Table 4 Differences in medicine use between countries with and without each of 25 policies hypothesised to be associated with better use
From: Promoting quality use of medicines in South-East Asia: reports from country situational analyses
Policy | Number of countries with policy (out of 20)a | % URTI cases treated with antibiotics | % patients treated with antibiotics | % medicines prescribed from the EML | % medicines prescribed by generic name | % patients prescribed multivitamins | % of patients prescribed injections | Average % better (+) medicines use with policy (95% CI) |
|---|---|---|---|---|---|---|---|---|
Direction of better medicines use: More (+); Less (−) | Less (−) | Less (−) | More (+) | More (+) | Less (−) | Less (−) | Sign changed where less use is better use | |
No user fee for drugs at most public health facilities | 17 | −9.6 | + 0.1 | + 9.5 | + 31.2 | −7.5 | + 0.8 | 9.5* (0.2 to 18.7) |
Undergraduate education of prescribers on STGs | 5 | −15.9 | −5.2 | + 12.0 | + 22.0 | − 1.1 | + 0.9 | 9.2* (2.1 to 16.4) |
Systemic antibiotics mostly not available OTC | 3 | −16.0 | − 5.2 | + 12.0 | + 22.0 | − 1.3 | + 1.4 | 9.2* (1.9 to16.4) |
MOH unit on Rational Use of Medicines established | 3 | −17.3 | −10.9 | + 0.1 | + 19.7 | + 0.9 | −6.9 | 9.0* (2.1 to 15.9) |
Some public-sector prescriber CME by MOH | 8 | −7.5 | −1.6 | + 5.7 | + 21.9 | − 8.7 | − 4.8 | 8.4* (2.7 to 14.0) |
Advertisements for OTC drugs monitored | 7 | −14.5 | −3.8 | + 4.0 | + 15.5 | − 2.0 | − 8.3 | 8.0* (3.4 to 12.7) |
Public sector generic prescribing policy | 9 | −3.9 | −1.6 | + 9.8 | + 35.1 | + 0.4 | + 2.2 | 8.0 (− 3.2 to 19.1) |
No drug revenue for public sector prescribers | 19 | −19.1 | −2.7 | −2.2 | + 18.8 | − 7.0 | −6.7 | 7.8* (0.1 to 15.5) |
MOH prescribing survey done in the last 2 years | 7 | −4.7 | −1.2 | + 4.6 | + 28.6 | + 2.7 | − 7.7 | 7.4 (− 1.4 to 16.2) |
STGs found in some public health facilities | 5 | − 11.4 | −9.7 | + 6.1 | + 17.8 | + 1.4 | + 2.4 | 6.9* (0.6 to 13.1) |
No public-sector registration or consultation fee | 12 | −13.0 | −3.3 | + 5.6 | + 15.2 | + 2.5 | − 5.6 | 6.7* (1.5 to 11.9) |
Some public education on medicines use in the last 2 years | 5 | −11.7 | −7.4 | + 2.5 | + 8.9 | −5.0 | + 2.4 | 5.5* (1.5 to 9.5) |
DTCs in most public referral hospitals | 8 | −1.7 | + 3.2 | −2.5 | + 15.2 | −9.3 | − 10.3 | 5.1 (− 0.9 to 11.2) |
Generic substitution in the public sector | 15 | + 6.0 | + 7.8 | + 16.1 | + 21.8 | −2.8 | + 0.4 | 4.4 (−5.2 to 14.0) |
No drug stock-out problems reported | 9 | −11.6 | −3.8 | −0.1 | − 1.4 | −2.3 | − 7.9 | 4.5* (0.1 to 8.0) |
National Formulary available | 7 | −8.7 | −0.7 | −3.4 | + 6.1 | − 5.9 | − 3.7 | 3.6* (0.2 to 7.1) |
National EML updated in the last 2 years | 12 | −6.0 | −0.7 | + 16.1 | − 0.4 | + 1.2 | + 2.2 | 3.2 (− 2.4 to 8.7) |
Undergraduate education of doctors on the EML | 6 | −9.9 | + 0.6 | −3.5 | + 1.7 | −3.7 | −6.8 | 3.0 (−0.9 to 6.9) |
No public-sector unqualified prescribers | 18 | −5.8 | −6.5 | + 8.4 | + 9.8 | + 8.4 | + 8.6 | 2.3 (−4.5 to 9.0) |
National STG updated in the last 2 years | 7 | + 5.8 | + 6.9 | + 6.9 | + 20.1 | + 5.5 | − 1.0 | 1.6 (−6.7 to 10.0) |
National AMR Containment Strategy | 4 | −1.3 | −3.7 | −10.0 | + 2.2 | − 3.4 | − 8.3 | 1.5 (− 3.4 to 6.4) |
Public procurement limited to EML drugs only (excl. DPRK) | 15 | + 12.6 | + 12.5 | + 15.5 | + 22.3 | + 0.2 | + 3.4 | 1.5 (− 10.1 to 13.1) |
National Drug Information Centre | 2 | + 7.2 | −1.5 | −3.9 | + 11.6 | + 3.4 | + 15.7 | − 2.8 (− 10.1 to 4.4) |
Public sector PHC prescribing by doctors | 13 | + 1.9 | + 3.5 | −2.3 | −10.3 | −4.0 | + 5.8 | −3.3 (− 7.1 to 0.4) |
Prescriber patient load moderate or low (< 60 patients /prescriber/day) | 12 | − 10.9 | −8.7 | −5.4 | −6.3 | + 27.2 | + 7.9 | − 4.5 (− 15.5 to 16.5) |