Rational drug prescription is an important domain of healthcare system because of its impact on population health and the drug industry economy. In this study the average number of drugs prescribed per encounter was estimated about 3.33 that was higher than WHO recommended limit. It is clear that a high number of drugs prescribed for a patient increase the risk of drug interactions and also the Cost-effective use of drugs should be considered. [16, 17] This index in this study was also higher than some studies such as UAE, Nepal and China. [18–20]
There was considerable difference in drugs prescribed for men and women. Men get more drugs, more antibiotics and even more injections. Its reason is not clear but the differences in the pattern of diseases between the two sexes or the effect of patients' tendencies on the prescription pattern should be the main reasons but it needs more investigation.
There were also some differences in prescribing drugs for different ages. Elder patients get more drugs in each encounter but the rate of antibiotic prescription was higher in children, teenagers, young adults and middle ages respectively. The only age group that had received less prescription antibiotics was infants. Different studies indicated that the amount of antibiotic use in the pediatric population was significantly higher, in terms of both the number of children receiving at least one prescription in a year and the number of antibiotic treatments per year. [21, 22] In another study that was done to describe the trends of outpatient oral antibiotic prescriptions from 2011–2016 by year and the ratio of broad- and narrow-spectrum outpatient oral antibiotic prescriptions in the US, the rate of antibiotic prescription in 2011 was higher in children but it decreased significantly by 2016. [23] It seems that the higher rate of antibiotic prescription for children is more affected by drug prescription policies and guidelines more than the incidence rate of infectious disease in children.
Drug prescription was not the same in different seasons. The number of drugs in each prescription and also the prescription with antibiotic was higher in autumn and winter but prescription of drugs was higher in spring. It is obvious that disease pattern is considerably related to the season. Other researches also support this finding. For example Galistiani study that concentrated on antibiotic prescription in children, showed that the highest monthly antibiotic prescription rates in the pediatric population were observed during the winter that peaking in January. [24] In another instance it was shown that a slightly increasing rate of antibiotic use was seen from August to September in children that could be explained by children attending school again after the summer holiday. [25] Seasonal fluctuation of outpatient antibiotic use in the general population and it is most likely to be related to the higher incidence of viral respiratory infections in winter months. But it should be more related to school attending in pediatrics population. [26, 27]
The prescriber effect also were investigated in this study. It was shone that general practitioners tend to prescribe more drugs in each encounter than other specialty and sub specialty groups. It was also true for prescribing injection drugs. But in antibiotic drugs, the dentists had more important role. In a study about the trend of antibiotic prescribing, according to profession in British Columbia, Canada the results indicated that overall antibiotic prescription by dentists increased from 1996 to 2013 about 62.2%, from 0.98 DID to 1.59 DID, and their proportionate contribution increased from 6.7–11.3% of antibiotic prescriptions. [28] It should be considered that the dentistry services treatment is more provided by dental procedure not by drug. So, in cases that dentist try to prescribe drugs, dental infectious will be the most important reason.
The comparison of drug prescription pattern in different health care facilities show that this item was different among different types of facilities. In some kinds of facilities such as hospital clinics, specialty clinics and even day clinics different specialty levels present most of health care services but in general clinics, general practitioners are the main body. Another point will be the variety of services. For example day clinics provide also some outpatient surgeries alongside outpatient visits. Another probable cause of this difference will be different par clinic services in each groups that attract different group of patients with different morbidities. It seems that the results of this study will help in reviewing the specific-center strategies for improving drug prescribing among SSO.
It is estimated that empowering the present database and providing the monthly and annual report to providers will be a good approach in improving the current situation. Also it seems that considering some prescription policies for physicians and considering them as evaluation indicators will be helpful.