| ObjectiveRational drug use has attracted global attentions now. However, reliable data about rational drug use is in short supply in China. This study aims to provide reliable and representative data about rational drug use in outpatients in large general hospitals by analyzing electronic prescriptions of outpatients obtained from a tertiary level hospital in Wuhan City.MethodsWe conducted comprehensive reviews of literature on rational drug use to understand the current research situation and master the standard analysis methods recommended by the World Health Organization (WHO). The WHO/INRUD prescription indicators analysis method and the ATC/DDD drug utilization analysis method were applied in this study. Nearly one million electronic prescriptions of outpatient in a tertiary level hospital in Wuhan City in2012were collected and analyzed. In addition, medicine use in upper respiratory tract infections outpatients, children less than5years old with acute diarrhea, hypertensive and diabetics were analyzed separately. The main measurements used in this study to assess rational drug use were average number of drugs per encounter, average prescription cost, percentage of encounters with an injection prescribed, percentage of encounters with an antibiotic prescribed, percentage of encounters with a hormone prescribed, percentage of encounters with an antiviral drug prescribed, frequency of antihypertensive and hypoglycemic agents prescribed, and so on. In the present study, descriptive analysis was carried out for demographics data and prescribing indicators. χ2Test, Student’s t-test and ANOVA were conducted to compare prescribing indicators between groups due to different outpatient socio-demographic characteristics and doctor title. Multivariate logistic regression analysis was used to analyze determinant factors of average number of drugs per encounter and average prescription cost. SAS9.2was used for all data analysis.Results1. Medicine use in all outpatients.990,029outpatients’prescriptions were analyzed in the study. The average age of all outpatients was38.77, standard deviation was19.97. Of the outpatients,44.79%were males.95.45%were private patients. Outpatients were mainly treated by attending doctors, associate chief physicians and chief physicians; the proportion was31.76%,31.51%and31.77%, respectively. The average number of drugs per prescription was2.50, the percentage of injection prescriptions was23.70%, the percentage of prescriptions containing antibiotics or hormone was24.31%and17.33%, respectively. The average prescription cost was581.14and the median was293.4. Prescribing patterns, in terms of average prescription cost, the number of drugs per prescriptions and the percentage of prescriptions with antibiotics, injections, or hormones, were significantly different due to outpatient’s age, gender, modes of payment, clinical departments and doctors’titles. The results of the multivariate logistic regression analysis showed that males were more likely to be prescribed with high cost prescriptions and to have excessive drug combination use than females, the OR was1.52and1.09. The probability of being prescribed with high cost prescriptions and to have excessive drug combination use increased among the outpatients who are older. Compared with outpatients insured by medical insurance, private patients were greater likelihood to be prescribed with high cost prescriptions and to have excessive drug combination use. The OR was2.00and1.52. In terms of clinical departments, outpatients of the internal medicine were more likely to be prescribed with high cost prescriptions and to have excessive drug combination use than that in other departments. And associate chief physicians had greater odds to prescribe high cost prescriptions and to use excessive drug combination than their counterparts.2. Medicine use in outpatients with upper respiratory tract infections31,909prescriptions of outpatients with upper respiratory tract infection were analyzed in the study. The average number of drugs per prescription was2.56, the percentage of prescriptions with antibiotics, hormones, antiviral agents and injections were64.05%,16.62%,10.45%and43.89%, respectively. The average prescription cost was254.25and the median was171.40. Prescribing patterns were significantly different due to outpatient’s age, gender, modes of payment, and doctors’titles.3. Medicine use in children less than5years old with acute diarrheaA total of1,749children under five years old suffered from diarrhea in the study. The average number of drugs per prescription was2.52, the percentage of prescriptions with antibiotics, antiviral agents and injections were25.52%,5.91%and25.50%, respectively. The average prescription cost was102.29and the median was79.80. With regard to various prescribing indicators, there were significant differences among outpatients with different age and different doctors’titles. While there were no