Diurnal variation of prescribing pattern of primary care doctors in Bahrain

Abstract

Rationale, aims and objectives: To evaluate the variation in prescribing by primary care doctors during the morning and the evening clinics and to determine whether these prescribing patterns are influenced by doctors' training background.

Methods: A retrospective prescription-based study was carried out in 17 out of 20 primary care health centres in Bahrain distributed across the Kingdom.

Results: A total of 4472 prescriptions containing 10 588 drug-items covering the prescribing practice of approximately 90% primary care doctors were analysed. Paracetamol was the most commonly prescribed drug in both clinics. Drugs such as diclofenac sodium, amoxycillin, ibuprofen, chlorpheniramine, hyoscine butylbromide, Actifed, Benylin and xylometazoline were the most commonly prescribed drugs to patients attending morning and evening clinics with a considerable variation in ordinal ranking of proportions. As regards morning clinic, chlorpheniramine and Fefol were prescribed by the family doctors (FDs) more often than by the general practitioners (GPs) (P<0.05), whereas, multivitamins were prescribed by the GPs more often than by the FDs (P=0.001). During the evening clinic, however, ibuprofen, chlorpheniramine, bromhexine and xylometazoline were prescribed by the FDs in a rate significantly higher than that prescribed by the GPs (P<0.05). The prevalence of acute and/or chronic morbidities in patient attending clinics was estimated based on the therapeutic indication for drugs used. The mean number of drugs per prescription was 2.41+/-1.3. Prescriptions containing three or more drugs comprised 41.7% of all prescriptions. The GPs had a greater tendency to practice polypharmacy than the FDs.

Conclusion: A significant diurnal variation in prescribing, and polypharmacy practice were related to the training background of the doctors. This quantitative study provides the baseline data for monitoring primary care prescribing practices in Bahrain. To further evaluate the underlying factors that influence drug use indicators, a qualitative study is needed.