Have we improved use of medicines in developing and transitional countries and do we know how to? Two decades of evidence

Holloway, Kathleen; Ivanovska, Verica; Wagner, Anita K.; Vialle-Valentin, Catherine; Ross‐Degnan, Dennis

doi:10.1111/tmi.12123

Cited by 95 publications

(157 citation statements)

References 13 publications

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“…Although China has implemented a zero drug profit policy since 2009, which aimed at removing profits on drug sales of health facilities, the connection between drug companies and individual doctors still contributes to this problem [18,19]. Compared with more developed regions, healthcare providers in less developed regions had lower incomes, experienced relaxed regulations, and were more likely to profit from overprescribing antibiotics [7,15,20]. Our findings also indicated that, even when doctors were initially unwilling to prescribe antibiotics, more students pressured doctors to prescribe antibiotics in less developed regions compared to developed regions [16,21].…”

Section: Discussionmentioning

confidence: 99%

Antibiotic misuse among university students in developed and less developed regions of China: a cross-sectional survey

Peng

Wang

et al. 2018

Global Health Action

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Background: Antimicrobial resistance (AMR) is a great threat to public health. The primary cause of AMR is human antibiotic misuse. Little is known about regional differences of antibiotic misuse behaviours in China. Objectives: To explore the antibiotic misuse behaviours among university students in western and eastern China and find out the regional differences. Methods: Participants were recruited from universities in less developed Guizhou Province and developed Zhejiang Province using a cluster random sampling method. A self-administered questionnaire was designed to collect data, and the χ2 test and logistic regression were adopted to assess the associations between region and antibiotic misuse behaviours. Results: A total of 2073 university students from Guizhou and 1922 from Zhejiang completed questionnaires. Students in Guizhou had lower household income, parents’ education, and urban residence proportion than those in Zhejiang. Compared with those in Zhejiang, students in Guizhou had higher antibiotic use prescribed by doctors (79.8% vs 56.2%) and self-medication with antibiotics (33.0% vs 16.1%). Students in Guizhou were more likely to buy over-the-counter antibiotics without prescriptions (73.9% vs 63.4%), ask for antibiotics from doctors (21.4% vs 15.6%), and use antibiotics prophylactically (29.9% vs 15.7%). Adjusted models showed that the less developed region was significantly associated with higher antibiotic misuse behaviours. Conclusions: Misuse of antibiotics by well-educated young adults was very high in two regions but most serious in the less developed one. Campaigns are urgently needed to promote appropriate antibiotic use especially in less developed regions.

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Section: Discussionmentioning

confidence: 99%

Antibiotic misuse among university students in developed and less developed regions of China: a cross-sectional survey

Peng

Wang

et al. 2018

Global Health Action

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“…As rasuras e emendas estavam presentes em 3,6% das prescrições analisadas (Tabela 2). Os resultados encontrados e dados provenientes de outros estudos [13,18] foram agrupados na Tabela 4, visando estabelecer uma análise comparativa.…”

Section: Resultsunclassified

“…Os indicadores da OMS referentes à prescrição de medicamentos pelo nome genérico e presentes nas LME apresentaram bons resultados na região estudada, principalmente quando comparados aos resultados obtidos em outros estudos nacionais ou internacionais, em que as porcentagens de adequação ao critério não ultrapassavam 90% [9,13,19,20]. A adesão a esses critérios pode ter impacto na redução de custos com a medicação para o usuário, além de proporcionar o acesso a medicamentos seguros e com eficácia terapêutica comprovada para as principais necessidades de saúde da população [21].…”

Section: Discussionunclassified

“…Os estudos de Rocha e Werlang [3] e Costa et al [11], ambos publicados em 2013, assim como o de Borges et al [12], publicado em 2015, abordaram a temática de uso de medicamentos na atenção básica e confirmaram o expressivo número de pacientes em uso de medicamentos psicotrópicos, bem como a necessidade da adoção de práticas de uso racional dos medicamentos. Em 2013, a revisão de Holloway et al [13] avaliou estudos sobre o uso de medicamentos em duas décadas de evidências, identificou aumento no número de medicamentos em uso e apontou que a necessidade de adequação aos critérios de uso racional é um problema mundial e necessita de atenção especial nos países em desenvolvimento.…”

Section: Introductionunclassified

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Prescrições em serviços de saúde mental: aspectos legais e indicadores do uso racional de medicamentos

