ABSTRACT
To assess the adherence of physicians and pharmacists in private sector to the guidelines of controlled psychotropic medications [CPM], the practicality of the guidelines and the degree of enforcement and follow-up of these guidelines stipulated by the Ministry of Health. The present study was performed in ten private community pharmacies [PCPs] and six private hospital pharmacies authorized to dispense CPM in Riyadh city. Data collection form was used to assess pharmacy records for CPM, and to collect data on prescription parameters in order to assess whether the prescriptions are properly written and dispensed. A twenty% random sample of prescriptions dispensed in each pharmacy, during January 1999 to September 2001 were collected through a systematic random sampling to assess the degree of physicians and pharmacists compliance to the guidelines laid down by the MOH. The pharmacists' opinions on the practicality of the guidelines and degree of enforcement and follow up were assessed prospectively through questionnaire. An analysis of 2077 prescriptions revealed that 54% of patients were male and the mean age was 37.7 years [ +/- 14.4]. Degree of physicians' adherence to guidelines was poor in documenting patient's full name in the prescription [12,5%], use of generic name of the drug when prescribing [12.1%], duration of treatment [22.4%] and quantity to be dispensed were specified in 52.2% of prescriptions. Moreover, prescribing drugs in class 1 and 2 for maximum of two weeks was observed only in 3.1% of prescriptions. Pharmacists documented the details of prescriptions dispensed in 90.5% and stamped 76.4% of prescriptions dispensed. Furthermore, the pharmacist write his/her name and sign the prescription upon dispensing in 62.7% of situations and in 7% of situations pharmacists dispensed prescriptions after the seven days period. About 69% of pharmacies were inspected only once during the year 2001 and prescriptions were repeated for the same patients within 14 days period in 3% of prescriptions. The most commonly prescribed drugs are alprazolam [41.6%], bromazepam [16.1%], diazepam [9.2%] and chlordiazepoxide [8.8%]. Several recommendations emerged from this study that could help MOH to gain better insight to control CPM. The MOH should review the current guidelines to address the problems raised by pharmacists, distribute the guidelines to all pharmacies, improve the inspection process, introduce electronic prescribing for CPM, and setting up a national computer network. The MOH, pharmacists and physicians should agree on the minimum standards of CPM prescription and the documentation procedures, which must be adhered to by both physicians and pharmacists. Finally, a national survey of psychotropic drugs prescribing should be conducted and consumption trend analyzed and compared with other countries