Key Findings From a Study to Compare Private and Public Sector Treatment of Adult Malaria and Acute Respiratory Illness in Kampala, Masaka, and Jinja

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A COMPARISON OF PRESCRIBING PRACTICES BETWEEN
PUBLIC AND PRIVATE SECTOR PHYSICIANS IN UGANDA
Obua C, Ogwal-Okeng JW, Waako P, Aupont O ,
Ross-Degnan D International Conference on
Improving Use of Medicines Chiang Mia,
Thailand April 1, 2004 INRUD Uganda and Makerere
University Project supported as part of the
Joint Initiative on Improving Use of Medicines
under a grant from ARCH
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Background

• Private sector physicians contribute
  significantly to health services in Uganda
• Governments overseers of health services in both
  private and public sector.
• Practices in both sectors characterized by
  alarming gaps in prescribing.
• Inappropriate prescribing practices likely to be
  a serious problem among private sector physicians

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Objectives

• To analyze and compare prescribing practices
  between public and private sector physicians for
  ARI and malaria in Kampala, Masaka and Jinja .
• Specific Objectives
• To analyze the overall quality of prescribing for
  ARI and malaria in the 2 sectors.
• To compare the prescribing patterns between the
  two sectors
• To assess overall difference in cost of
  prescriptions between the two practices.

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Methods

• Survey research design involving both
  quantitative and qualitative methods.
• Prospective survey of 119 private practices
  randomly selected from the study sites
• Use of surrogate patients in private sector
  data collection
• Retrospective survey of 595 prescription
  records randomly selected from 10 public health
  units.
• Only single-diagnosis prescriptions selected

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Methods (continued)

• Prescription indicators
• Types and number of drugs prescribed
• Duration of treatment
• Levels of antibiotic and injection use
• Appropriateness of prescribing
• Appropriateness of prescribing
• Indication
• Regimen
• Route of administration
• Use of generic names.

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Results

• Low levels of overall appropriateness of
  prescribing in the two conditions by both sector.
• High use of injections twice as much in malaria
  by public sector compared to private sector.
• High use of antibiotics by both sector in some
  cases up to 3 prescribed.
• Number of drugs per prescription generally more
  than 2. On average 3.1 and 3.3 drugs in malaria
  by private and public sectors 3.1 and 2.9 in ARI
  by Private and public sectors evidence of
  polypharmacy
• Comparatively high use of medicines of doughtfull
  benefits i.e.vitamins, steroid
  anti-inflammatory, brand combination drugs by
  private sector.
• Prescription costs too high both sector.

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Results (Continued)
Prescription patterns for treating adult cases
of ARI in urban health facilities
 S.E. Standard Error
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Results (continued)
Prescription patterns for treating adult cases of
malaria in urban health facilities
S.E. Standard Error
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Results (continued)
Fig.2 Prescribing of Injections in Private and
Public sector
Fig.1 Overall Appropriateness of Prescribing by
Private and Public Sector
pgt0.05
P0.07
P0.0001
P0.002
Fig.3 Selection of Antibiotics Prescribed to
Patients Treated for ARI
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Discussion

• UNSTG perceived by prescribers as irrelevant to
  practices hence rarely referred to a problem of
  ownership?
• The overall low appropriateness and poor
  prescribing in Malaria by public sector indicator
  of extensive irrationality in practices is
  govt. strategy wrong?
• While prescribing in the private sector could be
  underscored by economic reasons - What motives
  explain the pattern of prescribing in the public
  sector?
• In Uganda the average family survives on less
  than 1 a day negative impact on the health and
  financial implications by the prescription costs?
  

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Conclusion and Policy implications

• Prescribing patterns in both sector were not
  complying with the UNSTG recommendations timely
  reviews needed.
• Exploratory and educational Interventions
  urgently needed to address prescribing issues in
  both sector.
• Providers in both sectors need training and
  continuous monitoring and evaluation of their
  activity in order to improve practices.
• Govt. to actively promote National Treatment
  Guidelines for effective impact on health and
  economic outcomes.
• Periodic evidence based CME using the National
  Treatment Guidelines is recommended.