Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia.
Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Int J Qual Health Care. 2019 Jun 1;31(5):338-345. doi: 10.1093/intqhc/mzy172.
World Health Organization/International Network of Rational use of Drugs (WHO/INRUD) indicators are widely used to assess medicine use. However, there is limited evidence on their validity in Namibia's primary health care (PHC) to assess the quality of prescribing. Consequently, our aim was to address this.
DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: An analytical cross-sectional survey design was used to examine and validate WHO/INRUD indicators in out-patient units of two PHC facilities and one hospital in Namibia from 1 February 2015 to 31 July 2015. The validity of the indicators was determined using two-by-two tables against compliance to the Namibian standard treatment guidelines (NSTG). The receiver operator characteristics for the WHO/INRUD indicators were plotted to determine their accuracy as predictors of compliance to agreed standards. A multivariate logistic model was constructed to independently determine the prediction of each indicator.
Out of 1243 prescriptions; compliance to NSTG prescribing in ambulatory care was sub-optimal (target was >80%). Three of the four WHO/INRUD indicators did not meet Namibian or WHO targets: antibiotic prescribing, average number of medicines per prescription and generic prescribing. The majority of the indicators had low sensitivity and/or specificity. All WHO/INRUD indicators had poor accuracy in predicting rational prescribing. The antibiotic prescribing indicator was the only covariate that was a significant independent risk factor for compliance to NSTGs.
WHO/INRUD indicators showed poor accuracy in assessing prescribing practices in ambulatory care in Namibia. There is need for appropriate models and/or criteria to optimize medicine use in ambulatory care in the future.
世界卫生组织/国际合理用药网络（WHO/INRUD）指标被广泛用于评估药物使用情况。然而，在纳米比亚的初级卫生保健（PHC）中，这些指标用于评估处方质量的有效性证据有限。因此，我们旨在解决这一问题。
设计、设置、参与者和干预措施：采用横断面分析设计，于 2015 年 2 月 1 日至 7 月 31 日在纳米比亚的两家 PHC 机构和一家医院的门诊单位检查和验证 WHO/INRUD 指标。通过与纳米比亚标准治疗指南（NSTG）的符合性，使用四格表确定指标的有效性。绘制 WHO/INRUD 指标的受试者工作特征曲线，以确定它们作为符合商定标准的预测指标的准确性。构建多变量逻辑模型，独立确定每个指标的预测能力。
在 1243 份处方中，门诊护理中 NSTG 处方的依从性不理想（目标为>80%）。四个 WHO/INRUD 指标中有三个不符合纳米比亚或 WHO 的标准：抗生素处方、每张处方的平均用药数量和通用处方。大多数指标的敏感性和/或特异性较低。所有 WHO/INRUD 指标在预测合理处方方面的准确性都较差。抗生素处方指标是唯一符合 NSTG 依从性的独立危险因素。
WHO/INRUD 指标在评估纳米比亚门诊护理中的处方实践方面准确性较差。未来需要适当的模型和/或标准来优化门诊护理中的药物使用。
