Docs in developing nations take less than 60 sec on prescription – ToI – 23.4.11

Kounteya Sinha | TNN

New Delhi: On an average, doctors in developing countries spend less than 60 seconds in prescribing medicines and explaining the regimen to their patients, according to World Health Organisation's (WHO) World Medicines Situation 2011 that was released on Friday.
    As a result, only half of patients receive any advice on how to take their medicines and about one third of them don't know how to take their medicines immediately on leaving the facility. Though around 80% of all prescribed medicines are dispensed - usually, they are done by untrained personnel and as many as 20%-50% of medicines dispensed are not labelled. According to the report, "the dispensing process greatly influences how medicines are used. The WHO database shows that, on average, dispensing time is one minute. In such circumstances it is not surprising that patient adherence to medicines is poor."
    Dr Ranjit Roy Choudhury, eminent clinical pharmacologist, told TOI that "the issue of doctors taking no time to explain the drugs they give to their patients is an acute problem, especially in overcrowded hospitals in India. Adherence also improves if doctor and patient have a rapport among them which develops by giving each other time." As per the report, only about 60% countries train their medical students on various aspects of prescribing medicines, and only about 50% require any form of continuing medical education. The basic training for nurses and paramedical staff, who often do a bulk of prescribing, was even less - only about 40% of countries give them any basic training on how to prescribe.
    The problem of non-adherence, according to the WHO, is not only relevant for acute complaints, but even more so for chronic diseases.
    Due to the increasing number of patients suffering from diabetes, cardiovascular disease, mental health problems, epilepsy and chronic obstructive pulmonary disease (COPD), adherence to medication is becoming increasingly important, the report added. WHO feels many countries are making relatively little investment in promoting rational use of medicines. "It could be argued that such investment would be paid back many times over by the savings from better use of medicines, particularly reduced misuse. However, these savings would take some time to achieve and thus might not be felt by the investing government, particularly in health systems where there is a very large private sector and most medicines are paid for out-ofpocket by patients and not by government," the report said.
    In India, over 80% of health expenditure is out of pocket - majority of which is spent in purchasing drugs. Globally - and mainly in developing countries - doctors prescribe antibiotics to patients who do not need them, while patients do not adhere to their treatment causing the risk of antibiotic resistance. The report says two thirds of all antibiotics are sold without prescription through unregulated private sectors.
    "Irrational use of medicines is a global problem that is wasteful and harmful. In developing countries, less than 40% of patients in public sector and 30% of patients in private sector are treated in accordance with standard treatment guidelines," said Kathleen Holloway from WHO's Department of Essential Medicines and Pharmaceutical Policies.