| ObjectiveRational drug use has attracted global attentions now. However, reliable data aboutrational drug use is in short supply in China. This study aims to provide reliable andrepresentative data about rational drug use in outpatients in large general hospitals byanalyzing electronic prescriptions of outpatients obtained from a tertiary level hospital inWuhan City.MethodsWe conducted comprehensive reviews of literature on rational drug use to understandthe current research situation and master the standard analysis methods recommended bythe World Health Organization (WHO). The WHO/INRUD prescription indicators analysismethod 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 inWuhan City in2012were collected and analyzed. In addition, medicine use in upperrespiratory tract infections outpatients, children less than5years old with acute diarrhea,hypertensive and diabetics were analyzed separately. The main measurements used in thisstudy to assess rational drug use were average number of drugs per encounter, averageprescription cost, percentage of encounters with an injection prescribed, percentage ofencounters with an antibiotic prescribed, percentage of encounters with a hormoneprescribed, percentage of encounters with an antiviral drug prescribed, frequency ofantihypertensive and hypoglycemic agents prescribed, and so on. In the present study, descriptive analysis was carried out for demographics data and prescribing indicators.2Test, Student’s t-test and ANOVA were conducted to compare prescribing indicatorsbetween groups due to different outpatient socio-demographic characteristics and doctortitle. Multivariate logistic regression analysis was used to analyze determinant factors ofaverage number of drugs per encounter and average prescription cost. SAS9.2was used forall data analysis.Results1. Medicine use in all outpatients.990,029outpatients’ prescriptions were analyzed in the study. The average age of alloutpatients was38.77, standard deviation was19.97. Of the outpatients,44.79%weremales.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, thepercentage of injection prescriptions was23.70%, the percentage of prescriptionscontaining antibiotics or hormone was24.31%and17.33%, respectively. The averageprescription cost was581.14and the median was293.4. Prescribing patterns, in terms ofaverage prescription cost, the number of drugs per prescriptions and the percentage ofprescriptions with antibiotics, injections, or hormones, were significantly different due tooutpatient’s age, gender, modes of payment, clinical departments and doctors’ titles. Theresults of the multivariate logistic regression analysis showed that males were more likelyto be prescribed with high cost prescriptions and to have excessive drug combination usethan females, the OR was1.52and1.09. The probability of being prescribed with high costprescriptions and to have excessive drug combination use increased among the outpatientswho are older. Compared with outpatients insured by medical insurance, private patientswere greater likelihood to be prescribed with high cost prescriptions and to have excessivedrug 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 costprescriptions 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 analyzedin the study. The average number of drugs per prescription was2.56, the percentage ofprescriptions with antibiotics, hormones, antiviral agents and injections were64.05%,16.62%,10.45%and43.89%, respectively. The average prescription cost was254.25andthe median was171.40. Prescribing patterns were significantly different due to outpatient’sage, 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. Theaverage number of drugs per prescription was2.52, the percentage of prescriptions withantibiotics, antiviral agents and injections were25.52%,5.91%and25.50%, respectively.The average prescription cost was102.29and the median was79.80. With regard to variousprescribing indicators, there were significant differences among outpatients with differentage and different doctors’ titles. While there were no obvious statistics difference betweenmales 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. Theaverage number of drugs per prescription was3.28. The average prescription cost was530.84and the median was370.55. There were a total of40kinds of antihypertensive drugsin six categories. Calcium antagonists, Rennin-angiotensin system inhibitors and β-receptorblockers were most commonly used, with the frequency of utilization were35.85%,30.28%and20.07%, respectively. Amlodipine, Felodipine, Nifedipine, Irbesartan andPerindopril were the top five kinds of antihypertensive agents which were most frequentlyused, and their rankings of defined daily cost (DDDc) among40kinds of antihypertensivedrugs were21,23,27,18and22, respectively. Thus, the five most frequently usedantihypertensive agents were economic affordable.5. Medicine use in outpatients with diabetes 8,986prescriptions of outpatients with diabetes were analyzed in the study. Theaverage 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 inseven categories. Insulin, sulfonylurea secretagogues drugs and glucosidase inhibitors weremost commonly used; with the frequency of utilization were26.43%,18.27%and15.47%,respectively. Insulin injection, Glimepiride, Gliclazide, Sitagliptin and Metformin were thetop five kinds of hypoglycemic drugs which were most frequently used, and their rankingsof defined daily cost (DDDc) among18kinds of antihypertensive drugs were4,17,16,9and14, respectively. Thus, the five most frequently used hypoglycemic agents wereeconomic 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 therecommended level. There are significant associations between doctors’ prescribingbehaviors and their titles, as well as outpatients’ payment modes. It is worth noting thatthere is irrational usage of antibiotics and hormones among outpatients with upperrespiratory tract infection. However, the medical treatments for children less than5yearsold with acute diarrhea, hypertensive and diabetics are in line with the clinical guidelines ingeneral. It is necessary to implement essential drug system in outpatient department oftertiary level hospitals to alleviate outpatients’ economic burden. The managementdepartment of hospital should assess and supervise doctors’ prescribing behaviors regularly,especially for prescriptions of outpatients with upper respiratory tract infection, and takemeasures to control the irrational drug use. In addition, it is needed to conduct prospectivestudies to investigate outpatient prescribing indicators.Innovations and limitationsFirst of all, participants and research contents of the study is innovative. Rational druguse is a hot research field of health policy, and our study firstly and comprehensivelyanalyzed all outpatients’ electronic prescriptions collected from a tertiary level hospitalwhose outpatients exceed one million in a year. Second, the research method and perspective in this current study are innovative. In addition to comprehensively analyzerational drug use among outpatients, this study preliminary explored rational drug useamong various common diseases. Moreover, previous researches only investigated rationaldrug use, while our study explored the factors influencing doctors’ prescribing behavior onbasis of large samples as well. Meanwhile, our study had some innovative and interestingfindings. For example, associate chief physicians had greater odds to prescribe high costprescriptions and to use excessive drug combination than their counterparts. In addition, thenumber and cost of drug use of outpatients insured by medical insurance were much lessthan 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, thestudy was carried out in a relatively particular hospital, and may not be representative ofoutpatients from different levels and scales of hospitals. Second, this study was aretrospective analysis, and patient’s disease history, severity of illness and some otherimportant data were not collected, so we could only analyze rational drug usemacroscopically under the clinical guidelines instead of analyzing a single prescription indetail. Finally, due to the lack of information on taking medicine of participants, the studyonly analyzed the frequency of drug use, a preliminary indicator of ATC/DDD system, andit limited to analyze other prescription indicators such as DDD/100patients/day further. |
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