Very short dispensing time will negatively affect appropriate labeling and information provision about medications. See our User Agreement and Privacy Policy. Cite this article. You're about to find out how they're developed as we explore the basic nature of rational drug design and its role in this lesson. Considering WHO recommendation, 500 prescribing encounters were taken from each corresponding hospital [7]. Therefore, safer, cost effective and simple oral alternatives should be promoted. Box 235, Harar, Ethiopia, Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, P.O. Besides, 75.77% of the prescribed drugs were actually dispensed. The average consultation time in HFSUH (6.36 min) is better than the other hospitals involved in the study. Embaye A. Essential Drugs Survey. 2001;16(1):13–20. MS, GM, FA and TG conceived the original idea and helped to draft the proposal; all authors coordinated the data collection of the study; BM performed data entry, analysis and write-up. Google Scholar. Hitchings demonstrated an early interest in science through his selection of courses at Franklin High School in Seattle. Besides, on average, only 75.77% of prescribed drugs were actually dispensed in selected hospitals with lowest value seen in HFSUH (69.27%) (Table 5) and among dispensed prescriptions within the health facilities, only 3.3% of them were adequately labeled in target hospitals when taken together with zero value recorded in KGH (Table 6). Ayinalem GA, Gelaw BK, Belay AZ, et al. Training modules on operation and management of special pharmacies, Birnanenaselam printing enterprise, Ethiopia, 2003. Not more than, 20(66.7%) key drugs were available in stock while only 19(63.3%) of key drugs had adequate labeling. WHO. Haile Mariam A, Raghavendra Y, Bobasa EM. CAS These indicators highlight major problem areas of drug use patterns and quantify the magnitude of the problem at glance. Google Scholar. Drug use studies in Eritrean healthcare facilities. This result was somewhat lower than the ideal WHO standard (100%) [7]. Terms and Conditions, 2. If you continue browsing the site, you agree to the use of cookies on this website. http://apps.who.int/medicine docs/en/d/Js2289e/8.3.html.. Accessed on 24 Feb 2014. WHO: Geneva; 1991. Generally, over prescribing might, in part, be attributable to drug-drug interactions, high risk of adverse drug reactions, wastage of drugs (extravagancy), and increased out-of-pocket expenditures for patients, among others [7]. However, they do not answer why the problem exists. J Community Med Prim Health Care. Stop watch was used to determine the contact time of health care providers with patient (consultation and dispensing time). Article Md Rezal RS, Hassali MA, Alrasheedy AA, Saleem F, et al. Indicators of rational drug use have worsened over the past decade despite the implementation of managerial, regulatory and training interventions. Only 20(66.7%) key essential drugs were available in stock during the study and only 19(63.3%) of key drugs selected had adequate labeling. Your Medicare, Long-Term ... No public clipboards found for this slide. Amongst antibiotics prescribed, 44.4% of them were amoxicillin or amoxicillin + clavulanic acid followed by ciprofloxacin (15.4%) (Table 4). All authors read and approved the final version of the manuscript. Time spent for dispensing was very short when compared to the average dispensing time for ten countries (105 s) [9, 31, 32] and from a similar study done in Zimbabwe (150 s) [33] and Nigeria (210 s) [34], India [23] and different healthcare settings of Ethiopia [19, 35]. Data were collected using structured observational check list for prescribing, patient care and health facility indicators. Having this study as a baseline data, in-depth investigation of drug use (qualitative study) should be designed to probe the underlying causes of the problem in these health institutions. Rational drug use (RDU) generally covers appropriate prescribing, appropriate dispensing and appropriate patient use of medicines for the diagnosis, prevention, mitigation and treatment of diseases. WHO/DAP/91.10. On average 2.34 (±1.08) drugs were prescribed in selected public hospitals of eastern Ethiopia and 39.3% of the prescription contains three or more drugs (Table 1). Int J Basic Clin Pharmacol. 