Table 4.
Differences in medicine use between countries with and without each of 25 policies hypothesised to be associated with better use
| 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) |
*p ≤ 0.05
aSample size applies to the number of countries (out of 20) that had adopted the policy. The number of countries with and without policies for each individual QUM indicator varies slightly as certain QUM indicators were not measured in 5 country visits
OTC Over-the-counter, STG Standard treatment guidelines, MOH Ministry of health, CME Continuing medical education, DTC Drug and therapeutic committee, EML Essential medicines list, AMR Antimicrobial resistance, DPRK Democratic People’s Republic of Korea (which had no published EML)