Obakiro Samuel Baker, Kiyimba Kenedy, Napyo Agnes, Kanyike Andrew Marvin, Mayoka Wilberforce John, Nnassozi Aishah Ggalabuzi, Aguti Beatrice, Akech Gabriel Madut, Waako John Paul
Faculty of Health Sciences, Department of Pharmacology and Therapeutics, Busitema University, Tororo, Uganda.
Faculty of Health Sciences, Department of Public and Community Health, Busitema University, Tororo, Uganda.
PLoS One. 2021 Jan 5;16(1):e0245036. doi: 10.1371/journal.pone.0245036. eCollection 2021.
Irrational prescription of drugs can lead to high cost of treatment thus limiting access to essential medicines. We assessed the affordability and appropriateness of prescriptions written for diabetic patients in Eastern Uganda.
We collected secondary data from the health management information system registers of patients who attended the outpatient medical clinic at Mbale regional referral hospital from January 2019 to December 2019. The average cost of the prescriptions was calculated and adjusted odds ratios for predictors for unaffordability estimated using logistic regression. Computed scores for indicators of rational drug prescription were used to assess the extent of rational prescribing.
The median cost per prescription was USD 11.34 (IQR 8.1, 20.2). Majority of the diabetic patients (n = 2462; 94.3%, 95% CI: 93.3-95.1%) could not afford the prescribed drugs. Predictors for unaffordability were if a prescription contained: ≥ 4 medicines (AOR = 12.45; 95% CI: 3.9-39.7); an injectable (AOR = 5.47; 95%CI: 1.47-20.32) and a diagnosis of diabetes mellitus with other comorbidities (AOR = 3.36; 95%CI: 1.95-5.78). Having no antidiabetic drug prescribed was protective for non-affordability (AOR = 0.38; 95%CI: 0.24-0.61). The average number of drugs per prescription was 2.8. The percentage prescription of drugs by generic name and from the essential medicine and health supplies list of Uganda were (6160/7461; 82.6%, 96% CI: 81.7%-83.4%) and (6092/7461; 81.7%, 95% CI: 80.8%-82.5%) respectively against WHO standard of 100%.
The majority of diabetic patients (94.3%) in Eastern Uganda cannot afford to buy prescribed medicines. The government should therefore ensure that essential medicines are readily accessible in public health facilities.
不合理的药物处方会导致治疗成本高昂，从而限制基本药物的可及性。我们评估了乌干达东部为糖尿病患者开具的处方的可负担性和合理性。
我们从2019年1月至2019年12月在姆巴莱地区转诊医院门诊就诊患者的健康管理信息系统登记册中收集了二手数据。计算了处方的平均成本，并使用逻辑回归估计了不可负担性预测因素的调整比值比。使用合理用药处方指标的计算得分来评估合理用药的程度。
每张处方的中位数成本为11.34美元（四分位距8.1，20.2）。大多数糖尿病患者（n = 2462；94.3%，95%可信区间：93.3 - 95.1%）买不起所开的药物。不可负担性的预测因素包括：处方中含有≥4种药物（调整比值比 = 12.45；95%可信区间：3.9 - 39.7）；一种注射剂（调整比值比 = 5.47；95%可信区间：1.47 - 20.32）以及患有糖尿病合并其他疾病（调整比值比 = 3.36；95%可信区间：1.95 - 5.78）。未开具抗糖尿病药物对不可负担性有保护作用（调整比值比 = 0.38；95%可信区间：0.24 - 0.61）。每张处方的平均药物数量为2.8种。按通用名开具的药物以及来自乌干达基本药物和卫生用品清单的药物的处方百分比分别为（6160/7461；82.6%，96%可信区间：81.7% - 83.4%）和（6092/7461；81.7%，95%可信区间：80.8% - 82.5%），而世界卫生组织的标准为100%。
乌干达东部大多数糖尿病患者（94.3%）买不起所开的药物。因此，政府应确保基本药物在公共卫生机构中易于获取。
