Prescribing Practices in two Health Care Facilities in Warri; Southern Nigeria : a Comparative Study

ABSTRACT

PURPOSE: Inappropriate prescribing has been identified in many health facilities in developing countries. The purpose of this study was to evaluate the prescribing practices in two health care facilities in Warri located in south-south geopolitical region of Nigeria and identify factors influencing the practices. METHOD: WHO Prescribing Indicators were applied to evaluate 2000 prescription records; retrospectively; from a private and a public hospital in Warri. Factors influencing the prescribing practices in the facilities were identified through informal interviews of 10 prescribers in the facilities. Using a self-administered questionnaire administered to 40 prescribers in the facilities; we also evaluated the order of importance of the factors affecting drug prescribing. RESULTS: Average number of drugs per encounter in the health facilities is 3.4 (3.9 in the public hospital and 2.8 in the private hospital). Generic prescribing was generally low (54 percent in the public hospital and 16 percent in the private hospital) while the percentage of encounters with antibiotics prescribed was high (75 percent in the public hospital and 55 percent in the private hospital). Antimalarials; antihypertensives; antidiarrhoeals and analgesics accounted for 47.4 percent; 7.5 percent; 1.0 percent and 18.2 percent; respectively. The overuse of drugs and generic prescribing were significantly lower in the private hospital than in the public hospital. Major factors influencing prescribing practices included drug availability; clinician's level of training; cost of drugs; feedback from patients and socio-economic status of patients. CONCLUSION: Polypharmacy; overuse of antibiotics and low rate generic prescribing still occur in the health facilities studied. Drug availability; clinician's level of training; cost of drugs; feedback from patients and socio-economic status of patients are major factors influencing prescribing in the facilities