Pharmacoepidemiological studies of prescribing practices of health care providers of Pakistan: A cross-sectional survey

Hussain, Shahzad; Malik, Farnaz; Hameed, Abdul; Parveen, Ghazala; Raja, Fahadya Yasin; Riaz, Humayun; Shafaat, Shazia; Wajid, Amina; Channa, Rafique Ahmad

doi:10.5897/ajpp11.242

Cited by 9 publications

(16 citation statements)

References 19 publications

(16 reference statements)

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“…Similar findings were reported from Peru and Bangladesh, where pharmacists prescribed antibiotics much more commonly than doctors [38,39]. In Pakistan, surveys reported that Government doctors advised less antibiotics and laboratory tests than private practitioners [31,40].…”

Section: Discussionsupporting

confidence: 79%

Diarrhoea-related knowledge and practice of physicians in urban slums of Kolkata, India

et al. 2013

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Diarrhoeal management practices are unsatisfactory in India especially in the slum areas. Dearth of information regarding physicians' diarrhoea-related knowledge and practice in India necessitated this cross-sectional study of allopathic practitioners in the slums of Kolkata, to assess the distribution and interrelationship between physicians' characteristics, knowledge and practice regarding diarrhoea. A total of 264 randomly selected consenting practitioners were interviewed using a field-tested questionnaire. Nineteen percent had good overall knowledge, 49% and 80% prescribed antibiotics to diarrhoea and cholera patients, respectively, and 55% advised stool examination for every case. Qualified and Government physicians had better knowledge regarding diarrhoea [MBBS: odds ratio (OR) 5·96, P < 0·001; postgraduates: OR 9·33, P < 0·001; Government physicians: OR 11·49, P < 0·0001] and were less likely to prescribe antibiotics for all diarrhoea cases (MBBS: OR 0·30, P = 0·002; postgraduates: OR 0·20, P < 0·001; Government physicians OR 0·24, P < 0·029). Better knowledge was associated with a lower likelihood of prescribing antibiotics for diarrhoea (OR 0·72, P < 0·001), cholera (OR 0·78, P = 0·027) and investigative procedure (OR 0·85, P = 0·028). In the slums of Kolkata, diarrhoea-related knowledge and practice were poor with the exception of qualified physicians, hence an improvement in the knowledge of pharmacists and unqualified practitioners is necessary for the overall improvement of diarrhoeal management in these slums.

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Section: Discussionsupporting

confidence: 79%

Diarrhoea-related knowledge and practice of physicians in urban slums of Kolkata, India

et al. 2013

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“…Rational fluid therapy was significantly predicted by best knowledge regarding diarrheal signs/symptoms, occurrence/spread, prevention/control and ORS. Physicians’ knowledge and other patient related factors were found to have strong correlations in other studies also [ 3 , 32 , 57 ].…”

Section: Discussionmentioning

confidence: 59%

“…Longer duration of practice was associated with higher odds of rational antibiotic use in case of watery/bloody diarrhea. An exploratory research involving physicians in peri-urban area of Lima, Peru previously illustrated that length of practice was an important predictor of appropriate prescription habit among practitioners [ 53 ] while some other studies also reported similar influence of practitioners’ experience on management practices [ 3 , 40 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors of Rational Management of Diarrhea in an Endemic Setting: Observation from India

Mahapatra

Banerjee

et al. 2015

PLoS ONE

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BackgroundDecades after the establishment of clear guidelines for management, mostly due to irrational approach, diarrhea is still a major concern in the developing world, including India. The scenario is even worse in urban slums owing to poor health-seeking and socio-environmental vulnerability. Determining the distribution of rational diarrhea management by practitioners and identification of its important predictors seemed urgent to minimize the potential for antibiotic resistance, diarrhea-related mortality and morbidity in these areas.MethodsBetween May 2011 and January 2012, 264 consenting, randomly selected qualified and non-qualified practitioners (including pharmacists) were interviewed in the slums of Kolkata, a populous city in eastern India, regarding their characteristics, diarrhea-related knowledge (overall and in six separate domains: signs/symptoms, occurrence/spread, management, prevention/control, cholera and ORS), prescribed antibiotics, intravenous fluid (IVF) and laboratory investigations. Rationality was established based on standard textbooks.ResultsAmong participants, 53.03% had no medical qualifications, 6.06% were attached to Governmental hospitals, 19.32% had best knowledge regarding diarrhea. While treating diarrhea, 7.20%, 17.80% and 20.08% respectively advised antibiotics, IVF and laboratory tests rationally. Logistic regression revealed that qualified and Governmental-sector practitioners managed diarrhea more rationally. Having best diarrhea-related knowledge regarding signs/symptoms (OR=5.49, p value=0.020), occurrence/spread (OR=3.26, p value=0.035) and overall (OR=6.82, p value=0.006) were associated with rational antibiotic prescription. Rational IVF administration was associated with best knowledge regarding diarrheal signs/symptoms (OR=3.00, p value=0.017), occurrence/spread (OR=3.57, p value=0.004), prevention/control (OR=4.89, p value=0.037), ORS (OR=2.55, p value=0.029) and overall (OR=4.57, p value<0.001). Best overall (OR=2.68, p value=0.020) and cholera-related knowledge (OR=2.34, p value=0.019) were associated with rational laboratory testing strategy.ConclusionDiarrheal management practices were unsatisfactory in urban slums where practitioners’ knowledge was a strong predictor for rational management. Interventions targeting non-qualified, independent practitioners to improve their diarrhea-related knowledge seemed to be required urgently to ensure efficient management of diarrhea in these endemic settings.

