Evaluation of Drug Use at Four Hospitals in Khartoum, Sudan

Introduction

Medicines are essential components of a health care system and play a crucial role in saving people’s life. Essential medicines are selected to satisfy the real need of population in diagnostic, prophylactic, therapeutic purposes [1]. Increasing access to and ensuring appropriate use of essential medicines could improve health status and secure development gains [2]. Drug use evaluation is a system of ongoing, systematic, criteria-based assessment that ensures the appropriate use of drugs [3].

WHO core drug use indicators include: Prescribing indicators, patient care indicators and facility indicators.

Patient care indicators address key aspects of what patients’ experience at health facilities, and how well they have been prepared to deal with the pharmaceuticals that have been prescribed and dispensed and they serve as a simple method of monitoring drug use in a standardized way [4].

Patient consulting and dispensing times have the purpose of measuring the time that both medical personnel and dispensing personnel spend with patients in the process of consulting, prescribing and dispensing drugs. The time that prescribers and dispensers spend with each patient may indicate the potential quality of diagnosis and treatment [5, 6, 7, 8, 9].

Irrational drug uses are common in both developed and developing countries, the degree of the problem is higher in developing countries like Ethiopia where practices such as polypharmacy, the use of wrong or ineffective drugs, underuse or incorrect use of effective drugs and overuse of antimicrobials and injections are widespread [10]. Moreover, in developing countries, Sudan in particular, there are many medication safety issues and inappropriate practice habits at the health facilities. As the consequent this study was carried out to assess the Patterns of Drug Use by using World Health Organization’s Patient Care indicator in Selected Health Facilities in Khartoum state and the effectiveness of the information given to patients on the dosage schedule of the drugs they receive.

Results

All participants were interviewed, and the summary of patient care indicators included mean consultation time, mean dispensing time, percentage of drug adequately labelled and percentage of drugs dispensed in Table 1.

Frequency of dosing was not written in 13.11% of the medications dispensed, the duration of treatment was not included in the label information in 16.39% of the total number of the medication, side effects and precautions was not included in the label information in more than 90% of the total number of prescription of the patients have been interviewed (Figures 1 & 2).

Information to be told by the dispenser to the patients are:

1. The name of the drug dispensed
2. The dose of the drug dispensed
3. Duration of the treatment
4. Frequency of administration
5. Possible side effects.

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Discussion

The patient care indicators were developed by WHO to measure the mean consultation time, mean dispensing time, percentage of adequately labelled drug, percentage of drugs dispensed and the patient knowledge about the drug dispensed.

The physician should proceed with a full evaluation to the patient case at the time the patient enters the consultation room, and he should have left with the appropriate medication selected for him through a proper patient-physician interaction.

The mean consultation time of this study was found to be 13.93 minutes; this was longer than what was reported in North West Ethiopia, Jordan and India which were 3.9 and 4 min respectively [11, 12].

Mean consulting time in studies in six European countries was 10.7 min, and in the United Arab Emirates it was 10 min [13].

Times reported in this current study, as well as in the studies reviewed, were well below the optimal consultation time of ≥ 30 min recommended for conducting proper history taking, complete physical examination, appropriate health education instructions and prescribing therapy [14]. The current study showed that the consultation time is too short to enable physicians to communicate with their patients regarding their therapy and illness.

The average consultation times reported from other developing countries are even lower, ranging from 2.8-7 min [15, 16, 17, 18].

The average dispensing time reported in this study (122.78 s) was longer than the optimal dispensing time of ≥ 60 s. This average time was also longer than that reported in studies conducted at PHC facilities in Jordan (28.8 s) and in Kuwait (54.6 s) [19, 20].

This average time was also longer than that reported in studies conducted at PHC facilities in Jordan (28.8 s) and in Kuwait (54.6 s) [15, 20]. Dispensing time < 60 s is insufficient by WHO criteria to explain the dosage regimen, adverse effects of drugs, all precautions and label and dispense a drug. Patient compliance directly depends on his/her knowledge about the drug and therefore an adequate dispensing time is a necessary step towards improving patient care [21].

The percentage of prescribed drugs dispensed was low (58.98) comparing to the percentage of drugs dispensed in Kuwait which was 97 % [15]. An inadequate drug supply has implications for patients’ health status which is inconvenient for patients and jeopardises their trust in the health system [21]. WHO recommends that each drug label should contain the dose regimen, patient name and drug dose, in this study drug labelling practice was very poor, only 8.96%, compared with an optimal value of 100% which can be attributed to the lack of a labelling system where dispensary personnel only write the frequency of administration of each drug on the pillbox or medicines bag. The poor labelling reported in this study is comparable with the results of the study in Kuwait where 66.9% were adequately labelled [22, 23, 24, 25].

Patient’s knowledge of the correct dosage is highly beneficial to avoid drug overuse and abuse and prevent adverse effects that harm patients’ health status, which was low in this study.

Another study showed average consultation and dispensing time in facilities 3.82 minute and 3.66 minutes, respectively. The probable reason for such smaller time could be a large number of patient flow for which the doctors and pharmacy professionals urged to cover, and the smaller number of human resources. The findings from this study were smaller than the study conducted in South West of Ethiopia 6.14 minute and 1.28 minute respectively [22].

In this study, none of labels for the drugs dispensed was adequately done, according to WHO a label to be adequate it should contain at least patient name, drug name, strength, dosage (dose and frequency) and duration/quantity of the drug. However findings from similar studies showed that practice of adequate labelling was 67% [14, 24, 25]. It could be explained by high patient flow, and inadequacy of knowledge and skill in labelling of prescribed drugs could be the major factors for these low results.

Percentage of drugs dispensed in this study was 484 (45.7%) and 628(53.9%) respectively. This is lower than similar studies conducted in North West Ethiopia and different other countries like Nigeria and Colombia. It could be directly related to inadequate availability of essential drugs. Studies showed that good drug and medical supply management ensures a continuous supply of drugs and prevents frequent stock-outs and wastages [14, 25, 26, 27].

Conclusion

The result of the resent study indicates that the patient consulting time, medications, labeling and availability of key drugs in the hospitals are inadequate. The medication labeling practice in the four hospitals is unacceptability low. These patient care indicators need special attention for improvement. Professionals of all levels of health care, management and leaders should be trained in quality issues. Essential drug supply management systems should be established to ensure availability of key drugs in the outpatient pharmacies of the hospitals. We recommend that consultation times need to be longer and reasons for the short times need to be investigated. Drug labeling systems need to be improved to include drug regimen, patient name and drug dose, and the availability of key drugs stocks needs to be improved. Health care providers, professionals, financiers and also decision-makers (politicians) should be involved in the development and the selection of the quality indicators.