The Effect of Educational Intervention on Rational Prescribing in Public Health Facilities in Selected Local Government Areas of Rivers State: An Interventional Study

Background: Despite progress made so far in identifying intervention models to improve drug use, irrational use of drugs has remained a serious global health problem. The study intends to determine the effectiveness of an educational intervention on rational prescribing among prescribers in selected local government areas of Rivers State. Methods: This was a quasi-experimental study that measured the effect of educational intervention on rational prescribing of drugs among prescribers in public health facilities in two selected Local Government Areas (LGA) of Rivers State: Ikwerre LGA (KELGA) which served as the control and Port Harcourt LGA (PHALGA) which served as the intervention by using cluster sampling with randomization. Paired data were analysed using McNemar’s Chi-square test and the paired t-test. The level of significance was set at P≤ 0.05. The EPI-INFO version 7.02 statistical software was used in the analysis. Results: Findings showed that the largest category of prescribers was nurse/midwives representing 48.61% and 44.4% in the intervention and control LGA respectively. There was an improvement in the knowledge and attitude of respondents in the facilities in the intervention LGA at one month and three months post-intervention (P<0.05). The average number of drugs per encounter (ANDPE), the percentage encounters with an antibiotic (PEA), the percentage encounters with an injection (PEI) were lower for the interventions group compared to the control (P<0.05). Percentage generic drug prescription (PGD) was higher in the intervention group compared to the control (P=0.001). Conclusion: Educational intervention was an effective and sustainable means of improving rational prescribing in the state. Update courses and continuing medical education on rational drug use should be held periodically for health care professionals by the State and National Primary Health Care Development Agency as well as other interested stakeholders.

Rational Medicine Prescription and Adherence to Prescription Format: A Description of Practices in the Private Sector in Addis Ababa, Ethiopia

Background: In Ethiopia, despite the private health sector's role in healthcare delivery is growing, studies on private health sector prescribing practices are uncommon. The main aim of this study was to evaluate the private health sector's rational prescribing practices and adherence to prescription format, using some of the World Health Organization (WHO) core drug use indicators in Addis Ababa, Ethiopia. Method: A retrospective cross sectional study design was used to collect quantitative data from prescriptions prescribed and dispensed by private health sectors in the Lemi-kura sub-city, Addis Ababa. The study was conducted from June to July, 2021. The WHO criteria were used to evaluate prescribing and prescription completeness indicators. Prescriptions, kept for the last 1-year that prescribed between January 1, 2020 to January 1, 2021 by private drug outlets, were analyzed. A combination of simple random sampling and systematic sampling procedures were employed. All the statistical calculations were performed using SPSS® V 20.0 software. Result: Off total of 1,200 prescriptions, 2,192 drugs were prescribed and the average number of drugs per prescription was 1.83 (Standard Deviation (SD)=0.9). Generic names, antibiotics, injections, and issued from national essential medicines list accounted for 77.4%, 63.8%, 11.5%, and 80.6% of all prescriptions, respectively. The patients' full names, ages, and sexes were mentioned in 99%, 95.3%, and 96.3% of prescriptions, respectively. The patient's card number (54.3%) and weight (2.3%) were not adhered to properly. The drug name, strength, dose, frequency, duration, and how to use, ranges from 85 to 99% of the prescriptions. Dosage forms (35.5%) and diagnoses (31.7%) were less likely to be completed. Only 36.6% and 25.8% of prescriptions, respectively, contained names and qualifications of prescribers. Obtaining prescription papers with the full name (9%), qualification (1.3%), and signature (26.8%) of the dispenser, and date of dispensing (0.7%), is extremely difficult. Interestingly, no dispenser filled out all of this information on a single prescription. Conclusion: The study's findings indicated rational prescribing and prescription completeness indicators were all considerably deviate from WHO standards and hence unsuitable. To promote rational medication use, health practitioners in the private sector should be given regulatory interventions, ongoing monitoring from relevant bodies, and regular training on good prescribing and dispensing practices.

STUDY OF DRUG UTILIZATION PATTERNS IN POSTPARTUM WOMEN IN GOVERNMENT MEDICAL COLLEGE, JAMMU (INDIA).