1 The world medicines situations: chapter 8-rational use of medicines. Moreover, 163 (10.9%) prescription contained at least one injectable medication (Table 3). However, it was higher than studies undertaken in JUSH [16] and southern Ethiopia [15]. These indicators are grouped in to three categories namely: prescribing indicators, patient care indicators and facility indicators. Geneva: WHO; 1993. Objective: Irrational use of medicines is a serious problem in China and has been the primary target of China’s national essential medicines programme (NEMP). The average number of stock out days per year for adequately recorded drugs was 30 days. Therefore, more effort is to be invested to effectively avoid the problems of brand prescribing and to promote safe, cost effective and accessible generic drugs. Available online at: http://apps.who.int/medicinedocs/en/d/Js6160e/10.html. 2013;4:265–75. .Taking .what .is .arguably .an .overly .reductionist .approach, .the . Since the assessment of knowledge was done immediately, the impact of labeling on patient knowledge might seem insignificant. Pharmaceutical expenditure is up to 70/75% of total healthcare expenditure in low and middle-income countries [8]. Pharmacoeconomics. Bilal AI, Osman ED, Mulugeta A. Similarly, other studies outside of Ethiopia also reported a low number of drugs per encounter, for example, 1.4 in Sudan [20] and 1.3 in Zimbabwe healthcare settings [21]. Systematic random sampling for prescribing indicators and convenient sampling for patient care indicators was employed. Rational drug use is an important part of health policy ensuring that patients receive medications appropriate to their clinical needs, in doses that meet their own requirements for an adequate period of time and at the lowest cost to them and their community. CAS Most of WHO stated core drug use indicators were not met by the three hospitals included in the study. Dilbato DD, Kuma ZG, T/Mariam S. A base line survey on prescribing indicators and the underlying factors influencing prescribing in southern Ethiopia. Moreover, 75.7% patients know about the correct dosage schedule of the prescription in selected public hospitals of eastern Ethiopia (Table 7). According to a fact sheet by WHO (May, 2010) about the rational use of medicines, more than 50% of all medicines are not correctly prescribed, dispensed, and sold; and more than 50% of patients take their drugs incorrectly. Considering such problem, the overall drug use pattern should be evaluated to put a baseline data for further in-depth investigation of drug use to probe the underlying causes and interventional strategies to be implemented so as to try and reverse worrying trends in drug utilization in Ethiopia. However, the methodology and processes underlying classification systems are generally neither specified nor transparent, which reduces confidence in their accuracy and undermines health education messages. The study was aimed to evaluate rational drug use based on WHO-core drug use indicators in Dilchora referral hospital, Dire Dawa; Hiwot Fana specialized university hospital, Harar and Karamara general hospital, Jigjiga, eastern Ethiopia. Definition. Health Policy Plan. More realistically, the legal changes come in the form of relaxation of laws, or at least relaxation of the enforcement of the laws, or expansion of special cases. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. Significant amount of key drugs were out of stock. Several States have undertaken initiatives in the past to promote rational use of medicines in the government health services with mixed results. Rational Drug Use, ถ.อังรีดูนังต์ เขตปทุมวัน กทม. A couple of good examples are the antibiotic, penicillin, and the blood thinner warfarin (Coumadin). Retrospective cross sectional study design was used to evaluate prescribing indicators while prospective cross-sectional design was employed for patient care and facility indicators. Drug use evaluation of ceftriaxone in medical ward of Dessie Referral Hospital, North East Ethiopia. A variety of studies conducted in urbanized as well as in budding countries during precedent years concerning the safe & effective use of drugs demonstrate that irrational drug use is a comprehensive occurrence & simply few prescriptions pretext rational use of drugs. First and foremost, we would like to thank Haramaya University for providing such opportunity for conducting this research. Mekonnen Sisay. The concept of rational drug use is age old, as evident by the statement made by the. The concept of P-medication includes the active agent, the form of medication, the dosage scheme and the duration of the medication treatment. Brand prescribing is associated with unnecessary treatment costs, difficulty of remembering the medication, accessibility and bioequivalence problems [7]. Most of these values will fall within the WHO standard [7]. We would like to express appreciation to all patients and health professionals who participated in the study for their devotion of time and extremely generous cooperation. A systematic random sampling technique was employed to select 500 outpatient prescriptions from each hospital by taking every ten prescription in DRH, every eight in KGH and HFSUH. BMC Public Health. Management sciences for health (MSH), managing drug supply. In each hospital, 200 outpatient attendants and 30 key essential drugs were also selected using the WHO recommendation. Counting the costs of drug related adverse events. California Privacy Statement, Physicians’ knowledge, perceptions and behaviour towards antibiotic prescribing: a systematic review of the literature. Assen A, Abrha S. Assessment of drug prescribing pattern in dessie referral hospital, dessie. The average consultation and dispensing time were 276.5 