Validity of World Health Organisation prescribing indicators in Namibia's primary health care: findings and implications

Q Niaz, B. Godman, A. Massele, S. Campbell, A. Kurdi, H.R. Kagoya, D. Kibuule

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: World Health Organization/ International Network of Rational use of Drugs (WHO/INRUD) indicators are widely used to assess medicine use. However, there is limited evidence on their validity in Namibia’s primary health care (PHC) to assess the quality of prescribing. Consequently, our aim was to address this. Design, setting, participants and interventions: An analytical cross-sectional survey design was used to examine and validate WHO/INRUD indicators in outpatient units of two PHC facilities and one hospital from 1st February 2015 to 31st July 2015. The validity of the indicators was determined using two-by-two tables against compliance to the Namibian standard treatment guidelines (NSTG). The receiver operator characteristics for the WHO/INRUD indicators were plotted to determine their accuracy as predictors of compliance to agreed standards. A multivariate logistic model was constructed to independently determine the prediction of each indicator. Main outcomes and results: Out of 1243 prescriptions; compliance to NSTG prescribing in PHCs was sub-optimal (target was >80%). Three of the four WHO/INRUD indicators did not meet Namibian or WHO targets: antibiotic prescribing, average number of medicines per prescription and generic prescribing. The majority of the indicators had low sensitivity and/or specificity. All WHO/INRUD indicators had poor accuracy in predicting rational prescribing. The antibiotic prescribing indicator was the only covariate that was a significant independent risk factor for compliance to NSTGs. Conclusion: WHO/INRUD indicators showed poor accuracy in assessing prescribing practices in PHCs in Namibia. There is need for appropriate models and/or criteria to optimize medicine use in PHCs in the future
LanguageEnglish
Pages338-345
Number of pages8
JournalInternational Journal for Quality in Health Care
Volume31
Issue number5
Early online date28 Aug 2018
DOIs
Publication statusPublished - 30 Jun 2019

Fingerprint

Namibia
Primary Health Care
Pharmaceutical Preparations
Prescriptions
Medicine
Guidelines
Anti-Bacterial Agents
Health Facilities
Outpatients
Cross-Sectional Studies
Logistic Models
Sensitivity and Specificity
Therapeutics

Keywords

  • World Health Organization (WHO)
  • Namibia
  • Namibia primary health care
  • prescribing quality
  • infectious disease control

Cite this

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title = "Validity of World Health Organisation prescribing indicators in Namibia's primary health care: findings and implications",
abstract = "Objective: World Health Organization/ International Network of Rational use of Drugs (WHO/INRUD) indicators are widely used to assess medicine use. However, there is limited evidence on their validity in Namibia’s primary health care (PHC) to assess the quality of prescribing. Consequently, our aim was to address this. Design, setting, participants and interventions: An analytical cross-sectional survey design was used to examine and validate WHO/INRUD indicators in outpatient units of two PHC facilities and one hospital from 1st February 2015 to 31st July 2015. The validity of the indicators was determined using two-by-two tables against compliance to the Namibian standard treatment guidelines (NSTG). The receiver operator characteristics for the WHO/INRUD indicators were plotted to determine their accuracy as predictors of compliance to agreed standards. A multivariate logistic model was constructed to independently determine the prediction of each indicator. Main outcomes and results: Out of 1243 prescriptions; compliance to NSTG prescribing in PHCs was sub-optimal (target was >80{\%}). Three of the four WHO/INRUD indicators did not meet Namibian or WHO targets: antibiotic prescribing, average number of medicines per prescription and generic prescribing. The majority of the indicators had low sensitivity and/or specificity. All WHO/INRUD indicators had poor accuracy in predicting rational prescribing. The antibiotic prescribing indicator was the only covariate that was a significant independent risk factor for compliance to NSTGs. Conclusion: WHO/INRUD indicators showed poor accuracy in assessing prescribing practices in PHCs in Namibia. There is need for appropriate models and/or criteria to optimize medicine use in PHCs in the future",
keywords = "World Health Organization (WHO), Namibia, Namibia primary health care, prescribing quality, infectious disease control",
author = "Q Niaz and B. Godman and A. Massele and S. Campbell and A. Kurdi and H.R. Kagoya and D. Kibuule",
note = "This is a pre-copyedited, author-produced version of an article accepted for publication in International Journal for Quality in Health Care following peer review. The version of record Niaz, Q., Godman, B., Massele, A., Campbell, S., Kurdi, A., Kagoya, H. R., & Kibuule, D. (2018). Validity of World Health Organisation prescribing indicators in Namibia's primary health care: findings and implications. International Journal for Quality in Health Care is available online at: https://doi.org/10.1093/intqhc/mzy172",
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Validity of World Health Organisation prescribing indicators in Namibia's primary health care : findings and implications. / Niaz, Q; Godman, B.; Massele, A.; Campbell, S.; Kurdi, A.; Kagoya, H.R.; Kibuule, D.