Background: There is a paucity of literature regarding rational prescribing practices especially during postnatal period.It was found worthwhile to assess the drug utilization patterns during postpartum period.It is known fact that the drugs prescribed during postnatal period have significant impact on the health of both mother and child. Material and Methods:A total of 1300 prescriptions of the patients which include 552 caesarian sections (cs) and 748 pervaginal (pv) delivery were randomly selected and studied. Results:It was recorded that the average number of drugs prescribed per prescription were 6.01 in cs patients and 10.95 in pv delivery group.The most commonly drugs that were prescribed were Antibiotics, analgesics, anti-inflammatory drugs, nutritional supplements (iron, calcium, multivitamins), H2 blockers and proton pump inhibitors (PPIs).In addition the other drugs included were oxytocin,prostaglandins,uetrine relaxants,antihyperttensives,bronchodilators,benzodiazepines,antifungal agents and antiepileptics.It was also found that 36.88%,16.75%,80.71% and 6.33% drugs prescribed were fixed dose combinations,generics,essential drugs and off label respectively in cs patients.Whereas, 42.96%, 13.23%, 78.81% and 8.2% drugs prescribed were fixed dose combinations, generic, essential drugs and off label respectively in pv patients. Conclusion: The results of this study reveals that there is need for educating prescribers regarding rational prescribing practices, especially during postnatal period when health of both infant and mother is at stake.

EXPERIENTIAL LEARNING METHODS IMPROVES RATIONAL PRESCRIBING SKILL IN MEDICAL STUDENTS

Background: Rational prescribing is an important skill for medical doctors. Many graduates still feel insufficiently prepared to make rational prescribing and fail to demonstrate the related clinical reasoning after graduation. For these reasons, it is important to improve the medical student teaching of rational prescribing. The aim of this study is proving the effectiveness of experiential learning methods to improve rational prescribing skills of medical students.Methods: This study used a one-group pretest-posttest design. Rational prescribing courses use experiential learning methods for 6 year medical students. Every student provided evaluation of rational prescribing and clinical reasoning through pretest and posttest, and we analyzed the results by paired t test.Results: The change in the rational prescribing skill of the students is significant between pretest and posttest. However, in the hypertension case the scores are not significant between pretest and posttest. Also, the scores of clinical reasoning based on drug interaction and evidence based methods are not significant in the hypertension and otitis media cases.Conclusions: Experiential learning methods can enhance rational prescribing skill in medical students but the students were still not able to choose appropriate medications based on drug interaction and evidence based approach.

Core Prescribing Indicators and the Most Commonly Prescribed Medicines in a Tertiary Health Care Setting in a Developing Country

Irrational prescribing is common, especially in developing countries. It is important to identify the magnitude of irrational use, to take necessary steps to promote rational prescribing. We identified core prescribing indicators and commonly prescribed medicines at ward settings (IW) and outpatients’ clinics (OPC) in a tertiary care hospital in Sri Lanka. A descriptive cross-sectional study was carried out at IW and OPC settings. Prescriptions were obtained from 5 major specialties (Clinical Medicine (CM), Gynaecology and Obstetrics (GO), Paediatrics, Psychiatry, and Surgery). The WHO core prescribing indicators were used to describe the pattern of prescribing, and the most commonly prescribed medicines were identified. A total of 1,318 prescriptions were analyzed. The five most commonly prescribed medicines were paracetamol (31.0%), omeprazole (20.6%), folic acid (18.3%), atorvastatin (16.2%), and salbutamol (15.3%). The average number of medicines per encounter was 4.8 ± 3.6 (IW: 5.7 ± 4; OPC: 3.8 ± 2.8; p < 0.001 ), with the highest IW (7.8 ± 4.2) and OPC (7.8 ± 2.7) values were from CM, being significantly higher than all other disciplines ( p < 0.05 ). Percentage encounters with an antibiotic or an injection was 26.4% and 30.1%, respectively, with IW being significantly higher than OPC ( p < 0.001 ). Percentage of medicines prescribed by generic name and from the essential medicine list (EML) was 90.1% and 91.1%, respectively, with no significant IW and OPC difference. In conclusion, a high degree of polypharmacy was noted. The use of injectable medicines, prescribing from the EML, and generic name prescribing was satisfactory; however, overall rational prescribing needs further improvement. Further investigation into the degree of rational prescribing associating it with clinical information will be important.

Treatments for Parasitic Diseases Based on Rational Prescribing of Drugs according to Avicenna’s Approach

Objective: Infections caused by parasitic worms are among the most common diseases in the world. Considering the parasitic infections resistant to treatment, drug side effects and the emergence of new immunological diseases, it seems more necessary to pay attention to the views and therapeutic experiences of physicians in Iranian Traditional Medicine (ITM). Methods: As A review study, data related to parasitic diseases and worms were first collected from Avicenna’s the Canon of Medicine book and other ITM books, and then underwent content analysis. Avicenna’s approach in the treatment of these diseases was studied based on the rational prescribing model. Results: Avicenna’s approach in the treatment of parasitic diseases is based on problem-solving model and according to the summary of patients’ conditions in terms of disease severity and prioritization of causes. It varies from person to person. Conclusion: Awareness of the causes of parasitic diseases, categorization of their clinical symptoms based on ITM, knowledge of natural and herbal medicine and various methods of prescribing them according to the health principals along with diagnostic and therapeutic methods of classic medicine can be helpful in control and prevention of parasitic diseases.