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“…This will enhance appropriate prescribing as well as prescribers' and dispensers' knowledge of the prescribing process and formulary management. Alongside this, the development, distribution and monitoring of physician adherence to STGs for high priority disease areas [32]. The WHO provides good guidance on how to establish DTCs,[103] and the experience in Stockholm, Sweden, and other countries suggests that trusted physicians should be a key element in the development of formularies and prescribing guidance to enhance subsequent adherence [18,19].…”

Section: Discussionmentioning

confidence: 99%

“…Alongside this, the development, distribution and monitoring of physician adherence to STGs for high priority disease areas. [32] The WHO provides good guidance on how to establish DTCs, [103] and the experience in Stockholm, Sweden, and other countries suggests that trusted physicians should be a key element in the development of formularies and prescribing guidance to enhance subsequent adherence. [18,19] Such activities should be undertaken alongside instigating continuous medical education and continuous professional development for physicians surrounding an agreed list of prescribed drugs.…”

Section: Discussionmentioning

confidence: 99%

Prescribing of bisphosphonates and antibiotics in Pakistan: challenges and opportunities for the future

Riaz

Godman

Hussain

et al. 2015

Journal of Pharmaceutical Health Services Research

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This version is available at https://strathprints.strath.ac.uk/52649/ Strathprints is designed to allow users to access the research output of the University of Strathclyde. Unless otherwise explicitly stated on the manuscript, Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Please check the manuscript for details of any other licences that may have been applied. You may not engage in further distribution of the material for any profitmaking activities or any commercial gain. You may freely distribute both the url (https://strathprints.strath.ac.uk/) and the content of this paper for research or private study, educational, or not-for-profit purposes without prior permission or charge.Any correspondence concerning this service should be sent to the Strathprints administrator: strathprints@strath.ac.ukThe Strathprints institutional repository (https://strathprints.strath.ac.uk) is a digital archive of University of Strathclyde research outputs. It has been developed to disseminate open access research outputs, expose data about those outputs, and enable the management and persistent access to Strathclyde's intellectual output. AbstractIntroduction: The appropriate management of patients with osteoporosis and the rational use of antibiotics are growing concerns in Pakistan. The first step to improve patient care is to understand current prescribing patterns and the rationale behind these patterns. Aim: To assesses utilisation patterns, prescribing behaviour and the potential rationale among a range of medicines including bisphosphonates and antibiotics. Subsequently, use the findings to suggest potential future policies for all key stakeholders to improve patient care in the future. Methodology: A questionnaire based, cross-sectional study in both private and public health care facilities in Pakistan, conducted between January 2011 and December 2012, involving 438 physicians and15824 prescriptions. The second study involved 9984 outpatient prescriptions, 127 in-patient cases and over 100 prescribers and dispensers. Results: There was adequate history taking and examinations in approximately half of the physicians surveyed, with prescribing typically taking into account issues such as disease severity (84% of respondents) and the socioeconomic status of patients (53%). Prescribing of bisphosphonates was common certainly compared to medicines

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Pharmacoepidemiological studies of prescribing practices of health care providers of Pakistan: A cross-sectional survey

Cited by 9 publications

References 19 publications

Diarrhoea-related knowledge and practice of physicians in urban slums of Kolkata, India

Diarrhoea-related knowledge and practice of physicians in urban slums of Kolkata, India

Predictors of Rational Management of Diarrhea in an Endemic Setting: Observation from India

Prescribing of bisphosphonates and antibiotics in Pakistan: challenges and opportunities for the future

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