One-day out-patient prescribing patterns at a national referral hospital in Kenya

Margaret O Ambetsa, Margaret N Oluka, Faith A Okalebo, Nicholas C Mulwa, Joseph Fadare, Brian Godman

Abstract


Background: Poor prescribing habits lead to ineffective and unsafe treatment for patients, exacerbating or prolonging of illness as well as causing distress and harm to them. Drug utilization studies can help identifying gaps in prescribing and feed the results back to prescribers to enhance future rational use of medicines.

Objective: Evaluate outpatient prescribing practices and patterns in a leading national Hospital in Kenya.

Methods: A sample of 60 prescriptions was selected by quasi-random sampling. Data was abstracted using a pre-designed data collection form, entered into and analyzed using Excel software.

Results: The average number of drugs prescribed per prescription was three with a polypharmacy rate (>4 drugs) of 20%. Only two-thirds (65%) of the prescribed drugs were actually dispensed at the hospital pharmacy due to shortages, principally shortages of originators. Slightly more than half (52%) of the drugs were prescribed by generic name. Prescribing by brand names was highest among medical interns (61%). Almost all drugs prescribed (95%) were consistent with the hospital tender list.

Conclusions: There is a need to increase the rate of prescribing of generics to save costs as well as reduce stock-out levels. This can be helped by instigating a comprehensive generics policy. There is also a need to strengthen and empower drugs and therapeutic committees (DTCs) to improve selection and availability of quality generics to win the confidence of prescribers.

Keywords: Drug utilisation studies, generics, prescribing patterns, prescribing indicators, polypharmacy, WHO indicators, Kenya


References


Bangalore S, Kamalakkannan G, Parkar S, Messerli F. (2007). Fixed-dose combinations improve medication compliance: a meta-analysis. Am. J. Med. 120: 713–719

Baumgärtel C, Godman B, Malmström R, Andersen M et al. (2012). What lessons can be learned from the launch of generic clopidogrel? GaBI J. 1:58-68.

Bhartiy SS, Shinde M, Nandeshwar S and Tiwari SC. (2008). Pattern of prescribing practices in the Madhya Pradesh, India. Kathmandu Univ. Med. J. 6:55-59

Bilal AI, Osman ED, Mulugeta A (2016). Assessment of medicines use pattern using World Health Organization's Prescribing, Patient Care and Health facility indicators in selected health facilities in Eastern Ethiopia. BMC Health Serv. Res. 16:144

Bjorkhem-Bergman L, Andersen-Karlsson E, Laing R, Diogene E, Melien O, Jirlow M, Malmström RE, Vogler S, Godman B, Gustafsson LL (2013). Interface management of pharmacotherapy. Joint hospital and primary care drug recommendations. Eur. J. Clin. Pharmacol. 69 Suppl 1:73-8

Bushardt RL, Massey EB, Simpson TW, Ariail JC, Simpson KN (2008). Polypharmacy: misleading, but manageable. Clin. Interv. Aging. 3:383–389

Cameron A, Mantel-Teeuwisse AK, Leufkens HG, Laing RO (2012). Switching from originator brand medicines to generic equivalents in selected developing countries: how much could be saved? Value Health. 15:664-73

Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R (2009). Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. Lancet. 373:240-9.

Cessak G, Rokita K, Dabrowska M, Sejbuk-Rozbicka K, Zaremba A, Mirowska-Guzel D, Bałkowiec-Iskra E (2016). Therapeutic equivalence of antipsychotics and antidepressants - A systematic review. Pharmacol. Rep. 68:217-23

Civaner M (2012). Sale strategies of pharmaceutical companies in a "pharmerging" country: the problems will not improve if the gaps remain. Health Policy. 106:225-32.

Corrao G, Soranna D, Arfe A, Casula M, Tragni E, Merlino L, Mancia G, Catapano AL (2014) Are generic and brand-name statins clinically equivalent? Evidence from a real data-base. Eur. J. Intern. Med. 25:745-50

Davis C, Abraham J (2013). Is there a cure for corporate crime in the drug industry? BMJ. 346:f755.

