An Investigation of Prescription Indicators and Trends Among General Practitioners and Specialists From 2005 to 2015 in Kerman, Iran

Document Type : Original Article

Authors

1 Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

2 Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

3 Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran

4 National Institute of Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background
The World Health Organization (WHO) aims to promote strategies that ensure efficacy, safety, suitability, and cost effectiveness of medicine prescription. Health systems should design effective mechanisms to monitor prescription and rational use of medicines at all healthcare settings. This study aimed to determine and analyze prescription patterns of general practitioners and specialists in Kerman/Iran from 2005 to 2015.

 
Methods
This is an explanatory mixed method study. Data were gathered during two phases. At the first phase, prescriptions issued by physicians during 2005-2015 were reviewed to extract information required to develop eight main prescription indicators. In the second phase, the indicators trends were presented to experts participating in expert panel to have their opinions and analyses on the data obtained in the first phase. Experts were selected based on their experience and expertise in medicine and/or health policy and/or experience in implementation of polices to promote rational use of medicines. Some experts attending the panel were a sample of physicians whose prescriptions were included in the first phase.
 
 
Results
Findings revealed that two indicators of the average price of prescriptions and the maximum number of medicines in each prescription had an increasing trend over the study period. Reasons including unprecedented devaluation of the Iranian Rial and willingness of young physicians to prescribe more medications were proposed as the primary contributors to the observed increasing trends. However, other indicators including types of prescribed medicines, average number of medicines per prescription, the percentage of prescriptions with more than four medications, a percentage of encounters with a corticosteroid prescribed, a percentage of encounters with an antibiotic prescribed, and a percentage of encounters with an injection prescribed decreased in the study period. Reasons of controlling initiatives adopted by the Ministry of Health, the higher responsibility of physicians, adoption of continued medical education (CME) programs, and improved knowledge of pharmacists, physicians, and patients about irrational use of medicines were proposed by participants as the main reasons for the decreasing trend.
 
 
Conclusion
Findings indicated that prescription indicators were better in Kerman than those of country average over the study period based on comparing the results of this study and others in Iran. However, they were non-desirable when compared to the international average. The number of factors contributes to the irrational use of medicines, including lack of knowledge among healthcare providers and patients, patients’ misunderstanding about the efficacy of some particular medicines, the high cost of drug development and manufacturing, and unavailability of effective medicines.

