Prescribing Quality in Medical Specialists in Isfahan, Iran

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Abstract

Rational prescribing increases the quality of health care and patient outcomes. In this study, the quality of drug prescription in specialist physicians in Isfahan province of Iran was assessed for evaluating the rational use of drugs and improving the therapeutic outcomes.

This retrospective survey was conducted on a total of 7999530 prescriptions from all general and specialist physicians. The most frequently prescribed drugs and World Health Organization (WHO) prescribing indicators were evaluated in prescriptions of all medical specialties.

Assessment of prescribing indicators revealed poor-quality prescribing performance by general practitioners including high number of medicines prescribed per clients, wide range of prescribed medicines in each prescription, over-prescribing of antibiotics, corticosteroids and injectable drugs. There were also wide differences in the pattern of drug prescribing depending on the medical specialties. The average number of drugs prescribed per encounter by specialists was less than generalists except for the cardiologists. General practitioners, otorhinolaryngologists and general surgeons prescribed more antibiotics. Orthopedic surgeons and general practitioners were the top prescribers of injectable and corticosteroid drugs. The most frequently prescribed medicine groups varied according to the prescribers’ medical specialty. Analgesics and antipyretics were the most prescribed preparations in general medicine, pediatrics, orthopedics, general surgery and cardiology.

Because of the wide variability in the pattern of drug prescribing depending on the medical specialties, specific performance indicators should be developed for each specific medical specialty for better assessing of prescribing quality in specialist physicians.

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Most cited references 30

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European Surveillance of Antimicrobial Consumption (ESAC): quality indicators for outpatient antibiotic use in Europe.

Samuel Coenen, Matus Ferech, Flora M Haaijer-Ruskamp … (2007)

Indicators to measure the quality of healthcare are increasingly used by healthcare professionals and policy makers. In the context of increasing antimicrobial resistance, this study aimed to develop valid drug-specific quality indicators for outpatient antibiotic use in Europe, derived from European Surveillance of Antimicrobial Consumption (ESAC) data. 27 experts (15 countries), in a European Science Foundation workshop, built on the expertise within the European Drug Utilisation Research Group, the General Practice Respiratory Infections Network, the ESCMID Study Group on Primary Care Topics, the Belgian Antibiotic Policy Coordination Committee, the World Health Organization, ESAC, and other experts. A set of proposed indicators was developed using 1997-2003 ESAC data. Participants scored the relevance of each indicator to reducing antimicrobial resistance, patient health benefit, cost effectiveness and public health policy makers (scale: 1 (completely disagree) to 9 (completely agree)). The scores were processed according to the UCLA-RAND appropriateness method. Indicators were judged relevant if the median score was not in the 1-6 interval and if there was consensus (number of scores within the 1-3 interval was fewer than one third of the panel). From the relevant indicators providing overlapping information, the one with the highest scores was selected for the final set of quality indicators-values were updated with 2004 ESAC data. 22 participants (12 countries) completed scoring of a set of 22 proposed indicators. Nine were rated as relevant antibiotic prescribing indicators on all four dimensions; five were rated as relevant if only relevance to reducing antimicrobial resistance and public health policy makers was taken into account. A final set of 12 indicators was selected. 12 of the proposed ESAC-based quality indicators for outpatient antibiotic use in Europe have face validity and are potentially applicable. These indicators could be used to better describe antibiotic use in ambulatory care and assess the quality of national antibiotic prescribing patterns in Europe.

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Medication errors: what they are, how they happen, and how to avoid them.

Jeffrey Aronson (2009)

A medication error is a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient. Medication errors can occur in deciding which medicine and dosage regimen to use (prescribing faults--irrational, inappropriate, and ineffective prescribing, underprescribing, overprescribing); writing the prescription (prescription errors); manufacturing the formulation (wrong strength, contaminants or adulterants, wrong or misleading packaging); dispensing the formulation (wrong drug, wrong formulation, wrong label); administering or taking the medicine (wrong dose, wrong route, wrong frequency, wrong duration); monitoring therapy (failing to alter therapy when required, erroneous alteration). They can be classified, using a psychological classification of errors, as knowledge-, rule-, action- and memory-based errors. Although medication errors can occasionally be serious, they are not commonly so and are often trivial. However, it is important to detect them, since system failures that result in minor errors can later lead to serious errors. Reporting of errors should be encouraged by creating a blame-free, non-punitive environment. Errors in prescribing include irrational, inappropriate, and ineffective prescribing, underprescribing and overprescribing (collectively called prescribing faults) and errors in writing the prescription (including illegibility). Avoiding medication errors is important in balanced prescribing, which is the use of a medicine that is appropriate to the patient's condition and, within the limits created by the uncertainty that attends therapeutic decisions, in a dosage regimen that optimizes the balance of benefit to harm. In balanced prescribing the mechanism of action of the drug should be married to the pathophysiology of the disease.

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Field tests for rational drug use in twelve developing countries.

M A K Azad Chowdhury, B. Santoso, Bimo Tejo … (1993)

Increasing efforts are being made to improve drug-use practices and prescribing behaviour in developing countries. An essential tool for such work is an objective and standard method of assessment. We present here a set of drug-use indicators produced and tested in twelve developing countries. We describe practical applications, which include the use of indicators to increase awareness among prescribers in Malawi and Bangladesh, to identify priorities for action (eg, polypharmacy in Indonesia and Nigeria, overuse of injections in Uganda, Sudan, and Nigeria, and low percentage of patients who understood the dosage schedule in Malawi), and to quantify the impact of interventions in Yemen, Uganda, Sudan, and Zimbabwe.

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Author and article information

Journal

Journal ID (nlm-ta): Iran J Pharm Res

Journal ID (iso-abbrev): Iran J Pharm Res

Journal ID (publisher-id): IJPR

Title: Iranian Journal of Pharmaceutical Research : IJPR

Publisher: Shaheed Beheshti University of Medical Sciences (Tehran, Iran )

ISSN (Print): 1735-0328

ISSN (Electronic): 1726-6890

Publication date (Print): Winter 2013

Volume: 12

Issue: 1

Pages: 235-241

Affiliations

[a ] Food and Drug Deputy, Isfahan University of Medical Sciences, Isfahan, Iran.

[b ] Department of Pharmacology and Toxicology, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.

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[* ]Corresponding author: E-mail: lsafaeian@yahoo.com

Article

Publisher ID: ijpr-12-235

DOI: 10.22037/ijpr.2013.1260

PMC ID: 3813195

PubMed ID: 24250595

SO-VID: 4de883c5-46fb-4716-a23e-9642cf3da301

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Prescribing Quality in Medical Specialists in Isfahan, Iran

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Most cited references 30

European Surveillance of Antimicrobial Consumption (ESAC): quality indicators for outpatient antibiotic use in Europe.

Medication errors: what they are, how they happen, and how to avoid them.

Field tests for rational drug use in twelve developing countries.

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