Prescribing and dispensing pattern: Implication in the right of access to essential medicines

ABSTRACT

Background: Irrational use of medicines is distressing global problem. A medicine use survey was conducted to, a] assess the pattern of medicine prescribing and dispensing and b] find out factors, if any, affecting these. Methods: A cross-sectional observational study was conducted in 2005 in out patient department [OPD] of four randomly selected Central Government Health Scheme dispensaries in Kolkata, India. Data were collected by measuring time of interaction between randomly selected patients and prescribers/dispensers, conducting their interview on exit, review of prescriptions, interviewing doctors and storekeepers. The knowledge about rational use of medicines was assessed by pre-designed questionnaire. Results: Analysis revealed that 50% prescriptions belonged to patients aged 60 years or more. High fascination for using Latin abbreviations [93%] was found. On average, 3.7 [SD 2.1] medicines were used per prescription, 18% of which were prescribed with the generic name and 81% from list of essential medicines. Average consultation and dispensing time were 4.3 [SD 3.2] min and 2.1 [SD 3.7]. Routine procuring source was disrupted and only half of the prescribed medicines were dispensed instantaneously with appropriate label. About 11% patients left counter with inadequate knowledge about dosage. Proportion of prescriptions containing antibiotic and injections, and proportion of cost incurred to them, conformed to the recommendations by World Health Organization [WHO]. Number of medicines and average cost per prescription, prescribing out of essential medicine list and in brand name were significantly higher in the prescriptions of specialists compared to those from general duty medical officers. Inappropriate medicine was found in 37% of prescriptions for elderly patients. Conclusion: Supportive supervision and congenial working environment are prerequisites for rational use of medicines