Knowledge of Selected Medicine Related Issues among Inpatients in a Nepalese Teaching Hospital: A Preliminary Study
Correspondence Address :
Dr. P. Ravi Shankar
P.O. Box 14142
Knowledge of issues related to medicines among consumers can influence their rational use. These issues have not been studied in Nepal, a developing country in South Asia. KIST Medical College (KISTMC) is a new medical school with a 300 bedded teaching hospital in Nepal.
Studies on important issues related to the use of medicines among the general public are lacking in Nepal. Hence, the present study was carried out among inpatients in KISTMC hospital.
Research on certain issues related to medicines has been conducted in developed nations. A review of literature showed that consumers were positively inclined towards generic medicines, but their views differed according to personal and demographic characteristics and previous experience (1). Cost plays an important role in treatment decisions, with a number of strategies used by consumers to reduce cost, like not buying certain medicines, buying lesser quantity or buying cheaper medicines (2).
Participant opinion was collected by the first author who interviewed respondents in Nepali using a semi-structured questionnaire.
The issues covered were brand name and the generic name of drugs, adverse effects of drugs, variation in medicine prices among different brands, the national drug policy, essential medicines and pharmaceutical promotion. These issues, while not having a direct personal impact on consumer medicine use, are expected to indirectly influence the rational use of medicines. Verbal consent was obtained from all participants. The study was approved by the Institutional Research Committee. Basic demographic information was collected and analyzed descriptively. The participants were first asked if they knew about the various topics and if they said â€˜yesâ€™, then more detailed information was collected.
Results and Discussion
Forty respondents were interviewed. Twenty-seven (67.5%) were male. Twenty-one respondents (52.5%) were below the age of 40. Nine respondents (22.5%) were farmers, 7 (17.5%) were in service jobs, 6 (15%) were housewives and 5 (12.5%) were students. (Table/Fig 1) shows the percentage of respondents who said that they knew about the different topics on medicine use covered in the study. More respondents knew about adverse drug reactions (ADRs), essential medicines and the cost variation of medicines compared to other topics.
Only two respondents could correctly state that generic name is the common scientific name of a drug while brand name is the name given by a particular company, with examples. In Melbourne, Australia, consumers generally had positive attitudes towards the use of generic medicines, with cost being a major favourable factor (3). Regarding ADRs, ten respondents could name a few reactions which can be caused by medicines. They were not aware of how ADRs can be minimized. Only four respondents were able to speculate about the possible reasons for the substantial price variation among different brands. Two said that older companies with a good reputation charged more for their products. One said that the cost of gifts given to doctors and of bonuses/incentives given to pharmacists were included in the consumer price. An Australian study had shown that prescription medicine samples influenced the quality use of medicines and played a role in the marketing of medicines (4). An alternative distribution system for samples can be considered. In developing nations like Nepal, in the absence of health insurance schemes, consumers pay for medicines out of their pocket. In developed nations like the United States also, consumers are taking increased financial responsibility for their medicines. They need more accurate, balanced and reliable information on which to make purchasing decisions (5).
No respondent was able to explain the national drug or pharmaceutical policy properly. Fourteen respondents were able to explain essential medicines satisfactorily. They were able to mention examples of these medicines and stated that these should always be available in primary health facilities and hospitals. Pharmaceutical promotion was confused with public education about medicines. In Nepal, medicines like ORS and zinc tablets in diarrhoea are widely promoted in the mass media. Eight respondents stated that companies promote their medicines through medical representatives and give pens and umbrellas to doctors with the name of their company and the medicine highlighted. The respondents were of the opinion that the cost of promotion should not be recovered from the patient.
Summary and Conclusions
The study had limitations. It was a convenience sample of inpatients admitted in the hospital and may differ from the general population in many respects. The number of respondents was low and the study was carried out in only one teaching hospital in the Kathmandu valley. This preliminary study shows lack of awareness of many important medicine related issues among consumers. More detailed studies are needed.
The authors acknowledge the help of Ms. Nisha Jha, Ms. Omi Bajracharya and Mr. Harish Thapa with the study.
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