A Survey of Prescribing Patterns in the Wassa West District of Ghana with Special Reference to Antibiotics

Abstract

Study title: A survey of prescribing patterns in the Wassa West district of Ghana with special reference to antibiotics. Statement of the problem: The availability, affordability and rational use of drugs constitute a fundamental indicator of quality of health care delivery. Ghana has spent up to 40% of its recurrent budget to ensure the availability of. drugs in the health system. However, irrational prescribing has led to a wastage in drugs supply. 4 - •' < . - - \ & J . In the Wassa West district, several obstacles to rational prescribing exist: These include the lack of an active programme to promote rational prescribing, the lack of objective information to guide prescribers in their practice in the face of an increasing array of new drugs and the aggressive promotional activities of drug companies. A previous rapid qualitative assessment of the pharmaceutical system in the district indicated that there were inappropriate prescribing practices. The absence of relevant, objective and measurable indicators limited the usefulness of the findings of the study as a basis for the evaluation of any interventions instituted to improve the prescribing practices. This study provides the requisite baseline measures of prescribing patterns in the district and identifies areas for targeted interventions. Main objective: To describe and compare the patterns of drug prescribing in government health facilities in the Wassa West district with a view to developing strategies to improve prescribing practices. Place of study: Seven government health facilities located at Tarkwa, Nsuaem, Simpa, Dompim, Bogoso, Huni Valley and Prestea Himan. Study type: The study was cross-sectional comparative in type. Methodology: Retrospective prescribing data covering a one year period from June 1994 to June 1995 were obtained from 700 outpatients' clinical record cards, 100 from each of 7 government health facilities in the district. At the district hospital, prospective data from 100 outpatient prescriptions were also collected because of a relatively large number of incomplete data from the retrospective records. A one-day prevalence survey of prescribing patterns for 45 inpatients at the district hospital was also undertaken. Finally, the type of prescribers and the availability of the national Essential Drugs List (EDL) manual and some common drugs in all 7 health facilities were determined. Findings and conclusions: • irrational prescribing is both serious and widespread in the Wassa West district • prescribing patterns differed significantly between the health facilities. Bogoso and Himan had the worst prescribing indicators • prescribing patterns in the health centres were worse than those in the district hospital perhaps a reflection of the lower cadre of prescribers and a relative lack of diagnostic facilities • treatment records were poorly kept, at the district hospital as a result of a heavy workload • there was an average of 4 prescribers comprising combinations of medical officers, medical assistants, nurses and technical officers in each facility • the number of drugs prescribed per patient ranged from 0-13 with a mean of 4.6 • 80.0% and 57.9% of patients were treated with one or more injectable drugs and antibiotics respectively. The preference for injections was influenced by patient demand as well as by clinical and financial considerations. Antibiotics were commonly prescribed for malaria, respiratory infections and soft tissue infections. • 64.6% of all drugs were prescribed by their generic names; 97.1% were on the national Essential Drugs List. The use of essential drags was favoured by procurement from a central Regional Medical Store. Prescription by non-generic names was due to a concern that chemical sellers were not familiar with the generic names and may therefore not be able to dispense the right drugs • there were inappropriate treatment practices. About 87% and 41% of patients with malaria were treated with an injection chloroquine and antibiotics respectively. This was attributed to the lack of refresher training for prescribers in management of some common conditions • the national EDL manual was not available at any of the facilities surveyed owing to a general national shortage of the manuals • except for drugs for skin diseases, drags for the treatment of common diseases were generally available in the facilities • in relation to the severity of illness, drugs for inpatients of the district hospital were greater in number, more expensive and more frequently administered parenterally than those for outpatients. Recommendations: Policy makers: The urgent development, proclamation and promotion of a national drugs policy backed by the relevant legislation should provide a framework for the improvement of prescribing practices and for the entire pharmaceutical sector. The national Essential Drugs Programme should be reactivated and given the necessary legal backing. Funding should be provided for the regular revision and widespread marketing of the EDL manual. Training institutions'. Training institutions should prepare medical officers and medical assistants for the "real-world" practice of prescribing under negative pressures by adopting a problem-based teaching of therapeutics in place of the traditional approach of merely transferring knowledge about the action of drugs in the treatment of diseases. Regional Health Administration'. The regional health authorities should obtain copies of the EDL manual for distribution to the districts, ensure availability of essential drugs in the Regional Medical Store, organise training .as well as assist districts to prepare appropriate treatment guidelines for common diseases. i District Health Administration'. • The district health authorities should establish a District Medical Store to supply drugs to and monitor the consumption patterns of all health facilities. • a District Drugs and Therapeutics Committee should be formed to promote rational prescribing in the district • there should be regular in-service training for prescribers in which the management of common diseases, polypharmacy and the over-use of injections and antibiotics will be discouraged. Funding for training could be obtained from the district's quarterly financial allocation and donor agencies • training should be followed up with a programme of regular supervision of medical assistants and nurses by the medical officers at the district hospital • training of chemical sellers to correctly interpret prescriptions should favour generic prescribing • the district should undertake further studies on the nature and extent of prevailing prescribing influences. Regular assessment of prescribing practices for government as well as mines and private clinics will be necessary. Patients and communities'. Posters on the walls of clinics should be provided to educate public on the effects of patients' demands for certain drugs as well as educate the public on the dangers of self-medication, The appropriate use of drugs should be incorporated into the district's intersectoral social mobilisation programme.