Assessment of WHO/INRUD core drug use indicators in two tertiary care hospitals of Bahawalpur, Punjab, Pakistan

Medicines are a main therapeutic intervention provided within hospitals and their proper use in the outpatient setting is important for patients and the community. The objective of this study was to evaluate drug use patterns in the outpatient departments (OPDs) of two tertiary care hospitals (Bahawal Victoria Hospital and Civil Hospital) in the Bahawalpur district of the Punjab province of Pakistan by employing the standard World Health Organization/International Network of Rational Use of Drugs (WHO/INRUD) drug use indicators. A descriptive, cross-sectional study design was employed. For assessing the prescribing indicators a sample of 2400 prescriptions were systematically reviewed out of a total of 1,560,000 prescriptions written from 1st April 2014 to 31st March 2015. A total of 600 randomly selected patients and all pharmacy personnel were observed and interviewed to investigate the patient-care and facility-specific indicators. We used the published ideal standards for each of the WHO/INRUD indicators for comparison purposes. Among the prescribing indicators, the average number of drugs per prescription was 2.8 (SD = 1.3), the drugs prescribed by generic name were 56.6 %, the encounters with an antibiotic prescribed were 51.5 %, no injections were prescribed and 98.8 % of the drugs prescribed were from the Essential Drugs List (EDL). Among the patient-care indicators, the average consultation time was 1.2 min (SD = 0.8), the average dispensing time was 8.7 s (SD = 4.9), the percentage of drugs actually dispensed was 97.3 %, the percentage of drugs adequately labeled was 100 % and the patients' knowledge of correct dosage schedule was 61.6 %. Among the facility-specific indicators, all OPDs had a copy of the EDL and 72.4 % of the key drugs were available in stock. Irrational use of drugs was observed in both OPDs. Polypharmacy, brand prescribing, over-prescribing of antibiotics, short consultation and dispensing times, lack of patients' knowledge about prescribed medicines and unavailability of all key drugs in stock were the major issues that need attention of the healthcare authorities. This study necessitates the requirement to implement the relevant WHO recommended core interventions to promote rational use of medicines in these hospital-based OPDs.