A combined strategies intervention on the World Health Organization prescribing indicators: A quasi-randomised trial
Background: Irrational medicine use is a global problem that may potentiate antimicrobial resistance. Aim: This study aims to assess prescribing practices and the effect of a prescription audit and feedback coupled with small-group education intervention on prescribing indicators. Setting: The stu...
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| Format: | Article |
| Language: | English |
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AOSIS
2024-02-01
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| Series: | African Journal of Primary Health Care & Family Medicine |
| Subjects: | |
| Online Access: | https://phcfm.org/index.php/phcfm/article/view/3943 |
| _version_ | 1827337720585781248 |
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| author | Nondumiso B.Q. Ncube Tawanda Chivese Ferdinand C. Mukumbang Hazel A. Bradley Helen Schneider Richard Laing |
| author_facet | Nondumiso B.Q. Ncube Tawanda Chivese Ferdinand C. Mukumbang Hazel A. Bradley Helen Schneider Richard Laing |
| author_sort | Nondumiso B.Q. Ncube |
| collection | DOAJ |
| description | Background: Irrational medicine use is a global problem that may potentiate antimicrobial resistance.
Aim: This study aims to assess prescribing practices and the effect of a prescription audit and feedback coupled with small-group education intervention on prescribing indicators.
Setting: The study was conducted in public-sector healthcare facilities in Eswatini.
Methods: A cluster quasi-randomised controlled study was conducted from 2016 to 2019 using the World Health Organization/ International Network for Rational Use of Drugs (WHO/INRUD) prescribing indicators at baseline, post-intervention and post-follow-up. A 6-month unblinded intervention was tested in 32 healthcare facilities, randomly allocated to intervention (16) and control (16) arms. Prescribing practices were assessed post-intervention, and 6 months after the intervention, through an audit of 100 randomly selected prescriptions from each facility. Comparisons of WHO or INRUD prescribing indicators were conducted using the intention-to-treat analysis at the two times.
Results: At baseline, in both arms, rational prescribing standards were met by the number of medicines per prescription and the use of injections. Antibiotic use was above 50% in both arms. After adjustment for baseline antibiotics use, region and level of care, there were no significant differences in all prescribing indicators between the two arms, post-intervention and at 6 months follow-up.
Conclusion: In a lower middle-income setting with a high prevalence of irrational prescribing practices, a prescription audit, feedback and small-group education intervention had no benefits in improving rational prescribing.
Contribution: Multifaceted strategies, strengthening of pharmacy and therapeutics committees, and holistic monitoring of medicine use are recommended to promote rational medicine use. |
| first_indexed | 2024-03-07T19:01:21Z |
| format | Article |
| id | doaj.art-62d9a4380e2a47e3843b574869d59c0e |
| institution | Directory Open Access Journal |
| issn | 2071-2928 2071-2936 |
| language | English |
| last_indexed | 2024-03-07T19:01:21Z |
| publishDate | 2024-02-01 |
| publisher | AOSIS |
| record_format | Article |
| series | African Journal of Primary Health Care & Family Medicine |
| spelling | doaj.art-62d9a4380e2a47e3843b574869d59c0e2024-03-01T13:28:19ZengAOSISAfrican Journal of Primary Health Care & Family Medicine2071-29282071-29362024-02-01161e1e810.4102/phcfm.v16i1.39431105A combined strategies intervention on the World Health Organization prescribing indicators: A quasi-randomised trialNondumiso B.Q. Ncube0Tawanda Chivese1Ferdinand C. Mukumbang2Hazel A. Bradley3Helen Schneider4Richard Laing5Department of Community and Health Sciences, School of Public Health, University of the Western Cape, Cape TownDepartment of Population Medicine, College of Medicine, QU Health, Qatar University, DohaDepartment of Community and Health Sciences, School of Public Health, University of the Western Cape, Cape TownDepartment of Community and Health Sciences, School of Public Health, University of the Western Cape, Cape TownDepartment of Community and Health Sciences, School of Public Health, University of the Western Cape, Cape Town, South Africa; and South African Medical Research Council Health Services to Systems Research Unit, Cape TownDepartment of Community and Health Sciences, School of Public Health, University of the Western Cape, Cape Town, South Africa; and Boston University School of Public Health, Boston University, Boston, MassachusettsBackground: Irrational medicine use is a global problem that may potentiate antimicrobial resistance. Aim: This study aims to assess prescribing practices and the effect of a prescription audit and feedback coupled with small-group education intervention on prescribing indicators. Setting: The study was conducted in public-sector healthcare facilities in Eswatini. Methods: A cluster quasi-randomised controlled study was conducted from 2016 to 2019 using the World Health Organization/ International Network for Rational Use of Drugs (WHO/INRUD) prescribing indicators at baseline, post-intervention and post-follow-up. A 6-month unblinded intervention was tested in 32 healthcare facilities, randomly allocated to intervention (16) and control (16) arms. Prescribing practices were assessed post-intervention, and 6 months after the intervention, through an audit of 100 randomly selected prescriptions from each facility. Comparisons of WHO or INRUD prescribing indicators were conducted using the intention-to-treat analysis at the two times. Results: At baseline, in both arms, rational prescribing standards were met by the number of medicines per prescription and the use of injections. Antibiotic use was above 50% in both arms. After adjustment for baseline antibiotics use, region and level of care, there were no significant differences in all prescribing indicators between the two arms, post-intervention and at 6 months follow-up. Conclusion: In a lower middle-income setting with a high prevalence of irrational prescribing practices, a prescription audit, feedback and small-group education intervention had no benefits in improving rational prescribing. Contribution: Multifaceted strategies, strengthening of pharmacy and therapeutics committees, and holistic monitoring of medicine use are recommended to promote rational medicine use.https://phcfm.org/index.php/phcfm/article/view/3943rational drug prescribinginterventionantibiotic resistanceeswatinirational medicine userational drug use. |
| spellingShingle | Nondumiso B.Q. Ncube Tawanda Chivese Ferdinand C. Mukumbang Hazel A. Bradley Helen Schneider Richard Laing A combined strategies intervention on the World Health Organization prescribing indicators: A quasi-randomised trial African Journal of Primary Health Care & Family Medicine rational drug prescribing intervention antibiotic resistance eswatini rational medicine use rational drug use. |
| title | A combined strategies intervention on the World Health Organization prescribing indicators: A quasi-randomised trial |
| title_full | A combined strategies intervention on the World Health Organization prescribing indicators: A quasi-randomised trial |
| title_fullStr | A combined strategies intervention on the World Health Organization prescribing indicators: A quasi-randomised trial |
| title_full_unstemmed | A combined strategies intervention on the World Health Organization prescribing indicators: A quasi-randomised trial |
| title_short | A combined strategies intervention on the World Health Organization prescribing indicators: A quasi-randomised trial |
| title_sort | combined strategies intervention on the world health organization prescribing indicators a quasi randomised trial |
| topic | rational drug prescribing intervention antibiotic resistance eswatini rational medicine use rational drug use. |
| url | https://phcfm.org/index.php/phcfm/article/view/3943 |
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