Keywords

Main Subjects

References

  1. Sunartono G, Suryawati S. Impact evaluation of self monitoring of drug use Indicators in health facilities. Thailand: ICIUM; 2004. http://archives.who.int/icium/icium1997/posters/2D3_TXT.html.
  2. Picon-Camacho SM, Marcos-Lopez M, Bron JE, Shinn AP. An assessment of the use of drug and non-drug interventions in the treatment of Ichthyophthirius multifiliis Fouquet, 1876, a protozoan parasite of freshwater fish. Parasitology. 2012;139(2):149-190. doi:10.1017/s0031182011001867
  3. Okunade AA, Karakus MC, Okeke C. Determinants of health expenditure growth of the OECD countries: jackknife resampling plan estimates. Health Care Manag Sci. 2004;7(3):173-183.
  4. Almarsdottir AB, Traulsen JM. Rational use of medicines--an important issue in pharmaceutical policy. Pharm World Sci. 2005;27(2):76-80.
  5. World Health Organization. Action Programme on Essential Drugs and Vaccines. How to investigate drug use in health facilities: selected drug use indicators. Geneva: World Health Organization; 1993.
  6. World Health Organization. Promoting Rational Use of Medicines: Core Components - WHO Policy Perspectives on Medicines. Geneva: World Health Organization; 2002:1-6.
  7. Moghadam Nia AA, ZahedPasha Y, Mir Blooki MR, Baradaran Aghili M. An analysis of prescription indices of Babol general practitioners prescriptions, 1999 (Persian). J Babol Univ Med Sci. 2000;2(3):21-26.
  8. NCRUD. Prescription Indicators in Iran for Years 2011 (Persian). Tehran: National Committee for Rational Use of Drugs, Food and Drug Organization, Ministry of Health and Medical Education, Islamic Republic of Iran; 2011.
  9. Wang H, Li N, Zhu H, Xu S, Lu H, Feng Z. Prescription pattern and its influencing factors in Chinese county hospitals: a retrospective cross-sectional study. PLoS One. 2013;8(5):e63225. doi:10.1371/journal.pone.0063225
  10. Karimi A, Haerizadeh M, Soleymani F, Haerizadeh M, Taheri F. Evaluation of medicine prescription pattern using World Health Organization prescribing indicators in Iran: A cross-sectional study. J Res Pharm Pract. 2014;3(2):39-45. doi:10.4103/2279-042x.137058
  11. Sadeghian GH, Safaeian L, Mahdanian AR, Salami S, Kebriaee-Zadeh J. Prescribing quality in medical specialists in isfahan, iran. Iran J Pharm Res. 2013;12(1):235-241.
  12. Noori Hekmat S, Tourani S, Haghdoost AA, Ebrahimipour H, Mehrolhassani MH, Dehnavieh R. Beneficial and Adverse Effects of the Integration of Medical Education and Health Service in IR. Iran; A Delphi Exercise. J Med Sci. 2014;14(1):21-28. doi:10.3923/jms.2014.21.28
  13. Rashidian A, Eccles MP, Russell I. Falling on stony ground? A qualitative study of implementation of clinical guidelines' prescribing recommendations in primary care. Health Policy. 2008;85(2):148-161. doi:10.1016/j.healthpol.2007.07.011
  14. The Central Bank of Iran. A yearly publication of the Central Bank of Iran. Tehran: Central Bank of the Islamic Republic of Iran; 2014. http://www.cbi.ir/default_en.aspx.
  15. Hazra A, Tripathi SK, Alam MS. Prescribing and dispensing activities at the health facilities of a non-governmental organization. Natl Med J India. 2000;13(4):177-182.
  16. DiMasi JA, Hansen RW, Grabowski HG. The price of innovation: new estimates of drug development costs. J Health Econ. 2003;22(2):151-185. doi:10.1016/s0167-6296(02)00126-1
  17. Sandiumenge A, Diaz E, Rodriguez A, et al. Impact of diversity of antibiotic use on the development of antimicrobial resistance. J Antimicrob Chemother. 2006;57(6):1197-1204. doi:10.1093/jac/dkl097
  18. Desalegn AA. Assessment of drug use pattern using WHO prescribing indicators at Hawassa University Teaching and Referral Hospital, south Ethiopia: a cross-sectional study. BMC Health Serv Res. 2013;13:170. doi:10.1186/1472-6963-13-170
  19. Nguyen HT, Wirtz VJ, Haaijer-Ruskamp FM, Taxis K. Indicators of quality use of medicines in South-East Asian countries: a systematic review. Trop Med Int Health. 2012;17(12):1552-1566. doi:10.1111/j.1365-3156.2012.03081.x
  20. Latkin C, Friedman S. Drug use research: drug users as subjects or agents of change. Subst Use Misuse. 2012;47(5):598-599. doi:10.3109/10826084.2012.644177
  21. Tsega B, Hailu W, Ergetie Z. Measuring quality of drug use in primary healthcare facilities: a yearlong assessment of WHO prescribing indicators, Wolkite town, South West Ethiopia. Int J Pharm Ind Res. 2012;2(4):485-491.
  22. Elsalahi SH, Eltahir M, Ahmed A. Evaluation of prescribing patterns in primary health care centres of Khartoum state, Sudan. Pharmanest. 2014;5(4):2242-2247.
  23. Uzochukwu BS, Onwujekwe OE, Akpala CO. Effect of the Bamako-Initiative drug revolving fund on availability and rational use of essential drugs in primary health care facilities in south-east Nigeria. Health Policy Plan. 2002;17(4):378-383.
  24. Jain S, Khan ZY, Upadhyaya P, Abhijeet K. Assessment of prescription pattern in private teaching hospital in India. Int J Pharm Sci. 2013;3(3):219-222.
  25. Dehnavieh R, Noori Hekmat S, Ghasemi S, Mirshekari N. The vulnerable aspects of application of “health technology assessment.” Int J Technol Assess Health Care. 2015;31(3):197-198. doi:10.1017/S0266462315000288
  26. Dehnavieh R, Rashidian A, Reza Maleki M, Aldin Tabibi S, Ibrahimi Pour H, Noori Hekmat S. Criteria for Priority-setting in Iran Basic Health Insurance Package: Exploring the Perceptions of Health Insurance Experts. Healthmed. 2011;5(6):1542-1548.
  27. Awad A, Al-Saffar N. Evaluation of drug use practices at primary healthcare centers of Kuwait. Eur J Clin Pharmacol. 2010;66(12):1247-1255. doi:10.1007/s00228-010-0872-8
  28. Naseeb TA, Nasser MA. Drug prescribing indicators in primary health care centers in Bahrain. Saudi Med J. 2005;26(9):1436-1438.
  29. El Mahalli AA. WHO/INRUD drug prescribing indicators at primary health care centres in Eastern province, Saudi Arabia. East Mediterr Health J. 2012;18(11):1091-1096.

Files

History

  • Receive Date: 12 January 2017
  • Revise Date: 31 January 2018
  • Accept Date: 17 March 2018
  • First Publish Date: 01 September 2018

Share

How to cite

Statistics