The Use of Non-physician Prescribed Medications in Patients Presenting to Two Emergency Departments in a Low/Middle-income Country

Abstract

Introduction: With few trained healthcare practitioners and limited personal finances, many patients in low/middle income countries purchase prescription medications from non-physician prescribers (NPP). This study documents various aspects of this practice, including patterns of prescribing, and the patient’s understanding of medication risks. Methods: From January to April 2017, 479 patients entering two hospitals in Phnom Penh, Cambodia, were surveyed. Demographics, medications, types of NPP who provided the medication, patients history and physicians’ chart data were documented. Information, including symptoms when the medication was purchased, possible side effects, hospital presenting symptoms, etc, was recorded. The patient’s understanding of medication allergies and risk of serious side effects was also documented. Results: Of the 467 patients included, more than half (59%), reported buying medications from NPPs within the two weeks before presenting to the hospital. Nearly half of those patients, (42%), could not identify any of their medications. Of those 159 patients who could identify at least one drug, 79% bought at least one medication that would require a prescription in the United States. Only 8% of patients were aware that medications could cause serious harm. Twenty-three percent of the known medications were oral or injectable corticosteroids, and 56% of steroid users, typically chronic users, had evidence of possible side effects. Conclusion: Many patients in one low/middle income country received prescription medications from various NPPs with little information concerning these medications. Efforts to educate the public about their medications and the potential risks of medications are needed.