Lanip Nicole Andrea C, Dans Leonila F, Tan-Lim Carol Stephanie C, Gonzales Ma Liza Antoinette M, Galingana Cara Lois T, Sanchez Josephine T, Aquino Maria Rhodora N, Loreche Arianna Maever, Rey Mia P, Panganiban Janelle Micaela S, Dans Antonio L
Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila.
Philippine Primary Care Studies, Center for Integrative and Development Studies, University of the Philippines Diliman.
Acta Med Philipp. 2024 Oct 31;58(19):93-100. doi: 10.47895/amp.vi0.8668. eCollection 2024.
Appropriate use of medication is an important indicator of quality healthcare delivery among children. Previously published studies on drug utilization involved Filipino households in general and were conducted in the 1990s. No recent Philippine studies have been conducted that focus on drug utilization in children.
To describe the current prescribing patterns in one primary care service in a rural site in the Philippines using the World Health Organization (WHO) prescribing indicators.
A cross-sectional study was conducted by review of electronic medical records of patients seen at the primary care facility under the Philippine Primary Care Studies (PPCS) rural site from April 2019 to March 2020. Out of 9,930 total encounters, 623 patient encounters with prescriptions for pediatric patients were included in the study through systematic sampling. The average number of drugs per encounter, percentage of drugs prescribed by their generic names, percentage of encounters with prescribed antibiotics, percentage of encounters with prescribed injections, and percentage of drugs prescribed from the Philippine Drug Formulary were calculated. Values were compared to the cut-offs considered "good practice" for outpatient care in the WHO manual: (1) an average number of less than two drugs per encounter; (2) less than 30% of encounters are prescribed with antibiotics; (3) less than 20% of encounters are prescribed with injections; (4) 100% of drugs are prescribed by generic name; and (5) 100% of drugs are from the formulary.
On the average, three drugs were prescribed per encounter. Most patient encounters (80.9%) involved antibiotics prescription - higher than the WHO standard value of 30%. All drugs were prescribed by generic name and were prescribed from the formulary. Only 0.5% of encounters were prescribed injections, all of which were administered through the intramuscular route. Of the 1,962 prescriptions generated, antibiotics was the most prescribed medication (25.7%). The most common diagnosis was infectious in nature (88.8%).
The primary care service achieved the WHO standard values in terms of prescribing by injections and by generic names. There was a high rate of antibiotic prescriptions at 83%, and a high average number of drugs prescribed per encounter, exceeding the WHO standard value.
合理用药是儿童优质医疗服务的一项重要指标。此前发表的关于药物利用情况的研究涉及菲律宾普通家庭，且是在20世纪90年代进行的。最近没有针对菲律宾儿童药物利用情况的研究。
使用世界卫生组织（WHO）的处方指标描述菲律宾一个农村地区基层医疗服务机构当前的处方模式。
通过回顾2019年4月至2020年3月在菲律宾基层医疗研究（PPCS）农村地区基层医疗设施就诊患者的电子病历进行横断面研究。在总共9930次就诊中，通过系统抽样将623次儿科患者有处方的就诊纳入研究。计算每次就诊的平均用药数量、通用名开药的药物百分比、开具抗生素的就诊百分比、开具注射剂的就诊百分比以及从《菲律宾药品处方集》开药的药物百分比。将这些值与WHO手册中被视为门诊医疗“良好做法”的临界值进行比较：（1）每次就诊平均用药数量少于两种；（2）开具抗生素的就诊少于30%；（3）开具注射剂的就诊少于20%；（4）100%的药物用通用名开具；（5）100%的药物来自处方集。
每次就诊平均开具三种药物。大多数患者就诊（80.9%）涉及抗生素处方——高于WHO标准值30%。所有药物均用通用名开具且来自处方集。仅0.5%的就诊开具了注射剂，所有注射剂均通过肌肉注射途径给药。在开出的1962张处方中，抗生素是最常开具的药物（25.7%）。最常见的诊断为感染性疾病（88.8%）。
基层医疗服务机构在注射剂开具和通用名开具方面达到了WHO标准值。抗生素处方率高达83%，且每次就诊平均开具的药物数量较多，超过了WHO标准值。
