Situational
analysis of Family Physician utilization of drugs
and laboratory investigations at a hospital based
primary care clinic, Riyadh, Saudi Arabia
.........................................................................................................................
Dr Yousef Abdulah Al Turki
Associate Professor
and Consultant Family Medicine
Department of Family and community medicine
King Khalid University Hospital
College of Medicine
King Saud University
P.O Box 28054 Riyadh 11437
Saudi Arabia
Correspondence:
Telephone :096614671942
Fax: 096614671967
Email: yalturki@ksu.edu.sa
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ABSTRACT
To evaluate prescribing patterns and laboratory
requests for patients attending a primary
care clinic, in a teaching hospital, Riyadh,
Saudi Arabia.
Method: A cross sectional study
was conducted at a teaching hospital primary
care clinic, King Khalid university hospital,
College of medicine, King Saud University,
during January, February and March 2009.
Data collection form has been completed
by a consultant family physician at the
end of the consultation for each patient
entering a primary care clinic. Verbal
consent has been taken from each patient
in the study. The data collection form
included: the age, number of drugs prescribed,
number of laboratory, radiology, and ECG
requests. The data has been collected
and analysed by the Statistical Package
for Social Sciences (SPSS) version 11.5.
P value was considered significant if
it was less than 0.05%.
Results: The
total number of patients included in the
study was 243. The study showed that 75.7%
of consultations ended with prescription
of drugs to the patients, and 88% of the
consultations ended with laboratory requests.
Only 9.9% of consultations ended with
radiology request, and only 2.5% of consultations
ended with ECG order. The cross tabulation
between age groups and prescription patterns
was significant, as was the cross tabulation
between age group and laboratory requests
significant.
Conclusion and recommendations:
The prescription patterns of drugs and
requesting laboratory investigations at
Primary Care level is high, which needs
to be reviewed and audited to improve
the quality of care and to decrease the
cost and burden on the patient and health
system facilities.
Further national studies
are recommended to assure proper evidence
based scientific utilization of resources
like drugs and laboratory investigations
towards improving the quality of patient
care, and to be a more evidence-based,
scientific, cost effective health care
system.
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Prescribing decisions make
a considerable impact on health and national
budgets and require complex personal and professional
judgements to be made about physical, psychosocial
and cost dimensions of health (1- 7 ). Cost
of medications for chronic conditions continue
to escalate, particularly for the elderly (2)
. For that reason the primary care physician
should be able to decrease costs and improve
quality of care(8). In a primary care clinic,
not every consultation should end with prescription
or laboratory requests, as some patients might
need only counseling and proper health education
to improve their life styles.
Over the last two decades, health promotion
has developed into an accepted strategy for
solving public health problems and promoting
the health of its citizens. While there have
been certain successes marked by improvements
in the health of the population and the development
of an infrastructure for health promotion, there
are few evidence-based research studies that
measure health risk status or track health changes
over time with defined cost outcome measures
(9).
The primary care clinic is the first level
of contact with patients, and there is a lot
of demand on the primary care physician to order
unnecessary laboratory tests to reassure patients'
anxiety. One study showed that overinvestigation
of common physical symptoms can lead to 'somatic
fixation', reinforce anxiety, and deepen depression
and isolation, leading to a delay in the appropriate
treatment (10) . So it is important to evaluate
and audit the prescribing pattern and ordering
laboratory investigation among primary care
physicians to understand the situation and to
improve the quality of care and decrease the
cost of unnecessary laboratory investigations
and over- prescribing of drugs
The aim of this study was to evaluate the prescribing
pattern and laboratory requests for patients
attending a primary care clinic, in a teaching
hospital, Riyadh, Saudi Arabia.
A cross sectional study was
conducted at a teaching hospital primary care
clinic, King Khalid university hospital, College
of medicine, King Saud University, during January,
February, and March 2009. The data collection
form was completed by a consultant family physician
at the end of the consultation for each patient
entering a primary care clinic. Verbal consent
was taken from each patient in the study. The
data collection form included: the age, number
of drugs prescribed, number of laboratory, radiology,
and ECG requests. The data was collected and
analysed by the Statistical Package for Social
Sciences (SPSS) version 11.5. P value was considered
significant if it was less than 0.05%.
The total number of patients included in the
study was 243 male patients attending a Primary
Care clinic at King khalid university hospital,
College of medicine, King Saud University, Riyadh,
Saudi Arabia
The study showed that 75.7% of consultations
ended with prescription of drugs to the patients
and 88% of the consultations ended with laboratory
requests. Only 9.9% of consultations ended with
a radiology request, and only 2.5% of consultations
ended with an ECG order. The cross tabulation
between age groups and prescription pattern
was significant as was the cross tabulation
between age group and laboratory requests.
The result of the current study showed
that most of the consultations in a primary
health care clinic at a teaching hospital
ended with prescribing drugs (75.7%), and
88% ended with requesting laboratory investigations.
This emphasises how the burden of the cost
of this medication and laboratory investigations
on the health budget, especially at a primary
health care level, so it is important to
audit our prescribing patterns and ordering
laboratory tests to make sure that it will
be evidence- based clinical practice not
just to satisfy patient demand.
