WHO/INRUD Core drug use indicators and commonly prescribed medicines: a National Survey from Sri Lanka

Abstract

Background Identification of internationally comparable indicators of medicines use are important for a country to implement strategies and regulations to improve usage of medicines. Sri Lanka established a new National Medicines Regulatory Authority in 2015 and this survey evaluated the medication use indicators in Sri Lanka, according to the International Network on Rational Use of Drugs (INRUD), prior to its implementation. Methods This descriptive-cross-sectional study was conducted in 80 pharmacies, representing all 25 districts of the country. Three pharmacy categories were included; privately owned pharmacies, ‘Rajya Osusala’ pharmacies operated by the State Pharmaceuticals Corporation (SPC) of Sri Lanka and SPC Franchisee pharmacy outlets. Selection of pharmacies from respective districts were done proportionate to estimated population. Data were collected to identify WHO/INRUD core drug use indicators and the commonly prescribed medicines. Results Total of 2328 prescriptions were included (‘Rajya Osusala 559; SPC Franchise 711; private pharmacies 1058). Altogether 7,255 medicines were prescribed, and the 3 most commonly prescribed medicines were atorvastatin, losartan and metformin. Average number of medicines per encounter was 3.1±1.9 (Median: 3; range 1-12) Highest average number of medicines per encounter was reported in prescriptions received at ‘Rajya Osusala’ pharmacies (3.6±2.2), significantly higher than in other categories of pharmacies (p<0.001). Percentage of medicines prescribed by generic name was only 35.5%, highest at the ‘Rajya Osusala’ pharmacies (40.6%), significantly higher than other categories of pharmacies. The overall percentage of medicines prescribed from essential medicine list (EML) was 68.8%, without any significant variation between different categories of pharmacies. The percentage of medicines actually dispensed and accurately labelled were 92.4 and 98.5% respectively. Conclusions The average number of medicines per encounter was higher than the WHO recommended value but the usage of antibiotic and injectable drugs were within recommended standards. Generic prescribing, was very much lower. The EML prescribing, labelling and percentage dispensed medicines fared much better although lower than the WHO recommended 100% compliance. This island wide study has provided national wide data before the implementation of key changes in regulation of medicines in Sri Lanka and a repeat survey will be useful to identify impact of the new legislations.

Evaluating drug use patterns among paediatric outpatients in Burundi

“…Even though the percentage of drugs prescribed from EMLs were lower compared to WHO optimal value for the current study, the results were higher than more other findings revealed from studies conducted in India (37.37%; 58.3%), Nepal (65.8%; 80.9%), UAE(47.7%; 83.8%), Sri Lanka (68.8%), and Sudan (81.19%) (Abu Farha et al, 2022 ; Aryal et al, 2020 ; Atal et al, 2021 ; Galappatthy et al, 2021b ; Mandal et al, 2022 ; Rabbani et al, 2023 ; Shrestha et al, 2021 ; Yousif & Supakankunti, 2016 ).…”

“…The findings from the present study on average number of medicines per encounter were compared to results from prescribing indicator studies conducted in Ethiopia (1.95), Nigeria (3.4), Tanzania (1.99), Sudan (2.4), Ghana (3.5), Nepal(2.6), India (6.12), Sri Lanka (3.1), Sierra Leone (3.6), China(2), Iran (3.14), Brazil (2.4), and 3.1 for African region (1995–2015 systematic analysis) (Abdin & Mohammed, 2021 ; Ahmadi & Zarei, 2017 ; Aryal et al, 2020 ; Galappatthy et al, 2021b ; Jin et al, 2019 ; Kabba et al, 2020 ; Kilipamwambu et al, 2021 ; Lima et al, 2017 ; Mathew et al, 2021 ; Ofori-Asenso et al, 2016 ; Okoye et al, 2022 ; Prah et al, 2017 ; Yimer et al, 2022 ).…”

“…These findings were higher than the WHO optimal value (100%). Comparing these results to others from previous similar studies, lower results were found in India (15.96%), Nepal (57.7%), United Arab Emirates (UAE) (58.6%), Pakistan (56.6%), Sri Lanka (35.5%), Kenya (27.7%), Ghana (76%), Sudan (49.8%), and African region systematic review (68%) (Abdin & Mohammed, 2021 ; Amponsah et al, 2022 ; Atal et al, 2021 ; Atif et al, 2016b ; Galappatthy et al, 2021b ; Nyabuti et al, 2020 ; Ofori-Asenso et al, 2016 ; Rabbani et al, 2023 ; Shrestha et al, 2021 ). These lower results could be attributed to the non-establishment or non-enforcement of the regulatory policies.…”

“…The percentage of encounters in which a patient was prescribed at least one injection in the present study was 9.9%, which is closer the value found in 2014 Burundi outpatient encounter study all ages considered (Holloway & Henry, 2014 ), was lower than the value recommended by WHO (13.4–24.1). Results were similar to those from studies conducted in India (1.98%; 0.64%), Northwest Ethiopia (9.5%), Nepal (0.6%, 4.2%), UAE (9.5%; 0.5%), Pakistan (0%), Sri Lanka (1.2%), Ghana (7%), and in Rwanda (1.2%) (Abu Farha et al, 2022 ; Amponsah et al, 2022 ; Aryal et al, 2020 ; Atal et al, 2021 ; Atif et al, 2016b ; Galappatthy et al, 2021b ; Habimana et al, 2020 ; Mandal et al, 2022 ; Rabbani et al, 2023 ; Sema et al, 2021 ; Shrestha et al, 2021 ). In contrast, the results that exceeded the WHO optimal values were revealed from Iran (24.4%), the 1995–2015 African region systematic review (25%), and Kenya (24.9%) (Ahmadi & Zarei, 2017 ; Nyabuti et al, 2020 ; Ofori-Asenso et al, 2016 ).…”

“…For proper drug prescribing, research to determine the scope of irrational drug use are necessary in order to develop and put into practice corrective measures that will encourage rational prescribing (Galappatthy et al, 2021b ). In this way, the existing healthcare system would be able to guarantee that patients receive treatments that are both safe and effective.…”