Overuse of medications in low- and middle-income countries: a scoping review

Abstract

Objective To identify and summarize the evidence about the extent of overuse of medications in low- and middle-income countries, its drivers, consequences and potential solutions. Methods We conducted a scoping review by searching the databases PubMed®, Embase®, APA PsycINFO® and Global Index Medicus using a combination of MeSH terms and free text words around overuse of medications and overtreatment. We included studies in any language published before 25 October 2021 that reported on the extent of overuse, its drivers, consequences and solutions. Findings We screened 3489 unique records and included 367 studies reporting on over 5.1 million prescriptions across 80 low- and middle-income countries – with studies from 58.6% (17/29) of all low-, 62.0% (31/50) of all lower-middle- and 60.0% (33/55) of all upper-middle-income countries. Of the included studies, 307 (83.7%) reported on the extent of overuse of medications, with estimates ranging from 7.3% to 98.2% (interquartile range: 30.2–64.5). Commonly overused classes included antimicrobials, psychotropic drugs, proton pump inhibitors and antihypertensive drugs. Drivers included limited knowledge of harms of overuse, polypharmacy, poor regulation and financial influences. Consequences were patient harm and cost. Only 11.4% (42/367) of studies evaluated solutions, which included regulatory reforms, educational, deprescribing and audit–feedback initiatives. Conclusion Growing evidence suggests overuse of medications is widespread within low- and middle-income countries, across multiple drug classes, with few data of solutions from randomized trials. Opportunities exist to build collaborations to rigorously develop and evaluate potential solutions to reduce overuse of medications.

Mapping the environmental co-benefits of reducing low-value care: a scoping review and bibliometric analysis

“…As mentioned, the majority of LVC occurs in HIC settings, while environmental harms disproportionally impact LMIC settings [20, 21]. It is also important to note emerging research that identifies increasing overuse issues in low-resource settings [36]. The pervasiveness of LVC further supports global research and evaluation to inform practice change in this area, as overuse in LMIC settings is further exacerbated by limited public budgets, access to resources and complex population health needs [36].…”

Proton Pump Inhibitors in Germany: Status Quo of a Growing Market

“…Overuse of PPIs was reported in 53 of these studies. 17 Given the DDD calculations demonstrated in Table 1 , it is clear that high levels of PPI usage are common in regions such as Bavaria in addition to Germany as a whole. What this table shows specifically is that there seems to be a preference for large pack sizes, which is trend mirrored in this study ( Figure 4 ).…”

Overuse of computed tomography for mild head injury: A systematic review and meta-analysis

“…The overuse of diagnostic interventions in the health system is a growing concern worldwide [ 11 ]. The widespread use of diagnostic interventions such as CT scans, magnetic resonance imaging (MRI), and other imaging techniques, can result in unnecessary healthcare spending and increase the risk of harm to patients [ 12 ].…”

“…However, the lack of access to diagnostic interventions can also result in healthcare providers relying on guesswork or assumptions, which can lead to misdiagnosis and delayed treatment. Overuse of CT in cases of mild head injury is a significant concern as it can lead to unnecessary exposure to radiation and an increase in healthcare costs [ 11 ]. The aim of this systematic review is to investigate the rate of CT scan overuse in cases of mild head injury.…”