Agrawal Rohit, Shrestha Rajeev, Poudel Ramesh Sharma, Shrestha Shakti
Shree College of Technology, Purbanchal University, Bharatpur, Bagmati Province, Nepal.
NIHR Newcaste Patient Safety Research Collaboration, Newcastle University, Newcastle-upon-Tyne, United Kingdom.
Inquiry. 2025 Jan-Dec;62:469580251347136. doi: 10.1177/00469580251347136. Epub 2025 Jun 14.
Inappropriate drug use is a significant global health issue, particularly in low-resource settings. This systematic review evaluates drug utilization across healthcare facilities in Nepal, a low-resource setting, using WHO core prescribing indicators to identify areas for improvement. A systematic review was conducted by searching literature in PubMed, Embase, CINAHL, INRUD bibliography, NepJOL, NepMed, and Google Scholar. Original studies assessing at least one WHO prescribing indicator in healthcare settings of Nepal were included. Eligible studies were analyzed descriptively and through proportional meta-analysis using a random-effects model. Eighty-eight studies were identified involving 2108 healthcare facilities and 60 191 patient encounters. The average of three drugs per encounter (95% CI: 2.5-3.2) was determined. Generic prescribing occurred only in 21.8% (95% CI: 15.6%-28.8%) prescriptions, showing a decline trend. Antibiotics were prescribed in 64.4% (95% CI: 57.7%-70.8%) encounters, with higher prevalence in secondary and tertiary care settings. Injectables were prescribed in 22.9% encounters (95% CI: 12.2-35.8). Drugs prescribed from WHO and Nepal essential medicine lists accounted for 53.0% (95% CI: 41.1-64.7) and 54.4% (95% CI: 47.7-60.9), respectively. The evaluation of drug utilization in Nepal suggested that the standards for WHO core prescribing indicators were not met, including overuse of antibiotics, underuse of essential medicines, and minimal generic prescribing. Targeted interventions, including prescriber education, policy reforms, enhanced monitoring, and regular prescription audits, are essential to promote rational prescribing and improve drug-related outcomes, including an opportunity to reduce antimicrobial resistance.
不适当用药是一个重大的全球卫生问题，在资源匮乏地区尤其如此。本系统评价利用世界卫生组织核心处方指标评估了尼泊尔这一资源匮乏地区医疗机构的药物使用情况，以确定需要改进的领域。通过检索PubMed、Embase、CINAHL、INRUD文献目录、NepJOL、NepMed和谷歌学术搜索文献进行了系统评价。纳入了评估尼泊尔医疗机构中至少一项世界卫生组织处方指标的原始研究。对符合条件的研究进行描述性分析，并使用随机效应模型通过比例荟萃分析进行分析。共识别出88项研究，涉及2108个医疗机构和60191次患者诊疗。确定每次诊疗平均使用三种药物（95%置信区间：2.5-3.2）。通用名处方仅占21.8%（95%置信区间：15.6%-28.8%）的处方，呈下降趋势。64.4%（95%置信区间：57.7%-70.8%）的诊疗中开具了抗生素，在二级和三级医疗机构中患病率更高。22.9%的诊疗中开具了注射剂（95%置信区间：12.2-35.8）。世界卫生组织基本药物清单和尼泊尔基本药物清单上的药物分别占53.0%（95%置信区间：41.1-64.7）和54.4%（95%置信区间：47.7-60.9）。对尼泊尔药物使用情况的评估表明，未达到世界卫生组织核心处方指标的标准，包括抗生素使用过度、基本药物使用不足以及通用名处方极少。有针对性的干预措施，包括对开处方者的教育、政策改革、加强监测和定期处方审核，对于促进合理用药和改善与药物相关的结果至关重要，包括有机会减少抗菌药物耐药性。
