A combined strategies intervention on the World Health Organization prescribing indicators: A quasi-randomised trial

Nondumiso B.Q. Ncube; Tawanda Chivese; Ferdinand C. Mukumbang; Hazel A. Bradley; Helen Schneider; Richard Laing

doi:10.4102/phcfm.v16i1.3943

African Journal of Primary Health Care & Family Medicine (Feb 2024)

A combined strategies intervention on the World Health Organization prescribing indicators: A quasi-randomised trial

Nondumiso B.Q. Ncube,
Tawanda Chivese,
Ferdinand C. Mukumbang,
Hazel A. Bradley,
Helen Schneider,
Richard Laing

Affiliations

Nondumiso B.Q. Ncube: Department of Community and Health Sciences, School of Public Health, University of the Western Cape, Cape Town
Tawanda Chivese: Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha
Ferdinand C. Mukumbang: Department of Community and Health Sciences, School of Public Health, University of the Western Cape, Cape Town
Hazel A. Bradley: Department of Community and Health Sciences, School of Public Health, University of the Western Cape, Cape Town
Helen Schneider: Department of Community and Health Sciences, School of Public Health, University of the Western Cape, Cape Town, South Africa; and South African Medical Research Council Health Services to Systems Research Unit, Cape Town
Richard Laing: Department of Community and Health Sciences, School of Public Health, University of the Western Cape, Cape Town, South Africa; and Boston University School of Public Health, Boston University, Boston, Massachusetts

DOI: https://doi.org/10.4102/phcfm.v16i1.3943
Journal volume & issue: Vol. 16, no. 1
pp. e1 – e8

Abstract

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Background: Irrational medicine use is a global problem that may potentiate antimicrobial resistance. Aim: This study aims to assess prescribing practices and the effect of a prescription audit and feedback coupled with small-group education intervention on prescribing indicators. Setting: The study was conducted in public-sector healthcare facilities in Eswatini. Methods: A cluster quasi-randomised controlled study was conducted from 2016 to 2019 using the World Health Organization/ International Network for Rational Use of Drugs (WHO/INRUD) prescribing indicators at baseline, post-intervention and post-follow-up. A 6-month unblinded intervention was tested in 32 healthcare facilities, randomly allocated to intervention (16) and control (16) arms. Prescribing practices were assessed post-intervention, and 6 months after the intervention, through an audit of 100 randomly selected prescriptions from each facility. Comparisons of WHO or INRUD prescribing indicators were conducted using the intention-to-treat analysis at the two times. Results: At baseline, in both arms, rational prescribing standards were met by the number of medicines per prescription and the use of injections. Antibiotic use was above 50% in both arms. After adjustment for baseline antibiotics use, region and level of care, there were no significant differences in all prescribing indicators between the two arms, post-intervention and at 6 months follow-up. Conclusion: In a lower middle-income setting with a high prevalence of irrational prescribing practices, a prescription audit, feedback and small-group education intervention had no benefits in improving rational prescribing. Contribution: Multifaceted strategies, strengthening of pharmacy and therapeutics committees, and holistic monitoring of medicine use are recommended to promote rational medicine use.

Published in African Journal of Primary Health Care & Family Medicine

ISSN: 2071-2928 (Print); 2071-2936 (Online)
Publisher: AOSIS
Country of publisher: South Africa
LCC subjects: Medicine: Public aspects of medicine
Website: https://phcfm.org/index.php/phcfm

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Abstract

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