RIFT VALLEY UNIVERSITY
ABICHU CAMPUS
DEPARTMENT OF PHARMACY
10/08/2019 1
PRESCRIPTION ANALYSIS OF
DRUGS DISPENSED IN SELAM FIRE
HEALTH CENTER, AKAKI KALITY
SUB-CITY, ADDIS ABABA, ETHIOPIA
USING WHO INDICATOR.
By: -
DAWIT SOLOMON
DESALEGN TEKA
YOHANNES GETACHEW
HAILEMICHAEL YIMENSHEWA
Under the supervisor of Mr. Solomon
G/Amanuel (Msc.) 10/08/2019 2
Outlines
10/08/2019 3
Introduction
Prescription analysis of drugs is criteria based
systematic method of evaluating the rational
use of drugs.
It can be done by assessing the prescriptions
pattern of socio-demographic characteristics,
the diagnosis, therapeutic regimen
recommendations, legality of the prescription
or prescribers identifiers and level of WHO
core prescribing indicators ,the rational use of
drugs is achieved when patients receive
medications appropriate to their clinical
needs: in doses that meet their own individual
10/08/2019 4
Statement of the Problem
The physician’s poor level of prescribing of
medications towards their patients
Antibiotics are misused and over-used in
world wide
Mostly patient demographics, instructions for
drug use and prescriber identifiers are missing
in the prescription
10/08/2019 5
Cont...
Poor adherence to available standards being a
usual practice
Prescribing of many drugs per prescription
Higher amount of antibiotics and injectables
are also prescribed
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Significance of the Study
To develop;
Their good prescribing practice (GPP),
Therapeutic knowledge by prescribing the
right drug for the right patient with
appropriate route of administration and
duration of treatment at lowest possible cost,
and
10/08/2019 7
Cont...
Provide information on the rational use of drugs
for various medical conditions by identifying
whether the current prescribing practice in the
health center is rational or not.
Hence, the patient obtain the maximum benefit with
limited toxicity and adverse events from the use of
medications by influencing the prescriber or
dispenser as an input to provide
10/08/2019 drug information. 8
OBJECTIVES OF THE STUDY
General Objective
To analyze the prescription pattern of drugs
in Selam Fire Health Center.
Specific Objectives
To assess the therapeutic regimen
recommendations
To assess percentage of antibiotics
prescribed per encounter
To assess percentage of injectables
prescribed per encounter
10/08/2019 9
METHODS AND
MATERIALS
Study area and period
The study was conducted in Selam Fire Health Center,
which is found in southern part of Addis Ababa Akaki-
Kality Sub-city, Ethiopia.
It is located 21 km from the center of Addis Ababa,
Piazza. SFHC was established in 2004 E.C.
The Health Center has Disease prevention & health
promotion case team and Curative care case team they
are also integrate other departments like: Delivery,
10/08/2019 10
Cont...
The study will be conducted from July
2/2018 to October 27/2018.
Study design
A retrospective cross sectional study was
conducted by using prescriptions found in
the pharmacy of the health center.
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Population
Source Population
The source population was all prescriptions at
the outpatient pharmacy of SFHC, dispensed
from July 23/2018 – October21/2018.
Study Population
Prescription papers selected by systematic
random sampling among prescription papers
in the pharmacy of SFHC dispensed for 3
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Selection criteria
Inclusion criteria
All registered prescriptions containing any
type of the medications.
Patients of all age group
Exclusion criteria
Those prescriptions containing drugs
which are not clear to read and
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Sample Size Determination and
Sampling Technique
The study was done using the statically formula to
determine sample size:-
n= (1.96)2 * pq
d2
Where,
Probability coefficient for desired interval [CI =
95%],
n- Is minimum sample size determine
p - Is proportion of prescriptions possessing
characteristics of interest /50% prevalence?
q - 1-p
d- Is margin of sampling error tolerated (5%).
n= (1.96)2* 0.5(1-0.5)
10/08/2019 = 384 14
Cont...
These 384 prescriptions were selected from the
total of 11,900 prescriptions dispensed during 3
months period. Before selection, the total
prescriptions in the pharmacy were counted to
determine interval for random selection (k).
Interval for selection (k) = Total number of
prescription containing the required medications
within study period/ Sample size
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Variables
Dependent variables
◦ WHO core prescribing indicators
◦ Therapeutic regimen recommendations
Independent variables
◦ Age
◦ Sex
◦ Weight
◦ Diagnosis
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Data collection
Instruments
Data was collected from July 23/2018 to
October 21/2018 using data collection
format/checklist based on objective of the
research and accessories materials like tally
sheet, pen, pencil, calculator, binder.
Process
Data was collected from the prescriptions using
data collection format by the WHO. In addition
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Cont...