Although doctors have strategies in order
to cope with what they perceive to be unnecessary
demands for prescriptions, primary care
physicians reported a belief that patients
use strategies to obtain prescriptions(11-14)
. Working in a governmental sector might
make the working physicians unaware of the
cost of drugs and laboratory investigations
because health services in governmental
health institutes are free in Saudi Arabia,
while those who work in private health institutes
know about the the costs of drugs and laboratory
investigations for the patients. Ethically
it is important to follow the evidence-based
recommendation with ful consideration and
respect of patient opinion about his/ her
management plan.
On the other hand, teaching all the primary
health care physicians the skills of practising
evidence based medicine by feasible and
friendly methods should also be encouraged.
Strategies for encouraging change among
the primary health care physicians and overcoming
the barriers, should be part of the decision
makers' vision.
Lastly, patient values and expectations
as well as ethical issues should play a
role in determining whether and which interventions
should be implemented (15-18 ) .
The prescription patterns of drugs and requesting
laboratory investigations at the Primary
Care level is high, which needs to be reviewed
and audited to improve the quality of care
and to decrease the cost and burden on the
patients and health system facilities.
Further national studies are recommended
to assure proper evidence-based scientific
utilization of resources like drugs and
laboratory facilities towards improving
theq uality of patient care, and to be a
more scientific, evidence-based, cost effective
Health Care system.
| Age
group ( years) |
Frequency |
Percentage
% |
| 12-20 |
13 |
5.4 |
| 21-39 |
52 |
21.4 |
| 40-59 |
88 |
36.2 |
| 60
and above |
90 |
37 |
| Total |
243 |
100 |
Table (1) shows age distribution of
243 patients
| Number
of drugs |
Frequency |
Percentage
% |
| No
drugs |
59 |
24.3 |
| One
drug |
34 |
14 |
| 2-4
drugs |
62 |
25.5 |
| 5-7
drugs |
69 |
28.4 |
| 8
and above |
19 |
7.8 |
| Total |
243 |
100 |
Table (2) shows prescription patterns
for patients
| Age
group |
No
drugs |
One
drug |
2-4
drugs |
5-7
drugs |
8
and above |
P
Value* |
| 12-20 |
7 |
4 |
2 |
0 |
0 |
.000
|
| 21-39 |
33 |
11 |
3 |
3 |
2 |
.000 |
| 40-59 |
15 |
14 |
26 |
27 |
6 |
.000 |
| 60
and above |
4 |
5 |
31 |
39 |
11 |
.000 |
| Total
No (%) |
59
(24.3%) |
34
(14%) |
62
(25.5%) |
69
(28.4%) |
19
(7.8%) |
243
(100) |
* P value is considered significant if
it is less than 0.05%
Table (3) shows cross tabulation between
prescribing patterns and patient's age groups
among 243 participants
| Number
of laboratory requests |
Frequency |
Percentage
(%) |
| No
laboratory requests |
29 |
12 |
| 1
laboratory |
40 |
16.5 |
| 2
laboratories |
124 |
51 |
| 3
laboratories |
38 |
15.6 |
| 4
laboratories |
9 |
3.7 |
| 5
laboratories |
3 |
1.2 |
| Total |
243 |
100 |
Table (4) shows laboratory request among
patients
| Age
groups |
No
lab request |
1
lab |
2
labs |
3
labs |
4
labs |
5
labs |
P
value* |
| 12-20 |
7 |
0 |
4 |
2 |
0 |
0 |
.000 |
| 21-39 |
10 |
12 |
19 |
7 |
4 |
0 |
.000 |
| 40-59 |
5 |
19 |
47 |
13 |
3 |
1 |
.000 |
| 60
and above |
7 |
9 |
54 |
16 |
2 |
2 |
.000 |
| Total |
29 |
40 |
124 |
38 |
9 |
3 |
243 |
* P value is considered significant if
it is less than 0.05%
Table (5) shows cross tabulation between
patient's age groups and laboratory requests
| Radiology
request |
Frequency |
Percentage
% |
| None |
219 |
90.1 |
| One |
23 |
9.5 |
| Two |
1 |
0.4 |
| Total |
243 |
100 |
Table (6) shows Radiology requests among
patients
| Age
group (years) |
No
radiology request |
One
request |
Two
requests |
P
value* |
| 12-20 |
11 |
2 |
0 |
0.281 |
| 21-39 |
43 |
9 |
0 |
0.281 |
| 40-59 |
82 |
6 |
0 |
0.281 |
| 60
and above |
83 |
6 |
1 |
0.281 |
| Total |
219 |
23 |
1 |
243 |
* P value is considered significant if
it is less than 0.05%
Table (7) shows cross tabulation between
age group and radiology request
| ECG |
Frequency |
Percentage |
| ECG
request |
237 |
97.5 |
| No
request |
6 |
2.5 |
| Total |
243 |
100 |
Table (8) shows ECG requests among patients
| Age
group (years) |
No
ECG |
ECG
requested |
P
value* |
| 12-20 |
13 |
0 |
0.523 |
| 21-39 |
52 |
0 |
0.523 |
| 40-59 |
85 |
3 |
0.523 |
| 60
and above |
87 |
3 |
0.523 |
| Total |
237 |
6 |
243 |
* P value is considered significant if
it is less than 0.05%
Table (9) shows cross tabulation between
age group and ECG request
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