# A combined strategies intervention on the World Health Organization prescribing indicators: A quasi-randomised trial

## TL;DR

This study tested if a training and feedback program could improve doctors' prescribing habits in Eswatini but found no significant improvement.

## Contribution

The study evaluates a combined audit, feedback, and education intervention's impact on rational prescribing in a lower-middle-income country.

## Key findings

- Baseline prescribing met some rational standards but antibiotic use exceeded 50%.
- The intervention did not significantly improve prescribing indicators post-intervention or at follow-up.
- Multifaceted strategies are recommended to address irrational medicine use.

## Abstract

Irrational medicine use is a global problem that may potentiate antimicrobial resistance.

This study aims to assess prescribing practices and the effect of a prescription audit and feedback coupled with small-group education intervention on prescribing indicators.

The study was conducted in public-sector healthcare facilities in Eswatini.

A cluster quasi-randomised controlled study was conducted from 2016 to 2019 using the World Health Organization/ International Network for Rational Use of Drugs (WHO/INRUD) prescribing indicators at baseline, post-intervention and post-follow-up. A 6-month unblinded intervention was tested in 32 healthcare facilities, randomly allocated to intervention (16) and control (16) arms. Prescribing practices were assessed post-intervention, and 6 months after the intervention, through an audit of 100 randomly selected prescriptions from each facility. Comparisons of WHO or INRUD prescribing indicators were conducted using the intention-to-treat analysis at the two times.

At baseline, in both arms, rational prescribing standards were met by the number of medicines per prescription and the use of injections. Antibiotic use was above 50% in both arms. After adjustment for baseline antibiotics use, region and level of care, there were no significant differences in all prescribing indicators between the two arms, post-intervention and at 6 months follow-up.

In a lower middle-income setting with a high prevalence of irrational prescribing practices, a prescription audit, feedback and small-group education intervention had no benefits in improving rational prescribing.

Multifaceted strategies, strengthening of pharmacy and therapeutics committees, and holistic monitoring of medicine use are recommended to promote rational medicine use.