Costs of antibiotics prescribing errors to clients: a case Of Ubungo Municipal Health Facilities, Dar Es Salaam, Tanzania

Abstract

Background: Implied costs to clients associated with antibiotics prescribing errors of omission and commission have been reported in health facilities. Prevalence of 2.0% to 94.0% is reported worldwide and 55.1% proportional of prescribing errors has been reported in Tanzania. Adverse drug events, high morbidity and mortality rate, elevation of antibiotics costs to clients are the results of antibiotics prescribing errors. Broad objective: To assess the costs associated with antibiotics prescribing errors toclients attending health facilities in Ubungo Municipality. Methods: The study was conducted in health facilities located in Ubungo Municipality with 1-public hospital, 3-health centers and 16-dispensaries. Descriptive crosssectional study was employed to review prospective prescriptions with one or more antibiotics at the OPD. Target population were prescribers in Ubungo municipality and Study population were prescriptions with one or more antibiotics. Quantitative technique was used to collect prescriptions with one or more antibiotics from a hospital, 3-health centers and 3-dispensaries. Prescriptions were picked and screened for errors of omission and commission immediately before handling to the dispensers by two pharmacists each with a rating scale tool. Data collected were treated by using Statistical Package for Social Sciences (SPSS-20) software. Costs associated with antibiotics prescribing errors of omission and commission was calculated as the difference between the costs of actual antibiotics and the costs of optimal antibiotics. Results: A total of 21 antibiotics were prescribed in Ubungo municipal health facilities out-patient pharmacies on 20th of May to 5th of June 2021 (2 weeks). Penicillin group of antibiotics have the highest frequency of use whereas Aminoglycosides being thelowest. A total of 2,632 prescription errors out of 418 prescriptions at a proportional of 0.78 was recorded. Prescribing errors affecting direct costs of antibiotics are 665 (186 omission errors related to antibiotics and 479 commission errors). Implied costs of antibiotics due to prescription errors is 47.3% of the actual costs and optimum costs is 52.7% of the actual costs before ruling out prescription errors. Therefore, prescription errors tend to double the optimum costs of antibiotics in Ubungo municipal health facilities and make difficult to treat a patient of productive age. The mean costs for treating a patient with antibiotics regardless of prescription errors was 10,142.73 Tshs and when prescription errors were sorted out, the mean costs were 5,346.44 Tshs. Intern doctors were reported to cause more implied costs (34.3%) of the total implied costs followed by registrar (22.1%) and Clinical officers (20.0%). Conclusion: Implied costs of antibiotics prescription errors to clients is reported in Ubungo municipal health facilities. The findings indicate the presence of significant prescription errors of omission and commission at the proportion of 0.78 in study site, it highlights a need of conducting educational programmes among all prescribers especially interns in order to improve their prescribing skills. Prescription errors tend to double the costs of antibiotics at the health facilities.