Rational drug prescribing in public health care facilities in Ejisu-Juaben District of Ashanti Region, Ghana.

Irrational (Inappropriate) drug prescribing has been identified as an important health and economic problem in most developing countries including Ghana. The Ministry of Health (MOH ), Ghana, recognising the problem of inappropriate drug use in the health care delivery system( particularly those related to drug prescribing practices ), has taken a number of steps to improve on rational (appropriate ) drug use country-wide. Nevertheless the Ejisu-Juaben District Health Management Team (DHMT) had recently expressed concern about the inappropriateness of drug prescribing practices in the Public Health Care Facilities (PHCFs) in the district. Despite, the known problem of inappropriate drug prescribing practices countrywide in Ghana, that prevailing locally in Ejisu-Juaben district is not known. Local health authorities need local results and information about local inappropriate drug prescribing practices and the motivating factors underlying them to convince them to act, design and implement appropriate interventions (programmes) to improve on appropriate drug prescribing practices. It was in this light that, this cross-sectional survey was designed and carried out in Ejisu-Juaben district of Ashanti Region, Ghana with the main aim of assessing the inappropriateness of drug prescribing practices in the PHCFs and identifies the main motivating factors underlying them in order to improve on appropriate drug prescribing. The study was specifically aimed at assessing the nature of the inappropriateness of drug prescribing practices in the PHCFs in Ejisu-Juaben district of the Ashanti Region, Ghana retrospectively between January 1999 and August 1999, identify the main motivating factors underlying them (managerial, health system supply, prescriber- specific, and patient and community factors) and make recommendations to improve on appropriate drug prescribing practices in PHCFs in the district. Primary and secondary data were collected through prescription survey, (prescribing drug use indicators and specific malaria cases, prescription surveys), patient care drug use indicators survey, facility drug use indicator survey, observations, administration of structured questionnaires and in-depth interviews in four out of seven PHCFs selected. In the prescription survey, a total of 195 out of the targeted 200 of the total 11,872 new registered out-patient (OPD) curative medical record cards’ drug prescription between the period January 1999 and August 1999 were reviewed using a multi-stage sampling techniques. A sample of four selected PHCFs was prospectively selected in the facility drug use indicators survey and the observations. A total sample of 80 out of the targeted 100 outpatients in the four selected PHCFs was used prospectively for the patient care indicators survey. A total of six prescribers out of the seven targeted for the prospective questionnaire and in-depth interviews were interviewed. The results of the study indicated; poly-pharmacy, excessive use of injections, excessive use of antibiotics, excessive use of injections and antibiotics combined, incorrect choice of drug dosage forms in malaria treatment, incorrect choice of chioroquine dosage-regimens in malaria treatment and incorrect choice of anti-malarial in malaria treatment as the inappropriate drug prescribing practices in the PHCFs in the district. The motivating factors underlying the inappropriate drug prescribing practices consisted of many interacting factors namely; health system supply factors, health system management factors, prescriber- specific factors and patient and community factors. There is the need for the DHMT of the Ejisu-Juaben district to adopt feasible intervention strategies mainly; educational, managerial and regulatory to improve on appropriate drug prescribing in the PHCFs in the district. Further in-depth studies into the prevalent socio-cultural beliefs particularly about medication practices in the community is also needed in order to identify those factors that may facilitate appropriate drug use for re-enforcement and those that impede it, modify to improve on appropriate drug prescribing.

Source: KNUST