation of the
formulary was ongoing at the time of study
RECOMMENDATIONS…
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In summary,proper quantification and prompt
ordering from the main store.
Regular sensitization of prescribers on the
benefits of rational prescribing is required.
Prescribing by brand names should be avoided.
Finally, more studies are required to determine
the extent of irrational prescribing at Kenyatta
National Hospital.
Asanteni
sana