EFFECT OF A MULTIFACETED INTERVENTION ON RATIONAL DRUG PRESCRIBING AT NIGERIAN NAVY HOSPITALS

Abstract

Introduction
Rational drug prescribing is an important component of quality healthcare delivery. However, irrational drug prescribing is a common practice in Nigerian healthcare facilities including those run by the military. Efforts directed at improving rational prescribing using a single method of intervention have often been unsuccessful and only few intervention studies have taken cognitive behaviour change theories such as the Theory of Planned Behaviour into consideration. Consequently, this study was undertaken among doctors at Nigerian navy hospitals to document their beliefs and behavioural intentions concerning rational prescribing; determine their prescribing practice; and evaluate the effect of persuasive communication combined with audit and feedback on their drug prescribing beliefs, intentions and practices.
Methodology
A quasi experimental study design was used. The six secondary hospitals run by the navy were grouped into two based on their administrative control and location. Those in Lagos and Sapele were allocated into the intervention group while those in Port-Harcourt and Calabar were allocated into the control group. All consenting doctors (23 control and 24 intervention) were used for the study. Data was collected using a pre-tested, interviewer administered, theory of planned behaviour based questionnaire and a prescription survey form. The intervention was carried out at the 3 secondary hospitals in Lagos and Sapele. The intervention consisted of persuasive and interactive workshops to address doctors’ beliefs about rational prescribing followed by audit and feedback of prescribing practice given to doctor on a monthly basis for 6 months. Post intervention, the questionnaire and prescription survey form were re-administered with only 22 and 21 doctors from the control and study group respectively. Data was analysed using SPSS version 21. Doctors’ beliefs and intentions were summarized using medians and interquartile range while selected drug use indicators were calculated and summarized as percentages, means and standard deviation. Potential relationship
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between the study variables were tested for behavioural beliefs and intention (Wilcoxon test) and for drug use indicators (t-test and chi-square test). The level of significance was set at 0.05.
Results
The result at the baseline assessment showed that control and intervention groups were comparable in terms of their socio-demographic characteristics. The doctors’ beliefs and behavioural intentions regarding rational drug prescribing also did not differ between the control and intervention group at baseline. The doctors generally had negative attitudes and weak subjective norms, weak perceived behavioural controls and weak intentions concerning rational drug prescribing. The only exception was concerning prescribing of injections for which they had indifferent beliefs and intentions. The baseline drug prescribing indicators were generally poor for both the control and intervention group as indicated by the average number of drugs per prescription (3.81 and 3.67), percentage of generic prescription (53.99% and 54.89%), percentage of prescriptions with antibiotic (44.2% and 47.2%), percentage of prescriptions with injection (25.07% and 23.19%) and average prescription cost per patient (N707.20 and N720.00).
Persuasive communication combined with audit and feedback was associated with significant improvement in doctors’ beliefs and intentions to prescribe drugs rationally, although they still remained indifferent concerning prescribing of injections. The intervention also significantly improved doctors’ drug use indicators with the exception of percentage of injection prescription where the observed reduction was not significant.
Conclusion
This study has shown that a theory of planned behaviour based combination of persuasive communication with audit and feedback is effective in improving doctors’ beliefs, intention and rational prescribing behaviour. It is recommended that the Nigerian Navy Medical Directorate should organize and sustain regular trainings on rational drug use. In addition they should conduct periodic audit and feedback of doctors’ drug prescribing behaviour in all navy healthcare facilities.

EFFECT OF A MULTIFACETED INTERVENTION ON RATIONAL DRUG PRESCRIBING AT NIGERIAN NAVY HOSPITALS