Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 8:16:20420986251346321.
doi: 10.1177/20420986251346321. eCollection 2025.

Adherence to WHO/INRUD prescription indicators in public hospitals: evidence from the Ashanti Region, Ghana

Richard Delali Agbeko Djochie  1 , Rita Owusu-Donkor  2 , Elizabeth Modupe d'Almeida  3 , Francis Kwadwo Gyamfi Akwah  4 , Emmanuel Kyeremateng  2 , Samuel Opoku-Afriyie  5 , Cecilia Akosua Tabiri  6 , Francis Kyei-Frimpong  7 , Samuel Dwomoh  2 , Francis Fordjour  8 , Jonathan Boakye-Yiadom  9
Affiliations

Adherence to WHO/INRUD prescription indicators in public hospitals: evidence from the Ashanti Region, Ghana

Richard Delali Agbeko Djochie et al. Ther Adv Drug Saf. .

Abstract

Background: Rational prescribing optimizes medicine use, reduces costs, and improves patient outcomes. However, adherence to rational prescribing practices varies, particularly in low- and middle-income countries like Ghana, where healthcare systems differ across urban, peri-urban, and rural settings.

Objectives: This study assessed adherence to WHO/INRUD prescribing indicators in public hospitals and determined each hospital's Index of Rational Drug Prescribing (IRDP).

Design: A retrospective descriptive study was conducted in 25 public hospitals across rural, peri-urban, and urban settings in the Ashanti Region of Ghana.

Methods: Data from 5091 patient encounters were analyzed to assess prescribing indicators, including the average number of medicines per encounter, generic prescribing, adherence to the Essential Medicines List (EML), antibiotic use, and injection prescribing. IRDP scores were calculated, and geographic comparisons were performed using analysis of variance (ANOVA), with p < 0.05 considered statistically significant.

Results: No hospital met the WHO target of <2 medicines per encounter (regional average: 3.63 ± 0.62). Generic prescribing averaged 72.26%, and EML adherence was 91.85%, with no hospital achieving 100%. Antibiotic prescribing exceeded the <30% target, averaging 60.84%. Injection use aligned best with WHO standards (average: 13.42%), with 22 of 25 hospitals meeting the <20% threshold. The regional IRDP was 3.67, with rural hospitals scoring lowest (3.63), followed by peri-urban (3.64) and urban hospitals (3.81). No significant geographic differences in IRDP scores were observed (p > 0.05).

Conclusion: While injection use aligns with WHO standards, gaps remain in generic prescribing, antibiotic use, and EML adherence. Strengthening prescriber training, antimicrobial stewardship programs, and policy enforcement is essential to improving prescribing practices and patient outcomes in public hospitals in the Ashanti Region.

Keywords: Essential Medicines List; WHO/INRUD prescription indicators; irrational prescribing; patient safety; public hospitals in Ghana; rational medicine prescribing.

Plain language summary

Improving medicine prescribing practices in public hospitals: insights from the Ashanti Region, Ghana Doctors and other healthcare providers must prescribe medicines in a way that is safe, effective, and affordable for patients. This study looked at how well hospitals in Ghana’s Ashanti Region follow international guidelines for good prescribing practices. Researchers collected data from 25 hospitals across rural, peri-urban, and urban areas, analyzing 5,091 patient records to assess key prescribing patterns. The study found that, on average, patients received more medicines per visit than recommended, and the use of generic medicines (cheaper, equally effective alternatives) was lower than ideal. While most hospitals prescribed medicines from the approved Essential Medicines List, none fully met the 100% target. A major concern was the high use of antibiotics—double the recommended limit—raising the risk of antibiotic resistance. However, the use of injectable medicines was mostly appropriate, meeting international standards. Overall, prescribing quality varied slightly between rural and urban hospitals, but the differences were not statistically significant. The study suggests that better training for prescribers, stricter policies, and improved access to essential medicines could help hospitals improve their prescribing practices, leading to better patient care.

PubMed Disclaimer

References

    1. WHO. Promoting rational use of medicines. WHO Regional Office for South-East Asia, https://www.who.int/activities/promoting-rational-use-of-medicines (2021, accessed 25 July 2024).
    1. Akunne AA, Lam WI, Ezeonwumelu JOC, et al.. Assessment of rational prescribing in general outpatient department of Kampala International University teaching hospital, Western Uganda. Pharmacol Pharm 2019; 10: 48–60.
    1. Jain S, Jain P, Moghe V, et al.. A systematic review of prescription pattern monitoring studies and their effectiveness in promoting rational use of medicines. Perspect Clin Res 2015; 6: 86–90. - PMC - PubMed
    1. Ofori-Asenso R, Agyeman A. Irrational use of medicines: a summary of key concepts. Pharmacy 2016; 4: 35. - PMC - PubMed
    1. Bjerrum L, Larsen J, Søndergaard J. Drug prescription patterns in general practice. Extent, problems and possibilities of improvement. Ugeskr Laeger 2002; 164: 5273–5277. - PubMed

LinkOut - more resources