Many patients are being prescribed excessive medicines as hospitals offload near-expiry stocks.
A recent survey among 21,913 patients in Nairobi recorded huge over-prescriptions especially of antibiotics – well over and above recommended levels. One of the reasons for the over-prescription, the report says was for health facilities to offload near-expiry medicines and improve on revenues.
“When it comes to private clinics, you also have other goals . . . you have target revenues,” said a medical doctor.
Researchers analysed mobile phone data in the donor supported M-TIBA programme where majority of hospital visits were due to respiratory tract infections.
These infections included common cold, bronchitis, tonsillitis and other conditions some not normally recommended for antibiotics.
High degrees
However, the study published recently in the journal Plos One shows antibiotics prescriptions rates for respiratory infections going up to 99.8 per cent.
“These high degrees of prescription surpass levels recommended by national and international standard treatment guidelines,” says the study by Dutch researchers and the Gertrude’s Children’s Hospital, Nairobi.
The eight-month study, analysed 36,210 visits at four clinics in Nairobi involving 21,913 patients with 85,484 prescriptions. It indicates only a few of the treatments were supported by comprehensive laboratory tests.
Official treatment guidelines recommend no antibiotics for infections such as common cold and bronchitis, a major cause of hospital visits in Kenya. In this study, the antibiotic amoxicillin constituted nearly one-third 7,061 or 32.3 per cent of total antibiotic drug prescriptions.
In August, the World Health Organisation, warned of fake Augmentin (usually a combination of amoxicillin and clavulanic acid) pills circulating in Kenya. “Money first. Guys go straight to the more expensive Amoxil-Clavulanic combination . . . they tend to think about money first,” said a doctor in the current study.
Health workers also explained that they are under intense pressure from clinic owners to meet certain revenue targets.
“You are not going to prescribe drugs worth Sh100 and yet you have the original drug worth Sh3,000. So, you will tend to move towards the more expensive drugs, and keep away from the cheap drugs that are supposed to be used at first,” said another medical doctor.
In February 2019, the annual conference of the Kenya Medical Research Institute was told of widespread sale of substandard amoxicillin in many retail pharmacies in Nairobi.
The researchers reported purchasing samples from retail pharmacies in seven wards in Nairobi – the CBD, Karen, South C, South B, Zimmerman, Kayole and Kibra.
After laboratory analysis, 46 per cent of the samples were confirmed to be of poor quality.
In the current study, however, the researchers asked patients’ and healthcare providers the cause of excessive drug prescriptions.
“Sometimes clinics want to offload near-expiry drugs,” said a clinical officer.
Some distributors give doctors or clinics huge discounts on near-expiring drugs for the quick offload on patients.
The Kenya Health System Assessment report published in June 2019 by the Ministry of Health and USAID said Kenya has the fourth highest Adverse Drug Reactions (ADR) reporting rate in Africa.
Over-prescription
Other reasons for over-prescription in the current study was due to high patient load, clinician and patient perceptions that clinicians should prescribe, lack of access to laboratory tests and the use of obsolete treatment guidelines.
The health workers were especially worried over an increasing number of ‘Google-patients’ in Kenya.
“These are patients who already have the symptoms; they turn to Google, then come to you in a panic, and get annoyed when you do not give them antibiotics,” said a doctor.
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