Prescribing patterns of physicians working in both the direct and indirect treatment sectors in Iran; findings and implications

Abstract

Objective There can be different incentives in the private versus public healthcare systems across countries influencing the delivery of health care. The implementation of regulations along with financial incentives and quality targets are key initiatives to improve rational prescribing. However, there are concerns in Iran that the different incentives in the Direct versus Indirect sectors can influence the delivery of care even among the same physicians. Consequently, the objective of this study was to evaluate the effect of Social Security Organization (SSO) rules and regulations on the prescribing patterns of physicians working simultaneously in both sectors of the SSO in Iran. Subsequently use the findings to suggest initiatives to improve future prescribing if needed.Methods Retrospective cross-sectional study on claims data. All prescriptions written by general practitioners, internists, gynaecologists and paediatricians that had at least 100 claims and working in both sectors were collected. Non-parametric tests were undertaken to compare prescribing patterns. Key findings 455 549 prescriptions were analysed. The average number of medicine items per prescription was 4 in the direct treatment setting versus 2 in the indirect treatment setting, while the proportion of prescriptions including at least one antibiotic, injectable, corticosteroid and injectable corticosteroid, were 31.5, 16.1, 8.7 and 3% respectively in the indirect treatment setting versus 28.7,13.7, 7.7 and 3.2% in the direct treatment setting. Except for antibiotic prescribing, all other differences were significant. Conclusions There are a number of areas of potential concern with physician prescribing in this study. These include the high use of antibiotics in both sectors, potentially inappropriate polypharmacy in the Direct sector, as well as possibly the overuse of injections especially in the Indirect sector, increasing costs and potentially patient harm. These will be the subject of future research projects.

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

“…This is again very different to high income countries where typically expenditure on pharmaceuticals is 15% or less of total healthcare expenditure and there is often universal healthcare 176,177 . There can also be long waiting times to see physicians in primary healthcare centres (PHCs) in LMICs, as well as long distances to travel to PHCs, putting time pressures on physicians as well as patients to seek alternative approaches including community pharmacists and private physicians 49,69,98,[178][179][180][181][182] .…”

<p>Prescribing for Patients Seeking Maternal and Child Healthcare in Sierra Leone: A Multiregional Retrospective Cross-Sectional Assessments of Prescribing Pattern Using WHO Drug Use Indicators</p>

“…More evidence is needed for definitive conclusions; nonetheless, the antimicrobial audit program might help in their rational use. 7 The initiation of free healthcare was on the pretext that financial barriers were the primary deterrent affecting healthcare uptake, and the most affected are women and children under five. 21,36 Across all health facilities studied, none of their pharmacies were able to dispensing all prescribed medicines to patients seeking FHC services, as will be expected.…”

“…More evidence is needed for definitive conclusions; nonetheless, the antimicrobial audit program might help in their rational use. 7 …”

“…2 However, research evidence suggests otherwise, for instance, the World Health organization (WHO) estimated that more than 50% of all drugs were inappropriately prescribed, dispensed or sold globally. 5,6 Constituent of irrational drug use includes; under and over-prescribing, 7 selecting branded over generic drugs, indiscriminate prescription of injections, prescribing not in accordance with standard treatment guidelines (STG) or not from the Essential Medicines List (EML) 2,8 and selection of unjustified combination therapies that are relatively expensive with no added advantages than single products. 9 Such an untoward effect of irrational prescribing as reported in previous studies is enormous.…”

“…An understanding of how drugs are used within a health system will enable a comparison of results and helps create informed policy formulation in managing health resources which is an essential aspect of patient care. 23 There have been several of these studies in Pakistan, 24 Nigeria, 25 Iran, 7 Egypt, 26 China, 11 Ethiopia, 2,9 and even in Sierra Leone. 1,27 Findings from the studies in Sierra Leonean 1,27,28 show medicines are inappropriately used in public hospitals.…”