Bornova Eğitim Sağlık Grup Başkanlığı’na Bağlı Sağlık Ocaklarında Çalışan Pratisyen Hekimlerin İlaç Reçeteleme Davranışlarının Değerlendirilmesi

Hatice Şahin; Feride Saçaklıoğlu

Evaluation Of Primary Health Care Practitioners’ Prescribing Behaviours In Bornova Health District

Year 2005, Volume: 19 Issue: 19, 20 - 28, 01.02.2005

Abstract

BACKGROUND: Evaluation of physicians’ prescribing behaviour is very important for reducing of adverse drug reactions and health cost. The aim of this study is evaluation of primary health care practitioners’ prescribing behaviours in Bornova Health District. METHODS: This study, which was included in two parts was performed (January 1998) on 14 Primary Health Care practitioners in Bornova Health District. In first part, actual prescribing behaviours was evaluated by World Health Organization Prescribing Indicators and in the second part, intended prescribing behaviours was evaluated by using written simulated patients. RESULTS: 121 prescriptions were collected for evaluating of actual drug prescribing behaviour. Average number of drugs per prescription was 2.73. Percentage of prescriptions containing antibiotics was 57.7 %, injections was 3.7 %, vitamins was 38.5 %, non-opioid analgesics wais 59.1 %. 243 prescriptions were written for evaluating of intended drug prescribing behaviour. The choices of correct treatment for written simulated cases were evaluated by specialist options. Correct treatment rates were changed between 63.1 % and 95.3 %. Practitioners’ polypharmacy rate was changed between 63 % and 100 %. CONCLUSIONS: Inappropriate prescribing behaviours have been found among the practitioners. Basic and continuous medical education is necessary for prevention and improving of this inappropriate prescribing behaviour.

Keywords

prescribing behaviour, undergraduate medical education, rational pharmacothrapy, general practitioner

