1. The practice of dispensing prescribers – a threat to appropriate medicines use?
Trap B and Hansen EH
Euro Health Group
Danish University of Pharmaceutical Sciences
Denmark
DFH, Ebba
WHO, Hans
UZ, Charles
Økonomisk støtte RUF
Mange andre: ZEDAP data collection
Ide da jeg var i Zimbabwe
Anden rækkefølge Data indsamling før PHD studerende

2. Background
The number of Dispensing Doctors (DDs) has increased over past 15 years
In several countries the functions of prescribing are kept separate from dispensing
Little is know about :
RDU and quality of care by DDs
Influence on prescribing by for-profit motive
A Dispensing Doctor (DD) is defined as a medical practitioner permitted to sell and dispense a drug to some or all of his patients, either as an exemption to the general legislation governing the provision of pharmaceutical services or as part of the overall provision of medical services

3. Study Aims
Describe and assess appropriateness of medicines use by DDs in comparison to NDDs.

4. Method Design Analytical, cross-sectional, comparative survey Setting
Zimbabwe, Harare
Population
170 DDs, 1635 NDDs
Sample size
29 DDs (17%) – 28 NDDs (1.7%)
Inclusion rate
76% DD and 74% NDD of selected and reachable
Patient records
30 pt. encounters per practice

5. Assessment Criteria WHO/INRUD and STG indicators
Correctness score list- Panel assessment
URTI and use of cotrimoxazole
Diagnosis or symptoms
Medicines prescribed
Dosage- duration
Consultation time

6. (Significant differences)
Results
RDU Indicator
(Significant differences) DD
N=29
NDD
N=28
Ave. no. drugs/encounter
2.3
1.7
Ave. no. injections/encounter
0.3
0.1
Ave. no. antibiotics/encounter
0.72
0.54
Ave. no. mixtures/encounter
0.43
0.25
Ave. consultation time (min)
8.7 13

8. DDs compared to NDDs in treatment of URTI
Prescribed more drugs, injections, analgesics, cough & cold preparations and psycholeptics per encounter
Choice of antibiotics was rational, but differed. Both groups over-prescribed antibiotics
Symptomatic treatment and medicines of lower clinical value

9. Significant differences in dosage for antibiotics for Upper Respiratory Tract Infections by DDs & NDDs
Use of Cotrimoxazole in sub-curative dosage: 23% for DD versus 9% by NDDs

10. DD s inappropriate medicines use:
Summary
DDs provide less appropriate prescribing than NDDs, characterised by:
Symptomatic prescribing – a drug for each symptom
Poly-pharmacy
Over-use of antibiotics and injections
Sub-optimal dosages
DD s inappropriate medicines use:
Jeopardises patient safety, quality of care and makes treatment unnecessarily costly

11. Conclusion and Policy implications
§ WHO to make recommendations to guide countries regarding regulation of DDs
§ Making clear separation and regulation between the functions of prescribing and for profit dispensing
§ Regulation of “profit dispensing prescribers” and “prescribing pharmacists” at country level