Rational use of medicines: prescribing indicators at different levels of health care

Abstract

This multicenter study aimed to investigate prescribing patterns of drugs at different levels of health care delivery in university-affiliated outpatient clinics located in eight cities in the South and Midwest of Brazil. All prescriptions collected were analyzed for various items, including WHO prescribing indicators. A total of 2,411 prescriptions were analyzed, and 469 drugs were identified. The number of drugs prescribed per encounter, the frequency of polypharmacy, and the percentage of encounters with at least one injection or antibiotic prescribed were higher in centers providing primary health care services, compared to those where this type of care is not provided. Most drugs (86.1%) were prescribed by generic name. In centers with primary health care services, drug availability was higher, drugs included in the National and Municipal Lists of Essential Medicines were more frequently prescribed, and patients were given more instructions. However, warnings and non-pharmacological measures were less frequently recommended. This study reveals trends in drug prescribing at different levels of health care delivery in university-affiliated outpatient clinics and indicates possible areas for improvement in prescribing practices.Keywords: Medicines/rational use. Medicines/prescription. Health Care/quality indicators. Pharmacy/ community services.Este estudo multicêntrico teve como objetivo investigar o padrão de prescrição de medicamentos para pacientes ambulatoriais atendidos em serviços de saúde vinculados a universidades com diferentes níveis de atenção, em oito cidades do sul e centro-oeste do Brasil. As prescrições coletadas foram submetidas à análise de diversos itens, incluindo os indicadores de prescrição propostos pela OMS. No total, 2.411 prescrições foram analisadas e 469 medicamentos foram identificados. O número de medicamentos prescritos por consulta, a frequência de polifarmácia e a porcentagem de consultas com pelo menos um medicamento injetável ou um antimicrobiano prescrito foram maiores em centros de saúde que ofereciam cuidados de atenção básica, em comparação com aqueles que não dispunham desse tipo de atendimento. A maioria dos medicamentos foi prescrita pelo nome genérico (86,1%). Em unidades com cuidados de atenção básica, a acessibilidade foi maior, a prescrição de medicamentos presentes nas Listas Nacional e Municipais de Medicamentos Essenciais foi mais frequente e instruções foram fornecidas aos pacientes mais comumente. Entretanto, advertências e medidas não farmacológicas foram indicadas com menor frequência. Este estudo revela tendências de prescrição de medicamentos em serviços de

Generic prescribing, brand and generic substitution, availability and cost effectiveness of the available medicines

“…In 2016, the percentage of generic prescription in USA was 84.6 percent 22 . One multicentre study in eight cities of South and Midwest of Brazil reported that most drugs (86.1%) were prescribed by generic name 28 . In The Bangladesh, court ordered that 'doctors must use generic drug names rather than specifying particular brands.…”

“…The Government of Bangladesh controls the price of 209 generic drugs in specified dosage forms, along with 41 active pharmaceutical ingredients produced in the country and medicine imports [26][27] .Nonetheless, irrespective of the level of healthcare delivery system, prescribing drugs by generic name reduces duplicity, improves access to medicines, and subsequently, escalates patient compliance with drug therapy and disease control. It is expected that emphasizing to medical students about generic medicines will improve and promote rational prescribing 28 . Lack of official channels to announce the patent status of major drugs.…”

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“…Many of the FDC available in Indian market lack therapeutic rationale for their use, leading to wasteful expenditure. [11][12][13] Most commonly prescribed FDC was pantoprazole domperidone followed by muscle relaxant NSAID combination, and others. Most of the FDCs (62%) were rational as per WHO Essential Medicine List.…”

Evaluation of prescribing patterns of medical practitioners in the state of Goa, India

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