Assessment of Drug Utilization Patterns in Some Health Insurance Outpatient Clinics in Alexandria 1Ibrahem, Samaa Zenhom; 1Amer, N.; 2Ghoneim, M.

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1 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

2 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.

3 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.

4 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

5 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.

6 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.

7 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.

8 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.

9 Results Socio-demographic data for study sample Male 56.7% Female 43.3% % % % % % % Less than 10 years 4.5%

10 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%

11 Other diagnosis 56.9% Upper respiratory tract infections 43.1%

12 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 Pre scribing indicators Patie nt care indicators

13 Average Average number of drugs prescribed per encounter (No.) Average consultation time (minutes) Average dispensing time (seconds)

14 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.

15 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.