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

Abstract

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

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

“…be broken down into educational activities including (i) academic detailing with varying degrees of success and evidence, (ii) guidelines and clinical decision support systems, (iii) initiatives to delay the prescribing of antibiotics especially for URTIs, (iv) special prescription forms highlighting the importance of antibiotics in healthcare, (v) having posters in surgeries emphasizing the commitment of family doctors to reducing unnecessary prescribing of antibiotics, (vi) instigating point of care testing to determine the likely cause of the infection, (vii) instigating quality indicators (QIs) and monitoring performance against these, (vii) undertaking regular auditing of prescribing and feedback, (viii) restricting the number and prescribing of certain antibiotics, (ix) separating prescribing and dispensing, (x) and restricting pharmaceutical company activities 85 . Restricting or addressing inappropriate pharmaceutical company activities is particularly important in LMICs, where companies can be the principal source of physician education regarding antibiotics 330,331 . Selective point-of-care testing is seen as potentially beneficial in patients with URTIs 101,332 , and decision support systems have been shown to reduce the overuse of antibiotics in ambulatory care settings 333 .…”

Trends in the prescribing of antipsychotic medicines in Pakistan: implications for the future

“…Different brands of risperidone and olanzapine were also documented to see if appreciable competition would help to lower prices as seen in countries such as the Netherlands (75). This included different branded generics, which are common in Pakistan, with competition to potentially reduce prices seen as important given current high co-payment levels for medicines in Pakistan (76). The value of medicines has been documented in Pakistan Rupees [85 -105 Pakistan Rupees = 1 US$ -average from 2010 to 2015] (77).…”

“…The database of adult (≥ 18 years) patients receiving any antipsychotic medicine in the outpatient departments of both public and private hospitals in Rawalpindi and Islamabad was retrieved from May 2016 to October 2016. These two cities were chosen as they are representative of other cities in Pakistan (76).…”

The antibiotic prescription practice in primary health care from the pharmacist perspective

“…For almost every third diagnosis in this study (28.65%) there was no recommended therapy included in national guidelines. Th ere are several reasons for the inappropriate use of antibiotics: failure to adhere to national guidelines, lack of knowledge and professional training, pressure from pharmaceutical companies, the fi nancial benefi t for physicians, and patient pressure on doctors to prescribe antibiotics even when they are not necessary [32][33][34][35][36][37][38]. One of the most important steps to slow down the development and spread of resistance is the rational use of antibiotics [39], per local guidelines, which are based on local antibiotic resistance maps [3].…”