Shrestha Rajeev, Prajapati Srijana
Department of Pharmacy, Bharatpur District Hospital, kuber marga, Bhagawaoti Tol, Bharatpur-04, Chitwan, Nepal.
J Pharm Policy Pract. 2019 Jul 10;12:16. doi: 10.1186/s40545-019-0177-y. eCollection 2019.
The rational use of medicine improves patient's quality of life. Excessive and inappropriate prescriptions result in severe consequences. The study of drug use patterns and prescription errors is necessary to promote rational drug use in developing countries. The aim of the study was to evaluate prescription practice and help to the quality use of medicine.
A retrospective, cross-sectional and quantitative study was conducted at Bharatpur District Hospital in central Nepal. The outpatient prescriptions retained at the pharmacy from November to December 2017 were used to evaluate prescription patterns and errors. The total of 770 prescriptions were reviewed. The stratified random sampling method was used.
The total of 2448 drugs were prescribed in 770 prescriptions or patients. The average number of drugs per encounter was 3.2. The percentage of encounter with antibiotic and injection was 37.9% ( = 292) and 0.7% ( = 5), respectively. The percentage of drugs prescribed by generic and from an essential medicine list of Nepal was 2.9% ( = 72) and 21.3% ( = 521), respectively. The most common 32.5% of prescriptions contain three drugs and 24.7% of prescriptions contain four drugs. The average prescription errors per prescription were 3.4. Among total errors, omission errors related to prescriber were 1.5 ( = 1135), omission errors related to the drug were 1.5 ( = 1189) and commission errors were 0.3 ( = 269). The total of 249 drug interactions were found in 19.1% ( = 147) prescriptions. The common prescription errors were due to failure to mention prescriber name 87.5% ( = 674), failure to mention prescriber signature 19.2% ( = 148) and failure to mention diagnosis 39.2% ( = 302).
The study shows low compliance with WHO prescribing indicators and high prescription errors. The prescribing practices were not confirmed to the standard recommended by WHO. Prescribing from the Essential Drug List (EDL), low rates of generic prescribing, high antibiotic prescribing and polypharmacy were a major problem. The study found major errors in prescriber and prescribed medicine details. Remarkable drug interactions were seen in prescribed medicines. The study recommended necessary practices and policy formulation and implementation by DTC and regulatory bodies to promote the rational use of medicine.
合理用药可提高患者生活质量。过度和不恰当的处方会导致严重后果。研究用药模式和处方错误对于促进发展中国家的合理用药很有必要。本研究的目的是评估处方实践并助力药品的合理使用。
在尼泊尔中部的巴拉特普尔地区医院开展了一项回顾性、横断面定量研究。利用2017年11月至12月药房留存的门诊处方来评估处方模式和错误。共审查了770张处方。采用分层随机抽样方法。
770张处方或患者共开具了2448种药物。每次就诊的平均用药数量为3.2种。使用抗生素和注射剂的就诊比例分别为37.9%(n = 292)和0.7%(n = 5)。使用通用名开具的药物以及来自尼泊尔基本药物清单的药物比例分别为2.9%(n = 72)和21.3%(n = 521)。最常见的情况是,32.5%的处方包含三种药物,24.7%的处方包含四种药物。每张处方的平均处方错误数为3.4个。在所有错误中,与开处方者相关的遗漏错误为1.5个(n = 1135),与药物相关的遗漏错误为1.5个(n = 1189),而开错错误为0.3个(n = 269)。在19.1%(n = 147)的处方中发现了总共249种药物相互作用。常见的处方错误包括未提及开处方者姓名的占87.5%(n = 674)、未提及开处方者签名的占19.2%(n = 148)以及未提及诊断的占39.2%(n = 302)。
该研究表明对世界卫生组织的处方指标依从性较低且处方错误率较高。处方实践未符合世界卫生组织推荐的标准。从基本药物清单开处方、通用名处方率低、抗生素处方率高以及多药联用是主要问题。该研究发现开处方者和所开药物详情存在重大错误。在所开药物中发现了显著的药物相互作用。该研究建议药品技术委员会和监管机构采取必要措施并制定和实施相关政策以促进合理用药。