Drug Use in the National Health Insurance Scheme at a Tertiary Hospital in the South East Nigeria

Background: Due to increased out-of-pocket spending on health care by Nigerians, National Health Insurance Scheme (NHIS) was created to protect families from the financial hardship of huge health care bills among other objectives.

Aim: The objectives of the study were to investigate the drug use practices and overall prescribing pattern in the NHIS at a Tertiary Hospital in Nigeria.

Methods: Retrospectively, randomly sampled 1200 out-patient’s NHIS prescriptions were evaluated using WHO core drug use indicators. Prospectively, a conveniently sampled 120 patients each at General Out-Patient Department (GOPD) clinic, NHIS, and GOPD dispensing pharmacy outlets were observed during consultations and interviewed before leaving pharmacy to assess the patient care indicators. Data were analyzed using descriptive statistics and independent samples t-test.

Results: The average number of drugs per prescription, encounters with an antibiotic, and drug prescribed by generic name and from NHIS essential drug list were 4.2±1.8, 31.6%, 52.8% and 66.1% respectively. In NHIS and GOPD dispensing pharmacy outlets, the pharmacists’ average prescriptions assessment time were 9.24 seconds and 64.03 seconds with significant difference (P < 0.05), whereas the average medication counselling time were 15.6 seconds and 34.7 seconds respectively with significant difference also (P < 0.05). Dispensed drugs that were properly labelled were higher in NHIS than in GOPD (62.0% vs 20.4%). Patients’ correct drug dosage knowledge was also higher in NHIS than in GOPD (37.5% vs 23.3%).

Conclusion: Poor drug use practices including poly-pharmacy, overuse of antibiotics, lack of adherence to generic prescribing, poor conformity to NHIS essential drug policy, inadequate prescription assessment, inadequate patients’ medication counselling, incomplete labelling of drugs, and inadequate patients’ knowledge of correct drug dosage were apparent. Antihypertensive drug class was the most prescribed drug class.

The findings of this study have provided first time evidence of irrational drug use in NHIS in the South East Nigeria. Therefore, we recommend training and re-training of healthcare providers in the health insurance scheme on rational drug prescribing and dispensing.