Abstract
Objectives Standard treatment guidelines improve patient care outcomes. Few studies assess the impact of standard treatment guidelines on population-level medicine use indicators in resource limited settings in sub-Saharan Africa, where the burden of disease is greatest. The objective of this study was to determine the immediate and long-term impact of the national standard treatment guidelines on medicine use indicators at the population-level in Namibia. Methods An interrupted time-series modeling of the impact of national standard treatment guidelines implemented in Namibia in 2011, on population-level medicine use indicators. Antibiotic, generic and polypharmacy prescribing indicators were abstracted from the national Pharmaceutical Information System, over an eight-year period, 2007- 2015. This generated 15-quarterly time points. The impact was estimated by changes in trends of the indicators, immediately and after the intervention using R-software. The immediate impact was reflected by level change while long term impact was determined by trends/quarterly change after standard treatment guideline implementation. Key findings Data points from 522 Pharmaceutical Information System reports from 38 health facilities were included. The eight-year period estimates were, 2.9 ± 0.1 medicines prescribed per outpatient, 48.1 ± 2.5% of prescriptions had an antibiotic and 74.0 ± 4.2% of medicines were prescribed by generic name. Of the 13 regions, 61.3% and 53.8% had a decline in the average medicines per prescription and prescriptions with antibiotics respectively, as well as 53.8% of the regions had an increase in prescribing of generic medicines immediately after implementation of the standard treatment guidelines. Thereafter, quarterly trends in the three indicators did not significantly improve after the intervention at national and in all regions, except for generic prescribing in Oshikoto region, 4.5% (95% CI: 2.6 - 6.3%, P < 0.001). Conclusion Whilst national standard treatment guidelines immediately improved medicine use indicators, it is discouraging that the improvement over time was marginal across regions and was not sustained at the national level. Robust point of care interventions is needed for sustained and effective implementation of standard treatment guidelines.
Original language | English |
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Pages (from-to) | 61-68 |
Number of pages | 8 |
Journal | Journal of Pharmaceutical Health Services Research |
Volume | 12 |
Issue number | 1 |
Early online date | 7 Jan 2021 |
DOIs | |
Publication status | Published - 31 Mar 2021 |
Bibliographical note
Funding Information:Ministry of Health and Social Services (MoHSS), Division Pharmaceutical Services and Mr Wuletaw Z. Churfo for permission granted and facilitating access to the pharmacy management information system (PMIS) data used in this study. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Keywords
- Impact
- Medicine use indicators
- Namibia
- Treatment guidelines
ASJC Scopus subject areas
- Pharmacy
- Economics, Econometrics and Finance (miscellaneous)
- Pharmacology, Toxicology and Pharmaceutics (miscellaneous)