Desalegn AA (2013). 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. 13:170.

Enwere OO, Falade CO, Salako BL. (2007). Drug prescribing pattern at the medical outpatient clinic of a tertiary hospital in southwestern Nigeria. Pharmacoepidemiol. Drug Saf. 16:1244–1249. 57

Fadare JO, Adeoti AO, Desalu OO, Enwere OO, Makusidi AM, Ogunleye O, Sunmonu TA, Truter I, Akunne OO, Godman B (2015). The prescribing of generic medicines in Nigeria: knowledge, perceptions and attitudes of physicians. Expert Rev. Pharmacoecon. Outcomes Res. 28:1-12.

Gagne JJ, Choudhry NK, Kesselheim AS, Polinski JM, Hutchins D, Matlin OS, et al. (2014) Comparative effectiveness of generic and brand-name statins on patient outcomes: a cohort study. Annals Intern. Med. 161:400-7.

Godman B, Abuelkhair M, Vitry A, Abdu S, Bennie M, Bishop I et al (2012). Payers endorse generics to enhance prescribing efficiency; impact and future implications, a case history approach. GaBI J. 1:21-35.

Godman B, Bishop I, Finlayson AE, Campbell S, Kwon HY, Bennie M (2013a). Reforms and initiatives in Scotland in recent years to encourage the prescribing of generic drugs, their influence and implications for other countries. Expert Rev. Pharmacoecon. Outcomes Res. 13:469-82.

Godman B, Finlayson AE, Cheema PK, Zebedin-Brandl E, Gutierrez-Ibarluzea I, Jones J, et al. (2013b). Personalizing health care: feasibility and future implications. BMC Med. 11:179.

Godman B, Wettermark B, Hoffmann M, Andersson K, Haycox A, Gustafsson LL (2009) Multifaceted national and regional drug reforms and initiatives in ambulatory care in Sweden: global relevance. Expert Rev. Pharmacoecon. Outcomes Res. 9:65-83.

Godman B, Wilcock M, Martin A, Bryson S, Baumgärtel C, Bochenek T et al. (2015) Generic pregabalin; current situation and implications for health authorities, generics and biosimilars manufacturers in the future. GaBI J. 4(3):125-135.

Gustafsson LL, Wettermark B, Godman B, Andersen-Karlsson E, Bergman U, Hasselstrom J, et al. (2011) The 'wise list'- a comprehensive concept to select, communicate and achieve adherence to recommendations of essential drugs in ambulatory care in Stockholm. Basic Clin. Pharmacol. Toxicol. 108:224-33.

Hamilton HJ, Gallagher PF, O'Mahony D (2009). Inappropriate prescribing and adverse drug events in older people. BMC Geriatr. 9:5. DOI: 10.1186/1471-2318-9-5

Hassali MA, Kamil TK, MdYusof FA, Alrasheedy AA, Yusoff ZM, Saleem F, Al-Tamimi SK, Wong ZY, Aljadhey H, Godman B (2015). General practitioners' knowledge, attitude and prescribing of antibiotics for upper respiratory tract infections in Selangor, Malaysia: findings and implications. Expert Rev. Anti. Infect. Ther. 13:511-20.

Hines LE, Murphy JE (2011). Potentially harmful drug-drug interactions in the elderly: a review. Am. J. Geriatr. Pharmacother. 9:364-77.

Holloway KA, Ivanovska V, Wagner AK, Vialle-Valentin C, Ross-Degnan D (2013). Have we improved use of medicines in developing and transitional countries and do we know how to? Two decades of evidence. Trop. Med. Int. Health. 18:656-64.

Holloway K, Mathai E, Gray A. (2011) Surveillance of community antimicrobial use in resource-constrained settings - experience from five pilot projects. Trop. Med. Int. Health. 16:152-61.