s and 61.12 s respectively. www.medpages.co.za/sf/index.php?page=organisation&orgcode=282339, http://apps.who.int/medicinedocs/en/d/Jh3011e/, http://apps.who.int/medicinedocs/en/d/Js2289e/, http://apps.who.int/medicinedocs/en/d/Js6160e/10.html, http://archives.who.int/prduc2004/Resource_Mats/Asia_papers/PROMOTING%20RATIONAL%20USE%20OF%20DRUGS%20IN%20INDONESIA.htm, https://www.unicef.org/zimbabwe/ZMPMS_report.pdf : Accessed on 30 May, 2016, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12913-017-2097-3, Health systems and services in low and middle income settings, bmchealthservicesresearch@biomedcentral.com. Ethiop J Health Sc. None of the hospitals had developed its own EDL and STG. In: How to investigate drug use in health facilities. Ofori-Asenso R, Brhlikova P, Pollock AM. Amoxicillin/amoxicillin + clavulanic acid was the most frequently prescribed antibiotic followed by ciprofloxacin. Hiwot Fana Specialized University Hospital, Hawassa University Teaching and referral Hospital. The percentage of drugs prescribed by the generic name was found to be 90.61% (85.04–92.26%) with the lowest value recorded in HFSUH (85.04%). This difference might be ascribed to variation on patient load on the individual health care settings. Inappropriate and over use of antibiotics, as observed in this study, might result in the emergence of antimicrobial resistance which is one of the major bottlenecks of chemotherapy for our globe [7]. In: How to investigate drug use in health facilities. 2015;2(3):223–8. Accessed 9 May 2014. 2013;13:2–6. Assessment of medicines use pattern using World Health Organization’s prescribing, patient care and health facility indicators in selected health facilities in eastern Ethiopia. Besides, the data were evaluated as per the WHO guidelines. To ensure the data quality, the data collectors (pharmacy technicians) and supervisors (pharmacists) were trained by the principal investigators for three days. Assessment of drug use pattern using WHO prescribing indicators at Hawassa University teaching and referral hospital, south Ethiopia: a cross-sectional study. Majority of WHO stated core drug use indicators were not met by the three hospitals included in the study. Data were entered to EPI Data Version 3.1, exported and analyzed using SPSS version 16.0. Ann Afr Med. The English version of the checklist was translated to Amharic, Afaan Oromo and Somali languages and then back to English to maintain its consistency for data collection purpose. BMC Health Serv Res. 27.2 USE 27.1 Definition of rational medicine use The aim of any pharmaceutical management system is to deliver the correct medicine to the patient who needs that medicine. All outpatient prescriptions dispensed from Jan 1, 2014 to Jun 30, 2014 (prescribing indicators); patient attendants and their prescriptions in the outpatient departments (OPDs) of selected hospitals from Sep 1 to Nov 30, 2014 (patient care indicators) and drugs under essential drug lists (EDL) of 2013 of Ethiopia were included. The information available suggests medicines are not optimally used. 2016;4(4):35. The average number of drugs prescribed per encounter was slightly above the WHO recommendation. Therefore, to get a more reliable result (greater point estimate of the population) 200 samples of patients were assessed in each hospital. On average, selected key drugs were out of stock for 30 days per year. This is due to the imbalance between alarming rate of antimicrobial resistance and decelerating rate of new antimicrobial drug development [7]. volume 17, Article number: 161 (2017) The study was conducted from Sep 1 to Nov 30, 2014. This inappropriate manner of medicines dispensing is one of the key element to promote irrational use of medicine [3]. Finally, a multitude of remedial intervention strategies (managerial, educational, regulatory and economical strategies) should be designed to reverse the existing problem and modernize the drug utilization patterns on these public health institutions and the Ethiopian health care system in general. 2015;6(4):83–8. 2013;16:69–74. We acknowledge Haramaya University for funding of this research work. By using this website, you agree to our PubMed Assessment of patterns of drug use by using World Health Organization’s prescribing, patient care and health facility indicators in selected health facilities in southwest Ethiopia. Lenjisa JL, Ferejaa TH. 2013;11:179. 1999;15(5):445–58. Prescribing indicators at primary health care centers within the WHO African region: a systematic analysis (1995–2015). Box 1176, Addis Ababa, Ethiopia, You can also search for this author in Index of drugs actually dispensed was measured by the percentage of drugs actually dispensed and index of patients’ … Other negative impacts are the increased risk of adverse drug reactions, drug-drug interactions and non-adherence of patients to the treatment [9–12]. None of the hospitals involved in the current study had its own EDL or STG. Evaluation of rational drug use based on World Health Organization core drug use indicators in selected public hospitals of eastern Ethiopia: a cross sectional study. Geneva: WHO; 1993. Arustiyono. 