Audit on cards to discourage prescription of unnecessary testing and medicinesDoctors prescribing only required medicines and tests are in a minority in Nepal, health experts say.
Most ailments can be cured by medicines worth a few hundred rupees, but patients are being forced by doctors to buy vitamin supplements for thousands of rupees, complaints lodged by some patients at the Ministry of Health and Population, stated.
Another serious complaint concerns patients being forced to undergo unnecessary tests, for which they have to pay exorbitantly.
To address such complaints from the patients, which are growing alarmingly of late, the Health Ministry has decided to carry out a prescription auditing.
“With the help of professional councils—the Nepal Medical Council, the Nepal Pharmacy Council, and other agencies concerned—we have been preparing to start an audit of doctors’ prescriptions,” said Dr Roshan Pokhrel, secretary for Health and Population.
“We hope that the complaints and grievances of patients will be addressed by an audit of doctors’ prescriptions.”
Prescription audit is a systematic analysis, which is in practice in many countries across the globe, and is carried out to find errors in doctors’ prescriptions and improve patients’ care.
According to officials at the Health Ministry, a decision to carry out a prescription audit was taken to discourage malpractices being perpetuated in collusion by doctors, pharmacists, importers, drug manufacturers and the hospitals.
Some vitamin supplements being prescribed by the doctors and sold openly in the market are banned by the Department of Drug Administration for use in combinations with specified solutions and agents, said an official at the ministry, asking not to be named, since he is not authorised to speak to the media.
Moreover, under pressure from hospitals, patients are forced to undergo unnecessary and costly tests and they are being admitted to hospitals for more days than required, he added.
Experts hope the prescription audit will help minimise the irrational prescribing of medicines, improper dispensing, unnecessary testing and the practice of taking undue advantage of ailing patients.
“This is neither a new thing nor are we the first country to carry out a prescription audit,” said Dr Bhagawan Koirala, chairman of Nepal Medical Council, the national regulatory body of medical doctors. “This should have been done long ago. Prescription audit is important to curb malpractices and ensure rational use of drugs.”
Several doctors the Post talked to concede that more than two-thirds of the doctors in Nepal prescribe more medicines than what the patients actually need. Proportions of the nutraceuticals (pharmaceutical alternatives which claim physiological benefits) are several times more than the actual medicines and the patients are not being counselled as to why they should take additional vitamins.
Some doctors and dispensaries have been taking an undue advantage of poor patients, forcing them to buy additional vitamin supplements. A majority of patients are unaware and don’t ask if the supplements are necessary.
“First, the doctors do not prescribe medicines in handwritings that patients can understand, second, they do not mention the NMC number in the prescription, and third, they do not describe why the medicine or nutraceuticals are needed in the prescriptions,” an official at the council said, asking not to be named. “Such practices would stop if we could enforce prescription audits effectively and start making doctors accountable.”
Medical experts say that supplementary vitamins are needed in exclusive conditions, but most doctors prescribe unnecessary drugs for their patients.
“We started auditing the prescriptions of doctors during the Covid pandemic, but that could not be made effective, as its objective was limited,” said Prajwal Jung Pandey, chairman of the Nepal Pharmacy Council. “We hope that irrational use of antibiotics and unnecessary use of nutraceuticals will be stopped by the prescription audit.”