Survey of drug use practices and antibiotic prescribing pattern at a general hospital in Nigeria
Survey of drug use practices and antibiotic prescribing pattern at a general hospital in Nigeria
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DOI：
10.1023/a:1020570930844
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发表时间：
2002-10-01
影响因子：
--
通讯作者：
Sumonu, K
中科院分区：
文献类型：
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作者：
Chukwuani, CM;Onifade, M;Sumonu, K
目的：为了描述目前的药物使用的做法，在该机构，并收集基线数据，这可以作为设计一个适当的干预措施，以改善药物使用profile.Method的基础上：一个回顾性的审计在和门诊处方，在1999年1月至3月期间产生的。药物使用模式的指标包括：每次就诊的平均药物处方数（ANDPE）、每次就诊的平均抗生素处方数（ANAPE）、抗生素就诊百分比（PEA）、基于微生物敏感性试验结果的抗生素处方百分比（MCST）。此外，“知识，态度和实践”（KAP）的处方和配药调查进行。处方和配药质量的指标包括：药物/处方信息的来源，医院处方集的可用性和使用，处方过程的知识和药品供应管理系统的充分性。结果：共9984门诊处方和127住院病例笔记进行了审计。接受调查的处方者和配药者总数分别为88人和13人。门诊和住院病人的ANDPE分别为3.16和9.7，ANAPE分别为1.1和2.4。门诊病人PEA为50.3%，住院病人PEA为96.7%。只有4.2%的住院患者抗生素处方是基于MCST，抗菌治疗中转换的百分比为52.1%，而每次转换的平均数量为1.35。在18.5%的住院病人遇到有证据的药物incompatibiles.The KAP调查显示，处方和配药在医院依靠不同的来源，他们的药物信息需求（MIMS与马丁代尔Extrapharmacoepia）。接受调查的处方者中没有一个能够正确列举处方过程中涉及的所有4个步骤，约25%的处方者至少正确列举了2个步骤，只有9.1%的接受调查的配药者能够准确定义医院处方集。药品供应管理系统被发现是不充分的。结论：调查显示，在知识方面的合理用药，这些干部的医疗专业人员之间仍然存在明显的差距。上述情况表明，迫切需要审查医院的现行政策和制度，以加强保健提供者的药物使用做法。具体而言，建议应该有一个干预计划，包括协调的继续教育（影响各种骨干的医疗保健提供者的KAP）和建立医院处方集/标准治疗指南。
Objective: To describe the current drug use practices at the institution, and gather baseline data, which can serve as a basis for designing an appropriate intervention to improve the drug use profile.Method: A retrospective audit of in- and out-patient prescriptions, generated during the period January-March 1999. Indicators of drug use pattern include: average number of drugs prescribed per encounter (ANDPE), average number of antibiotics prescribed per encounter (ANAPE), % encounter with antibiotics (PEA), percent of antibiotic prescriptions based on microbial sensitivity test results (MCST). Additionally, a "knowledge, attitude and practice" (KAP) survey of prescribers and dispensers was performed. Indicators of prescribing and dispensing quality include: sources of drug/prescribing information, availability and use of the hospital formulary, knowledge of the prescribing process and the adequacy of the drug supply management system.Results: A total of 9984 outpatient prescriptions and 127 inpatient case notes were audited. The total number of prescribers and dispensers surveyed were 88 and 13 respectively. The ANDPE was found to be 3.16 for outpatients and 9.7 for in-patients, ANAPE was 1.1 and 2.4 for out-patients and inpatients respectively. The PEA was 50.3% for out-patients and 96.7% for in-patients. Only 4.2% of inpatient antibiotic prescriptions were based on MCST and percent encounter with switches in antimicrobial therapy was 52.1% while the average number of switches per encounter was 1.35. In 18.5% of the in-patient encounters there was evidence of drug incompatibilities.The KAP survey revealed that prescribers and dispensers in the hospital rely on different sources for their drug information needs (MIMS vs Martindale Extrapharmacoepia). None of the prescribers surveyed was able to correctly enumerate all the 4 steps involved in the prescribing process, about 25% got at least 2 steps correctly, and only 9.1% of the dispensers surveyed could accurately define a hospital formulary. The drug supply management system was found to be inadequate.Conclusion: The survey revealed that appreciable gaps in knowledge with respect to rational drug use, still exists among these cadre of healthcare professionals. The foregoing suggests an urgent need for review of current policies and systems in the hospital with the view of enhancing the drug use practices of the health providers. Specifically it is recommended that there should be an intervention program involving concerted continuing education (to influence the KAP of the various cadre of healthcare providers) and the establishment of a hospital formulary / standard treatment guidelines.