2014;5(11):777–81. Only 20 (3.3%) of medications were adequately labeled (DRH, 9%, HFSUH, 1%, and KGH, 0%) and 75.7% of patients had adequate knowledge about the dosage of their treatment. The average consultation time and dispensing time in selected public hospitals of eastern Ethiopia were found to be 4.61 min and 61.12 s, respectively. Thirty key drugs were selected from each hospital as per WHO recommendation which is a minimum of 15 essential drugs in each health facility [7]. Part of Bannenberg WJ, Forshaw CJ, Fresle D, Salami AO, Wahab HA. medicines . WHO. Deterrence Theory is heavily influenced by Classical Theory, the criminological theory that dominated the late 1700s and much of the 1800s. The term rational drug useis in this overview limited to the medical therapeutic view accepted at the WHO conference of 1985 in Nairobi: rational use of drugs requires that patients receive medications appropriate to their clinical Ten recommendations to improve use of medicines in developing countries. The study was targeted at three tertiary care public hospitals found in two regions and one city administration (Dire Dawa) of eastern Ethiopia. 74 (WHO/DAP/93.1). Evaluation of the Nile province essential drug project. East Cent Afr J Pharm Sci. BMC Health Serv Res 17, 161 (2017). In addition, lower values of generic prescribing practices were recorded in several health care settings such as selected hospitals of west Ethiopia (79.2%) [18], Nigerian army hospitals (49.3%) [25], secondary care referral hospital of south India (42.9%) [23]. Therefore, the study is, aimed to evaluate RDU by using WHO core drug use indicators in selected public hospitals of eastern Ethiopia. 1. To ehnance RDU, the patient should receive medicines appropriate to their heath care conditions, at optimum doses and sufficient time, as well as at the cost that the individual and the community can afford [1]. 2013;2:711. BMC Med. Available at: http://apps.who.int/medicinedocs/en/d/Jh3011e/. Box 235, Harar, Ethiopia, Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. PubMed Google Scholar. The average number of drugs per prescription in the present study was slightly higher than the ideal WHO standard which is less than two (1.6–1.8) [7]. Rational drug design for anti-cancer chemotherapy: multi-target QSAR models for the in silico discovery of anti-colorectal cancer agents. Mean, 2.34 (±1.08) drugs were prescribed in the selected hospitals. Drug administration and control authority (DACA). Patient knowledge was higher than similar study done in Zimbabwe (70%) [33]. Hospital based quantitative cross sectional study design was employed to evaluate rational drug use based on WHO core drug use indicators in selected hospitals. 74 (WHO/DAP/93.1). All of the hospitals included in the study use the national EDL, formulary and STGs but none of them had their own EDLs, formularies or STGs (Table 9). Such examples are when marijuana was (temporarily) reduced from "Class B" to "Class C" in the UK, or in parts of the US where it has been legalized for medical use. White TJ, Arakelian A, Rho JP. Drug use indicators at a secondary health care facility in Lagos, Nigeria. Ministry of Health/Zimbabwe Essential Drugs Action Programme. https://doi.org/10.1186/s12913-017-2097-3, DOI: https://doi.org/10.1186/s12913-017-2097-3. Base line survey on drug prescribing indicators for outpatient in Jimma University specialized hospital in South west Ethiopia. Article The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. In: How to investigate drug use in health facilities. Statistical significance was determined by one way analysis of variance (ANOVA) in some of the patient care indicators. ใช้ยาอย่างสมเหตุผล คือใช้เมื่อจำเป็น เกิดประโยชน์จริง ปลอดภัย และคุ้มค่า Angamo MT, Wabe NT, Raju NJ. Prasad PS, Rudra JT, Vasanthi P, Sushitha U. For a long time, the definition of “Rational Use of Drugs” has set the basic conceptual framework for health providers worldwide to implement relevant… Finally, tabular presentation was used to present the data. The result was similar to the finding of a research conducted in Eritrea (4.7 min) [30] but lower than on time spent for consultation in Nigeria [29]. Besides, 39.3% of prescriptions contained three or more drugs. Available at: www.medpages.co.za/sf/index.php?page=organisation&orgcode=282339. The current finding was better than studies conducted in India [24] Zimbabwe [21], southern Ethiopia [15], GUH [26] and HUTRH [14], west Ethiopia [18] and lied within WHO standard [7] but higher than the finding from JUSH [16]. Continental J Pharm Sci. P-value of less than 0.05 was considered statistically significant. Available online at (http://ddc2:bumc.bu.edu./richardl/EmbayeConcentrationPaper.htm.). The high level of generic prescription could probably be attributed to the fact that the study was conducted in governmental hospitals, where procurement of generic drugs is the prevailing practice.