Comparison of Prescribing Practices in Public & Private Sectors for the Treatment of Tuberculosis in Dhaka Metropolis

Abstract

It drugs are not the only therapeutic interventions, which provide a desirable health level, rational use of them plays an important role in the efficacy and sufficiency of therapeutic interventions. Rational drug utilization means that each individual receives the right medicine, in an adequate dose for an adequate duration, with appropriate information and follow-up treatment, and at an affordable cost. Some examples of irrational prescription are over- and under-prescribing, polypharmacy, no indicated drug prescription, unreasonable use of expensive medicines and inappropriate use of antibiotics. In addition to high cost of treatment, inappropriate prescribing causes ineffective, unsafe treatment, exacerbation or prolongation of illness, distress, and harm to the patient. Like other countries, inappropriate use of drugs due to irrational prescription practices is a common problem in Iran, and requires being concisely controlled. Due to the high cost of inappropriate use of drugs, developing countries face more problems because of the limited economic resources and lack of organized drug policy. In order to improve the prescription quality and rational prescription pattern promotion there is an inevitable need to investigate the factors that affect doctors' prescription patterns. Studies have shown that there is a correlation between prescription patterns and gender, age, educational status, work experience, economic situation, and physician's specialty. Defining drug prescription and consumption pattern provides advantageous feedback to prescribers in order to improve their prescribing behavior. Prescription analyzing studies help the policymakers to set the priorities to promote the rational use of medicines nationwide. This study aims to quantify the current situation of drug use pattern for the treatment of Tuberculosis in correlation with prescribing behavior of physicians based on their different specialties. The objective was to quantify the specialists' prescription pattern in ten different public and private sectors in Dhaka metropolis, Bangladesh and to point out the prescribing behavioral differences among several specialties. A retrospective cross-sectional study was carried out on the claim data and 6000 prescription is collected from 10 different hospitals among which 5 are private and five are government owned. Outdoor prescription data were obtained on the basis of the claims that the pharmacies submitted to the insurers during 1 year period of the study. More than 6000 prescriptions were analyzed depending on various parameters thatis designed and outcome has been justified. After comparison study we have seen that average number of drug per prescription in case of public hospitals is 5 where as it is 7 for private hospitals. As Tuberculosis is a specialized disease to be cured and also an infectious diseases so it needs extensive diagnostic test and history study and we see that in both prescriptionscollected from private and public sectors contain 100% disease diagnosis history. Near about 91% prescription contain more than 4 diagnostic test in case of public hospitals where as it is 97% for private hospitals. As immunity break down in tuberculosis patients it is necessary to prescribe multivitamins and minerals to boost up the patients immunity system. This is why prescription collected from private sectors contains 87% multivitamins and prescriptions collected from private sectors contain 100% multi vitamins. All the drugs need for tuberculosis treatment is supplied by WHO and UNDP finance and tuberculosis treatment is totally free but depending on patients conditions it needs others bronchodilators, multi vitamins, antihistamines, others drugs which cost near 293 BDT for public sectors and 523 for private sectors. Age missing in both prescriptions was 4% and date missing was 1%. Tuberculosis is prone to patient’s year less than 4 and greater than 35years.Tendency of Antibioticuse was 296%before intervention and after intervention 258% it is reduced by 38% in public sects. In private sectors before intervention it was 397% and after intervention 371% reduced by 26%. Patient satisfaction is also analyzed. Clinical check list is also analyzed. There is an inevitable need to improve prescription habits among different specialties, especially among general practitioners. This causes the policymakers to put more emphasis on priorities such as continuous education.