AN ASSESSMENT OF RATIONAL DRUG USE IN PUBLIC TERTIARY HOSPITALS IN EDO STATE

Abstract

Rational use of medicine requires that patients receive quality efficacious medicines appropriate to their needs, in doses that meet their individual requirements, for the adequate period of time and at the lowest cost to them and to the community. Only 12% value of budgetary allocation for drugs in developing countries are received by consumers. The objective was to assess rational drug use in public tertiary hospitals in Edo State.
A descriptive cross sectional study was carried out using quantitative and qualitative methods of data collection. All the three public tertiary health facilities in the state were studied. Samples were selected by proportionate allocation among the three health facilities and the individual patient selected by systematic sampling method to achieve 644 patients studied. A total population of 182 prescribers and dispensers in the GOPD of all three tertiary health facilities were studied. The respondents were interviewed with questionnaires on their drug use practices. Key informant interviews were also carried out with the Heads of clinical services of the institutions studied. Also nine hundred and sixty prescription sheets for the past one year across all three public tertiary health facilities in the state were retrieved and analysed using the WHO drug use indicators as a guide.
Mean ages of the respondents studied were 34.9 ± 6.2, 36.7 ± 8.1 and 29.2 ± 8.8 years for prescribers, dispensers and patients respectively. Few prescribers (23.5%) and some dispensers (41.7%) could tell correctly what rational drug use is all about. Fewer prescribers (13.7%) and dispensers (13.9%) had received training in rational drug use. Average number of drugs prescribed per encounter was 3.77. It was found that (54.2%) drugs were prescribed by generic names, encounters with an antibiotic prescribed was 15.5%, while 7.3% were with an injection prescribed. Though, essential drug list was not available in one of the three institutions studied, 62.6% of drugs were prescribed from essential drug list. Most prescribers (75.3%) were usually influenced in their prescription pattern by the nature of ailment being treated. The problem of lack of dispensing materials was most frequently recounted by dispensers (52.8%) as the commonest dispensing problem in the health facilities, most of them (86.1%) also felt that their dispensing environment was not conducive enough for
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patient counseling. Adequate labeling of drugs was found in 80.3% of encounters and availability of drugs in stock was 86.6%. Patients’ knowledge of correct dosage was high, 84.2%, but 77.4% of them were reported to have self medicated wrongly. Average drug cost per encounter was found to be N 1224.38 (US$ 7.91) and 84.5% of patients said they felt satisfied with the treatment and general services they received in the health facility.
The overall prescription pattern was encouraging with respect to the use of antibiotics, injections and essential drug list, though generic prescribing was relatively poor and the tendency to prescribe too many drugs than are clinically required was observed. There is still a lot of room for improvement, especially in the use of standard treatment guidelines. Drug supply and labeling was adequate, even with poor drug dispensing environment and lack of some dispensing materials. Patient’s counseling by pharmacists still leaves a lot to be desired. Hence the general attitude of patients towards drug use can best be described as poor. This poor compliance to drugs by patients was influenced mainly by the educational status of the patient, the accessibility of the health facility personnel/ their attitude to the patient, as well as the cost of purchasing the prescribed drugs.
There should be an intervention program involving concerted continuing education to influence the knowledge, attitude and practice of prescribers and dispensers. This would help sustain the right practices and correct the wrong ones.

AN ASSESSMENT OF RATIONAL DRUG USE IN PUBLIC TERTIARY HOSPITALS IN EDO STATE