The prescribing of generic medicines in Nigeria : knowledge, perceptions and attitudes of physicians

Generic medicines have the same efficacy and safety as originators at lower prices. However, there are concerns with their utilization in Nigeria. Evaluate physicians’ understanding and perception of generics. Questionnaire among physicians working in tertiary healthcare facilities in four geo-political regions of Nigeria. Response was 74.3% (191/257) among mainly males (85.9%). The mean knowledge score regarding generics was 5.3 (maximum of 9) with 36.6%, 36.1% and 27.2% having poor, average and good knowledge respectively. Cross-tabulation showed statistical significance (P = 0.047) with the duration of practice but not with position, subspecialty or sex. The majority did not agree that generic medicines are of lower quality than branded medicines. Therapeutic failure was a major concern in 82.7%, potentially discouraging prescribing of generics. Majority (63.9%) did not support generic substitution by pharmacists. Knowledge gaps were identified especially with the perception of generics. These need to be addressed

Physician’s Knowledge of Appropriate Prescribing for the Elderly—A Survey Among Family and Internal Medicine Physicians in Nigeria

Background: Prescription and use of inappropriate medications have been identified as a major cause of morbidity among the elderly. Several screening tools have been developed to identify inappropriate medications prescribed for elderly patients. There is dearth of information about the knowledge of Nigerian physicians regarding these screening tools and appropriate prescribing for the elderly in general. The primary objective of this study was to assess the knowledge of Nigerian physicians about these screening tools and appropriate prescribing of medications for the elderly.Methods: The study was a cross-sectional questionnaire-based study conducted among physicians working in Family Medicine and Internal Medicine departments of four tertiary health care facilities in Nigeria. The questionnaire consisted of sections on general characteristics of respondents and their knowledge of four selected screening tools for inappropriate medications in the elderly. Ten clinical vignettes representing different therapeutic areas (using the best option type questions) about medicine use in the elderly were included with a score of 1 and 0 for correct and wrong answers, respectively. The knowledge of respondents was classified as (total score, over 10): poor (score, < 5), average (score, 5-6), and good (score, 7-10).Results: One hundred and five physicians returned completed questionnaires. Twenty percent of respondents knew about Beers criteria, whereas 15.6% were familiar with the STOPP criteria. Majority (83; 84.7%) of the respondents were confident of their ability to prescribeappropriately for elderly patients. The mean knowledge score was 5.3 ± 2.0 with 32 (30.5%), 41 (39%), and 32 (30.5%) having low, average, and good scores, respectively. The association between the knowledge score, duration of practice, and seniority was statistically significant (OR, 3.6, p = .004 and OR, 3; p = .012), respectively.Conclusion: There are significant gaps in the knowledge of Nigerian physicians about screening tools for inappropriate medications. There is a need for stakeholders involved in the care of elderly Nigerian patients to develop new strategies to improve services being offered. These may include introduction of modules on appropriate prescribing in the curriculum of undergraduate and postgraduate medical education and the routine use of some screening tools for inappropriate medications in daily clinical practice

Addressing antimicrobial resistance in Nigerian hospitals : exploring physicians prescribing behavior, knowledge, and perception of antimicrobial resistance and stewardship programs

Introduction: We assessed the knowledge of, attitude toward antimicrobial resistance (AMR) and practice of antimicrobial stewardship (AMS) among physicians in Nigeria to provide future guidance to the Nigerian National Action Plan for AMR. Methods: A descriptive cross-sectional questionnaire-based study explored the physicians’ self-reported practice of antibiotic prescribing, knowledge, attitude, and practice of AMR and components of ASPs. Results: The majority (217; 67.2%) of respondents prescribed antibiotics daily in their clinical practice AMR was recognized as a global and local problem by 308 (95.4%) and 262 (81.1%) respondents, respectively. Only 91 (28.2%) of respondents have ever heard of antibiotic stewardship. The median AMR knowledge score was 40 (19–45)out of 45while that for ASP was 46.0(32–57) out of 60. There was significant statistical difference between the ASP median scores among the medical specialties category (P value <0.0001) More respondents had good knowledge of AMR than ASPs (82.7% versus 36.5%; p < 0.0001). Conclusion: Respondents in this study were more knowledgeable about AMR than AMS and its core components

Knowledge, Attitude and Practice of Adverse Drug Reaction Reporting among Healthcare Workers in a Tertiary Centre in Northern Nigeria

Purpose: To determine the knowledge, attitude and practice of ADR monitoring and reporting among healthcare workers in a teaching hospital in Kano, Nigeria Methods: The study was cross-sectional and questionnaire-based involving mainly medical doctors, nurses and pharmacists working in different departments of the Aminu Kano Teaching Hospital hospital. A total of 110 questionnaires were distributed to the respondents (60 doctors, 40 nurses, 10 pharmacists). The completion of the questionnaire by respondents was taken as their consent to participate in the study. Results: Only 65 respondents filled and returned the questionnaire within the stipulated time frame giving a response rate of about 59.1 %. The standard yellow reporting form for adverse drug reactions was only known to 35.9 % of the participating health care workers. Only 42.7 % of the respondents had ever reported an adverse drug reaction and the report was verbal in over 75 % of cases. Ignorance of the rules and procedures of reporting, lack of knowledge of the forms for reporting and which ADRs to report were some of the factors responsible for non-reporting of adverse drug reactions among respondents in the study Conclusion: Adverse drug reaction reporting using the yellow card reporting scheme is low among health care workers (doctors, nurses and pharmacists) in Kano, Nigeria. There is a need for regular training and re-enforcement of guidelines for ADR reporting among health care personnel. The inclusion of nurses in pharmacovigilance will go a long way in improving reporting of ADRs

