ABSTRACT
Drug research facilitates the rational use of and suggests to improve prescribing habits. Irrational use of drugs is a global problem affecting patient care. It results in increased mortality, morbidity, adverse drug events, and wastage of economic resources.
The success of treatment is dependent on a patient’s adherence to the medication regimen and non- amongst psychiatric patients is associated with poor clinical outcomes and high resource utilization.
The objectives of this study were to evaluate the pattern of drug utilization and the level of patients’ adherence to psychotropic drugs in a Nigerian Psychiatric Hospital.
Based on the WHO core indicators of rational drug use, data was obtained retrospectively from a review of 5400 outpatient prescriptions from September 2007 to August 2012.
Data evaluation was done using the WHO guideline for assessment of drug use in health facilities.
Furthermore, Morisky’s scale, (an eight-item validated questionnaire) was employed to obtain information on adherence of patients to medications from two hundred (200) outpatients.
The results were analyzed using the Statistical Package for the Social Sciences (SPSS).
A total number of 5400 prescriptions were used in this study. The pattern of prescription in the facility revealed that an average of 2.88 drugs was prescribed per encounter, 94.38 % of the drugs were prescribed by their generic names, and 36.13% of the prescriptions had injection prescribed.
The percentage of encounters with antibiotics prescribed was 2.6% while 99.4% of all the drugs encountered were prescribed from the essential drugs list.
The drugs whose utilization accounted for about 90% of the entire drug use (DU90%) include Haloperidol, Amitriptyline, Benzhexol, Trifluoperazine, Chlorpromazine and Carbamazepine. Haloperidol was the most utilized drug in the setting with a DDD/ 1000 inhabitants /day of 5.
In more than 70% of the prescriptions encountered, all the drugs prescribed were available in the hospital pharmacy. With respect to patient adherence, 55.5% of patients were classified as having low adherence, 36% with moderate adherence and 8.5% having high medication adherence level.
The drug utilization review at the psychiatric hospital, Uselu found that polypharmacy was frequently practiced while haloperidol was the most utilized drug. About 70% of the prescribed drugs were available at the hospital pharmacy.
Outpatients’ adherence to medications was very low while socio-demographic features of patients did not affect adherence.
TABLE OF CONTENTS
TITLE PAGE …………….. i
CERTIFICATION ………. ii
DEDICATION………… iii
ACKNOWLEDGEMENT …….. iv
TABLE OF CONTENTS………… v
LIST OF TABLES …… vii
LIST OF ABBREVIATIONS……………… viii
ABSTRACT………….. x
CHAPTER ONE INTRODUCTION
1.0 BACKGROUND ………… 1
1.1 STATEMENT OF THE PROBLEM / RESEARCH QUESTIONS…………….. 4
1.2 JUSTIFICATION OF STUDY…………………………….. 5
1.3 SIGNIFICANCE OF THE STUDY………………….. 6
1.4 LITERATURE REVIEW……………………………….. 7
1.4.1 DEFINITION OF PSYCHIATRIC DISORDER ……………………… 7
1.4.2 PREVALENCE OF PSYCHIATRIC DISORDERS…………………. 7
1.4.3 CLASSIFICATION OF PSYCHIATRIC DISORDERS …………………………. 8
1.4.4 DRUG UTILIZATION (GENERAL CONSIDERATION)……………………… 12
1.4.5 DRUG UTILIZATION IN PSYCHIATRY……………….. 15
1.4.6 IMPROVING DRUG UTILIZATION………………………… 17
1.4.7 RATIONAL DRUG USE …………………………………… 19
1.4.8 THE CONCEPT OF ATC CLASSIFICATION AND DDD ASSIGNMENT 27
1.4.9 ADHERENCE…………….. 30
1.4.10 ADHERENCE IN THE ADULT AND ELDERLY ……….. 31
1.4.11 ADHERENCE IN CHILDREN AND ADOLESCENTS……… 36
1.4.12 ADHERENCE TO PSYCHOTROPIC DRUGS …………….. 37
1.4.13 IMPROVING ADHERENCE……………… 39
1.5 OBJECTIVES OF THE STUDY………….. 43
CHAPTER TWO METHODS.
2.0 STUDY DESIGN………... 44
2.1 SETTING ……………. 44
2.2 DATA COLLECTION…………… 45
2.2.1 Drug Utilization Review ……….. 45
2.2.2 Medication Adherence …………… 46
2.3 DATA ANALYSIS …………….. 47
2.3.1 Analysis of Drug Utilization Data ……………. 47
2.3.2 Analysis of Adherence Data …………….. 49
2.4 ETHICAL APPROVAL ……………….. 49
CHAPTER THREE RESULTS
3.0 DRUG UTILIZATION DATA PRESENTATION………….. 50
3.1 ADHERENCE DATA PRESENTATION… 57
CHAPTER FOUR DISCUSSION AND CONCLUSION
4.1 DRUG UTILIZATION …………… 63
4.2 ADHERENCE ……………….. 66
4.3 LIMITATIONS OF THE STUDY…….. 69
4.4 CONCLUSION……………… 70
REFERENCES……. 71
APPENDIX………….. 83
INTRODUCTION
1.1 Background
Drug utilization research has been defined by the World Health Organization (WHO) as “the marketing, distribution, prescription and use of drugs in a society with a special emphasis on the resulting medical, social and economic consequences’’.1
The principal aim of drug utilization research is to facilitate the rational use of drugs in population and to suggest measures to improve prescribing habit. Irrational use of drugs is a widespread global phenomenon cutting across all levels of care.
This results in increased mortality, morbidity, adverse drug reactions and economic wastages. Medicines are pivotal to healthcare delivery and disease prevention therefore, the availability and affordability of good quality drugs coupled with their rational use is fundamental to effective healthcare delivery in any country.2
However, irrational use of medicines are regular occurrences in many countries especia
lly developing ones due to irrational prescribing, dispensing and administration of medications.2,3
According to the World Health Organization, more than half of all medicines are prescribed, dispensed or sold inappropriately and that half of all patients fail to take them correctly4 giving rise to patients poor clinical outcomes.
REFERENCES
World Health Organization: Introduction to Drug utilization research. What is Drug Utilization research and why is it needed?World Health Organization, Norway, 2003:9.
Enato E.F.O and Chima I.E: Evaluation of drug utilization pattern and patient care practices.West African Journal of Pharmacy 2011: 22(1): 36-40.
World Health Organization: Medicines strategy 2008-2013. WHO, Geneva, 2008.
Adebayo E.T, Hussain N.A: Pattern of Prescription drug use in a Nigerian Army Hospital. Ann Afr. Med. 2010 July-september 9(3): 152-158.
Stimac D, Culig J.: Out-patient utilization of psychopharmacenticals in the city of Zagreb 2001-2006. PsychiatriaDambina, 2009; Vol. 21, NO. 1:56-64.
Osterberg L, Blaschke T: Adherence to medication. N Engl J Med 2005, 353: 487-497.
StudentsandScholarship Team
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