Validity of World Health Organisation prescribing indicators in Namibia’s primary healthcare: findings and implications

Niaz, Qamar; Godman, Brian; Massele, Amos; Campbell, Stephen; Kurdi, Amanj; Kagoya, Harriet Rachel; Kibuule, Dan

doi:10.1093/intqhc/mzy172

Cited by 69 publications

(100 citation statements)

References 25 publications

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“…There are also planned activities in Botswana and Namibia to develop pertinent quality indicators for assessing the quality of prescribing of antibiotics in ambulatory care given concerns with the WHO/INRUD (International Network for the Rational Use of Drugs) indicators as well as concerns with the extent of prescribing of antibiotics for URTIs among private general practitioners in Botswana 180,232,270,271 . This builds on discussions of possible quality indicators to influence future prescribing of antibiotics in other LMICs 272 .…”

Section: Malaysiamentioning

confidence: 99%

“…This builds on discussions of possible quality indicators to influence future prescribing of antibiotics in other LMICs 272 . Adherence to current guidelines is seen as a better predictor of the quality of prescribing of antibiotics than current WHO/ INRUD criteria 271 . Encouragingly in Namibia, whilst patients and parents regularly self-medicate for acute respiratory infections including the common cold and influenza for themselves and their children, this was typically with cold/flu medication, paracetamol and decongestants, rather than antibiotics.…”

Section: Malaysiamentioning

confidence: 99%

“…A team approach with consistent advice, improved communication between family doctors or general practitioners (GPs), patients and children's parents, including addressing current perceptions and de-medicalizing self-limiting viral infections, is seen as critical to improve antibiotic prescribing among family doctors for respiratory tract infections 152,156,202,208,318 . Seeking ways to improve guideline adherence is also seen as important 271 . Education initiatives for doctors starting at medical school may be necessary in LMICs where there are concerns with current training and its impact on reducing inappropriate prescribing of antibiotics 48,50,315,[319][320][321][322][323][324][325][326][327] .…”

Section: Physiciansmentioning

confidence: 99%

“…Specific QIs also include adherence to guidelines. Adherence to guidelines has been found to better represent the quality of prescribing in ambulatory care versus current WHO/INRUD criteria 271,313,335,348 . However, it is important that there is only one national reference guideline since where multiple guidelines exist contradictions can occur 236 .…”

Section: Quality Indicators (Qis) To Improve Antibiotic Prescribing Imentioning

confidence: 99%

See 3 more Smart Citations

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

Godman

Haque

McKimm

et al. 2019

Current Medical Research and Opinion

132

170

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Section: Malaysiamentioning

confidence: 99%

Section: Malaysiamentioning

confidence: 99%

Section: Physiciansmentioning

confidence: 99%

Section: Quality Indicators (Qis) To Improve Antibiotic Prescribing Imentioning

confidence: 99%

See 2 more Smart Citations

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

Godman

Haque

McKimm

et al. 2019

Current Medical Research and Opinion

132

170

View full text Add to dashboard Cite

show abstract

“…Prescribing indicators include the average number of drugs per encounter, the percentage of drugs prescribed by generic name, the percentage of encounters where an antibiotic is prescribed, the percentage of encounters where an injection is prescribed and the percentage of drugs prescribed from an essential medicine list or formulary . Having said this, there are concerns whether the INRUD indicators actually measure the quality of care in practice, and indicators surrounding issues such as guideline adherence may be more appropriate to measure the quality of prescribing . However, the INRUD criteria are still considered as standards for assessing prescribing practices across countries …”

Section: Introductionmentioning

confidence: 99%

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

Soleymani

Godman

Yarimanesh

et al. 2019

J Pharm Health Serv Res

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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.

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Compliance to prescribing guidelines among public health care facilities in Namibia; findings and implications

et al. 2020

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Background The World Health Organization estimates that over 50% medicines are prescribed inappropriately and the main driver of antimicrobial resistance globally. There have only been a limited number of studies evaluating prescribing patterns against national standard treatment guidelines (STGs) in sub-Saharan African countries including Namibia. This is important given the high prevalence of both infectious and non-infectious diseases in sub-Saharan Africa alongside limited resources. Objective Our aim was to assess prescribing practices and drivers of compliance to National guidelines among public health care facilities in Namibia to provide future guidance. Setting Three levels of public healthcare in Namibia. Method A mixed method approach including patient exit and prescriber interviews at three levels of health care in Namibia, i.e. hospital, health centre and clinic. Main outcome measures Medicine prescribing indicators, compliance to and attitudes towards National guidelines. Results Of the 1243 prescriptions analysed, 73% complied with the STGs and 69% had an antibiotic. Of the 3759 medicines (i.e. mean of 3.0 ± 1.1) prescribed, 64% were prescribed generically. The vast majority of prescribers were aware of, and had access to, the Namibian STGs (94.6%), with the majority reporting that the guidelines are easy to use and they regularly refer to them. The main drivers of compliance to guidelines were programmatic, that is access to up-to date objective guidelines, support systems for continued education on their use, and ease of referencing. Lack of systems to regulate noncompliance impacted on their use. Conclusion Whilst the findings were encouraging, ongoing concerns included limited prescribing of generic medicines and high use of antibiotics. A prescribing performance management system should be introduced to improve and monitor compliance to prescribing guidelines in public healthcare.

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Validity of World Health Organisation prescribing indicators in Namibia’s primary healthcare: findings and implications

Abstract: WHO/INRUD indicators showed poor accuracy in assessing prescribing practices in ambulatory care in Namibia. There is need for appropriate models and/or criteria to optimize medicine use in ambulatory care in the future.

Cited by 69 publications

References 25 publications

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

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

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

Compliance to prescribing guidelines among public health care facilities in Namibia; findings and implications

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