The Problem of Drug Prescription Practices

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Published on International Journal of Agriculture & Agribusiness
Publication Date: April 23, 2019

Kindalem Bayew & Lakech Ewnetu
Animal Health Department Head in Janamora Wereda Livestock Development Office
Animal Health Disease Surveillance Expert in Janamora Wereda Livestock Development Office
Janamora, Ethiopia

Journal Full Text PDF: The Problem of Drug Prescription Practices (Study in Janamora Wereda Veterinary Clinics).

Abstract
Cross sectional study was conducted from October, 2018 to February, 2019. The objective of this study were identify principles and requirements of drug prescribing practice, know the process of prescription of veterinary drugs, to adhere animal health workers to rational drug prescription guidelines and to remove irrational drug prescription practices in their work places. In Janamora Wereda (3/34) health personnel had a Doctrate Degree, (1/34) health personnel had been specialized in Veterinary surgery and imaging, (3/34) health personnel had a bsc degree and the other 27 animal health and drug dispensary professionals are diploma. One private clinic was run by the owner himself. The duration of work experience of the professionals are ranged from 2 month to 9 years. From the table 3 shows that written drug prescription, verbal, and verbal/written drug prescriptions are 3/21, 12/21, and 6/21 respectively. This shows that most veterinary clinics in the study area do not follow the correct drug prescription methods. The figure 2 is a regular form of drug prescription paper that has been prescribed by Veterinarian Specially by Doctor of Veterinary Medicine /DVM/ to drug dispenser in order to control irregularly drug wastage, to show drug type that has been prescribed and the amounts of drug. As the figure 3 shows that the drug prescriber name, drug dispenser name, the Owner name, and the amount of money the owner has been paid to the drug dispenser for drug medication has not been described. The paper also do not allowed in Amhara National Regional State Finance and Economic Development Bureau. 18 Veterinary Clinics in Janamora Wereda followed such types of illegal drug prescription system. Generally such types of drug prescription is illegal and cheating the owners.

Keywords: Prescription Practice, Problem of Drug, Animal Health, Veterinary Clinics, & Janamora Wereda

1. INTRODUCTION
A prescription is an important therapeutic transaction between the prescriber and veterinary drug consumer through a dispenser. It is a written order of the prescriber for one or more medication, and instructs the dispenser how to prepare and dispense veterinary drugs and the owner how to use them. Prescription should be written on a standard prescription paper, written in ink, legible, written in generics, clear (not ambiguous), written in English with some Latin abbreviations, and The quantity of ingredients should be expressed in metric system [1].
According to Guidelines for the control of use of prescription paper published by the Veterinary Drug Administration and Control Authority of Ethiopia, the content of any prescription paper should include the following information: Serial number and area code and date, Name, level and address of the animal health institution, Owner’s name and address, Species of the animal, breed, age, sex, status, colour card Number and ID No (name), Type of Diagnosis, Name, strength, dosage form and dosage of the drug, If the drug is to be compounded the type of ingredients needed, direction for use and how to prepare it, If the drug is refillable direction for refill, The withdrawal period for milk, meat and egg, Prescriber’s name, qualification, registration number, and signature and date on which the prescription is written, Dispenser’s name, qualification, registration number, and signature and date on which the prescription is filled [2].
Animal health professionals involved in prescribing and dispensing of veterinary drugs have the need for veterinary drugs information in order to keep themselves up to date with developments related to veterinary drugs and to provide such information to owner, other animal health professionals and to the general public. Because of an increasing number and complexity of veterinary drugs, the need for up-to-date information is greater than ever. Updated veterinary drugs information is mainly directed at improving prescribing, dispensing and veterinary drugs administration [3]. On the other hand, because counselling of owner of animal patients on medications is an integral part of the veterinary drugs prescribing and dispensing process. Lack of knowledge and information by the owners about the veterinary drugs they took leads to incorrect use which in turn results in loss of efficacy or occurrence of adverse effects, drug residue and drug resistance [4].
Drug resistance is the reduction in effectiveness of a drug (antimicrobial, anthelmintic or antineoplastic) in curing a disease or condition. It occurs when the drug is unable to inhibit or kill the disease causing organism due to the development of a mechanism to cope the effect of the drug. Resistance to antimicrobials is a natural, biological evolutionary phenomenon but human practices hasten it. As more antimicrobials are used, it creates a selection pressure on microorganisms. Susceptible ones are killed while resistance one survives and flourish [5]. The rational use of drugs can be improved by proper diagnosis and selection of the drug which is effective, convenient and safe, and by accurate and complete prescription and dispensing of drugs. Informing owners on side effects, adverse drug reactions, dosage schedule and risk of withdrawing the therapy is also essential [6].
There is no study conducted in the current study area to identify problem of drug prescription practices in Janamora Wereda veterinary clinics. The objective of this study were to
a. Identify principles and requirements of drug prescribing practice ,
b. Know the process of prescription of veterinary drugs,
c. Adhere animal health workers to rational drug prescription guidelines
d. Remove irrational drug prescription practices in their work places.

