ASSESSMENT OF MEDICINE USE PRACTICES IN MBAGATHI DISTRICT HOSPITAL OUTPATIENT DEPARTMENT.

Abstract

Irrational use of drugs is a major health problem whose consequences include ineffective treatment, unnecessary prescription, development of resistance to antimicrobials, adverse effects and economic burden to the patients. The rational use of antibacterial agents is being increasingly recognized as an important contribution to control the worldwide emergence of bacterial resistance, to minimize the side effects and to reduce the cost of the treatment. A study of prescription patterns is an important tool to determine rational drug therapy and maximize utilization of resources. Despite the grave consequences about the irrational use of medicines in public facilities, there is limited data available about the appropriate or inappropriate prescription practices in government hospitals in Kenya. The general objective of this study therefore was to assess medicine use practices by health care workers by using World Health Organization prescribing and patient care indicators in Mbagathi District Hospital outpatient department. Specific objectives were to determine the number of medicines per prescription, to determine what proportions were antibiotics, injectables, prescribed using their generic names and from the essential medicine list. The study also determined what proportion of the prescribed drugs were actually dispensed to the patient. This was a hospital based cross sectional retrospective study involving the review of prescriptions from the outpatient department from January 1st 2012 to June 30th 2012. A standard data collection tool developed by WHO was used for assessing prescribing indicators. Total number of drugs prescribed was 1,506. On average, each patient was prescribed 3.85 types of drugs. A total of 835 drugs were prescribed by generic name, accounting for 55.4% of total number of drugs prescribed (1,506). Out of 391 sampled prescriptions, 266 had antibiotics accounting for 68%. A relatively small proportion of the prescriptions (9.5%) had an injection prescribed. A total of 1,087 drugs were prescribed according to the essential medicine list (EML) accounting for 72.2%. Only 55.2% of total medicines prescribed were actually dispensed. This study revealed that prescribing practices were unacceptable as depicted by poly-pharmacy and prescription by brand names. Medicines were also not available in 44.8% of the cases. It is necessary to make prescribers aware about the appropriate use of drugs and importance of prescribing drugs with their generic names. There is also a need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of drugs as well as supervision. Procurement of approved fixed dose combinations of medicines was recommended to reduce pill burden and allocation of more funds for drug procurement. Medicine and therapeutics committees should be set up and be fully functional at both the county level and the hospital level.