PRESCRIPTION PATTERN AND FACTORS INFLUENCING THE PRESCRIBING PRACTICE AT PRIMARY HEALTHCARE CENTERS IN NATIONAL HEALTH INSURANCE FUND, SUDAN

Abstract

Objectives: The study aimed to investigate the prescription pattern and its influencing factors in the NHIF, at Gezira State-Sudan. Method: The study followed WHO established guidelines. A cross-sectional retrospective study was carried out across six months. Controlled questionnaires were completed by 197 general practitioners representing 90% of the total study population. For each doctor, a systematic random sample of one hundred prescriptions were collected. Prescribing core indicators as dependents were regressed with the doctor, practice, patient, and drug-related factors as independent variables. Poisson, logistic, and OLS regression were conducted according to the indicator data type. Results: The mean medication per patient was 2.55±1.32; the percentage of prescriptions prescribed by generic name was 46.34%, and percentage of prescriptions contained antibiotics and injections was 54.71% and 12.84%, respectively. The percentage of medicines prescribed from the NHIF medicine list was 81.19%. The overall Index of Rational Prescribing Indicator (IRDP) was 3.39, while the average cost per prescription was 40.57 SDG. The factors had a significant influence on the prescribing indicators, IRDP, and cost. The prescription cost was inversely and significantly proportional with IRDP. The average prescription cost reduction significantly correlated with being a doctor with more education, more professional training, longer experience, job satisfaction, and exposure to peer contact and medical discussions. Moreover, older doctors tended to prescribe expensive medications. Doctor nativity, patient demand, and urban health facility were significantly correlated with prescription cost escalation. Pharmaceutical firms’ promotion visits were significantly associated with prescription cost escalation. The younger patients and female patients had less prescription cost. The chronic diseases significantly escalated the prescription cost 2.6 times. Conclusion: Promotion of general practitioners education, holding of professional and rational use of medicine training activities, providing unbiased information sources, rotation, permanent type of employment and doctor satisfaction payment mechanisms are crucial to improve the prescription quality and reduce the pharmaceutical costs.