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Last countrywide prescription audit was held a decade ago.

Byline: Ikram Junaidi

ISLAMABAD -- The last countrywide prescription audit in Pakistan was held almost a decade ago.

According to Ministry of National Health Services Director General Dr Asad Hafeez, prescription audits are done across the world in order to ensure that doctors do not prescribe more than necessary medicines and to ensure that the most affordable medicines are provided to patients.

He said the audits also ensure that prescriptions are made on a scientific basis.

'After the audits, doctors are contacted with suggestions for improving their style of prescriptions. It is good practice and can be beneficial if done regularly,' Dr Hafeez said.

The audits ensure doctors do not over-prescribe medicines

A country-wide study was conducted in 2006-7 and a follow-up survey followed for seeing if there was any improvement, he said.

He added that though the audits are conducted to improve the method of prescription, there is no benchmark for prescribing medicines.

'It is generally considered good practice to suggest only one antibiotic to a patient at a time. However, in some cases two or three antibiotics can also be prescribed,' he explained.

The Khyber Pakhtunkhwa government recently directed the health facilities to ensure that good prescription practices are followed so that the public has the choice for getting the more affordable drugs and also so that a healthy competition is promoted between leading brands in order for reducing prices.

Dr Hafeez said it is a positive step that the KP government has started making efforts for improving prescriptions.

According to a letter dated March 28 and signed by KP Secretary Health Mohammad Abid Majeed, available with Dawn, studies in Pakistan have shown that drug induced morbidity is an important problem in ambulatory care patients and that one of its major factors is prescription errors.

A study appearing in the Pakistan Journal of Medical Sciences, titled 'Prescription Patterns of General Practitioners in Peshawar' shows that of the 1,097 prescriptions studied from six major hospitals and pharmacies, not a single contained all the essential components of a prescription.

Legibility was poor in 58.5pc of the prescriptions, physician's names and registration numbers were not mentioned in 89pc and 98.2pc respectively.

Over 78pc of the prescriptions did not have diagnosis or indication mentioned. Dosage, duration of use, signature of physician and directions for taking drugs were not mentioned in 63.8pc, 55.4pc, 18.5pc and 10.9pc of prescriptions respectively. The study also shows almost 62pc of the prescriptions were of pain killers, which raises issues of medical ethics but also points towards the issue of affordability for poor patients and leads to discussions about the use of generic name based prescriptions and brand name based.

In some cases, doctors prescribe medicines in hurry without taking proper history. This leads to drugs reaction at times. It says it's better to prescribe medicines with consultation of a pharmacist.

'There are cases where medicines are prescribed at urging of pharmaceutical companies. Opening of government pharmacies in hospital will discourage that trend. Another issue is the dosage. Dose should be as per patient requirement. It requires checking the body mass and not just age,' the letter says.

It goes on to say that health facilities have been informed that international best practices and guidelines, including of WHO, are very clear on the do's and dont's of prescription writing.

The University of Florida College of Medicine Prescription Writing Guidelines state that a written prescription for drugs must be legibly printed or typed and contain the information such as name of prescribing practitioner, name and strength of medication, quantity of the drug in both textual and numeric formats, directions for use, dated with the month written in textual letters.

It is further suggested to give tips to reduce errors including that all prescriptions must be legible and written in black ink, always use a leading zero before a number less than one (e.g. 0.5 mg) and never use a terminal zero (e.g. 5.0 mg).

The letter says that WHO endorsed guidelines state that the most important requirement is that the prescription be clear. It should be legible and indicate precisely what should be given and should include the name, address, telephone of prescriber, date, generic name of the drug etc.

It is now imperative that measures be taken for forming clear standard operating procedures for prescription writing and record keeping in the health system, public and private, based on international best practices, the health secretary said.
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Publication:Dawn (Karachi, Pakistan)
Geographic Code:9PAKI
Date:Apr 4, 2018
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