Assessing the Rational use of Essential Medicines in Public Health Facilities Montserrado County, Liberia.

摘要

The Republic of Liberia has had a fourteen year civil war which has a devastating effect on the lives of people and healthcare infrastructures. Among the many health challenges, irrational use of essential medicines is of high priority. The determinants of the irrational use of essential medicines in the country are unknown. In order to obtain the magnitude at which medicines are used and advance possible recommendations for remedy, a descriptive crosssectional was conducted in 30 public health facilities in Montserrado County, Liberia administrative center. To assess the rational use of essential medicines in public health facilities in Montserrado County, Liberia. A descriptive cross sectional study was conducted according to the (WHO) guidelines for monitoring and assessing country pharmaceutical situation. The study was conducted from March to June, 2012. About 30 TEMs using the WHO model list of 15 medicines (that is a standard set by WHO /DAP for sampling and study of medicines) and an additional 15 medicines of interest were assessed in the targeted healthcare facilities. A total of 486 essential medicines were dispensed in 121 prescriptions. An average of 4 medicines per prescription was encountered. About 42 (67%) TEMs were prescribed by generic names. The availability of the TEMs in the hospitals ranged from 43.3% to 96.7% with St.Joseph Catholic Hospital (97%) ranking the first. In the healthcare centers, about 43% of TEMs were readily available with a range of (33% to 43%) whiles in clinics these ranged from between (13% to 90%). By therapeutic groups, the comparative availability of TEMs showed 93% for analgesics, 90% for antimalarial medicines, 83% for anti-infective agents, 27% for antihelminthics, 37% for vitamins, 43% for antacids, 37% for antihypertensive and 87% for other medicines. In this study, the majority 25 (70%) of the dispensers interviewed were nurse aides and minority being Pharmacists (3%). The pharmacists were mainly deployed in the referral hospitals. Of the 144 out-patients interviewed, 91 (63.3%) of them knew how to take medicines as per indications and 121 (84%) were satisfied with the healthcare services they received. There were no problems of medicines availability in the County. Significant variabilities of essential medicines availability, prescription and dispensing patterns of essential medicines were observed. Unequal medicines distribution patterns were observed between health facilities. Healthcare providers demonstrated the lack of basic skills and knowledge in pharmaceutical management. Irrational use of medicines: unnecessary prescription of injectables and use of brand names of medicines were evident. Rational use of medicines requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community. Irrational use of medicines on the other hand is the overuse, underuse or misuses of medicines which results in wastage of scarce resources and widespread health hazards. Example, the use of too many medicines per patient (polypharmacy),inappropriate use of antimicrobial agents, over-use of injections when oral formulations would be more appropriate; failure to prescribe in accordance with clinical guidelines; inappropriate self-medications; and non-adherence to dosing regimens.1 In the prescription practice (lawful medical order by health provider of medicines for use by a patient), the use of brand (trade) names of medicines was observed. Skills in dispensing medicines and poor (inadequate) communication with patients are the main shortfalls encountered among health care providers. STGs were only available and used for malaria, TB and AIDS/HIV.