2. MATERIALS AND METHODS
2.1. Study area
Janamora Wereda is located in North Janamora Zone of Amhara region, at the latitude and longitude of 12o59’N 38o07’E at a distance of about 180km from Janamora town. Janamora Wereda is well-known with Semien mountain National Park, Ras Dashen i.e the highest point in Ethiopia and it is a home to a number of endangered species including the Ethiopian Wolf, waliya ibex, and a wild goat which no found in elsewhere in the world. The area has an altitude range of 2900 meters above sea level. The region is marked by numerous mountains, hilly, and sloppy areas, plateaus, rivers, and many streams. Livestock population of the area comprises 100,386 cattle, 32,975 sheep, 131,041 goats, 2,540 horses, 634 mules, 7758 donkeys, 119,347 poultry. There are 21 better constructed veterinary clinics in the study area. The farming system of the study area is characterized by a mixed crop-livestock production system. Transhumance, from the highlands to western lowlands, is practiced as an important strategy to secure grazing resources for the highland livestock during the dry season of the year. In the case of the lowlands, crop farming is not as intensive as high and mid-highland areas and livestock has larger contributions to the farmer’s livelihoods [7].

2.2 Sample size determination
The study was conducted from November 2018 to March 2019 in Janamora Wereda Veterinary clinics. The sample size required for this study was 20 public clinics and 1 private clinic with the total of 21 clinics. Data on the methods of diagnosis and drug selection, the frequently prescribed drugs and prescription methods, availability of information sources and encountered treatment failures were collected by using a structured questionnaire. Descriptive statistics were used to describe the data.

2.3. Data management and analysis
The data obtained from observation of case record book and prescription papers and these samples were entered to Microsoft worksheet excels. Then descriptive statistics was used to analyze the data using statistical package for social sciences (SPSS) software version 20.

3. RESULTS
From the study area (3/34) health personnel had a Doctrate Degree, (1/34) health personnel had been specialized in Veterinary surgery and imaging, (3/34) health personnel had a bsc degree and the other 27 animal health and drug dispensary professionals are diploma. One private clinic was run by the owner himself. The duration of work experience of the professionals are ranged from 2 month to 9 years.

The importance of, combination therapy, use of narrow spectrum agents before broad spectrum agents, use of antibacterial agents for prophylactic purposes and use of older drugs than newer agents were considered by 4/21, 9/21, 9/21, and 5/21of the respondents respectively.

The importance of, combination therapy, use of narrow spectrum agents before broad spectrum agents, use of antibacterial and antiparasitic agents for prophylactic purposes and use of older drugs than newer agents were considered by 9/21, 8/21, 7/21, and 6/21of the respondents respectively.

From the above table shows that written drug prescription, verbal, and verbal/written drug prescriptions are 3/21, 12/21, and 6/21 respectively. This shows that most veterinary clinics in the study area do not follow the correct drug prescription methods.

As the above figure shows that the owner will pay his/her money for medication purpose when the drug dispenser in the veterinary clinic gives this cash receipt voucher. Unless when they pay their money without cash receipt voucher, it is illegal and cheating. So the cash receipt voucher is legal and who has been prepared by Amhara National Regional State Finance and Economic Development Bureau. The above Serial number 881557 will be registered in bellow figure 2 for further auditing and cross check activity.

The above figure is a regular form of drug prescription paper that has been prescribed by Veterinarian Specially by Doctor of Veterinary Medicine /DVM/ to drug dispenser in order to control irregularly drug wastage, to show drug type that has been prescribed and the amounts of drug.

As the above figure shows that the drug prescriber name, drug dispenser name, the Owner name, and the amount of money the owner has been paid to the drug dispenser for drug medication has not been described. The paper also do not allowed in Amhara National Regional State Finance and Economic Development Bureau. 18 Veterinary Clinics in Janamora Wereda followed such types of illegal drug prescription system. Generally such types of drug prescription is illegal and cheating the owners.

4. DISCUSSION
The study shows that most animal’s health workers are diploma. Due to this reason those diploma animal health workers did not adhere to the rational antimicrobial and antiparasitic drug prescription guidelines. Doctor of Veterinary Medicine /DVM/ professionals are few in number. They also did not follow correct drug prescription guidelines due to lack of cash receipt voucher in Janamora Wereda Finance and Economy Development Office.
Verbal prescription was the majority form of prescription and most Veterinary Clinic uses this forms. In general illegal form of drug prescription leads to false treatment which causes drug resistance [8]. Published studies on the drug prescription behaviors of animal health workers in Ethiopia is not available, non adherence to rational antimicrobial and antiparasitic prescriptions guidelines were recorded in several hospitals [9].
Oxytetracycline 10% is the most frequently prescribed drug. This finding is disagreed with Getachew [10] who reported that pencillin is the most frequently prescribed drug. Inappropriate selection of drugs, over prescription of drugs and inappropriate treatment duration were recorded in Veterinary Clinic. This finding is agreed with the reported of Bisht [11].
The overall prescribing practices require attention and animal health workers should be updated in order to ensure the perceived benefits of the animals and reduces the risk of public health.
In conclusion animal health worker should improve their knowledge and follow the standard drug prescription guidelines. From this study we recommended the following points.
a. Animal health workers should receive money with cash receipt voucher.
b. They must prescribe drug with standard guidelines.
c. They must use the right drug for the right patient and right dose for the right time.
d. They must avoid unwanted drug for patients.
e. Extension must be given for farmers to prevent drug resistance because some farmers will inject drug to patient.