Burkina Faso: study shows value of qualitative monitoring
While prescribing practices have been studied in various developing countries, most research has limited evaluation to numerical analysis, such as the number of drugs prescribed or the percentage of prescriptions containing an antibiotic. But a study carried out in Burkina Faso1 used both qualitative and quantitative indicators to investigate the rationality of drug prescriptions at outpatient consultations. The study results demonstrate the importance of a multifaceted research approach, and add to the evidence that greater efforts must be made to improve prescribing practices globally.
Specially trained medical students and nurses observed a total of 313 outpatient consultations in nine health centres in three rural districts. Data on 2,815 drug prescriptions were also analysed. These had been copied from patient registers two months before observation began, in order to compare prescribing habits in observed and unobserved consultations.
During the two-week study period 366 prescriptions for 793 drugs were given out and an average of 2.3 drugs was prescribed per visit. A total of 33.1% of prescriptions contained antibiotics and 24.6% contained injections. Of the drugs prescribed, 88.0% were on the essential drugs list, but only 59.3% of prescriptions conformed to standard treatment guidelines. In all other prescriptions at least one drug was not indicated or the dosage was wrong. Errors in dosage occurred significantly more often in children under the age of five, mostly in terms of dangerous overdosing. Seven out of 21 pregnant women received drugs contraindicated in pregnancy. In two-thirds of all cases the patients received no information on how long a prescribed drug had to be taken. Prescribing was similar in both the observed and the unobserved consultations.
The study concludes that a significant proportion of patients probably received ineffective or even harmful prescriptions, although the interpretation of quantitative indicators alone would have led to a positive evaluation of prescribing practices.
Only by correlating prescriptions to patients’ diagnoses was it possible to detect problems of false dosage and contraindications, and to identify certain risk groups. So while quantitative drug use indicators have proved very useful for a rapid and economic assessment of general drug use habits, in-depth studies may be necessary from time to time. Additionally this methodology allowed the identification of special risk issues and risk groups, so helping to determine the focus of further interventions.
1. Krause G et al. Rationality of drug prescriptions in rural health centres in Burkina Faso. Health Policy and Planning 1999;14 (3):291-298.
Science shopping in the Netherlands
A move to bring science out of the “ivory tower” and into the service of a wider public has been proving very successful in the Netherlands. The idea for Science Shops originated in the 1970s, and today there are more than 30 such research information centres, affiliated with 11 universities and covering a wide field - from health to literature. Financed by the universities, the Shops may work free of charge for non profit social organizations needing help with community-based research. One of them is the Science Shop for Medicines attached to Utrecht University’s Faculty of Pharmacy, which receives many of its research questions from patients’ associations, consumer organizations and women’s groups.
When a question comes in, the Science Shop looks for a staff member in the Pharmacy Faculty whose work ties in to the topic, which generally concerns pharmacotherapy or pharmacoepidemiology. Then, under supervision, a student does a literature review and receives study points for the work. The study is usually written up as a short report or brochure, available from the Shop for a nominal charge. While a literature review is usually what is required, other types of research, such as surveys, interviews and drug analyses are also possible. In recent years many questions have been asked about the use of drugs for psychiatric disorders and about women’s health issues.
As well as collaborating with the other research information centres at Utrecht University, the Science Shop for Medicines often works with Groningen University’s Medicines Shop and the country’s seven Health Shops.
For further information contact: Science Shop for Medicines, Sorbonnelaan 16, Postbus 80082, 3508 TB Utrecht, the Netherlands. Tel: + 31 30 253 7309, fax: + 31 30 253 9166, e-mail: email@example.com