Chukwuani C M, Onifade M, Sumonu K
School of Pharmacy, College of Medicine, University of Lagos, Idi-Araba, PMB 12003, Lagos, Nigeria.
Pharm World Sci. 2002 Oct;24(5):188-95. doi: 10.1023/a:1020570930844.
To describe the current drug use practices at the institution, and gather baseline data, which can serve as a basis for designing an appropriate intervention to improve the drug use profile.
A retrospective audit of in- and out-patient prescriptions, generated during the period January-March 1999. Indicators of drug use pattern include: average number of drugs prescribed per encounter (ANDPE), average number of antibiotics prescribed per encounter (ANAPE), % encounter with antibiotics (PEA), percent of antibiotic prescriptions based on microbial sensitivity test results (MCST). Additionally, a "knowledge, attitude and practice" (KAP) survey of prescribers and dispensers was performed. Indicators of prescribing and dispensing quality include: sources of drug/prescribing information, availability and use of the hospital formulary, knowledge of the prescribing process and the adequacy of the drug supply management system.
A total of 9984 outpatient prescriptions and 127 in-patient case notes were audited. The total number of prescribers and dispensers surveyed were 88 and 13 respectively. The ANDPE was found to be 3.16 for out-patients and 9.7 for in-patients, ANAPE was 1.1 and 2.4 for out-patients and inpatients respectively. The PEA was 50.3% for out-patients and 96.7% for in-patients. Only 4.2% of in-patient antibiotic prescriptions were based on MCST and percent encounter with switches in antimicrobial therapy was 52.1% while the average number of switches per encounter was 1.35. In 18.5% of the in-patient encounters there was evidence of drug incompatibilities. The KAP survey revealed that prescribers and dispensers in the hospital rely on different sources for their drug information needs (MIMS vs Martindale Extrapharmacoepia). None of the prescribers surveyed was able to correctly enumerate all the 4 steps involved in the prescribing process, about 25% got at least 2 steps correctly, and only 9.1% of the dispensers surveyed could accurately define a hospital formulary. The drug supply management system was found to be inadequate.
The survey revealed that appreciable gaps in knowledge with respect to rational drug use, still exists among these cadre of healthcare professionals. The foregoing suggests an urgent need for review of current policies and systems in the hospital with the view of enhancing the drug use practices of the health providers. Specifically it is recommended that there should be an intervention program involving concerted continuing education (to influence the KAP of the various cadre of healthcare providers) and the establishment of a hospital formulary/standard treatment guidelines.
描述该机构目前的用药情况，并收集基线数据，为设计适当干预措施以改善用药情况提供依据。
对1999年1月至3月期间开具的门诊和住院处方进行回顾性审核。用药模式指标包括：每次就诊开具的平均药物数量（ANDPE）、每次就诊开具的平均抗生素数量（ANAPE）、使用抗生素的就诊百分比（PEA）、基于微生物敏感性试验结果的抗生素处方百分比（MCST）。此外，还对开处方者和药剂师进行了“知识、态度和实践”（KAP）调查。开处方和配药质量指标包括：药物/处方信息来源、医院处方集的可用性和使用情况、开处方流程知识以及药品供应管理系统的充分性。
共审核了9984张门诊处方和127份住院病历。接受调查的开处方者和药剂师总数分别为88人和13人。门诊患者的ANDPE为3.16，住院患者为9.7；门诊患者和住院患者的ANAPE分别为1.1和2.4。门诊患者的PEA为50.3%，住院患者为96.7%。只有4.2%的住院抗生素处方基于MCST，抗菌治疗换药的就诊百分比为52.1%，每次就诊的平均换药次数为1.35。在18.5%的住院病例中存在药物不相容的证据。KAP调查显示，医院的开处方者和药剂师获取药物信息的来源不同（MIMS与《马丁代尔药物大典》）。接受调查的开处方者中，没有一人能够正确列举开处方过程中涉及的所有4个步骤，约25%的人至少正确回答了2个步骤，接受调查的药剂师中只有9.1%能够准确界定医院处方集。发现药品供应管理系统存在不足。
调查显示，这些医疗专业人员在合理用药知识方面仍存在明显差距。上述情况表明迫切需要对医院现行政策和系统进行审查，以改善医疗服务提供者的用药情况。具体建议开展一项干预计划，包括协同进行继续教育（以影响各类医疗服务提供者的KAP）以及制定医院处方集/标准治疗指南。
