Quality of Prescribing at Primary Care Centers in Saudi Arabia

Objective: To assess serious prescribing errors, prescribing rate per patient, and ranking of common illnesses and medications prescribed at primary care centers in Saudi Arabia. A proposal for improvement measures will be formulated. Methodology: A cross-sectional study of a randomly selected afternoon shift (4 working h) was carried out on November 1, 1994. All of the 367 physicians working in the health centers in Riyadh, Saudi Arabia participated. All prescriptions issued by physicians during this shift were entered into the study and examined with regard to a number of variables. The variables included patient demographic characteristics, vital signs, the physician's name and center, diagnosis, and prescription items. Demographic variables were excluded from analysis for purposes of confidentiality. Results: During the study period, 11,326 patients were seen, and 6,350 prescriptions were issued (for 20,320 drug entries). The average number of consultations per primary health care (PHC) physician was 30 ± 9. The average number of prescriptions per PHC physician was 17.3 ± 6, for a total of 0.56 prescriptions per patient. Of all prescriptions, 11.6% were found to have at least one error. The average number of drugs per prescription was 3.2 ± 0.4. The average number of drugs per patient was 1.8 ± 0.3. Of all patients, 73% had two or fewer drug items prescribed. Upper respiratory tract infection was the most frequent diagnosis, and accounted for 31.0% of the illnesses seen. Antibiotics, analgesics/antipyretics, and tonics/vitamins were the most common items prescribed (to 16.8%, 15.4%, and 11.8% of the patients, respectively). The most common errors were those considered type B (5.39%), where the pharmacist must contact the physician before dispensing the prescription, and type C (4.59%), where the pharmacist must make a professional decision before dispensing the prescription. Missing drug strength and missing quantity of medication and frequency of dosing were observed in relatively high proportions (3.8% and 3.2%, respectively). Frequency of the daily dose, generic name of the drug, and strength of the drug were the top three missing pieces of information (89.5%, 86%, and 76.3%, respectively). Conclusions: These results represented a challenge and justified setting standards and indicators to ensure the quality of these vital activities of prescribing and dispensing. There is a need to design and implement training programs to improve PHC team prescribing and dispensing skills and establish an accurate system of error reporting.