Assessment of prescribing practices at the primary health care facilities in Botswana with an emphasis on antibiotics; findings and implications

Yohana Mashalla, Vincent Setlhare, Amos Massele, Enoch Sepako, Celda Tiroyakgosi, Joyce Kgatlwane, Mpo Chuma, Brian Godman

Research output: Contribution to journalArticle

Abstract

Background and Aims: Inappropriate drug prescribing has increased especially in developing countries where systems for monitoring medicine use are not well developed. This increases the rate of antimicrobial resistance. The study aim was to assess the prescribing patterns among urban primary health facilities in Botswana to provide future guidance including developing future quality indicators. Methods: Retrospective data from patients’ records between January – December 2013 in 19 clinics were collected in a cross-sectional study. The WHO/INRUD indicators were used to assess prescribing patterns in the study clinics. Results: Average number of drugs per prescription was 2.8; 78.6% of the prescribed antibiotics were by INN and 96.1% complied with the Botswana Essential Drugs List. Overall rate of antibiotic prescribing was high (42.7%) with 14.7%, 5.9% and 1.3% of prescriptions having two, three and four antibiotics respectively. Systemic antibiotics (J01C) were most (45.1%) commonly prescribed of which amoxicillin accounted for (28.4%) and metronidazole 14.4% of all antibiotic prescriptions. There was low use of co-amoxiclav (0.3% of all antibiotic prescriptions). Third generation cephalosporins and macrolides accounted for 9.8% and 6.2% of antibiotic prescriptions respectively, with no prescribing of fluoroquinolones. The majority of indications (87%) for antibiotic prescriptions were according to ICD classification. Conclusions: While most indications for antibiotic prescriptions were based on signs and symptoms according to ICD, antibiotic prescribing rates were high with some conditions not requiring antibiotics because they are viral infections. There is a need to further improve prescribing practices through induction and training of in-service prescribers. An effective management tool for monitoring antibiotic prescribing practices at PHC facilities should be designed and implemented, including developing robust quality indicators.
LanguageEnglish
Number of pages14
JournalInternational Journal of Clinical Practice
StateAccepted/In press - 31 Oct 2017

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Botswana
Health Facilities
Primary Health Care
Anti-Bacterial Agents
Prescriptions
Drug Prescriptions
Inappropriate Prescribing
Essential Drugs
Urban Health
Amoxicillin-Potassium Clavulanate Combination
Fluoroquinolones
Amoxicillin
Macrolides
Metronidazole
Virus Diseases
Cephalosporins
Systems Analysis
Developing Countries
Signs and Symptoms

Keywords

  • inappropriate drug use
  • primary health care
  • prescribing indicators
  • antibiotics prescribing
  • Botswana

Cite this

Mashalla, Yohana ; Setlhare, Vincent ; Massele, Amos ; Sepako, Enoch ; Tiroyakgosi, Celda ; Kgatlwane, Joyce ; Chuma, Mpo ; Godman, Brian. / Assessment of prescribing practices at the primary health care facilities in Botswana with an emphasis on antibiotics; findings and implications. In: International Journal of Clinical Practice. 2017
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abstract = "Background and Aims: Inappropriate drug prescribing has increased especially in developing countries where systems for monitoring medicine use are not well developed. This increases the rate of antimicrobial resistance. The study aim was to assess the prescribing patterns among urban primary health facilities in Botswana to provide future guidance including developing future quality indicators. Methods: Retrospective data from patients’ records between January – December 2013 in 19 clinics were collected in a cross-sectional study. The WHO/INRUD indicators were used to assess prescribing patterns in the study clinics. Results: Average number of drugs per prescription was 2.8; 78.6{\%} of the prescribed antibiotics were by INN and 96.1{\%} complied with the Botswana Essential Drugs List. Overall rate of antibiotic prescribing was high (42.7{\%}) with 14.7{\%}, 5.9{\%} and 1.3{\%} of prescriptions having two, three and four antibiotics respectively. Systemic antibiotics (J01C) were most (45.1{\%}) commonly prescribed of which amoxicillin accounted for (28.4{\%}) and metronidazole 14.4{\%} of all antibiotic prescriptions. There was low use of co-amoxiclav (0.3{\%} of all antibiotic prescriptions). Third generation cephalosporins and macrolides accounted for 9.8{\%} and 6.2{\%} of antibiotic prescriptions respectively, with no prescribing of fluoroquinolones. The majority of indications (87{\%}) for antibiotic prescriptions were according to ICD classification. Conclusions: While most indications for antibiotic prescriptions were based on signs and symptoms according to ICD, antibiotic prescribing rates were high with some conditions not requiring antibiotics because they are viral infections. There is a need to further improve prescribing practices through induction and training of in-service prescribers. An effective management tool for monitoring antibiotic prescribing practices at PHC facilities should be designed and implemented, including developing robust quality indicators.",
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Assessment of prescribing practices at the primary health care facilities in Botswana with an emphasis on antibiotics; findings and implications. / Mashalla, Yohana; Setlhare, Vincent; Massele, Amos; Sepako, Enoch; Tiroyakgosi, Celda; Kgatlwane, Joyce; Chuma, Mpo; Godman, Brian.

