TABLE OF CONTENTS
Cover page…………………………………………………………………………..i
Title page………………………………………………………………………….. ii
Certification…………………………………………………………………………iii
Approval page……………………………..………………………………………iv
Dedication………………………………….………………………………………v
Acknowledgement…………………………………………………………………vi
Table of content……………………………………………………………………vii
Abstract……………………………………………………………………………xiiCHAPTER ONE: INTRODUCTION
- Background of study …………………………………………………………1
- Statement of the problem……………………………..………………………3
- General objective…………………………………………….………………4
- Specific objectives……………………………………………………………5
- Justification of the study………………………………………………..……5
CHAPTER TWO
2.0. Psychiatric disorder…………………………………………..………………6
2.1. Psychotropic drugs…………………………………………………………..7
2.1.1. Classes of psychotropic drugs……………………………………………7
- Issues regarding psychotropic drugs ………………………………………20
- World health organisation (who) drug use indicator……………………….23
CHAPTER THREE: METHOD
3.0. Location of study……………………………………………………………….35
3.1. Sample size and sample size determination ………………………………..38
3.2. Data collection………………………………………………….……………39
3.3. Method of analysis………………………………………………………….40
CHAPTER FOUR: RESULTS
4.0. Demographic distribution in both hospitals…………………………………………41
4.1. Frequency of diagnosis….…………………………………………………….43
4.2. Number of drugs per prescription………………..…………………………..44
4.3. Average duration and cost of drugs …………………….,……………………45
4.4. Percentage by generics………………………………………………………..46
4.5. Classification of dosage form……………………………….…………………47
4.6. Percentage of drugs from essential drug list…………………………………..48
4.7. Class of psychotropic drugs prescribed………………………………………49
4.8. Drug ratio……………………………………………………………………..50
4.8.1. Antianxiety drugs………………………………………………………………50
4.8.2. Anticholinergics…………………………………………………………….51
4.8.3. Anti depressants…………………………………………………………….52
4.8.4. Antipsychotics……………………………………………………………….53
4.8.5. Mood stabilizers…………………………………..………………………..54
4.9. Summary of result …………………..……………………..………………….55
CHAPTER FIVE: DISCUSSION AND CONCLUSION
5.0. Discussion………………………………………………………………………56
5.1. Conclusion……………………………………………………………………64
5.2. Recommendations……………………………………………………………65
References…………………………………………………………………………66
LIST OF TABLES
2.0. Mechanism based classification of antidepressant…………………………10
2.1. Stimulants……………………………………………………………………….12
4.1. Average cost and average duration of treatment……………………………..45
4.2. Summary of results………………………………………………………………55
LIST OF FIGURES
4.1. Demographic distribution in both hospitals…………………………………………41
4.2. Frequency of diagnosis……………………..…………………………..…….42
4.3. Number of drugs per prescription……………………………………………43
4.4. Average duration and cost of drugs …………………………………………44
4.5. Percentage by generics……………………………………………………….46
4.6. Classification of dosage form……………………………….………………..47
4.7. Percentage of drugs from essential drug list………………………………….48
4.8. Class of psychotropic drugs prescribed………………………………………49
4.9. Drug ratio of antianxiety drugs……………………………………………………..50
4.10. Drug ratio ofanticholinergic.……………….………………………………51
4.11. Drug ratio of Antidepressants………………………………………………52
4.12. Drug ratio of antipsychotics…………………………………………………53
4.13.Drug ratio of mood stabilizers.…………………………………………………54
ABSTRACT
Background:
In patient care, the evaluation of drug use and patient care practice is very essential. It measures the quality of care provided to the patients by health practitioners. Data generated from this study is very essential in healthcare management and planning.
Objectives:
To compare the pattern of prescription of psychotropic drugs in two health facilities in Anambra state, south-eastern Nigeria using WHO/INRUD developed indicators in order to promote the rational prescribing of drugs.
Methods:
The study was conducted at Nnamdi Azikiwe University Teaching Hospital, Nnewi and State Neuropsychiatry Hospital, Nawfia both in Anambra state. A total of 300 prescriptions in each of the hospitals were selected by random sampling. Data collected was analyzed based on the WHO guideline for assessment of drug use in healthy facilities.
Results:
The average number of drugs prescribed per encounter was 2 in NAUTH and 3 in NAWFIA; Injections were prescribed in 8.3% and 11.4% of encounters in NAUTH and NAWFIA respectively. 92.6% of drugs were prescribed by generic name in NAUTH while in NAWFIA it was 11.4%. The average cost and duration in NAUTH was ₦878 for 21days while in NAWFIA it was ₦1004 for 18 days. Percentage of drugs from the essential drug list was 45% in NAUTH and 61.9% in NAWFIA.
