Drug prescribing and dispensing practices in regional and national referral hospitals of Eritrea: Evaluation with WHO/INRUD core drug use indicators

Abstract

Rational use of medicine (RUM) for all medical conditions is crucial in attaining quality of healthcare and medical care for patients and the community as a whole. However, the actual medicine use pattern is not consistent with that of the World Health Organization (WHO) guideline and is often irrational in many healthcare setting, particularly in developing countries. Thus, the aim of the study was to evaluate rational medicine use based on WHO/International Network of Rational Use of Drugs (INRUD) core drug use indicators in Eritrean National and Regional Referral hospitals. A descriptive and cross-sectional approach was used to conduct the study. A sample of 4800 (600 from each hospital) outpatient prescriptions from all disciplines were systematically reviewed to assess the prescribing indicators. A total of 1600 (200 from each hospital) randomly selected patients were observed for patient indicators and all pharmacy personnel were interviewed to obtain the required information for facility-specific indicators. Data were collected using retrospective and prospective structured observational checklist between September and January, 2018. Descriptive statistics, Welch’s robust test of means and Duncan’s post hoc test were performed using IBM SPSS (version 22). The average number of medicines per prescription was 1.78 (SD = 0.79). Prescriptions that contained antibiotic and injectable were 54.50% and 6.60%, respectively. Besides, the percentage of medicines prescribed by generic name and from an essential medicine list (EML) was 98.86% and 94.73%, respectively. The overall average consultation and dispensing time were 5.46 minutes (SD = 3.86) and 36.49 seconds (SD = 46.83), respectively. Moreover, 87.32% of the prescribed medicines were actually dispensed. Only 68.24% of prescriptions were adequately labelled and 78.85% patients knew about the dosage of the medicine(s) in their prescriptions. More than half (66.7%) of the key medicines were available in stock. All the hospitals used the national medicine list but none of them had their own medicine list or guideline. In conclusion, majority of WHO stated core drug use indicators were not fulfilled by the eight hospitals. The results of this study suggest that a mix of policies needs to be implemented to make medicines more accessible and used in a more rational way.

Evaluating drug use patterns among paediatric outpatients in Burundi

“…This study discovered that the four-IRDP was 3.38, which is less than the optimal four. In addition, when evaluating the four indicators, this result was lower than the 3.89 and 3.83 revealed, respectively, by the Eritrea regional and national referral hospitals study, North-East Ethiopia (Siele et al, 2022 ; Wendie et al, 2021 ). However, this is higher than the 2.78 reported from Sri Lanka study (Galappatthy et al, 2021a ).…”

“…In addition, to assess drug usage comprehensively, Indices such as Index of Rational Facility Specific Drug Use (IRFSDU) and Index of Rational Drug Prescribing (IRDP) were developed by Zhi and Zhang (Akl et al, 2014 ; Siele et al, 2022 ; Wendie et al, 2021 ). To calculate indices of non-pharmacy and injection use safely, the following formula was applied.…”

Evaluation of the Knowledge and Practices About Drug Prescribing and Adverse Reaction Reporting Among Turkish Dentists

“…Good drug-prescribing knowledge and practices are the most important indicators of quality healthcare service (12). Scientific evidence-based correct drug indications and a properly filled out prescription are critical parameters of quality pharmacotherapy delivery (2).…”

Assessment of Prescribing Practices and Factors Related to Antibiotic Prescribing in Community Pharmacies

“…The World Health Organization (WHO) defines rational use of medication as the provision of “right medicine to the right patient, in the right dose, for the right duration of time, at the most economical cost to the patients and their community” [ 8 ]. According to the WHO, it is estimated that over half of all medicines are not properly prescribed, dispensed, or taken, leading to adverse patient outcomes [ 9 ]. Irrational use of medications has become a global problem.…”

“…Many studies have assessed general and antibiotic specific prescribing practices employing WHO core indicators in different settings, community pharmacies [ 15 , 16 , 17 , 18 , 19 , 20 , 21 ], primary health care centers [ 22 , 23 ], general [ 24 ] and referral [ 9 ] hospitals. The majority of these studies reported deviation from the optimum values of WHO core indicators, highlighting the need for regular review of drug use practices, education and training for health care providers on responsible drug use, and fostering a culture of continuous quality improvement.…”