Evaluation of Knowledge, Attitude, and Practice about Rational Prescribing and Use of Drugs among General Practitioners in Tehran City, Iran

Document Type : Original Article (s)

Authors

1 Resident, Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

2 Pharmacist, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

3 General Practitioner, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran

4 Associate Professor, Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: Accuracy and expertise are the essential factors that must be applied by general practitioners (GPs) due to their important role in preventing irrational prescribing. The aim of this study was to determine the knowledge, attitude, and practice of the rational use of drugs among general practitioners, and affecting factors.Methods: In this descriptive cross-sectional study which was conducted in Tehran City, Iran, the knowledge and attitude of 135 general practitioners in the area of rational prescribing and use of drugs were assessed using a questionnaire and their performance was checked via a checklist. Checklists were carefully completed by trained patients (standard patient) following a doctor's visit.Findings: 79.3% of general practitioners had good knowledge, and 45.9% of them had positive attitudes toward rational prescribing and use of drugs. 50.4% of physicians also had good performance in the field of rational drug prescribing. Physicians’ performance or practice was significantly different in the two sex groups (P = 0.03, t = 2.1). In addition, it was a significant relationship between physicians’ age (P = 0.006, R = -0.23) and occupational history (P = 0.005, R = -0.16) with knowledge level, and between the geographical area of the office with physicians’ knowledge, attitude, and practice. (P = 0.001, F = 2.4).Conclusion: It seems that general practitioners in Tehran City have a good knowledge of the rational prescribing and use of drugs, but most of them do not have a positive attitude in this regard and display a modest performance. Therefore, it is necessary to intervene in order to improve the attitudes and performance among general practitioners. It is necessary that some interventions should be done to promote physicians’ attitude and practice in terms of rational use of drugs.

