Assessment of core drug use indicators using WHO/INRUD methodology at primary healthcare centers in Bahawalpur, Pakistan

BACKGROUND Proper utilization of medicines is a critical component of pharmaceutical care plan. The aim of this study was to assess drug use pattern at ten primary healthcare centers (PHCCs) of the Bahawalpur district of the Punjab province of Pakistan by employing the WHO/INRUD core drug use indicators. METHODS This was a descriptive, non-experimental and cross-sectional study. For the prescribing indicators, 1000 prescriptions (100 prescriptions per PHCC) were systematically sampled out of the total 290,000 prescriptions written during January to December 2014. A total of 300 randomly selected patients (30 per PHCC) and 10 pharmacy personnel (one per PHCC) were observed and interviewed to investigate the patient-care and facility-specific indicators, respectively. We used published ideal standards for each of the WHO/INRUD indicators. RESULTS Among the prescribing indicators, the average number of drugs per encounter was 3.4 (SD = 0.8) (optimal range = 1.6-1.8), the drugs prescribed by the generic name were 71.6% (optimal value = 100%), the encounters with an antibiotic prescribed were 48.9% (optimal range = 20.0-26.8%), the encounters with an injection prescribed were 27.1% (optimal range = 13.4-24.1%) and the drugs prescribed from the Essential Drugs List (EDL) were 93.4% (optimal value = 100%). Among the patient-care indicators, the average consultation time was 2.2 min (SD = 0.8) (optimal value ≥10 min), the average dispensing time was 38 s (SD = 12.1) (optimal value ≥90 s), the percentage of drugs actually dispensed was 90.9% (optimal value = 100%), the percentage of drugs adequately labeled was 100% (optimal value = 100%) and the patients' knowledge of correct dosage was 62.1% (optimal value = 100%). Among the facility-specific indicators, all PHCCs had a copy of the EDL and the key drugs available in the stock were 82% (optimal value = 100%). CONCLUSIONS Irrational use of drugs was observed in all healthcare facilities. This study necessitates the need to implement the WHO/INRUD recommended 12 core interventions to promote rational use of medicines.