Comparison of Prescribing Pattern in Public & Private Health Sectors for the Treatment of ARI (Acute Respiratory Infection) in Dhaka Metropolis

Abstract

World Health Organization (WHO) was suggested some guidelines to evaluate a prescription pattern. Most of the cases, in national aspects, physicians do not follow the guidelines. Irrational prescription pattern is a common finding in Bangladesh. Maximum physicians prescribe the patients in wrong as well irrational way. Firstly, we can say the generic name of the drug which is totally absent in the prescription. Many brand name drugs have cheaper generic content which confer less therapeutic effects. Ontheother hand, polypharmacy is a common problematic issue. Polypharmacy refers to use of four or more medications by a patient. Therefore, patients are easy to prone drug interaction, non adherence, hospitalization and mortality. In rural area this trend is spread tremendously. Another problem is prescribing of inappropriate antibiotic. Sorrowfully, in Bangladesh most of the physicians think that without antibiotic a prescription will be incomplete. But it’s a great threat to patients, leading to adverse drug reactions, bacterial resistance and elevated costs. Children are also arrested by this rule. These drugs are not use 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. 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 that is 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 4 where as it is 7 for private hospitals. As Acute Respiratory Infection 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 prescription collection from private and public sectors contain 73% and 99% respectively. 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 142% multivitamins and prescriptions collected from public sectors contain 62% multi vitamins. ARI is prone to patient’s year less than 2 and less than 5 years. Tendency of Antibiotic use was 124% before intervention and after intervention 96% it is reduced by 24% in public sects. In private sectors before intervention it was 157% and after intervention 147% reduced by 6%. Patient satisfaction is also analyzed. Clinical check list is also analyzed.