Q Niaz1, B Godman2,3,4, A Massele5, S Campbell6,7, A Kurdi3,8, H R Kagoya9, D Kibuule1. 1. Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia. 2. Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden. 3. Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom. 4. Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa. 5. Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana. 6. Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK. 7. NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health. University of Manchester, Manchester. 8. Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq. 9. Monotiring and Evaluation Unit, Management Sciences for Health, Windhoek-Namibia.
Abstract
OBJECTIVE: World Health Organization/International Network of Rational use of Drugs (WHO/INRUD) indicators are widely used to assess medicine use. However, there is limited evidence on their validity in Namibia's primary health care (PHC) to assess the quality of prescribing. Consequently, our aim was to address this. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: An analytical cross-sectional survey design was used to examine and validate WHO/INRUD indicators in out-patient units of two PHC facilities and one hospital in Namibia from 1 February 2015 to 31 July 2015. The validity of the indicators was determined using two-by-two tables against compliance to the Namibian standard treatment guidelines (NSTG). The receiver operator characteristics for the WHO/INRUD indicators were plotted to determine their accuracy as predictors of compliance to agreed standards. A multivariate logistic model was constructed to independently determine the prediction of each indicator. MAIN OUTCOMES AND RESULTS: Out of 1243 prescriptions; compliance to NSTG prescribing in ambulatory care was sub-optimal (target was >80%). Three of the four WHO/INRUD indicators did not meet Namibian or WHO targets: antibiotic prescribing, average number of medicines per prescription and generic prescribing. The majority of the indicators had low sensitivity and/or specificity. All WHO/INRUD indicators had poor accuracy in predicting rational prescribing. The antibiotic prescribing indicator was the only covariate that was a significant independent risk factor for compliance to NSTGs. CONCLUSION: WHO/INRUD indicators showed poor accuracy in assessing prescribing practices in ambulatory care in Namibia. There is need for appropriate models and/or criteria to optimize medicine use in ambulatory care in the future.
OBJECTIVE: World Health Organization/International Network of Rational use of Drugs (WHO/INRUD) indicators are widely used to assess medicine use. However, there is limited evidence on their validity in Namibia's primary health care (PHC) to assess the quality of prescribing. Consequently, our aim was to address this. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: An analytical cross-sectional survey design was used to examine and validate WHO/INRUD indicators in out-patient units of two PHC facilities and one hospital in Namibia from 1 February 2015 to 31 July 2015. The validity of the indicators was determined using two-by-two tables against compliance to the Namibian standard treatment guidelines (NSTG). The receiver operator characteristics for the WHO/INRUD indicators were plotted to determine their accuracy as predictors of compliance to agreed standards. A multivariate logistic model was constructed to independently determine the prediction of each indicator. MAIN OUTCOMES AND RESULTS: Out of 1243 prescriptions; compliance to NSTG prescribing in ambulatory care was sub-optimal (target was >80%). Three of the four WHO/INRUD indicators did not meet Namibian or WHO targets: antibiotic prescribing, average number of medicines per prescription and generic prescribing. The majority of the indicators had low sensitivity and/or specificity. All WHO/INRUD indicators had poor accuracy in predicting rational prescribing. The antibiotic prescribing indicator was the only covariate that was a significant independent risk factor for compliance to NSTGs. CONCLUSION: WHO/INRUD indicators showed poor accuracy in assessing prescribing practices in ambulatory care in Namibia. There is need for appropriate models and/or criteria to optimize medicine use in ambulatory care in the future.
Authors: Julius C Mwita; Olayinka O Ogunleye; Adesola Olalekan; Aubrey C Kalungia; Amanj Kurdi; Zikria Saleem; Jacqueline Sneddon; Brian Godman Journal: Int J Gen Med Date: 2021-02-18
Authors: Daniel Kwame Afriyie; Israel A Sefah; Jacqueline Sneddon; William Malcolm; Rachel McKinney; Lesley Cooper; Amanj Kurdi; Brian Godman; R Andrew Seaton Journal: JAC Antimicrob Resist Date: 2020-02-18