In: International Journal for Quality in Health Care , Vol. 31, No. 5, 30.06.2019, p. 338-345.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Validity of World Health Organisation prescribing indicators in Namibia's primary health care

T2 - International Journal for Quality in Health Care

AU - Niaz, Q

AU - Godman, B.

AU - Massele, A.

AU - Campbell, S.

AU - Kurdi, A.

AU - Kagoya, H.R.

AU - Kibuule, D.

N1 - This is a pre-copyedited, author-produced version of an article accepted for publication in International Journal for Quality in Health Care following peer review. The version of record Niaz, Q., Godman, B., Massele, A., Campbell, S., Kurdi, A., Kagoya, H. R., & Kibuule, D. (2018). Validity of World Health Organisation prescribing indicators in Namibia's primary health care: findings and implications. International Journal for Quality in Health Care is available online at: https://doi.org/10.1093/intqhc/mzy172

PY - 2019/6/30

Y1 - 2019/6/30

N2 - Objective: World Health Organization/ International Network of Rational use of Drugs (WHO/INRUD) indicators are widely used to assess medicine use. However, there is limited evidence on their validity in Namibia’s primary health care (PHC) to assess the quality of prescribing. Consequently, our aim was to address this. Design, setting, participants and interventions: An analytical cross-sectional survey design was used to examine and validate WHO/INRUD indicators in outpatient units of two PHC facilities and one hospital from 1st February 2015 to 31st July 2015. The validity of the indicators was determined using two-by-two tables against compliance to the Namibian standard treatment guidelines (NSTG). The receiver operator characteristics for the WHO/INRUD indicators were plotted to determine their accuracy as predictors of compliance to agreed standards. A multivariate logistic model was constructed to independently determine the prediction of each indicator. Main outcomes and results: Out of 1243 prescriptions; compliance to NSTG prescribing in PHCs was sub-optimal (target was >80%). Three of the four WHO/INRUD indicators did not meet Namibian or WHO targets: antibiotic prescribing, average number of medicines per prescription and generic prescribing. The majority of the indicators had low sensitivity and/or specificity. All WHO/INRUD indicators had poor accuracy in predicting rational prescribing. The antibiotic prescribing indicator was the only covariate that was a significant independent risk factor for compliance to NSTGs. Conclusion: WHO/INRUD indicators showed poor accuracy in assessing prescribing practices in PHCs in Namibia. There is need for appropriate models and/or criteria to optimize medicine use in PHCs in the future

AB - Objective: World Health Organization/ International Network of Rational use of Drugs (WHO/INRUD) indicators are widely used to assess medicine use. However, there is limited evidence on their validity in Namibia’s primary health care (PHC) to assess the quality of prescribing. Consequently, our aim was to address this. Design, setting, participants and interventions: An analytical cross-sectional survey design was used to examine and validate WHO/INRUD indicators in outpatient units of two PHC facilities and one hospital from 1st February 2015 to 31st July 2015. The validity of the indicators was determined using two-by-two tables against compliance to the Namibian standard treatment guidelines (NSTG). The receiver operator characteristics for the WHO/INRUD indicators were plotted to determine their accuracy as predictors of compliance to agreed standards. A multivariate logistic model was constructed to independently determine the prediction of each indicator. Main outcomes and results: Out of 1243 prescriptions; compliance to NSTG prescribing in PHCs was sub-optimal (target was >80%). Three of the four WHO/INRUD indicators did not meet Namibian or WHO targets: antibiotic prescribing, average number of medicines per prescription and generic prescribing. The majority of the indicators had low sensitivity and/or specificity. All WHO/INRUD indicators had poor accuracy in predicting rational prescribing. The antibiotic prescribing indicator was the only covariate that was a significant independent risk factor for compliance to NSTGs. Conclusion: WHO/INRUD indicators showed poor accuracy in assessing prescribing practices in PHCs in Namibia. There is need for appropriate models and/or criteria to optimize medicine use in PHCs in the future

KW - World Health Organization (WHO)

KW - Namibia

KW - Namibia primary health care

KW - prescribing quality

KW - infectious disease control

UR - https://academic.oup.com/intqhc

U2 - 10.1093/intqhc/mzy172

DO - 10.1093/intqhc/mzy172

M3 - Article

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EP - 345

JO - International Journal for Quality in Health Care

JF - International Journal for Quality in Health Care

SN - 1353-4505

IS - 5

ER -