Prescribing and dispensing activities at the health facilities of a non-governmental organization

Background. Prescribing and dispensing surveys are prerequisites to achievi ng rational drug use. There is a dearth of such studies in India, particula rly in the non-governmental organization sector. Methods. We carded out a survey at the outpatient facilities maintained by the Southern Health Improvement Samity, a non-governmental organization in the South 24 Parganas district of West Bengal. Data were collected prospect ively by interviewing patients immediately after patient-physician and pati ent-dispenser encounters. Pre-designed forms were used to collect data pert aining to World Health Organization drug-use indicators and some additional indices. The calculations of cost of therapy involved some approximation. Results. Of the 312 prescriptions analysed, the majority were signed, legib le and complete with respect to age/gender data; 95.5% used Latin abbreviat ions and 7.7% mentioned neither signs and symptoms nor diagnosis. The avera ge number of drugs per encounter was 3.2; only 2 patients were treated with out drugs; 45.2% of drugs were prescribed by generic name. Use of antibioti cs (72.8% of encounters) and irrational fixed dose combinations (45.6% of p rescribed drugs) were frequent, but injection use (3.9% of prescriptions) w as low. The average drug cost per encounter was Rs 74.19, of which antibiot ics comprised 37.1%. The availability of first-line antitubercular drugs wa s adequate but other key drugs were in limited supply. Essential drugs list s and formularies were not followed. Only 45.7% of prescribed drugs conform ed to the World Health Organization model list of essential drugs. Only 12 preparations accounted for 70.9% of the prescribed drugs, including therape utically doubtful ones such as cough syrups, multivitamins and carminative syrups. For the dispensing survey, 301 prescriptions were analysed separate ly. All the prescribed drugs were supplied for only 11.6% of prescriptions. There were no serious errors in dispensing but 43.8% of dispensed products were inadequately labelled. Patients knew the correct mode of use for 64.5 % of dispensed drugs. The average consultation and dispensing times were 3. 7 and 3.1 minutes, respectively. Conclusion. Frequent use of antibiotics, irrational fixed dose combinations and preparations of uncertain efficacy, inadequate labelling of dispensed drugs and lack of access to standard tools for rational drug use such as lo cally adapted essential drugs list, formularies and standard treatment guid elines were some of the problematic prescribing and dispensing trends ident ified through this survey. Educational interventions are required to rectif y these problems.