Holbeach E, Yates P (2010). Prescribing in the elderly. Aust. Fam. Physician. 39:728–733.

Kaseje D (2006). Health Care in Africa: Challenges, Opportunities and an emerging model for improvement. (Accessed Nov 2013). Available at: www.wilsoncenter.org/sites/default/files/Kaseje2.pdf

Kalaba M, Godman B, Vuksanovic A, Bennie M, Malmstrom RE (2012). Possible ways to enhance renin-angiotensin prescribing efficiency: Republic of Serbia as a case history? J. Comp. Eff. Res. 1:539-49

Kesselheim AS, Misono AS, Lee JL, Stedman MR, Brookhart MA, Choudhry NK, Shrank WH (2008) Clinical equivalence of generic and brand-name drugs used in cardiovascular disease: a systematic review and meta-analysis. JAMA. 300:2514-26

Labiris G FM, Kastanioti C, Alexias G, Protopapas A, Karampitsakos T, Niakas D (2015): Greek Physicians' Perceptions on Generic Drugs in the Era of Austerity. Scientifica. 251792

Little P, Stuart B, Francis N, Douglas E, Tonkin-Crine S, Anthierens S, et al. (2013) Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial. Lancet. 382(9899):1175-82.

Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M et al. (2009). Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J. Hypertens. 27: 2121–2158.

Markovic-Pekovic V, Skrbic R, Petrovic A, Vlahovic-Palcevski V, Mrak J, Bennie M, et al. (2016) Polypharmacy among the elderly in the Republic of Srpska: extent and implications for the future. Expert Rev. Pharmacoecon. Outcomes Res. 16:609-618.

MdRezal RS, Hassali MA, Alrasheedy AA, Saleem F, MdYusof FA, Godman B. (2015) Physicians' knowledge, perceptions and behaviour towards antibiotic prescribing: a systematic review of the literature. Expert Rev. Anti. Infect. Ther. 13:665-80.

Muyu G, Mbakaya C, Makokha A (2013). Outpatient prescribing practices at Mbagathi district hospital-Nairobi County. East Afr. Med. J. 90:387-95.

Paton C (2006) Generic clozapine: outcomes after switching formulations. Br. J. Psychiatry. 189:184-5

Patterson SM, Hughes C, Kerse N, Cardwell CR, Bradley MC (2012). Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst. Rev. 5:Cd008165. doi:

1002/14651858.CD008165.pub2

Riaz H, Godman B, Hussain S, Malik F, Majmood S, Shami A, Bashir S (2015). Prescribing of bisphosphonates and antibiotics in Pakistan: challenges and opportunities for the future. J. Pharm. Health Serv. Res. 6:111–121.

Sabuncu E, David J, Bernede-Bauduin C, Pepin S, Leroy M, Boelle PY, Watier L, Guillemot D (2009) Significant reduction of antibiotic use in the community after a nationwide campaign in France, 2002-2007. PLoS Med. 6:e1000084. doi: 10.1371/journal.pmed.1000084

Spurling GK, Mansfield PR, Montgomery BD, Lexchin J, Doust J, Othman N, Vitry AI (2010) Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review. PLoS Med. 7:e1000352. doi: 10.1371/journal.pmed.1000352.

Tamuno I, Fadare JO. (2012) Drug prescription pattern in a Nigerian tertiary hospital. Trop. J. Pharm. Res. 11:146–152.

Veronin M (2011) Should we have concerns with generic versus brand antimicrobial drugs? A review of issues. J. Pharm. Health Serv. Res. 2:135-50.

WHO. The World Medicines Situation (2011) - Rational Use of Medicines. (Accessed Nov 2013). Available at: http://apps.who.int/medicinedocs/en/m/abstract/Js18064en/

World Health Organization (1993). How to investigate drug use in health facilities: selected drug use indicators - EDM Research Series No. 007. (Accessed Nov 2013). Available at: http://apps.who.int/medicinedocs/en/d/Js2289e/


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