Recent prescription pattern and uncertain health future in Bangladesh

Salman Shah Bhuiyan

It’s too difficult to find any person who didn’t go to the physician. And it’s also a common scene of patients who hold a piece of paper in their hand after exit the doctor’s room which is filled up with a lot of medicines and tests. Is it prescription? According to Tripathi (2008) prescription, an order written by doctors for patients contains directions for pharmacists to compound or dispense medications regarding patient diagnosis history and diseased condition. World Health Organization (WHO) was suggested some guidelines to evaluate a prescription pattern. Most of the cases, in national aspects, physicians do not follow the guidelines. The irrational prescription pattern is a common finding in Bangladesh. Maximum physicians prescribe the patients in wrong as well irrational way.

Firstly, we can say the generic name of the drug which is totally absent in the prescription. Many brand name drugs have cheaper generic content which confers less therapeutic effects. On the other hand, polypharmacy is a common problematic issue. Polypharmacy refers to the use of four or more medications by a patient. Therefore, patients are easy to prone drug interaction, nonadherence, hospitalization, and mortality. In the rural area, this trend is spread tremendously. Another problem is prescribing of inappropriate antibiotic. Sorrowfully, in Bangladesh, most of the physicians think that without antibiotic a prescription will be incomplete. But it’s a great threat to patients, leading to adverse drug reactions, bacterial resistance, and elevated costs. Children are also arrested by this rule. A study of antibiotic use in a rural area of Bangladesh found that 26% of purchased drugs were antibiotics for children aged 0-4 years. The most frequently prescribed antibiotics are ceftriaxone, cefixime, and amoxicillin. Therefore, those drugs have abnormally high resistance.

Illegible hand writing in prescriptions kills than 7,000 people annually. It’s a shocking statistic of America, according to a July 2006 report from National Academy of Medicine. If it’s applicable to America, then how much the condition can be worse in Bangladesh? Just imagine!! Unclear hand writing of prescriptions can result in misinterpretation and mistakes which are a common incident in our country.

Besides, various lacking commonly found of the renal and hepatic patient’s prescription.  Renal disease affects drug elimination and pharmacokinetic processes. So it’s so significant to adjust the dosages of drugs according to creatinine clearance and filtration rate. Besides, dose adjustment also necessary for hepatic patients. The liver converts fat soluble medications into water soluble medications that excreted through the urine. So some fat soluble medications should be avoided totally. But in our country, almost all physicians do not pay attention about drug dose adjustment for those patients.

Some physicians use the abbreviation in a prescription which has a chance of spelling error or ambiguous. In addition, diagnostic history of the patient is not mentioned clearly. They are used to prescribe a lot of unnecessary tests, vitamin tablets, and costly branded drugs which are a usual objection of suffering patients.

Notably, Bangladesh formulated its National Drug Policy in 1982 to ensure that common people can get the essential drugs easily and rational use of drugs through appropriate prescribing and dispensing the health care professionals. Has the policy fulfilled yet?

Now many questions may arise that, what’s the problem? Why this problem? One of the big problems is the autocratic tendency of a doctor. There is an uncomely proverb that “A physician is worse than a disease” but in many cases it’s true. Many doctors take very less period to consult a patient. They can never imagine co-relating with a pharmacist about patients case. And they are not accountable to anyone about their activities. Lack of knowledge or inadequate training of doctors is another reason.

In a rural area, community practitioners, health workers or quack doctors are prescribed to a patient that is in completely unethical and also bears health hazard probability. Pharmacists also have responsibility. They are failed to provide the proper use of drug information to the doctors. Pharmaceuticals company all time try to impress the doctor in many ways to write down their brand drug. Health regulatory authorities of Bangladesh also have some drawback. They are not concerned about those errors. Many directorates under Ministry of Health and Family Welfare have evaluated these sectors. But their dull activity can’t detect this problem properly.

The irrational prescribing pattern is a habit which cure is troublesome. But everything is possible. Physicians need to be clarified in their conception about the rational prescription pattern, clinical pharmacology, and pharmacotherapy to improve prescription practice rather. Doctors, pharmacists, and nurses all together should need to build triangle health care committee to minimize health problem. Though this trend is not turned on in our country yet it’s highly expected.

As a naïve pharmacist, I hope those problems will be solved immediately. Governing bodies have to be more concerned and should take necessary steps for the irrational prescribing pattern. No interruption is desirable in our public health care system. Patients will get their proper consultancy and be happy.

Trust me, I dream that!

Md. Salman Shah Bhuiyan is a student at Department of Pharmacy, East West University. He can be reached at   salman133145@ gmail.com

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