Investigation of drug use at primary health centres in Nashik, Maharashtra, India

Abstract

Background: By recognizing the need to promote rational utilization of medicines, the World Health Organization (WHO) in collaboration with the International Network for Rational Use of Drugs (INRUD) developed a set of core indicators. This study aimed to investigate drug use based on it.Methods: The study was performed in Primary Health Centers (PHC) in Nashik District, Maharashtra, India. Prescriptions data for the last one year from PHCs were sampled out retrospectively. Outpatients from PHCs were selected, observed and interviewed for the patient-care indicators, prospectively. Pharmacy personnel was interviewed for the facility-specific indicators. The data were analyzed; results and conclusions were drawn.Results: The average number of drugs per prescription was 3.48 (SD=0.36). The percentages of drugs prescribed by generic name and from Essential Drug List or formulary were 83.98% and 68.97% respectively. The percentages of encounters with antibiotics and injections were 60.33% and 50.83% respectively. The average consultation and dispensing times were 3.89 minutes and 58.28 seconds respectively. 98.19% of the prescribed drugs were actually dispensed. 67.27% of the dispensed drugs were labelled. The percentage of patients’ knowledge of the correct dosage was 87.78%. The percentage availability of the EDL or formulary was 100% and of the key drugs in the stock was 85.71%.Conclusions: The need for improvement in prescribing practices can be encouraged by devising strategies such as training to physicians, rewards systems, etc. There should be plans to increase staff members for a particular working period and to educate patients with healthcare, hygiene, medicines’ compliance and common diseases.

Evaluation of Rational Use of Medicine Using WHO/INRUD Core Drug Use Indicators at Teda and Azezo Health Centers, Gondar Town, Northwest Ethiopia

“…Similarly, higher results were recorded in studies from different parts of Ethiopia (ranging from 1.9 to 3), 22,[24][25][26][27][28][29][30][31] and other developing countries (ranging from 2.30 to 3.98). 32,34,35,37,40,43,44,46,48,49,54 On the contrary, the average number of medicines per prescription within the acceptable range was reported by other studies from Ethiopia (ranging from 1.65 to 1.8). 17,18,36 The prescription of many medicines for a patient may decrease adherence to treatment, increase the cost of medicine incurred by the patient, elevate the risk of drug interaction, and expose the patient to unnecessary potential side effects of the medication.…”

“…35,68 Similarly, a consultation time lower than the optimal value was recorded in many previous studies done in developing countries including Ethiopia (ranging from 1.2 to 7.3 minutes). 19,25,32,37,42,43,45,47,54,56 However, optimum consultation time was recorded by studies done at Debre Markos Referral Hospital, Northern Ethiopia (10.46 minutes); 66 in Rural Rwanda (10.1 minutes), and western Nepal (30.33 min). 33 The workload of the prescribers, the number of patients visiting the institutions, and the number of staff may affect the consultation time, so that the institutions should work on improving the consultation time.…”

“…66 Similarly, higher values were reported by several previous studies in Ethiopia (ranging from 27.62% to 82.5%) [22][23][24][25][26][27][28][29][30][31]36 and other developing countries (ranging from 35.3% to 84.8%). 32,35,[37][38][39][40][41][47][48][49]51,54 Although the high use of antibiotics may be due to the prevalent nature of the infectious disease in developing countries, it should be given attention since it may increase the risk of antibiotic resistance.…”

“…However, a higher value was reported by the study done at Gondar University Teaching Referral Hospital (28.5), 18 Tikur Anbessa Specialized Hospital (53.1), 29 Hawassa University Teaching and Referral Hospital (38.1%), 20 Dilchora Referral Hospital (44.77%), 21 Debre Markos Referral Hospital (48.36%), 66 and Mekelle General Hospital (42.2%) in Ethiopia; 27 Khartoum State, Sudan (57.6%), 35 and Nashik, India (50.83%). 54 The difference may be due to the difference in the level of care of the institution. Even though injections are important formulations in certain emergency situations due to their fast onset of action, when other alternatives are not feasible, they have their own drawbacks including the risk of transmission of blood-borne infection and increased extra out-ofpocket expenditure.…”

“…50 However, the WHO/INRUD recommendation was not achieved in the most of previous studies in different parts of Ethiopia (ranging from 79.8% to 99.5%), [22][23][24][25][26][27][28][29][30][31]36 and many previous study reports outside of Ethiopia (ranging from 22.57% to 98.80%). 32,34,37,43,44,46,47,49,52,54,55 The prescription of medicine from the essential drug list in the facilities should be preserved since it is one of the major tools for implementing RUM. The adoption of such a list for any health facility can significantly improve the effectiveness of therapy; it decreases the amount of unwanted medicine prescription and promotes RUMs because medicines from the list are well known, already tested in practice, with established clinical use, and of lower cost than newer.…”