References

) Denig P (1994). Factors Influencing Rational Prescribing. In Drug Choice in Medical Practice. Rationales, Routines and Remedies. sf: 7-22, Groningen
) Hemminki E (1975). Review of Literature on the Factors Affecting Drug Prescribing. Soc.Sci.& Medicine. Vol.9, sf: 111-119
) Laing R., Hogerzeil H., Ross-Degnan D (2001). Ten Recommendations To Improve Use Of Medicines In Developing Countries. Health Policy Plan. Mar;16(1):13-20
) Pfaffenbach G., Carvalho OM., Bergsten-Mendes G (2002). Drug Adverse Reactions Leading To Hospital Admission. Rev Assoc Med Bras.Jul-Sep;48(3):237-41
) Ayuthya SK., Matangkasombut OP., Sirinavin S., Malathum K., Sathapatayavongs B (2003). Utilization Of Restricted Antibiotics In A University Hospital İn Thailand. Southeast Asian J Trop Med Pub Health. Mar;34(1):179-86
) Denig P., Wahlstrom R., de Saintonge MC., Haaijer-Ruskamp F (2002). The Value Of Clinical Judgement Analysis For Improving The Quality of Doctors’ Prescribing Decisions. Med Educ. Aug;36(8):770-80
) Denig P. (1992). Therapeutic Decision Making of Physicians’. Development of a More Sophisticated Drug Choice Model. Pharm Weekbl, vol:14, sf: 9-15
) Rishi RK., Sangeeta S., Surendra K., Tailang M (2003). Prescription Audit:Experience İn Garhwal (Uttaranchal), India. Trop.Doct. Apr:33(2):76-9
) Chukwuani CM., Onifade M., Sumonu K (2002). Survey Of Drug Use Practices And Antibiotic Prescribing Pattern At A General Hospital In Nigeria. Pharm World Sci. Oct;24(5):188-95
) Desta Z., Abula T., Beyene L., Fantahun M., Yohannes AG., Ayalew S (1997). Assessment Of Rational Drug Use And Prescribing In Primary Health Care Ficilities In North West Ethiopia. East Afr Med J. Dec; 74(12):758-63
) Mallet HP., Njikam A., Scouflaire SM (2001). Evaluation Of Prescription Practices And Of The Rational Use Of Medicines In Niger. Sante.Jul-Sep;11(3):185-93
) Walker G.J.A., Hogerzeil H.V., Sallami A.O., Alwan A.A.S., Fernando G., Kassem F.A (1990). Evaluation of Rational Drug Prescribing in Democratic Yemen. Soc.Sci.& Medicine. Vol.31, 823-828
) Ashworth M., Golding S., Majeed A. (2002). Prescribing Indicators and Their Use by Primary Care Groups to Influence Prescribing. Journal of Clinical Pharmacy and Therapeutics. 27, 197-204
) Wilson H.J.(2000). An Integrated Approach to Consultation Coaching Using Professional Actors as Simulated Patients. Medical Teacher, Vol:22;4, 370-379
) Managing Drug Supply (1997). Kumarian Press. 419-496. Connecticut, USA
) Trostle J (1996.) Inappropriate Distribution of Medicines by Professionals in Developing Countries. Soc.Sci.Med. Vol.42, No.8, 1117-1120
) Gill P.S., Makela M., Vermeulen K.M., Freemantle N., Ryan G., Bond C., Thorsen T., Haaijer-Ruskamp F Haaijer- Ruskamp F. (1999). Changing Doctor Prescribing Behaviour. Pharmacy World & Science. Vol:21;4.158-167
) Odusanya OO., Oyediran MA (2004). The Effect of An Educational Intervention On Improving Rational Drug Use. Niger Postgrad. Med. J. Jun;11(2):126-31
) Ogunnowo BE., Asuzu MC (2003). Evaluation Of Rational Prescribing Practices Of Doctors And Medical Students At The Igbo-Ora Comprehensive Hospital, Nigeria. Niger J Med. Jan-Mar;12(1):39-42
) Welschen I., Kuyvenhoven MM., Hoes AW., Verhij TJ (2004). Effectiveness Of A Multiple Intervention To Reduce Antibiotic Prescribing For Respiratory Tract Sypmtoms In Primary Care: Randomised Controlled Trial. BMJ.Aug 21;329(7463):431
) Bexell A., Lwando E., Von Hofsten B., Tembo S., Eriksson B., Diwan V.K.(1996). Improving Drug Use Through Continuing Education: A Randomized Controlled Trial in Zambia. J. Clinical Epidemiology. Vol:49;3. 355-357
) Cialdella P.H., Figon G., Haugh M.C., Boissel J.P. (1991). Prescription Intentions in Relation to Therapeutic Information: A Study of 117 French General Practitioners. Soc.Sci.Med. Vol: 33;11. 1263-1274
) Scobie S.D., Lawson M., Gavell G., Taylor K., Jackson S.H.D., Roberts T.E. (2003). Meeting the Challenge of Prescribing and Administering Medicines Safely: Structured Teaching and Assessment for Final Year Medical Students. Medical Education. 37; 434-437
) Carnate J., Javellana J.J. (1999). Knowledge, Attitudes, Practices and Behavior of First Year Medical Students on Drug Utilization. The Medical. Journal of De La Salle University. Vol.15;3 http://www.hsc.dlsu.edu.ph/aking/publications/carnateandjavellana.htm. ziyaret tarihi: 01.02.2001
) De Vries TPGM., Henning RH., Hogerzeil HV., Bapna JS., Bero L., Kafle KK., Mabadeje AFB., Santoso B., Smith AJ (1995). Impact of a Short Course in Pharmacotherapy for Undergraduate Medical Students: An International Randomized Controlled Study. The Lancet. Vol. 346; 1454-1456
) Galan Herrera S., Delgado Marro MT., Altisent Trota R (2004). Analysis Of The Relationship Between Primary Care Doctors And The Pharmaceutical Industry. Aten Primaria. Sep 30;34(5):231-7
) Lam TP., Lam KF (2003). Why Do Family Doctors Prescribe Antibiotics For Upper Respiratory Tract Infection? Int J Clin Pract. Apr: 57(3):167-9
) Öcek ZA, Şahin H, Akdeniz G, Apaydın Ş (2004). Bir Eğitim Programı Modeli: Diş Hekimliğinde Akılcı İlaç Kullanımı. III. Ulusal Tıp Eğitimi Kongresi Özet Kitabı B119

Bornova Eğitim Sağlık Grup Başkanlığı’na Bağlı Sağlık Ocaklarında Çalışan Pratisyen Hekimlerin İlaç Reçeteleme Davranışlarının Değerlendirilmesi

