An education intervention on prescribing patterns of drugs for acid-related disorders in a clinic setting : a case study

Abstract

The South African national drug policy (NDP) was implemented in 1994 to ensure the availability and accessibility of essential drugs to all citizens. The NDP also hoped to ensure the safety, efficacy and quality of drugs as well as to promote the concepts of individual responsibility for health, preventative care and informed decision making. However, drug utilisation studies performed after the implementation of the national drug policy showed that South Africa's pharmaceutical sector was characterised by indiscriminate and irrational drug use, high drug prices and polypharmacy. A retrospective study that was done in 2001 in the clinics supplied by Evander Hospital showed that only 11.9% of prescriptions for acid-related disorders complied with the standard treatment guidelines (STG). It became evident that there was need for an intervention. The general objective of this study was to determine the effect of an education intervention, implemented in 2003, on the prescribing patterns of drugs for acid-related disorders in the Govan Mbeki municipal clinics serviced by Evander Hospital. An empirical pre-intervention and post-intervention study using primary data obtained from patient files at the clinics was done. A quantitative survey of the use of the drugs included in the study (magnesium trisilicate, aluminium hydroxide/magnesium trisilicate combination tablets, cimetidine or omeprazole) was conducted. To determine a baseline, all prescriptions where the drugs selected for this study were prescribed from 1 July 2001 to 31 December 2001 were collected. For the period I January 2002 to 31 December 2002 retrospective data was collected in the form of all prescriptions where the relevant drugs were prescribed. Additional retrospective data was collected for the period January 2002 to 30 June 2003 to determine the outcome of treatment given. The phi coefficient was calculated, and although statistical correlation could not be proven, important tendencies could be detected in the data. Only 8% of the prescriptions adhered to the STG before the presentation of the face to face education intervention. In the first six months following the intervention, STG compliance increased to 15.2%. In the following six-month period, the STG compliance decreased to 14.1 %. The assumption was made that patients were cured if they did not return with the same complaint. Based on this assumption the conclusion was drawn that, before the intervention, 50.2% of the patients were cured. In the first six months after the intervention had taken place the percentage patients who did not return increased from 50.2% to 60.6%. In the second six months after the intervention the percentage of patients who did not return increased to 70.7%. It may be concluded that compliance with the STG improved as a result of the face to face education intervention. Moreover, it was found that cost efficiency improved in parallel and the cure rate seemed to be positively affected by the intervention.