A Systematic Review of Main Factors leading to Irrational Prescription of Medicine

Abstract

Context: One of the serious global problems is the irrational prescribing of medicines that can be regarded as harmful or wasteful. Inappropriate use and overuse of medicines, waste resources and therefore lead to health and economic consequences in patients. The goal of this systematic review was to identify factors associated with irrational prescriptions of medicine.Evidence Acquisition: We searched the Cochrane database of systematic reviews (via Cochrane library), PubMed, Medline, Scopus, Science Direct, BMC, Scholar Google, and SID from 1980 up to October of 2016. Results:Of the 594 papers, 26 papers were finally included. The combined results of the 26 papers indicated 24 factors for unnecessary prescriptions of medicine. Factors related to the patient were expectations, demand to prescribe, and poor medical knowledge. Factors related to the physician were inaccurate diagnosis, inadequate awareness and knowledge, low experience, information asymmetry, poor medical education, and the physician's attitude. Factors related to the institutional and political issues were fee-for-service, out-of-pocket payment, financial incentives, insurance reimbursements, insurance coverage, medicine subside, medicine advertisement, ineffective monitoring programs, regulation on prescription, prescription supervision, clinical guidance, and medicines near-expiry dates or expired. Conclusions:It can be concluded that the irrational/unnecessary prescription of medicine was influenced by many different factors, such as patient, physician, and institution. Thus to prevent irrational/unnecessary prescription, one needs to consider all the involved factors.Keywords: Drug Prescriptions, Prescriptions, Physician-Patient Relations ContextDifferent forms of irrational prescription include misuse, abuse, overuse, and polypharmacy. One of the serious global problems is irrational prescribing of medicines that can be considered as harmful and/or wasteful (1). While patients have the choice to select their doctors, doctors have the choice to decide on the kind of diagnosis and the quantity of health services patients consume. In other words, the doctor is the first gate to medicine use (2, 3). However, because of the patient's inadequate information about medicine, the physician has the possibility to influence both the kind of diagnosis and the number of health services provided, as well as possibly the number of visits (4-8). Physician-induced demand clearly implies an effort to persuade patients to overuse services (4, 9-12). According to WHO reports, more than 50% of all medicines are inappropriately prescribed or sold, and nearly half of the patients do not take them appropriately (13). The report shows that patients are treated better in public sectors than private ones based on standard clinical guidelines (1). Ramezankhani et al. in a study on assessing the medicine prescriptions of health care centers, found out that prescription of medicine in the private sector was more than that of the public sector due to better monit...

Irrational Use of Medicine in the Treatment of Presumptive Asthma Among Rural Primary Care Providers in Southwestern China

“…The number of encounters in which only unnecessary drugs were prescribed in an SP visit is almost twice that in a clinical vignette without (76 vs. 38%) and with (76 vs. 51%) consideration of drug availability. Inappropriate incentives for drug dispensing has been widely cited as a factor that encourages providers to prescribe more unnecessary drugs than they should ( World Health Organization, 2002 ; Holloway and Van Dijk, 2011 ; Mao et al, 2015 ; Mohamadloo et al, 2017 ). Another explanation is that providers were more likely to prescribe unnecessary drugs in an SP visit because there were more uncertainties in the diagnosis due to unavailability of medical equipment for examinations and tests.…”

“…Existing studies suggest three main reasons for IUM in LMICs. First, inadequate knowledge and poor training of health professionals have been shown to be highly correlated with a high prevalence of IUM in LMICs (World Health Organization, 2002;Das et al, 2012;Mao et al, 2015;Mohamadloo et al, 2017;Machowska and Lundborg, 2019). Second, there is evidence that structural factors related to limited health system resources (e.g., the unavailability of medical equipment, unrestricted availability of medications, high caseloads) are negatively associated with appropriate prescribing practices and the ability of providers to apply their knowledge (Das and Hammer, 2014;Giorgio et al, 2020).…”

“…Second, there is evidence that structural factors related to limited health system resources (e.g., the unavailability of medical equipment, unrestricted availability of medications, high caseloads) are negatively associated with appropriate prescribing practices and the ability of providers to apply their knowledge (Das and Hammer, 2014;Giorgio et al, 2020). Third, studies of IUM in different settings have found that institutional features, including financial incentives, promotion of medications, and system-wide legislations as well as sociocultural factors and political issues, to affect the behavior of providers (World Health Organization, 2002;Holloway and Van Dijk, 2011;Mao et al, 2015;Mohamadloo et al, 2017). These institutional and other features also can amplify knowledge deficits of both providers and patients (Mao et al, 2013).…”

“…Existing studies suggest three main reasons for IUM in LMICs. First, inadequate knowledge and poor training of health professionals have been shown to be highly correlated with a high prevalence of IUM in LMICs ( World Health Organization, 2002 ; Das et al, 2012 ; Mao et al, 2015 ; Mohamadloo et al, 2017 ; Machowska and Lundborg, 2019 ). Second, there is evidence that structural factors related to limited health system resources ( e.g.…”

Psychometric Design of a Questionnaire for the Prevention of Induced Demand for Medicine Prescription

“…Unnecessary demand for healthcare services for patients is a major concern in health economics research [1][2][3], which may include various medical interventions ranging from medicine prescription to operational interventions [4,5]. According to the literature, some of the main contributing factors to unnecessary medicine prescription include physician-related factors, patient-related factors, and political and institutional factors [6,7]. According to the World Health Organization (WHO), more than 50% of medicines are not prescribed or sold appropriately, and approximately 50% of patients use medicines improperly [8].…”