Knowledge, Attitude and Practice of Adverse Drug Reaction Reporting among Healthcare Workers in a Tertiary Centre in Northern Nigeria

Purpose: To determine the knowledge, attitude and practice of ADR monitoring and reporting among healthcare workers in a teaching hospital in Kano, Nigeria Methods: The study was cross-sectional and questionnaire-based involving mainly medical doctors, nurses and pharmacists working in different departments of the Aminu Kano Teaching Hospital hospital. A total of 110 questionnaires were distributed to the respondents (60 doctors, 40 nurses, 10 pharmacists). The completion of the questionnaire by respondents was taken as their consent to participate in the study. Results: Only 65 respondents filled and returned the questionnaire within the stipulated time frame giving a response rate of about 59.1 %. The standard yellow reporting form for adverse drug reactions was only known to 35.9 % of the participating health care workers. Only 42.7 % of the respondents had ever reported an adverse drug reaction and the report was verbal in over 75 % of cases. Ignorance of the rules and procedures of reporting, lack of knowledge of the forms for reporting and which ADRs to report were some of the factors responsible for non-reporting of adverse drug reactions among respondents in the study Conclusion: Adverse drug reaction reporting using the yellow card reporting scheme is low among health care workers (doctors, nurses and pharmacists) in Kano, Nigeria. There is a need for regular training and re-enforcement of guidelines for ADR reporting among health care personnel. The inclusion of nurses in pharmacovigilance will go a long way in improving reporting of ADRs

Knowledge and attitude of physicians towards the cost of commonly prescribed medicines : a case study in three Nigerian tertiary healthcare facilities

Objective: One of the core principles of rational prescribing is consideration of the cost of the medicines prescribed, especially in countries with high patient copayments and low incomes such as Nigeria. Little is known about Nigerian physicians’ knowledge about the cost of commonly prescribed medicines. The principal objective of the study was to assess the knowledge of Nigerian physicians about the cost of commonly prescribed medicines. Methods: Descriptive cross-sectional survey conducted among physicians in 3 tertiary institutions in Nigeria. Apart from socio-demographic and other information, questions about the estimated costs of branded and generic versions of 11 commonly prescribed medications were included in the questionnaire. Results: One hundred and seventy-nine (179; 95.7%) respondents agreed that costs of medicines were important when writing prescriptions, although only 7 (3.7%) of them had any formal training in the economics of healthcare. The median percentages of respondents with accurate estimated costs for generic and originator brands were 6.2% and 12%, respectively. Respondents were more knowledgeable about the cost of medicines used for the treatment of infectious diseases (malaria, bacterial infections) than noncommunicable diseases (diabetes mellitus, hypertension, and dyslipidemia). Conclusions: The knowledge of Nigerian physicians in the 3 participating hospitals about the costs of commonly prescribed medicines was poor. This is despite their awareness about the importance of costs of medicines when prescribing

Drug promotional activities in Nigeria: impact on the prescribing patterns and practices of medical practitioners and the implications.

Pharmaceutical companies spend significant amount of resources on promotion influencing the prescribing behavior of physicians. Drug promotion can negatively impact on rational prescribing, which may adversely affect the quality of patient care. However, little is known about these activities in Nigeria as the most populous country in Africa. We therefore aimed to explore the nature of encounters between Nigerian physicians and pharmaceutical sales representatives (PSRs), and how these encounters influence prescribing habits.Cross-sectional questionnaire-based study conducted among practicing physicians working in tertiary hospitals in four regions of Nigeria.176 questionnaires were completed. 154 respondents (87.5%) had medicines promoted to them in the previous three months, with most encounters taking place in outpatients' clinics (60.2%), clinical meetings (46%) and new medicine launches (17.6%). Information about potential adverse effects and drug interactions was provided in 41.5%, and 27.3% of cases, respectively. Food, in the form of lunch or dinner, was the most common form of incentive (70.5%) given to physicians during promotional activities. 61% of physicians felt motivated to prescribe the drug promoted to them, with the quality of information provided being the driving factor. Most physicians (64.8%) would agree to some form of regulation of the relationship between medical doctors and the pharmaceutical industry.Interaction between PSRs and physicians is a regular occurrence in Nigeria, influencing prescribing practices. Meals and cheap gifts were the most common items offered to physicians during their encounters with PSRs. The need for some form of regulation by professional organizations and the government was expressed by most respondents to address current concerns

Drug and therapeutics committees in Nigeria: evaluation of scope and functionality

Introduction: Inappropriate use of medicines remains a problem, with consequences including increasing adverse drug reactions (ADRs) and prolonged hospitalizations. The Essential Medicines List and Drug and Therapeutics Committees (DTCs) are accepted initiatives to promote the rational use of medicines. However, little is known about DTC activities in Nigeria, the most populous African country. Areas covered: A cross-sectional questionnaire-based study was conducted among senior pharmacists, consultant physicians and clinical pharmacologists in 12 leading tertiary healthcare facilities across Nigeria. Expert commentary: Six (50%, 6/12) healthcare facilities had existing DTCs with three (50%) having a sub-committee on antimicrobials. 75% had infection control committees, with presence even in centres without DTCs. Chairpersons and secretaries of the DTCs were predominantly physicians (83.3%) and pharmacists (100%) respectively. Hospital formularies were available in five facilities with DTCs, while one facility without a DTC had an Essential Medicines Committee responsible for developing and updating the hospital formulary. The evaluation of ADRs was undertaken by pharmacovigilance units in nine facilities. Overall, DTCs were present in only half of the surveyed facilities and most were performing their statutory functions sub-optimally. The functioning of DTCs can be improved through government directives and mechanisms for continuous evaluation of activities