Prescription pattern monitoring of outpatient pediatric patients.
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Date
2019
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Abstract
Prescribing for paediatric patients can be challenging for prescribers as children are especially vulnerable to harmful effects of drugs due to differences in pharmacokinetics and pharmacodynamics as well as the limited availability of licensed drugs in their appropriate dosage forms. The World Health Organisation has estimated that over 50% of drugs globally are prescribed inappropriately. Prescription pattern monitoring studies (PPMS) are tools for assessing the prescribing, dispensing and administering of drugs. They help in explaining the extent and profile of drug use, trends, and quality of drugs and compliance of prescribing with standard treatment guidelines (STGs) and essential medicines list (EML). Regular assessment of prescribing practice and evaluation for compliance in reference with treatment guidelines is crucial in promoting rational drug use and identifying problems related to drug therapy. This study was therefore conducted to monitor the prescription patterns in paediatric outpatients and to determine the level of compliance of prescribed treatments against the South African 2017 paediatric STGs/EML at a public sector tertiary hospital located in KwaZulu-Natal, South Africa.
Methods
This was a retrospective descriptive study, based on systematic sampling of paediatric patient files visiting the outpatient department. Paediatric outpatient files containing prescriptions dated between June 1, 2016 and May 30, 2017 were used. A systematic sampling technique was used to minimize bias in the selection process and to ensure equal representation of samples. Data regarding patient demographic characteristics, diagnosis and disease condition as well as details of the treatments prescribed (drug name, dose, dosage form, frequency and duration of treatment) were extracted from patient files and captured using MS Excel 2016. The data were analysed using the following statistical packages; the Statistical Package for Social Sciences® (SPSS®) version 25 and Minitab® version 18. Compliance was determined using the loose criteria model, a method adopted from a report by the Ministry of Health and Social Services of Namibia and the Systems for Improved Access to Pharmaceuticals and Services (SIAPS). Where applicable, associations were carried out and a p-value ˂ 0.05 was estimated as statistically significant.
Results
A total of 327 patient files were evaluated, of which 193 (59.02%) were for male patients and 134 (40.98%) female patients. The total number of drugs prescribed was 845 constituted by 29 drug groups, of which antibiotics 155/845 (18.34%), emollients 118/845 (13.96%) and analgesics 117/845 (13.85%) were most predominantly prescribed. Of the 155 antibiotics, penicillins 55/155 (35.48%), penicillins combined with beta-lactamase inhibitors 40/155 (25.81%) and cephalosporins 39/155 (25.16%) were most commonly used. The percentage of encounters with antibiotics was 35.47% and the average number of drugs per prescription was 2.58. Out of the overall 845 drugs prescribed, 354 (41.89%) were generic drugs prescribed from the paediatric EML while 491 (58.11%) were non-generic drugs prescribed using trade names. Out of the total of 419 disease conditions assessed, 134 disease conditions were identified as most commonly diagnosed. Majority of the patients 100/134 (74.63%) did not have comorbidities, while 34/134 (25.37%) had co-occurring conditions ranging from 2 - 4 diseases. Male patients 19/34 (55.88%) presented slightly higher number of comorbidities compared to female patients 15/34 (44.12%). In order to determine compliance, disease conditions which were not listed in the 2017 paediatric STGs were excluded, resulting in 275 disease conditions. Treatments prescribed for 219/275 (79.64%) disease conditions were in accordance with the South African paediatric STGs, while treatments prescribed for 56/275 (20.36%) disease conditions did not comply with the STG recommendations.
Conclusion
There was a high level of antibiotic prescribing among the paediatric outpatients, and penicillins were the most often prescribed. The average number of drugs per prescription identified in this study was higher than that recommended by the World Health Organization. Overall, majority of the treatments prescribed conformed with the recommendations of the South African 2017 paediatric STGs, however extent of generic prescribing was low. There is a need for training of prescribers and healthcare professionals, especially regarding generic prescribing in order to promote appropriate use of drugs and overall patient safety.
Description
Masters Degree. University of KwaZulu-Natal, Durban.