Assessment of Drug Utilization Patterns in Some Health ... - INRUD

Assessment of Drug
Utilization Patterns in Some
Health Insurance Outpatient
Clinics in Alexandria
1Ibrahem, Samaa Zenhom; 1Amer, N.;
2Ghoneim, M.; 1Abou El Enein N
1High Institute of Public Health, Egypt
2Faculty of Medicine

Problem statement: The selection and rational use of medicines are accepted as key principles of health service
quality and management in both the public and private sectors. Many researchers in developing countries,
however, have described drug use as irrational, documenting cases of ineffective, unsuitable, suboptimal or
unsafe prescribing, supply, and/or consumption of pharmaceutical products.
Objectives: To assess the pattern of drug use concerning prescribing, patient care, and facility standards in the
selected outpatient clinics in Health Insurance Organization using World Health Organization (WHO) core
indicators of drug use in health facilities
Design: A prospective cross-sectional study design was carried out.
Setting: The study was conducted in five randomly selected Health Insurance outpatient clinics in the
Alexandria governorate.
Study population: A random sample of 30 encounters per each physician of all 62 general practitioners, internal
medicine, and ENT specialists working in those clinics was carried out as recommended by WHO for studies
describing current treatment practice, so the required sample of patients was 1,860.
Results: Results indicated that as regards prescribing indicators, the overall mean number of drugs prescribed
per encounter was 2.8, the overall percentage of drugs prescribed by generic name was 61.0%, the overall
percentage of prescriptions containing antibiotics was 52.2%, the percentage of encounters where an injection
was prescribed was 20.6% overall. As regards health facility indicators, the essential drug list was found only in
one clinic and the percentage of drugs prescribed from the list was 100.0% in that clinic. As regards patient care
indicators, the overall average consultation time was 3.0 minutes, the mean time taken to dispense medications
was 16.9 seconds, and the overall percentage of correct patient knowledge of dosage of prescribed drugs was
69.3%. Additionally in all clinics, the percentage of drugs adequately labeled was 0.0%.
Conclusions: It was concluded that continuous medical education of doctors at all levels of qualification on
rational drug use should be instituted and treatment guides and training courses are recommended emphasizing
the importance of adequate labeling and instructions to the patient.

Introduction/Background
Rational drug use has increasingly received public policy
attention in efforts to maintain quality health care at lower costs.
It helps to ensure that drugs are used only when they are needed,
and that people understand what the medicines are and how to
use them. Therefore, rational prescription and use of drugs has
been a concern in both developed and developing countries
during the last two decades and has been promoted by WHO
and others.

Introduction/Background
For the rational drug use, there are five important criteria including, accurate
diagnosis, proper prescribing, correct dispensing, suitable packing and patient
adherence.
Drug use in developing countries is influenced by many factors: health and
drugs policy determines the legal frameworks for drug use and its regulation;
the organization and processes of health care provision affect access to
professionals and drug therapy; also there are commonly big differences in the
availability of drugs and services between regions (notably urban and rural
areas). In addition, provision and uptake of care are limited by financial
constraints on the part of governments and individuals

Objectives/Study Questions
The aim of this study is to assess the pattern of drug use
concerning prescribing, patient care, and facility standards in the
selected outpatient clinics affiliated to Health Insurance
Organization using World Health Organization (WHO) core
indicators of drug use in health facilities.

Methods
Prospective cross-sectional study was conducted in
five randomly selected Health Insurance outpatient
clinics in Alexandria governorate.
The target population consists of a Sample of
patients with different health problems and different
ages who attended the selected Health Insurance
outpatient clinics during the study period.

Methods
A random sample of 30 encounters per each
physician of all 62 general practitioners, internal
medicine and ENT specialists working in the
selected clinics was carried out as recommended by
WHO for studies describing current treatment
practice, so the required sample of patients was 1860.

Methods
In each of the selected Health Insurance outpatient clinics, the
researcher observed 30 patients during physician-encounter to collect
the data related to patient care. The recording of all prescribed drugs
was done. In each physician patient encounter, time of entering and time
of leaving consultation room were recorded. Then, the researcher
accompanied the patients to the pharmacy and recorded the time of
arrival and time of departure from dispensary counter. In the pharmacy,
the recording of dispensed drugs and drugs that were adequately labeled
was done. Also the researcher recorded if patients know the dosage of
the dispensed drugs or not through interview of observed patients
regarding their knowledge. Drug use patterns in the selected outpatient
clinics were assessed according to WHO indicators which are classified
into three categories including: prescribing indictors, patient care
indicators and health facility indicators.

Results
Socio-demographic data for study sample
Male
56.7%
Female
43.3%
20-
9.9%
30-
18.3%
10-
19.5%
40-
17.9%
50-
15.4%
60+
14.5%
Less than
10 years
4.5%

Results
Socio-demographic data for study sample
Skilled worker
8.6%
Clerk
24.2%
Professional
9.8%
Student
24.0%
Recurrent
82.7%
Non-skilled
worker
11.9%
Housewife
13.3%
Retired
8.1%
New
17.3%

Other
diagnosis
56.9%
Upper
respiratory
tract
infections
43.1%

Percentage
Correct
patient
knowledge
about dose
Drugs
adequately
labeled
Drugs
actually
dispensed
Drugs from
essential
drug list
Encounters
with
injection
Encounters
with
antibiotic
Drugs by
generic
names
100
80
60
61
52.2
69.3
40
20
20.6
12.7
0
0
Prescribing indicators
Patient care indicators

Average
20
18
16.90
16
14
12
10
8
6
4
2.80 3.00
2
0
Average number of drugs
prescribed per encounter
(No.)
Average consultation time
(minutes)
Average dispensing time
(seconds)

Implications/Conclusions
Although teaching basic pharmacology is necessary to build
knowledge, physicians urgently need systematic,
comprehensive and applicable pharmacotherapy curriculum in
their education to develop rational prescribing habits.
Limiting the role of pharmaceutical companies in physician
training and promoting more objective sources of information
such as therapeutic guidelines for common medical conditions.

Implications/Conclusions
Bringing the essential drug list to clinician’s attention at the time
of consultation either through availability of a hardcopy or
inclusion of the list on a desk top computer will influence the
rational use of drugs.