Audit of Prescribing Patterns in Saudi Primary Health Care: What Lessons Can be Learned?

Abstract

Background:The prescription of drugs is one of the most important factors in the rising costs of health services. The lack of proven benefit, and the definite cost and side effects of many prescriptions, have been found in many studies. The aim of the present study is to assess the prescribing pattern of primary health care (PHC) physicians in Riyadh city, the capital of Saudi Arabia. Patients and Methods: Prescriptions issued from eight PHC centers over two weeks (six months apart) were analyzed. The health centers were randomly selected to represent the geographical parts of Riyadh city. Results: A total of 17,067 prescriptions were analyzed. The most frequently prescribed drugs were antihistamines (25%), paracetamol (20.3%) and antibiotics (14.7%). Upper respiratory tract infection (URTI) was the diagnostic label used on more than half of the prescriptions. On the other hand, drugs for chronic illnesses such as diabetes mellitus (DM) and hypertension were written in a minority of the prescriptions. Antibiotics were prescribed for 26% and antihistamines for 28% of patients with URTI. Although it is well known that a large proportion of patients seen in PHC have a significant psychological or psychiatric disorder, no diagnoses of mental disorders were made. Conclusion: There is a pressing need for education of both patients and doctors regarding the benefit of treatment and control of chronic illnesses, and the limited contribution that the doctor or an antibiotic can make to many selflimiting conditions like URTI. Doctors should be educated on more appropriate and cost-effective prescribing. The detection and management of psychological disorders need special emphasis.

Assessing the construct validity and reliability of the parental perception on antibiotics (PAPA) scales

“…Most infections of the upper respiratory tract are viral in nature and neither require, or are effectively treated by, antibiotics [19]. The use of antibiotics to treat viral URTIs is considered a misuse of antibiotics [4,20-23]. Parents’ knowledge regarding URTIs and their treatment needs to be assessed in order to develop strategies that may reduce antibiotic overuse in children.…”

How NICE do we have to be? Lessons learned from the NICE experience

“…[8] The programs targeting chronic disease management were often less effective. [2–5] Several reasons were cited for this, including poor professional skills, which reflected in the misdiagnosis or mismanagement of major chronic conditions, such as, hypertension,[4] diabetes,[5] mental disorders,[9] and asthma. [10] Similarly, problems were documented in the diagnosis and management of common conditions such as upper respiratory tract infections.…”

“…The effectiveness of clinical decisions was reported in terms of prescribing patterns,[910] as also diagnostic and referral practices. [5] Studies reported over-prescribing due to the fact that medications were provided free of charge.…”

“…[10] Prescriptions often lacked complete information, including dosage, strength, and duration of treatment. [9] Poor diagnostic and referral practices were also observed, for example, despite a high prevalence of diabetic retinopathy, only 40–68% of the diabetic patients were referred to eye clinics. [5]…”

Quality of primary care from the patient perspective in Saudi Arabia : a multi-level study.

“…There is evidence of misdiagnosis or mismanagement of major chronic diseases such as diabetes (Al-Khaldi, et al, 2002b), hypertension (Siddiqui, et al, 2001), asthma (Dashash, et al, 2003), and mental disorders (Al-Faris, et al, 1999). For example, one study evaluated the referral and feedback system for diabetic patients attending a primary care center in Abha city who also required a referral to an eye specialist.…”