Study on drug use pattern in primary healthcare centers of Kathmandu valley

Abstract

Background: The basic health service is a fundamental right of every citizen. Appropriate use of medicine is an essential component for the quality of health. Drug use evaluation is a systematic and criteria-based drug evaluation, which ensures the appropriate use of the drug. The purpose of this study was to analyze the drug use situation in primary healthcare centers of Kathmandu valley. Methodology: A cross-sectional descriptive study was performed in all primary healthcare centers of Kathmandu valley. Six hundred prescriptions were analyzed retrospectively, choosing a simple random sampling method for prescribing indicators. One hundred twenty patients were interviewed for patient-care indicators, and health facility representatives were interviewed for health facility indicators. Drug use indicators developed by World Health Organization/International Network for Rational Use of Drugs were used with slight modification. Result: The average number of drugs per encounter was 2.6. The percentage of drugs prescribed by generic names and from the essential medicine list was 60% and 80.9%, respectively. The prescriptions encounters with antibiotics and injections were 58% and 4.2%, respectively. The average consultation and dispensing time were 3.6 min and 54.4 s, respectively. The percentage of drugs actually dispensed was 76.6%. Only half of the patients knew the correct dose of the dispensed drug and no adequate labeling at all. The majority of dispensers were intern nursing students (42%), and all prescribers were medical officers. Ten out of 12 primary healthcare centers had a copy of EML. The availability of key drugs in primary healthcare centers was incomplete (64.7%). Conclusion: The observed values for all World Health Organization indicators deviated from the optimal range. Patient care provided by health facilities was insufficient and thus an effective intervention program for the promotion of rational drug use practice is recommended.

Generic Medicine and Generic Prescribing in Nepal: An Implication for Policymakers

“…Studies showed that 90–95% of medicines are prescribed in brand name in tertiary care health facilities where patients have the choice to choose generic alternative; whereas, only around 40% of medicines were found to be prescribed in brand name in governmental healthcare facilities where the government freely supplies the medication, and generally, patients do not have to purchase out of pocket. 7 , 8 , 30 , 32 …”

“… 31 On the other hand, Nepalese customers have low health literacy, 46 and do not have sufficient knowledge and awareness of generic medicines. They even do not clearly understand the medical terminologies, names of medications being prescribed, dose and administration schedule of prescribed medicines 7 ; thus, they rely entirely on the prescribers, pharmacists, nurses, and other healthcare professionals (HCPs), regardless of whether the medicines can be substituted by generic alternative or not. They do not have many options to choose medications themselves, highlighting the necessity of generic medicine intervention at both the HCPs’ and general population’s levels.…”

“…In addition, it often troubles patients to search for a particular brand and pay more incurred by high price variation among different brand alternatives. 7 , 8 , 32 So, strengthening the generic prescribing policy and practices can eradicate their confusion and facilitate their access to cost-effective generic alternatives.…”

“…Currently, majority of the Nepalese population relies on out-of-pocket (OOP) payment for their healthcare expenditure, 5 , 6 including medicines due to meager availability of limited essential medicines in a designated government healthcare institutions such as health posts (HPs), primary healthcare centers (PHCs), and district hospitals (DHs) at free of cost. 7–9 According to the Government of Nepal, medical products and medicines are the major (63.4%) OOP expenditure in Nepal. 5 Besides, the medicines available in the Nepalese market have wide variations in their price.…”

“…5 Besides, the medicines available in the Nepalese market have wide variations in their price. 7 , 8…”