الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Rational use of drugs is an essential element in achieving quality of health and medical care for patients and the community, however irrational use of medicines is still a worldwide problem. There are many ways that lead to irrational use of medicines such as polypharmacy, overprescribing of antibiotics and injections, prescribing medication for inappropriate patient, incorrect drug administration, and inefficient dispensing process.
The aim of the present study was to assess the application of drug use indicators in family health centers/units in Alexandria Governorate. The specific objectives were:
1. To assess prescribing indicators in family health centers/units in Alexandria.
2. To assess patient care indicators in family health centers/units in Alexandria.
3. To evaluate drug use health facility indicators in family health centers/units in
Alexandria.
To conduct the present study, the following techniques were used:
1. An observational checklist based on WHO/INRUD drug use indicators and WHO guide to good prescribing to investigate prescription indicators.
2. An interview questionnaire based on WHO/INRUD drug use indicators to assess patient care indicators and patient’s knowledge about dispensed medication.
3. An observational checklist based on WHO/INRUD drug use indicators and primary health care accreditation program survey instrument to assess drug use health facility indicators.
4. A separate checklist of obligatory vaccines based on Egypt’s expanded program on immunization (EPI) to assess adequate supply of obligatory vaccines.
5. A separate checklist based on WHO immunization in practice and Ministry of Health and Population practice guidelines for family physicians volume 1, to evaluate proper arrangement of vaccines in the refrigerator.
6. A separate checklist based on WHO immunization in practice, to evaluate proper use of ice box according to guidelines.
7. A separate checklist of IMCI medications based on IMCI chart booklet (2010) to assess adequate supply of medications for IMCI cases.
8. A separate checklist of contraceptives based on standards of practice for integrated maternal and child health and reproductive health services, to assess adequate supply of contraceptives.
9. An observational checklist based on WHO/INRUD drug use indicators and primary health care accreditation program–survey instrument to assess pharmacists’ average dispensing time and the provision of verbal instructions to patients by pharmacists.
Data were subjected to statistical analysis and interpretation.
The results of the present study could be summarized as follows:
1. Prescribing practices among general practitioners and family physicians in the studied FHC/Us were lower than optimal values regarding non-polypharmacy, generic name prescribing, rational antibiotics/injections prescription and prescribing from EDL.
2. Completeness of patient and medications’ information on the prescription forms was satisfactory except for patient’s age (73.7%) and duration of treatment (67.5%).
3. Physicians at the studied FHC/Us spent shorter consultation timethan recommended with patients.
4. Pharmacists spent relatively long dispensing time; however none of the dispensed medications were adequately labeled.
5. The majority of the observed pharmacists (83.3%) gave verbal instructions to patients about their medicationsregardless of the content of the instructions.
6. There is deficiency in some EDL’s medications with (87.3%) of medications actually dispensed as well as unequal supply of them to the different FHC/Us.
7. More than half of patients(56.0 %) had an adequate knowledge, with no significant statistical correlation between Patients’ knowledge score and their general characteristics.
8. All the studied FHC/Us had an essential drug list and Key drugs availability ranged from (50%) to (90%).
9. None of the surveyed FHC/Us dispensed drugs in appropriate packaging with adequate labeling.
10. Dispensed medications were consistent with the prescribed ones in the majority of FHC/Us (87.5%).
11. Half of the FHC/Us fully adoptedproper arrangement of vaccines in the refrigerator according to the guidelines, while none of them did regarding the proper use of ice box according to guidelines.
12. Most of FHC/Us (87.5%) had sufficient space, proper aeration and working refrigerator with freezer compartment.
13. All FHC/Us had posted expiry dates on the shelves, however some of them lack periodic checking and updating.
14. Easy accessibility of fire extinguisher was achieved in only (37.5%) of FHC/Us.
Accordingly, the followings can be recommended:
A. Recommendations for family physicians:
1. To prescribe drugs by generic names and to adhere to EDL.
2. To prescribe antibiotics when only indicated.
3. To avoid polypharmacy by prescribing only necessary medications.
B. Recommendations for pharmacists:
1. Cooperation between pharmacists is recommended in high attendance rate FHC/Us; with one pharmacist assigned the task of adequate drugs’ labeling. Adequate drugs’ labeling should be motivated in low attendance rate FHC/U.
2. Proper arrangement of vaccines in the refrigerator should be monitored, with paying special attention to freeze sensitive vaccines.
3. Use of conditioned ice packs with freeze sensitive vaccines as well as monitoring of freezing temperature in the ice box by using freeze sensitive indicator.
4. Regular checking and updating the expiry dates posted on shelves in the FHC/Us’ pharmacy.
5. Fire extinguisher should be accessible and easily seen by anyone who enters the pharmacy for the first time.
C. Recommendations for Ministry of Health:
1. Rational drug prescribing in family practice should be included in the national practice guidelines for family physicians.
2. Emphasizing the critical role of the DICs in promoting rational use of drugs.
3. A training program for primary care physicians to discourage polypharmacy; atraining that targets specific commonly overused medicines or specific health problems in which polypharmacy is common is more likely to have an effect than targeting polypharmacy as a general problem.
4. Continuous education and training of family physicians about rational prescribing of antibiotics and injections is recommended.
5. Patient-to-physician ratio should be reduced for the sake of prolongation of consultation time, which allows thorough history taking, comprehensive examination and development of proper therapeutic relationship between patient and physician.
6. Availability of essential drugs should be ensured at all times and in adequate amounts.
7. Manufacturer’s validity card posted on fire extinguisher of the FHUC/Us pharmacies should be stamped rather than signed after each regular checking.