Conclusion: The results obtained were encouraging however some of the prescribing indicators assessed were found to be below standard in both hospitals and need to be improved upon. Prescribing at NAWFIA gave a greater picture of poly – pharmacy than at NAUTH. The overall picture of drug use suggests that the indicators at this facility are not yet at the optimal level.
CHAPTER ONE
INTRODUCTION
- BACKGROUND OF STUDY:
This study was carried out to compare the pattern of prescription of psychotropic drugs in two health facilities in south-eastern Nigeria using World Health Organisation/International Network for The Rational Use of Drugs (WHO/INRUD) developed indicators in order to promote the rational prescribing of drugs.
Drug utilisation study promotesthe rational use of medicine. It is indispensable indecision making when it comes to issues pertaining to the clinical and economic standpoints of chemotherapy (Janaki et al., 2011). It is a superb way of studying the patient’s medication and correlating it to the expected outcome of patients as it reveals medication errors and other anomalies that could generally lead to poor patient outcomes. Hence, it won’t be out of place to say that there are a lot of benefits that could be gained when drug utilisation studies are carried out on a regular basis in our heath facilities however, this is not the case as reflected by the scarcity of drug utilisation data in our country with a much lesser amount of this publications relating to the field of mental health and psychiatry (WHO-AIMS, 2006).
Psychiatry is a very sensitive area of health care system and the nature of the practices carried out in mental health facilities should be reviewed from time to time. This is because of the nature of these psychotropic drugs taken by the patients. These drugs pose special risks in that we have only a limited understanding of the full impact of such medications on brain circuitry and they are associated with numerous adverse effect, drug interactions and toxicities, withdrawal symptoms inclusive. Also, the fact that most patients are on long term use of psychotropic drug exposes them to drug therapy problems (DTPs). DTPs can be a consequence of irrational prescribing which is prevalent in many health care systems, especially in developing countries, resulting in poly-pharmacy, overuse of injections and lack of compliance with the principles of essential drug concept (Enato et al., 2011). This leads to issues of non-adherence, relapse, as well as high cost of management.
Hence, avoidance of the occurrence of these drug therapy problems seems prudent and this can only be done with rational prescribing.
A drug utilization study is an effective way of evaluating rationality of the prescribing pattern (Yuen et al., 1998) and without the knowledge of how the drugs are being prescribed; it is difficult to suggest the measures to improve prescribing habits.
This study looks into the prescribing pattern of psychotropic drugs in mental health facilities using the WHO core indicators this will give an insight into the pharmacotherapy rendered in these health facilities for necessary awareness and intervention program which would consequently improve the therapeutic outcome of the patients as well as their quality of life.
- STATEMENT OF THE PROBLEM
Information about the level of mental health service in Nigeria is hard to come by as an estimated 3% of all health publications in the country are on mental health. It is therefore difficult to identify areas of need, to make informed decisions about policy direction, and to monitor progress (WHO-AIMS, 2006).
A lot of issues are on the increase affecting patients’ outcome in the field of psychiatry. This range from increase in the number of available psychotropic agents, to poor response of patients to therapy and high risk of complications. Also, many prescriptions for psychotropic drugs contain so many psychotropic drugs which may expose the patients to disturbing side effects leading to non-adherence.
As a result, there is high degree of non adherence, relapse, polypharmacy, high cost of therapy and a host of other effects that can arise from irrational prescribing and the summation of it all results in non-optimization of drug therapy and therapy failure.
Psychotropic drug utilisation pattern would serve as a mirror to highlight the flaws of the prescribing patterns and consequently help improve overall patients’ outcome.
This study would help to identify areas of need and thus help to make informed decision about policy direction and progress monitoring in health facilities which would inadvertently result in the rational and cost effective management of mental illness. This study is therefore due to the concern regarding psychotropic drug therapy for patients with one form of mental illness or the other.
1.2. GENERAL OBJECTIVE
To compare the pattern of prescription of psychotropic drugs in two health facilities in south-eastern Nigeria using WHO/INRUD developed indicators in order to promote the rational prescribing of drugs.
1.3. SPECIFIC OBJECTIVES
The study is aimed at determining the following:
- Average number of drugs per prescription
- Percentage of drugs prescribed by the International non-proprietary name (INN or generic nomenclature)
- Percentage of encounters in which an injection is prescribed
- Percentage of drugs prescribed from hospital formulary
- Percentage of drugs from Nigeria’s essential drug list
- Average cost per prescription
- Pattern of prescription of psychotropic drugs in the two health facilities.
- Compare the pattern of prescription in both facilities.
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JUSTIFICATION OF THE STUDY
Safe and efficacious drugs when used rationally play a very important role in improving health and promoting wellbeing of patients. It is difficult to understand the rational use of drugs without the knowledge of how the drugs are used. Drug utilisation studies like this contribute immensely to rational drug use by describing the drug use pattern and intervention.
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