Ahmed Tashfeen, Khan Ceemal, Khan Kausar
Department of Surgery, Aga Khan University, Karachi, Pakistan.
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
J Pak Med Assoc. 2024 Nov;74(11 (Supple-12)):S28-S37. doi: 10.47391/JPMA.AKU-EPP-07.
The ethics of physician prescriptions is a matter of global concern. While commonalities exist in reasons for unethical prescribing practices such as physician incentivization by pharmaceutical companies, the underlying social determinants may be different across countries and socioeconomic strata. This scoping review has collected themes from publications around prescription ethics from Pakistan. Four major themes were identified: 1) Impact - including physical and financial harm to patients, deficit in trust and development of antibiotic resistance, 2) Causes - including personal financial needs, peer pressure, inadequacy of education in ethics and professionalism, lack of evidence for policy-making, and weak regulatory framework, 3) Type - includes unethical practices like excessive, inappropriate/unnecessary, expensive, nonevidence- based, and off-label prescriptions, and prescription of controlled drugs to addicts, and 4) Solution - proposed strategies to curb unethical prescribing practices included education of community and undergraduates, trainees and practicing physicians, improvement in policies/laws on drug dispensation/prescriptions, their enforcement and accountability, as well as making health care accessible. In summary, this review identifies various social determinants of prescription ethics in the context of Pakistan, a low-middle income country, and highlights locally applicable measures to prevent unethical prescribing practices.
医生处方的伦理问题是一个全球关注的问题。虽然在不道德处方行为的原因方面存在一些共性，比如制药公司对医生的激励，但潜在的社会决定因素在不同国家和社会经济阶层可能有所不同。这项范围综述收集了来自巴基斯坦有关处方伦理的出版物中的主题。确定了四个主要主题：1）影响——包括对患者的身体和经济伤害、信任缺失以及抗生素耐药性的发展；2）原因——包括个人经济需求、同行压力、伦理和专业精神教育不足、政策制定缺乏证据以及监管框架薄弱；3）类型——包括过度、不适当/不必要、昂贵、无证据依据、超说明书用药等不道德行为，以及向成瘾者开具管制药品；4）解决方案——提出的遏制不道德处方行为的策略包括对社区、本科生、实习生和执业医生进行教育，改进药品配发/处方方面的政策/法律，加强其执行和问责，以及使医疗保健可及。总之，本综述确定了低收入和中等收入国家巴基斯坦背景下处方伦理的各种社会决定因素，并强调了预防不道德处方行为的适用于当地的措施。