Year 2005, Volume: 19 Issue: 19, 20 - 28, 01.02.2005

Hatice Şahin Feride Saçaklıoğlu

Abstract

GEREKÇE: Akılcı olmayan ilaç kullanımları hem hastalara sunulan sağlık hizmet kalitesini hem de sağlık maliyetlerini olumsuz yönde etkilemektedir. Hekimlerin reçeteleme davranışlarının bilinmesi, hekimlere yönelik girişimleri ve eğitim programlarını belirlemede önem taşımaktadır. Bu araştırma ile Bornova Eğitim Sağlık Grup Başkanlığı’na bağlı sağlık ocaklarında çalışan pratisyen hekimlerin ilaç reçeteleme davranışlarının değerlendirilmesi amaçlanmıştır. YÖNTEM: Çalışma hekimlerin reçeteleme davranışlarını değerlendiren iki bölümden oluşmaktadır. Her iki bölüm de 1998 yılı Ocak ayı boyunca, Bornova Sağlık Grup Başkanlığı’na bağlı 14 sağlık ocağında çalışan hekimlerle yürütülmüştür. Birinci çalışma bir sağlık ocağında, bir ay süre ile hekimlerin yeni tanı ve tedavi süreci sonunda hastalara yazdıkları reçetelerin içerik analizini (gerçek reçeteleme davranışı), ikinci araştırma ise diğer sağlık ocaklarındaki hekimlere sunulan yazılı simüle hastalara yazdıkları reçetelerin analizini (niyetlenilen reçeteleme davranışı) içermektedir. Gerçek reçeteleme davranışının değerlendirilmesinde Dünya Sağlık Örgütünün Reçeteleme Kriterleri, niyetlenilen reçeteleme davranışının değerlendirilmesinde ise yazılı simüle hastalar kullanılmıştır. Ayrıca hekimlerin reçete yazma gerekçeleri de açık uçlu olarak toplanmıştır. BULGULAR: Gerçek reçeteleme davranışının değerlendirildiği hekimlerden bir ay sonunda 121 reçete toplanmıştır. Hekim başına ortalama reçete sayısı 20.5 ± 13.8’dır. Hekimler reçetelerinde ortalama olarak 2.7 adet ilaç yazmışlardır. Hekimlerin her yüz reçetesinin ortalama % 57.7’sinde antibiyotik, % 3.7’sinde parenteral ilaç, % 38.5’inde vitamin, % 59.1’inde analjezik yazdıkları gözlenmiştir. Niyetlenilen reçeteleme davranışının ölçüldüğü olgular için toplam 243 reçete yazılmıştır. Uzman görüşleri ile karşılaştırıldığında olgular için doğru tedavi düzenleme oranının %63.1 ile % 95.3 arasında değiştiği gözlenmiştir. Olguların tamamında (% 63.8- %100) değişen oranlarda polifarmasi yapıldığı saptanmıştır. SONUÇ: Hekimlerin hem gerçek hem de niyetlenilen (yazılı simüle olgulara) reçeteleme davranışlarının bütüncül olarak değerlendirilmesi hem pratik hem de teorik anlamda tedavi düzenlemede sorunların yaşandığına işaret etmektedir. Davranışların iyileştirilmesinde, düzenli reçete izlemlerinin yapılması, hekimlere reçeteleme sınırlaması getirilmesi yanında mezuniyet öncesi ve sonrası eğitimlere de gereksinim vardır.

Keywords

reçeteleme davranışı, mezuniyet öncesi tıp eğitimi, rasyonel farmakoterapi, pratisyen hekim

