Prescription Practices Need To Be Reviewed
BMI View : It is vital that the Pakistani government enforces regulations to ensure the rational prescription, dispensing and consumption of medicines. While on one hand medicine affordability levels are low, a study highlighting irrational drug use in the country is a cause for concern. As hospitals and doctors continue to be the primary access point to healthcare and as access to medical services and pharmaceuticals improves over time - it is important that both public and private resources are directed towards the consumption of appropriate medicine regimens.
In 2012, Pakistan's prescription drugs market was valued at PKR142.93bn (US$1.53bn), accounting for 75.5% of the total drug market. The segment is forecast to reach a value of PKR228.77bn (US$2.13bn), experiencing a compound-annual growth rate (CAGR) of 9.9% in local currency terms and 6.9% in US dollar terms. The boundary between the prescription and non-prescription segments is blurred by the fact that many prescription medicines are dispensed freely over the counter. Additionally, the lack of correct protocols when prescribing drugs has made it difficult to track the consumption and demand of prescription medicines in Pakistan. Nevertheless, the prescription drugs sector will remain the dominant part of the overall pharmaceutical market over the coming years, as hospitals and doctors continue to be the primary access point to healthcare and as access to medical services and pharmaceuticals improves over time.
|Dominating The Drug Market|
|Pakistan: Prescription Drug Expenditure|
Highlighting the difficulty in tracking the demand and consumption of prescription medicines, although an Essential Medicines Program was established in Pakistan in the 1970s, a study published in the International Journal of Pharmacy and Pharmaceutical Sciences indicates that irrational drug use continues to be widely prevalent.  The study defines irrational medicines use as the prescription of an unnecessary number of medicines, the use of injections where oral prescriptions are available, the prescription of inadequate medicine dosages or consumption of medicines over an inadequate period of time, the use of antimicrobials for non-bacterial infections and inappropriate self-medication by patients. The study found that:
The average number of drugs prescribed per patient is three or more in Pakistan as compared to an average of just over two in lower-middle-income countries such as India. The prescription of medicines is significantly higher in the private sector with an average of 4.1 medicines per prescription as compared to 2.7 in the public sector.
Antibiotic overuse is one of the main reasons for the excessive prescription of medicines, with antibiotics prescribed in 70% of patient encounters in Pakistan.
Unnecessary Injection Use
Pakistan has one of the highest rates of injection usage with over 60% patient encounters involving an injection. Preference for injection usage is higher amongst general practitioners in rural areas (53%) as compared to urban areas (28%).
Deviated Prescription Practices
Prescription practices for both common endemic diseases and chronic diseases frequently deviate from standard protocols. As an example, antibiotics are prescribed for nearly 89% of upper respiratory tract infections despite the majority of infections being self-limiting in nature. Appropriate therapy for hypertension is initiated by only 35% of practitioners and thiazide diuretics, (a first line treatment for hypertension) are rarely prescribed (4.2%).
Inadequate Consultation Times
The mean consultation time in public sector facilities stands at 1.79 minutes - an insufficient amount of time to give proper advice on medicine usage. Dispensing time in the public sector was reported as 38 seconds across a range of facilities, none of the dispensers wore gloves while dispensing and only 11% of drugs dispensed were adequately labelled.
Weak Dispensing Practices
A survey of drug outlets shows that only 12% of drug dispensers were pharmacologically trained and only 35% had secondary school qualification. There are 45,000-50,000 pharmacies and medical stores in Pakistan.
 Rational Prescription & Use: A Snapshot Of The Evidence From Pakistan And Emerging Concerns. Int J Pharm Pharm Sci, Vol 5, Suppl 1, 131-135.