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
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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.
Description:
This thesis submitted in partial fulfillment of the requirements for the degree of Bachelor of Pharmacy (B.Pharm) in East West University, Dhaka, Bangladesh.