An evaluation of medicine prescribing practices in out-patient departments in public health facilities in Khomas region, Namibia
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Date
2016
Authors
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Publisher
University of Namibia
Abstract
It is estimated by the World Health Organisation (WHO, 2004) that globally, over 50% medicines are prescribed inappropriately. In Namibia, suboptimal prescribing practices have been reported in previous medicine use surveys. Prescribing patterns in the out-patient settings have however not been evaluated in the Khomas Region. The aim of this study was to evaluate the medicine prescribing patterns in out-patient departments of public health facilities in the Khomas Region, Namibia.
The study adopted the WHO descriptive cross-sectional observational design for a medicine use survey using both quantitative and qualitative methods of data collection. The study was conducted at three levels of health care: Hospital, Health Centre and Clinic. Data on prescribing indicators were collected from patient prescriptions and data on prescribers’ use of treatment guidelines was also collected. The main outcome variables were the use of STGs in prescribing of medicines at OPD units and five prescribing indicators recommended by WHO.
A total of 1,243 prescription records were reviewed and 37 prescribers participated in the study. Four out of the five prescribing indicators were below acceptable prescribing thresholds clearly showing that rational prescribing in Khomas Regions is suboptimal. The very high level of antibiotic prescribing (69%) is very worrying and will directly lead to increase in Anti-microbial resistance. The average of over three medicines per prescription shows that there is a degree of polypharmacy and the low level of generic prescribing only (64%) is also worrying. Adherence to STGs was found to be 73%, which is better than found in some other studies but still below the acceptable level. The main factors driving the use of STGs were access to STGs and/or training; access to STG recommended medicines at the health facility and the simplicity in indexing of the STG. The study recommends implementation of a prescribing performance management systemto standardize, continuously monitor and improve on the prescribing of medicines at OPD units in Khomas Region.
Description
A thesis submitted in partial fulfilment of the requirements for the Award of the Degree of Master of Public Health
Keywords
Prescribing patterns, Mdicines, Standard treatment guidelines