References

) Denig P (1994). Factors Influencing Rational Prescribing. In Drug Choice in Medical Practice. Rationales, Routines and Remedies. sf: 7-22, Groningen
) Hemminki E (1975). Review of Literature on the Factors Affecting Drug Prescribing. Soc.Sci.& Medicine. Vol.9, sf: 111-119
) Laing R., Hogerzeil H., Ross-Degnan D (2001). Ten Recommendations To Improve Use Of Medicines In Developing Countries. Health Policy Plan. Mar;16(1):13-20
) Pfaffenbach G., Carvalho OM., Bergsten-Mendes G (2002). Drug Adverse Reactions Leading To Hospital Admission. Rev Assoc Med Bras.Jul-Sep;48(3):237-41
) Ayuthya SK., Matangkasombut OP., Sirinavin S., Malathum K., Sathapatayavongs B (2003). Utilization Of Restricted Antibiotics In A University Hospital İn Thailand. Southeast Asian J Trop Med Pub Health. Mar;34(1):179-86
) Denig P., Wahlstrom R., de Saintonge MC., Haaijer-Ruskamp F (2002). The Value Of Clinical Judgement Analysis For Improving The Quality of Doctors’ Prescribing Decisions. Med Educ. Aug;36(8):770-80
) Denig P. (1992). Therapeutic Decision Making of Physicians’. Development of a More Sophisticated Drug Choice Model. Pharm Weekbl, vol:14, sf: 9-15
) Rishi RK., Sangeeta S., Surendra K., Tailang M (2003). Prescription Audit:Experience İn Garhwal (Uttaranchal), India. Trop.Doct. Apr:33(2):76-9
) Chukwuani CM., Onifade M., Sumonu K (2002). Survey Of Drug Use Practices And Antibiotic Prescribing Pattern At A General Hospital In Nigeria. Pharm World Sci. Oct;24(5):188-95
) Desta Z., Abula T., Beyene L., Fantahun M., Yohannes AG., Ayalew S (1997). Assessment Of Rational Drug Use And Prescribing In Primary Health Care Ficilities In North West Ethiopia. East Afr Med J. Dec; 74(12):758-63
) Mallet HP., Njikam A., Scouflaire SM (2001). Evaluation Of Prescription Practices And Of The Rational Use Of Medicines In Niger. Sante.Jul-Sep;11(3):185-93
) Walker G.J.A., Hogerzeil H.V., Sallami A.O., Alwan A.A.S., Fernando G., Kassem F.A (1990). Evaluation of Rational Drug Prescribing in Democratic Yemen. Soc.Sci.& Medicine. Vol.31, 823-828
) Ashworth M., Golding S., Majeed A. (2002). Prescribing Indicators and Their Use by Primary Care Groups to Influence Prescribing. Journal of Clinical Pharmacy and Therapeutics. 27, 197-204
) Wilson H.J.(2000). An Integrated Approach to Consultation Coaching Using Professional Actors as Simulated Patients. Medical Teacher, Vol:22;4, 370-379
) Managing Drug Supply (1997). Kumarian Press. 419-496. Connecticut, USA
) Trostle J (1996.) Inappropriate Distribution of Medicines by Professionals in Developing Countries. Soc.Sci.Med. Vol.42, No.8, 1117-1120
) Gill P.S., Makela M., Vermeulen K.M., Freemantle N., Ryan G., Bond C., Thorsen T., Haaijer-Ruskamp F Haaijer- Ruskamp F. (1999). Changing Doctor Prescribing Behaviour. Pharmacy World & Science. Vol:21;4.158-167
) Odusanya OO., Oyediran MA (2004). The Effect of An Educational Intervention On Improving Rational Drug Use. Niger Postgrad. Med. J. Jun;11(2):126-31
) Ogunnowo BE., Asuzu MC (2003). Evaluation Of Rational Prescribing Practices Of Doctors And Medical Students At The Igbo-Ora Comprehensive Hospital, Nigeria. Niger J Med. Jan-Mar;12(1):39-42
) Welschen I., Kuyvenhoven MM., Hoes AW., Verhij TJ (2004). Effectiveness Of A Multiple Intervention To Reduce Antibiotic Prescribing For Respiratory Tract Sypmtoms In Primary Care: Randomised Controlled Trial. BMJ.Aug 21;329(7463):431
) Bexell A., Lwando E., Von Hofsten B., Tembo S., Eriksson B., Diwan V.K.(1996). Improving Drug Use Through Continuing Education: A Randomized Controlled Trial in Zambia. J. Clinical Epidemiology. Vol:49;3. 355-357
) Cialdella P.H., Figon G., Haugh M.C., Boissel J.P. (1991). Prescription Intentions in Relation to Therapeutic Information: A Study of 117 French General Practitioners. Soc.Sci.Med. Vol: 33;11. 1263-1274
) Scobie S.D., Lawson M., Gavell G., Taylor K., Jackson S.H.D., Roberts T.E. (2003). Meeting the Challenge of Prescribing and Administering Medicines Safely: Structured Teaching and Assessment for Final Year Medical Students. Medical Education. 37; 434-437
) Carnate J., Javellana J.J. (1999). Knowledge, Attitudes, Practices and Behavior of First Year Medical Students on Drug Utilization. The Medical. Journal of De La Salle University. Vol.15;3 http://www.hsc.dlsu.edu.ph/aking/publications/carnateandjavellana.htm. ziyaret tarihi: 01.02.2001
) De Vries TPGM., Henning RH., Hogerzeil HV., Bapna JS., Bero L., Kafle KK., Mabadeje AFB., Santoso B., Smith AJ (1995). Impact of a Short Course in Pharmacotherapy for Undergraduate Medical Students: An International Randomized Controlled Study. The Lancet. Vol. 346; 1454-1456
) Galan Herrera S., Delgado Marro MT., Altisent Trota R (2004). Analysis Of The Relationship Between Primary Care Doctors And The Pharmaceutical Industry. Aten Primaria. Sep 30;34(5):231-7
) Lam TP., Lam KF (2003). Why Do Family Doctors Prescribe Antibiotics For Upper Respiratory Tract Infection? Int J Clin Pract. Apr: 57(3):167-9
) Öcek ZA, Şahin H, Akdeniz G, Apaydın Ş (2004). Bir Eğitim Programı Modeli: Diş Hekimliğinde Akılcı İlaç Kullanımı. III. Ulusal Tıp Eğitimi Kongresi Özet Kitabı B119

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Details

Primary Language	Turkish
Journal Section	Original Article
Authors	Hatice Şahin This is me Feride Saçaklıoğlu This is me
Publication Date	February 1, 2005
Submission Date	September 5, 2015
Published in Issue	Year 2005 Volume: 19 Issue: 19

Cite

Vancouver	Şahin H, Saçaklıoğlu F. Bornova Eğitim Sağlık Grup Başkanlığı’na Bağlı Sağlık Ocaklarında Çalışan Pratisyen Hekimlerin İlaç Reçeteleme Davranışlarının Değerlendirilmesi. TED. 2005;19(19):20-8.

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