# Assessment of adherence to the World Health Organization’s prescribing indicators at the family medicine clinic of a quaternary facility

## TL;DR

This study evaluated drug prescription patterns at a clinic in Ghana using WHO indicators and found moderate adherence to rational prescribing practices.

## Contribution

The study provides a detailed assessment of adherence to WHO prescribing indicators in a family medicine clinic in a developing country.

## Key findings

- Three WHO indicators met reference standards: average medicines per encounter, injectable prescriptions, and antibiotic prescriptions.
- Female patients had 46.4% reduced odds of being prescribed antibiotics compared to males.
- Patients with chronic conditions were 93.2% more likely to receive antibiotics than those without.

## Abstract

To promote rational drug use in developing countries, it is important to assess drug use patterns. This study assessed the drug prescription patterns of the family medicine clinic at the Outpatient Pharmacy of the University of Ghana Medical Centre using the World Health Organization’s drug use indicators. An analytic, cross-sectional survey with data extracted from patient’s electronic medical records was carried out. Questionnaires were given to all prescribers in the family medicine clinic to evaluate factors related to rational medicine use. Frequencies and percentages were employed for description with further analysis, including Zero-inflated Poisson regression and logistic regression, used to determine associations between variables with a 95% confidence interval. Of the 600 participants whose prescriptions were analyzed, 367 (61.17%) were male and 233 (38.83%) were female. The prescribers interviewed were 3 males and 7 females. The mean number of medications per prescription was 1.4 (SD = 1.61), with antibiotics and injections making up 12.74% (n = 107) and 4.17% (n = 35) respectively. Generic prescriptions were 34.88% (n = 293) and those from the Essential Medicines List (EML) were 72.38% (n = 608). Prescriptions with a record of diagnosis were 50.83% (n = 305). Patients with comorbidities were shown to have a 52.2% lower prevalence rate of the total number of medications prescribed compared to those without comorbidities (p-value <0.001). Female patients have 46.4% reduced odds of being prescribed an antibiotic compared to male patients (p-value 0.012). The odds of a patient with a chronic condition being prescribed an antibiotic is 93.2% more than that of a patient without a chronic condition (p-value = 0.025). Additionally, the prevalence of drugs prescribed from the EML for a patient with a chronic condition is 74.4% lower than that prescribed for patients without a chronic condition (p-value = 0.048). There was moderate adherence to rational prescribing. Three prescribing indicators met reference standards, these were: average number of medicines per encounter, percentage of prescriptions with an injectable and percentage of encounters with antibiotics. Rational drug prescribing may be enhanced through training, guidelines, EML distribution, drug and therapeutics committee support and integrated Clinical Decision Support Systems (CDSS).