Patterns of prescribing practices in Makueni County Referral Hospital, Kenya

Abstract

Introduction: Irrational prescribing is widespread across the globe and is a major problem in many healthcare facilities, especially in developing countries. According to the World Health Organization (WHO), statistics indicate that more than half of all drugs are prescribed, dispensed or sold improperly across the globe. Many studies carried out in different countries have documented various forms of irrational prescribing. It is advisable to describe and quantify the current situation of prescribing practices before mechanisms are put in place to promote rational drug use. Prescribing surveys, using WHO core prescribing indicators, have been employed to describe prescribing patterns in healthcare facilities. Objective: The study objective was to determine patterns of prescribing practices in Makueni County Referral Hospital. Methodology: The study was a hospital based cross-sectional survey divided into two parts: a retrospective prescription survey and a questionnaire-based knowledge, attitudes and practices (KAP) survey. In the prescription survey, 824 patient encounters were sampled from outpatient and inpatient departments between 1st January and 31st December, 2013. Data was abstracted using a pre-tested data collection form, entered into and analyzed using Epi info version 7.0 and Stata version 10.0 software. The KAP survey involved administering questionnaires to fifty one prescribers. Results: The mean number of drugs per patient encounter was 2.7. Only 45.5% of the total drugs were prescribed using international non-proprietary names (generic names). Antibiotics were prescribed in 74% while injections were prescribed in 13.2% of the total prescriptions surveyed. The percentage of drugs prescribed from the Kenya Essential Medicines List was 89.1%. The percentage of complete prescriptions was 49%. Clinical setting, comorbidities, chronic conditions and prescriber cadre were all found to be significantly associated with both polypharmacy and antibiotic prescribing. Patient age was positively correlated to the number of drugs prescribed per patient encounter. The KAP survey revealed gaps in prescribers‟ knowledge of prescribing guidelines. Conclusion: The results show a trend towards inappropriate prescribing, particularly polypharmacy, underuse of generic names when prescribing, over prescription of antibiotics and incomplete prescription writing. Frequent continuous medical education forums (CMEs), seminars and trainings on prescribing are recommended to address irrational prescribing in the hospital. Periodic prescription surveys and drug utilization studies are also recommended to identify any forms of irrational prescribing. The findings of such studies should be disseminated to all healthcare workers and particularly the prescribers, followed by relevant interventions to remedy any problems identified.