南非国家药物政策对处方模式的影响：以林波波省为例

Implications of the South African National Drug Policy on prescribing patterns: a case study of the Limpopo province.

作者信息

Akunne Onyinye Onyeka, Valoyi Vutomi, Wehmeyer Alexander, Johnson Yasmina, Coetzee Renier

机构信息

School of Public Health, University of the Western Cape, Cape Town, South Africa.

School of Pharmacy, University of the Western Cape, Cape Town, South Africa.

出版信息

J Pharm Policy Pract. 2023 Oct 2;16(1):111. doi: 10.1186/s40545-023-00622-4.

DOI:10.1186/s40545-023-00622-4

PMID:37784167

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10544492/

Abstract

BACKGROUND

The South African National Drug Policy (SA-NDP) was introduced to promote rational medicine use (RMU). This study evaluates the quality of prescribing in the public healthcare sector in South Africa's Limpopo province following the World Health Organization's (WHO) rational prescribing standards. In addition, the prescribing practices in South Africa were compared to other African countries.

METHODS

A prospective cross-sectional survey of patients' prescriptions was conducted in Limpopo, South Africa, from October to December 2018. Findings were compared with the WHO reference values (WHO-RV), and the International Network of Rational Use of Drugs (IRDP) tool was used to measure the degree of rational prescribing. The optimal IRDP value was defined as 1. Study findings were compared with results from a previous study conducted in Limpopo and studies from Ethiopia and Eritrea.

RESULTS

Six hundred prescriptions were reviewed. The mean (SD) age was 43.9 ± 24.4 years (females = 56.5%). The average number of drugs prescribed (4.3, IRDP = 0.47) was higher than the WHO-RV (< 2). Generic prescribing (43%, IRDP = 0.43) and medicines prescribed from the essential medicines list (EML) (90%, IRDP = 0.90) were less than the WHO-RV (100%, respectively). Antibiotics (28%, IRDP = 1) and the number of injections prescribed (8%, IRDP = 1) were below the WHO-RV (< 30% and < 20%, respectively). The number of medicines prescribed was higher compared to previous years (4.3 vs. 3.4). Antibiotic prescribing declined (28% vs. 63.4%). Generic prescribing (43% vs. 41.7%) and medicines prescribed from the EML (90% vs. 93.1%) did not improve. A higher number of medicines were prescribed in this study compared to Ethiopia (1.7) and Eritrea (1.8), and a lower number of antibiotics were prescribed compared to Ethiopia (58.2%) and Eritrea (54.5%). Generic prescribing was low compared to Ethiopia (95.6%) and Eritrea (94.9%). All studies showed reduced injection prescribing (6.6-15.9%) and similar prescribing from the EML (90-95%).

CONCLUSIONS

There is an increased potential for drug-drug and adverse reactions with the increased number of prescribed medicines; however, the patient's clinical needs may warrant using multiple medicines. There is a need for generic prescribing to reduce medicine expenditure.

摘要

背景

南非国家药物政策（SA-NDP）旨在促进合理用药（RMU）。本研究依据世界卫生组织（WHO）的合理用药标准，评估南非林波波省公共医疗部门的处方质量。此外，还将南非的处方实践与其他非洲国家进行了比较。

方法

2018年10月至12月，在南非林波波省对患者处方进行了前瞻性横断面调查。将调查结果与WHO参考值（WHO-RV）进行比较，并使用国际合理用药网络（IRDP）工具来衡量合理用药程度。IRDP的最佳值定义为1。将研究结果与之前在林波波省进行的一项研究以及埃塞俄比亚和厄立特里亚的研究结果进行比较。

结果

共审查了600份处方。平均（标准差）年龄为43.9±24.4岁（女性占56.5%）。平均处方药物数量（4.3，IRDP = 0.47）高于WHO-RV（<2）。通用名药物处方率（43%，IRDP = 0.43）和基本药物清单（EML）中的药物处方率（90%，IRDP = 0.90）低于WHO-RV（分别为100%）。抗生素处方率（28%，IRDP = 1）和注射剂处方数量（8%，IRDP = 1）低于WHO-RV（分别<30%和<20%）。与前几年相比，处方药物数量有所增加（4.3对3.4）。抗生素处方率下降（28%对63.4%）。通用名药物处方率（43%对41.7%）和EML中的药物处方率（90%对93.1%）没有改善。与埃塞俄比亚（1.7）和厄立特里亚（1.8）相比，本研究中处方的药物数量更多，与埃塞俄比亚（58.2%）和厄立特里亚（54.5%）相比，抗生素处方数量更少。与埃塞俄比亚（95.6%）和厄立特里亚（94.9%）相比，通用名药物处方率较低。所有研究均显示注射剂处方减少（6.6 - 15.9%），EML中的药物处方情况相似（90 - 95%）。