Keywords


  1. Oviawe O. Prescriber performance in a paediatric general practice clinic of a university teaching hospita. West Afr J Med1988; 8(2): 130-4.
  2. Lexchin J. Doctors and detailers: Therapeutic education or pharmaceutical promotion? Int J Health Serv 1989; 19(4): 663-79.
  3. Weedle PB, Poston JW, Parish PA. Drug prescribing in residential homes for elderly people in the United Kingdom. DICP 1990; 24(5): 533-6.
  4. Hogerzeil HV. Promoting rational prescribing: An international perspective. Br J Clin Pharmacol 1995; 39(1): 1-6.
  5. Barber N. What constitutes good prescribing? BMJ 1995; 310(6984): 923-5.
  6. Hogerzeil HV, Walker GJ, Sallami AO, Fernando G. Impact of an essential drugs programme on availability and rational use of drugs. Lancet 1989; 1(8630): 141-2.
  7. Holloway KA, Ivanovska V, Wagner AK, Vialle-Valentin C, Ross-Degnan D. Have we improved use of medicines in developing and transitional countries and do we know how to? Two decades of evidence. Trop Med Int Health 2013; 18(6): 656-64.
  8. Soleymani F, Valadkhani M, Dinarvand R. Challenges and achievements of promoting rational use of drugs in Iran. Iran J Public Health 2009; 38(Suppl.1): 166-8.
  9. Le Grand A, Sri-Ngernyuang L, Streefland PH. Enhancing appropriate drug use: the contribution of herbal medicine promotion. A case study in rural Thailand. Soc Sci Med 1993; 36(8): 1023-35.
  10. Foster S. Supply and use of essential drugs in sub-Saharan Africa: Some issues and possible solutions. Soc Sci Med 1991; 32(11): 1201-18.
  11. Dean B, Schachter M, Vincent C, Barber N. Prescribing errors in hospital inpatients: their incidence and clinical significance. Qual Saf Health Care 2002; 11(4): 340-4.
  12. Walker GJ, Hogerzeil HV, Sallami AO, Alwan AA, Fernando G, Kassem FA. Evaluation of rational drug prescribing in Democratic Yemen. Soc Sci Med 1990; 31(7): 823-8.
  13. Hogerzeil HV. Use of essential drugs in rural Ghana. Int J Health Serv 1986; 16(3): 425-40.
  14. Ahmed SM, Islam QS. Availability and rational use of drugs in primary healthcare facilities following the national drug policy of 1982: Is Bangladesh on right track? J Health Popul Nutr 2012; 30(1): 99-108.
  15. Crigger N, Holcomb L. Improving nurse practitioner practice through rational prescribing. J Nurse Pract 2008; 4(2): 120-5.
  16. Howie JG. Clinical judgement and antibiotic use in general practice. Br Med J 1976; 2(6043): 1061-4.
  17. Hartley RM, Charlton JR, Harris CM, Jarman B. Patterns of physicians' use of medical resources in ambulatory settings. Am J Public Health 1987; 77(5): 565-7.
  18. Baker D, Klein R. Explaining outputs of primary health care: Population and practice factors. BMJ 1991; 303(6796): 225-9.
  19. Dawood OT, Hassali MA, Saleem F. Factors affecting knowledge and practice of medicine use among the general public in the State of Penang, Malaysia. J Pharm Health Serv Res 2017; 8(1): 51-7.
  20. Watkins C, Harvey I, Carthy P, Moore L, Robinson E, Brawn R. Attitudes and behaviour of general practitioners and their prescribing costs: a national cross sectional survey. Qual Saf Health Care 2003; 12(1): 29-34.
  21. Catic T, Avdagic L, Martinovic I. Knowledge and attitudes of physicians and pharmacists towards the use of generic medicines in Bosnia and Herzegovina. Med Glas (Zenica) 2017; 14(1): 25-32.
  22. Kulkarni P, Kuruvilla A, Roy R, Indla R. An evaluation of knowledge, attitude and practice of rational antibiotic usage and antibiotic resistance among interns in a teaching tertiary care hospital: A crosssectional questionnaire/ based study. Indian Journal of Pharmacy and Pharmacology 2017; 4(4): 192-7.
  23. Hooli TV, Srikanth, Somashekara SC, Suraj B. Knowledge, attitude, practice of rational use of medicines among junior residents in a tertiary care hospital. Int J Basic Clin Pharmacol 2017; 6(8): 2001-4.
  24. Amini A, Kargarmaher Mh, Hatami Sadabadi F, Salami H. Determining CME needs of general physicians in East Azarbaijan province. Iran J Med Educ 2002; 2: 12. [In Persian]
  25. Ross-Degnan D, Laing R, Santoso B, Ofori-Adjei D, Lamoureux C. Improving pharmaceutical use in primary care in developing countries: A critical review of experience and lack of experience. Proceedings of the 1st International Conference on Improving Use of Medicines; 1997 Apr 1-4; Chiang Mai, Thailand.
  26. Cheraghali AM, Nikfar S, Behmanesh Y, Rahimi V, Habibipour F, Tirdad R, et al. Evaluation of availability, accessibility and prescribing pattern of medicines in the Islamic Republic of Iran. East Mediterr Health J 2004; 10(3): 406-15.
  27. Nabiswa AK, Makokha JD, Godfrey RC. Malaria: Impact of a standardized protocol on inpatient management. Trop Doct 1993; 23(1): 25-6.
  28. Laing RO. Rational drug use: An unsolved problem. Trop Doct 1990; 20(3): 101-3.
  29. Borgsdorf LR, Miano JS, Knapp KK. Pharmacist-managed medication review in a managed care system. Am J Hosp Pharm 1994; 51(6): 772-7.
  30. Afrasiabian S, Hajibagheri K, Roshani D, Zandsalimi S, Barari M, Mohsenpour B. Investigation of the knowledge, attitude and performance of the physicians in regard to rational antibiotic prescription. Sci J Kurdistan Univ Med Sci 2017; 22(1): 25-35. [In Persian].
  31. Lipton HL, Byrns PJ, Soumerai SB, Chrischilles EA. Pharmacists as agents of change for rational drug therapy. Int J Technol Assess Health Care 1995; 11(3): 485-508.
  32. Watson MC, Bond CM, Grimshaw J, Johnston M. Factors predicting the guideline compliant supply (or non-supply) of non-prescription medicines in the community pharmacy setting. Qual Saf Health Care 2006; 15(1): 53-7.
  33. Gutierrez G, Guiscafre H, Bronfman M, Walsh J, Martinez H, Munoz O. Changing physician prescribing patterns: Evaluation of an educational strategy for acute diarrhea in Mexico City. Med Care 1994; 32(5): 436-46.
  34. Cagri BA, Ermertcan S, Hosgor-Limoncu M, Ciceklioglu M, Eren S. Rational antibiotic use and academic staff. Int J Antimicrob Agents 2003; 21(1): 63-6.