In: International Journal of Clinical Practice, 31.10.2017.

Research output: Contribution to journalArticle

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T1 - Assessment of prescribing practices at the primary health care facilities in Botswana with an emphasis on antibiotics; findings and implications

AU - Mashalla,Yohana

AU - Setlhare,Vincent

AU - Massele,Amos

AU - Sepako,Enoch

AU - Tiroyakgosi,Celda

AU - Kgatlwane,Joyce

AU - Chuma,Mpo

AU - Godman,Brian

PY - 2017/10/31

Y1 - 2017/10/31

N2 - Background and Aims: Inappropriate drug prescribing has increased especially in developing countries where systems for monitoring medicine use are not well developed. This increases the rate of antimicrobial resistance. The study aim was to assess the prescribing patterns among urban primary health facilities in Botswana to provide future guidance including developing future quality indicators. Methods: Retrospective data from patients’ records between January – December 2013 in 19 clinics were collected in a cross-sectional study. The WHO/INRUD indicators were used to assess prescribing patterns in the study clinics. Results: Average number of drugs per prescription was 2.8; 78.6% of the prescribed antibiotics were by INN and 96.1% complied with the Botswana Essential Drugs List. Overall rate of antibiotic prescribing was high (42.7%) with 14.7%, 5.9% and 1.3% of prescriptions having two, three and four antibiotics respectively. Systemic antibiotics (J01C) were most (45.1%) commonly prescribed of which amoxicillin accounted for (28.4%) and metronidazole 14.4% of all antibiotic prescriptions. There was low use of co-amoxiclav (0.3% of all antibiotic prescriptions). Third generation cephalosporins and macrolides accounted for 9.8% and 6.2% of antibiotic prescriptions respectively, with no prescribing of fluoroquinolones. The majority of indications (87%) for antibiotic prescriptions were according to ICD classification. Conclusions: While most indications for antibiotic prescriptions were based on signs and symptoms according to ICD, antibiotic prescribing rates were high with some conditions not requiring antibiotics because they are viral infections. There is a need to further improve prescribing practices through induction and training of in-service prescribers. An effective management tool for monitoring antibiotic prescribing practices at PHC facilities should be designed and implemented, including developing robust quality indicators.

AB - Background and Aims: Inappropriate drug prescribing has increased especially in developing countries where systems for monitoring medicine use are not well developed. This increases the rate of antimicrobial resistance. The study aim was to assess the prescribing patterns among urban primary health facilities in Botswana to provide future guidance including developing future quality indicators. Methods: Retrospective data from patients’ records between January – December 2013 in 19 clinics were collected in a cross-sectional study. The WHO/INRUD indicators were used to assess prescribing patterns in the study clinics. Results: Average number of drugs per prescription was 2.8; 78.6% of the prescribed antibiotics were by INN and 96.1% complied with the Botswana Essential Drugs List. Overall rate of antibiotic prescribing was high (42.7%) with 14.7%, 5.9% and 1.3% of prescriptions having two, three and four antibiotics respectively. Systemic antibiotics (J01C) were most (45.1%) commonly prescribed of which amoxicillin accounted for (28.4%) and metronidazole 14.4% of all antibiotic prescriptions. There was low use of co-amoxiclav (0.3% of all antibiotic prescriptions). Third generation cephalosporins and macrolides accounted for 9.8% and 6.2% of antibiotic prescriptions respectively, with no prescribing of fluoroquinolones. The majority of indications (87%) for antibiotic prescriptions were according to ICD classification. Conclusions: While most indications for antibiotic prescriptions were based on signs and symptoms according to ICD, antibiotic prescribing rates were high with some conditions not requiring antibiotics because they are viral infections. There is a need to further improve prescribing practices through induction and training of in-service prescribers. An effective management tool for monitoring antibiotic prescribing practices at PHC facilities should be designed and implemented, including developing robust quality indicators.

KW - inappropriate drug use

KW - primary health care

KW - prescribing indicators

KW - antibiotics prescribing

KW - Botswana

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JF - International Journal of Clinical Practice

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