Drug Use Pattern in Upazilla Health Complexes of Bangladesh

Abstract

Medically inappropriate, ineffective, and economically inefficient use of pharmaceuticals is commonly observed in the health care system throughout the world especially in the developing countries like Bangladesh. However, various forms of inappropriate prescribing often remain unnoticed by those who are involved in health sector decision making or delivery of health services. This problem will usually come to the attention of health decision makers or managers when there is an acute shortage of pharmaceutical budget and action for cost efficiency is required. The need for promoting appropriate use of drugs in the health care system is not only because of the financial reasons with which policy makers and managers are usually most concerned. Appropriate use of drugs is also one essential element in achieving quality of health and medical care for patients and the community. Obviously, this should also become the concern of practitioners. Actions or intervention programs to promote the appropriate use of drugs should, therefore, be continuously implemented and systematically incorporated as an integral part of the health care system. This session serves as an introduction to the entire issue of Promoting Rational Use of Drugs in the developing countries. The definition of rational use will be discussed, and a description of irrational drug use

will build on that definition, with common examples highlighted. The impacts as well as the underlying factors of irrational use of drugs will be addressed. A series of examples will be presented, ranging from general drug use patterns to disease specific examples for ARI,diarrhea, and other common illnesses The study focused on determination of prescribing and health care practices of doctors and pharmacist in the Thana health complexes in Bangladesh. Drug use indicators developed by international network for rational use of drug (INRUD) were used in the study. The study used the indicators like prescribing, patient cares, and drug systems and captured the key information on prescribing pattern, patients care and health facility management. This was done through collecting prospective data. To determine the pattern of drug prescription by consulting in Thana Health Complex of Bangladesh, 30 prescriptions were collected from Savar Thana Health complex. In total, 57 drugs were prescribed. The average number of drugs per encounter was 2.1 %. This survey revealed :..~at 54% drugs were prescribed by generic names and 65% drugs were ~:-escribed from essential drug list. Poly-pharmacy was observed in 80% c):- all encounters. Information about the prescribing physician and the 4 patient was invariably deficient. Name of patient, age and gender were totally absent in all prescriptions. In addition, none of the prescriptions mentioned address, diagnosis, or allergy of the patient. The most commonly prescribed therapeutic classes of drugs of total cases were as follows: 50% antibiotics, 12% antidiarrhoeal and 26% antiulcer. Other drugs included vitamin supplements 15%, ferrous sulphate 6.2% and Co-trimoxazole (40%) of total cases. Other agents prescribed in small proportions of encounters collectively amounted to 5%of total cases. No patients were given injection. The average consultation time was found to be 1.7 minutes and the dispensing time was only 23 seconds. The availability of key drugs '\\"as 58% and there was no essential drug list. The survey showed that 61.4% total prescribed drugs were actually dispensed and no dispensed drugs were adequately labeled. 86.67%patients had adequately knowledge on correct dose. In many case the doctors were found to comply with the patients demand by prescribing unnecessary drugs. From the result of the study it is understood that many drugs were prescribed irrationally or inappropriately in rural area and Thana health complexes in Bangladesh.