Silva

Lima

2017

Sci Med

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Este artigo está licenciado sob forma de uma licença Creative Commons Atribuição 4.0 Internacional, que permite uso irrestrito, distribuição e reprodução em qualquer meio, desde que a publicação original seja corretamente citada. ABSTRACT AIMS: To evaluate the legal aspects and indicators of rational drug use in prescriptions issued by mental health services. METHODS: Prescriptions dispensed by pharmacies of reference of the Psychosocial Care Centers located in the Medio Paraopeba region, Minas Gerais, Brazil, were evaluated. A semi-structured questionnaire was developed for the collection of data, including the World Health Organization prescribing indicators and the criteria for compliance of prescriptions with the Brazilian legislation. RESULTS: A total of 390 prescriptions were analyzed, and the average number of drugs in each prescription was 2.17. It was observed that 96.78% of the drugs were prescribed by their generic names and that 97.13% were on the essential medicines list of municipalities. Legal aspects of the prescriptions were met for several criteria: 99.23% of the prescriptions had the prescriber's signature, 98.97% showed the date of issue, and 97.69% contained minimum information for the user regarding the use of the medications. None of the assessed health centers issued prescriptions with all the necessary patient data and with information about the dispensed medications, as required by law. CONCLUSIONS: The study indicated that most of the prescriptions analyzed complied with the legal requirements and that the indicators of rational medication use were satisfactory. However, information on dispensing control and records of users was incomplete, demonstrating problems with patient identification and with the traceability of dispensed medicines.

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“…The option to go on the more expensive second-line and third-line therapy increases the cost with serious consequences on the provision of healthcare especially in the developing and middle income countries . It has previously been reported that inappropriate use of antibiotics may be escalated by limited adherence to guidelines among physicians in a number of countries and non-adherence to guidelines is thought to be more prevalent among physicians in the public sector (40%) than private-forprofit sector facilities at <30% (Holloway et al, 2013;MdRezal et al, 2015). A study in Malaysia's private ambulatory care clinics (third highest category facility) showed high antibiotics utilisation compared to public primary health care centres (WHO, 2012).…”

Section: Discussionmentioning

confidence: 99%

Availability of guidelines and policy documents for enhancing performance of practitioners at the Primary Health Care (PHC) facilities in Gaborone, Tlokweng and Mogoditshane, Republic of Botswana

Mashalla¹,

Sepako²,

Setlhare³

et al. 2016

J. Public Health Epidemiol.

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This study aimed to determine the profile and availability of policies and guidelines as reference documents at Primary Health Care (PHC) facilities in Gaborone and its surrounding in Botswana using the World Health Organisation/Drug Action programme (WHO/DAP) Questionnaire. The Questionnaire is a standard recommended by WHO and therefore was not piloted. All 20 PHC facilities were included in the study, however, data from 18 clinics was collected and analysed. The Matron from each PHC facility was asked to name and produce as evidence, guidelines and policy documents available as reference in his/her PHC facility. Data was entered in an Excel spread sheet and percentages, averages and frequencies were used to describe the profile and availability of the documents at each facility. Fifty two different documents were available at the facilities, 50% of them were on treatment and management of diseases. The remaining 50% were distributed between general information/policy, Ante-Natal Clinic, obstetrics and gynaecological care, and family planning. Except for guidelines for treating sexually transmitted diseases (86%), availability of the other guidelines and policy documents was low (56%) or less. Policy and guideline reference information for disease immunisation and prevention were available at 4 and 13% PHC, respectively. This low availability of such important instruments may be compromising patient care in the studied PHC facilities and should be addressed. While the Ministry of Health has produced many policy documents and guidelines as reference documents for PHC providers, none of the clinics had all the documents, raising questions on what is available at the facilities as reference and guide in the prescription practices. It is recommended that ministries of health and PHC workers should ensure that necessary reference documents are available at the facilities and staff should be trained and retrained on the use of such documents.

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Have we improved use of medicines in developing and transitional countries and do we know how to? Two decades of evidence

Cited by 95 publications

References 13 publications

Antibiotic misuse among university students in developed and less developed regions of China: a cross-sectional survey

Antibiotic misuse among university students in developed and less developed regions of China: a cross-sectional survey

Prescrições em serviços de saúde mental: aspectos legais e indicadores do uso racional de medicamentos

Availability of guidelines and policy documents for enhancing performance of practitioners at the Primary Health Care (PHC) facilities in Gaborone, Tlokweng and Mogoditshane, Republic of Botswana

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