obvious statistics difference between males and females and among outpatients with different modes of payment.4. Medicine use in outpatient with hypertension28,788prescriptions of outpatients with hypertension were analyzed in the study. The average number of drugs per prescription was3.28. The average prescription cost was530.84and the median was370.55. There were a total of40kinds of antihypertensive drugs in six categories. Calcium antagonists, Rennin-angiotensin system inhibitors and β-receptor blockers were most commonly used, with the frequency of utilization were35.85%,30.28%and20.07%, respectively. Amlodipine, Felodipine, Nifedipine, Irbesartan and Perindopril were the top five kinds of antihypertensive agents which were most frequently used, and their rankings of defined daily cost (DDDc) among40kinds of antihypertensive drugs were21,23,27,18and22, respectively. Thus, the five most frequently used antihypertensive agents were economic affordable.5. Medicine use in outpatients with diabetes 8,986prescriptions of outpatients with diabetes were analyzed in the study. The average number of drugs per prescription was2.88. The average prescription cost was701.02and the median was491.1. There were a total of18kinds of hypoglycemic agents in seven categories. Insulin, sulfonylurea secretagogues drugs and glucosidase inhibitors were most commonly used; with the frequency of utilization were26.43%,18.27%and15.47%, respectively. Insulin injection, Glimepiride, Gliclazide, Sitagliptin and Metformin were the top five kinds of hypoglycemic drugs which were most frequently used, and their rankings of defined daily cost (DDDc) among18kinds of antihypertensive drugs were4,17,16,9and14, respectively. Thus, the five most frequently used hypoglycemic agents were economic affordable.Conclusions and suggestionsThe average prescription cost for an outpatient encounter is relatively too high. Prescribing indicators such as percentage use of antibiotics are still higher than the recommended level. There are significant associations between doctors’ prescribing behaviors and their titles, as well as outpatients’ payment modes. It is worth noting that there is irrational usage of antibiotics and hormones among outpatients with upper respiratory tract infection. However, the medical treatments for children less than5years old with acute diarrhea, hypertensive and diabetics are in line with the clinical guidelines in general. It is necessary to implement essential drug system in outpatient department of tertiary level hospitals to alleviate outpatients’ economic burden. The management department of hospital should assess and supervise doctors’ prescribing behaviors regularly, especially for prescriptions of outpatients with upper respiratory tract infection, and take measures to control the irrational drug use. In addition, it is needed to conduct prospective studies to investigate outpatient prescribing indicators.Innovations and limitationsFirst of all, participants and research contents of the study is innovative. Rational drug use is a hot research field of health policy, and our study firstly and comprehensively analyzed all outpatients’ electronic prescriptions collected from a tertiary level hospital whose outpatients exceed one million in a year. Second, the research method and perspective in this current study are innovative. In addition to comprehensively analyze rational drug use among outpatients, this study preliminary explored rational drug use among various common diseases. Moreover, previous researches only investigated rational drug use, while our study explored the factors influencing doctors’ prescribing behavior on basis of large samples as well. Meanwhile, our study had some innovative and interesting findings. For example, associate chief physicians had greater odds to prescribe high cost prescriptions and to use excessive drug combination than their counterparts. In addition, the number and cost of drug use of outpatients insured by medical insurance were much less than those of private patients, which may provide a new perspective to understand doctors’ prescription behaviors.There are still some limitations needed to be pointed out. First, the study was carried out in a relatively particular hospital, and may not be representative of outpatients from different levels and scales of hospitals. Second, this study was a retrospective analysis, and patient’s disease history, severity of illness and some other important data were not collected, so we could only analyze rational drug use macroscopically under the clinical guidelines instead of analyzing a single prescription in detail. Finally, due to the lack of information on taking medicine of participants, the study only analyzed the frequency of drug use, a preliminary indicator of ATC/DDD system, and it limited to analyze other prescription indicators such as DDD/100patients/day further. |
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