Rasu Rafia S, Iqbal Mohammad, Hanifi Sma, Moula Ariful, Hoque Shahidul, Rasheed Sabrina, Bhuiya Abbas
School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA.
Centre for Equity and Health System, International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh.
Clinicoecon Outcomes Res. 2014 Dec 3;6:515-21. doi: 10.2147/CEOR.S67424. eCollection 2014.
Village doctors, informal health care providers practicing modern medicine, are dominant health care providers in rural Bangladesh. Given their role, it is important to examine their prescription pattern and inappropriate use of medication.
These cross-sectional study data were collected through surveys of patients seen by village doctors during 2008 and 2010 at Chakaria, a typical rural area of Bangladesh. Categorization of appropriate, inappropriate, and harmful prescriptions by disease conditions was based on guidelines defined by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), and the Government of Bangladesh. Analytical categorization of polypharmacy was defined when five or more medications were prescribed for a patient at a single visit.
A total of 2,587 prescriptions were written by village doctors during the survey periods. Among the prescriptions were appropriate (10%), inappropriate (8%), combination of appropriate and inappropriate (63%), and harmful medications (19%). Village doctors with more than high school education were 53% less likely (odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.26-0.86) to give polypharmacy prescriptions than those with less than high school education. While exploring determinants of prescribing inappropriate and harmful medications, this study found that polypharmacy prescriptions were six times more likely [OR: 6.00, 95% CI: 3.88-9.29] to have harmful medications than prescriptions with <5 medications.
Village doctors' training and supervision may improve the quality of services and establish accountability for the benefit of the rural population.
乡村医生是在孟加拉国农村地区从事现代医学的非正规医疗服务提供者，是农村地区主要的医疗服务提供者。鉴于他们的作用，研究他们的处方模式和药物不当使用情况很重要。
这些横断面研究数据是通过对2008年至2010年期间孟加拉国典型农村地区查卡里亚的乡村医生诊治的患者进行调查收集的。根据世界卫生组织（WHO）、联合国儿童基金会（UNICEF）和孟加拉国政府制定的指南，按疾病情况对适当、不适当和有害处方进行分类。当一次就诊为患者开具五种或更多药物时，定义为多药联用的分析分类。
在调查期间，乡村医生共开出2587张处方。其中适当处方（10%）、不适当处方（8%）、适当与不适当混合处方（63%）以及有害药物处方（19%）都有。受过高中以上教育的乡村医生开出多药联用处方的可能性比受过高中以下教育的乡村医生低53%（比值比[OR]：0.47，95%置信区间[CI]：0.26 - 0.86）。在探究开具不适当和有害药物处方的决定因素时，本研究发现多药联用处方含有有害药物的可能性是开具药物少于5种处方的6倍[OR：6.00，95% CI：3.88 - 9.29]。
乡村医生的培训和监督可能会提高服务质量，并为农村人口的利益建立问责制。