Calculation of indicators
The recommended WHO core indicators [5]
were calculated:
Mean number of drugs per encounter
Percentage of total drugs prescribed by generic
name
Percentage of total patient encounters with an
antibiotic prescribed
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Data Quality Assurance
To assure the quality of the data the following
measure was taken.
Properly designed data collection
checklist/format was used and pre test will
be done prior to the study to identify possible
sources of difficulties that were occur during
formal data collection. 10/08/2019 19
Data analysis
The collected data was analyzed using
tallying method and scientific calculator,
and then frequencies and percentages
were determined. The result of the study
was presented by table, bar graphs and pie
chart. The result was compared with
Essential medicine list, standard treatment
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Operational definition
Poly-pharmacy:-concomitant
use of three and more drugs
per prescription
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RESULTS
Socio-demographic characteristics
Out of 384 prescriptions taken from 11,900
prescriptions prescribed during the 3 months
period, 2 prescriptions were excluded per the
exclusion criteria; the remaining 382 prescriptions
were analyzed.
Name of patient were provided on each of the
prescriptions (100%)
Age and sex of patients were mentioned on 376
(98.4%) and 380 (99.5%) of the prescription
respectively Table 10/08/2019
1 22
Age composition
Among 382 prescriptions reviewed,
169 (45%) were prescribed for males and
Table
213 (55%) were prescribed for females. 2
The age composition of the study reveal that
164 (42.93 %) are between the ages of 15-30
years and females take the higher percentage
(23.82 %) and males (19.10%) respectively.
The rest 41 (10.73 %), 64 (16.75 %), 43 (11.25 %),
18 (4.71 %) and 52 (13.61 %) lied between the23
10/08/2019
Commonly prescribed drugs
From 382 patient encounters 50.06% of them were
prescribed with antibiotics which is higher than
Table
WHO recommendations(20%-26.8%) although the
result is:
3
Better than those findings from Hawassa (58%),
Dessie (52.8%), South west Ethiopia (54.7%) and
Sudan (64%)
Comparable with results from rural
India(45%),Osun state, Nigeria(50.1%)
10/08/2019 24
Therapeutic regimen
recommendations
Correct name of the drug were written in each of the
prescriptions (100%), 52.9% and 57.9% of
prescriptions contain the dose and Table
dosage form
5 of the
drug respectively.
These findings are lower than those from:
Lahore, Pakistan where only 88% contain dose and
97% contain dosage form
Rural India where dosage forms of the drug were 94%
and dose 87.1%
The results of this study setting are appreciable where
route of administration provided in 369 prescriptions
(96.6%), frequency of administration in 370
prescriptions (96.9%) and duration of treatment in 366
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Level of injectables
The level of injectables was (14.4%) which is
around standards set by WHO (13.4-24.1),
although
Higher values are also encountered in Hawassa
(38.1%), Dessie (31.2%), Osun state, Nigeria (72.7%).
Higher level of injectables prescribing might
be due to wrong beliefs of patients and
physicians towards injectables that unlike
oral medications, they are effective and
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Prescribing of medications from EDL was 99.63%
which is appreciable and within the ideal value of
WHO (100%). The result is also:
Better than those findings from Dessie (91.7%)
and Hawassa (96.6%). and ensures practices in
SFHC conform to a national drug policy.
The percentage of prescribing drugs by generic
name in the area was 90.89% which is 10% less
than ideal values set by WHO (100%), and from
other studies, Dessie (93.9%), Hawassa (98.7%),
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Number of drugs prescribed per
encounter, 113 (30%), 147 (38%), 98
(26%), 20 (5%) and 4 (1%) of
prescriptions contain one, two, three, four
and five drugs per prescription
respectively.
Average number of drugs per prescription
was 2.1 which shows slightly increase
from WHO recommendations (1.6-1.8).
This result is better than those findings
Fig 1
from Sudan (2.6) and comparable with the
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Prescribers adherence
Name of prescriber and signature were
written on 375 (98%) and 380(99%)
Fig 2
prescriptions
These results are better than findings
from Lahore, Pakistan where name of
prescribers was stated in 82% of
prescriptions 10/08/2019 29
CONCLUSION
Patient demographics, therapeutic
regimen recommendations and prescribers
identifiers are more or less with in
standards.
It need upgrading like Dose and Dosage
form although weight of patients missed
in the prescription.
The degree of poly-pharmacy is not a
major concern in the area. However, level
of prescribing of antibiotics showed
deviation from recommendations of WHO
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Recommendation
Prescribers should give emphasis on socio-
demographic characteristics and WHO core
prescribing indicators while prescribing medications
The Health facility should have educational
program and provide information on the
consequences of poor prescribing practices by
providing current updates.
Further studies are needed to be conducted in the
area to identify the underlying
10/08/2019 cause of irrational31
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