Schizophrenia diagnosis and treatment by general practitioners: A cross-sectional study in district Peshawar, Pakistan.

OBJECTIVE: To assess the knowledge and practices of general practitioners about diagnosis and treatment of schizophrenia and determine their association with clinical exposure to such cases in practice. METHODS: The cross-sectional study was conducted in Peshawar from August 2009 to December 2011 at the clinics of general practitioners enrolled with the provincial Health Regulation Authority. All the listed GPs were contacted and those consenting to participate were included. A semi-structured questionnaire was used to assess their knowledge and practices related to diagnosis and treatment of schizophrenia. They were categorised as having Good Knowledge/Practice, in this regard, when they responded to >60% of the questions correctly. RESULTS: Of the 135 general practitioners contacted, 114(84.5%) agreed to participate and represented the study sample. Of them, 61(53.5%) physicians did not treat any diagnosed case while 15(13.2%) treated more than 10(8.8%) annually. Only 6(5.3%) practitioners spent more than 30 minutes, while 22(19.3%) spent less than 10 minutes per patient. Besides, 14(12.3%) practitioners had good knowledge about schizophrenia diagnosis and treatment, while 100(87.7%) had poor or no knowledge. Similarly, 32(28.1%) practitioners had good practice skills regarding schizophrenia compared to 82(71.9%) having poor practice skills or no practice regarding schizophrenia. General practitioners who were not treating any patients with schizophrenia had lower knowledge and practice scores compared to those who were treating one or more patients with schizophrenia annually (p<0.001 each). CONCLUSIONS: The knowledge and practice skills of general physicians were below average by medical standards regarding schizophrenia diagnosis and treatment.

Prescription patterns of general practitioners in peshawar, pakistan.

OBJECTIVES: To find out prescription patterns of general practitioners in Peshawar. METHODS: Cross-sectional survey of drug prescriptions was done at six major hospitals and pharmacies of Peshawar between April and May 2011. A total of 1097 prescriptions that included 3640 drugs, were analyzed to assess completeness, average number of drugs, prescription frequency of various drug classes, and number of brands prescribed. RESULTS: No prescription contained all essential components of a prescription. Legibility was poor in 58.5% prescriptions. Physician's name and registration number were not mentioned in 89% and 98.2% prescriptions respectively. Over 78% prescriptions did not have diagnosis or indication mentioned. Dosage, duration of use, signature of physician and directions for taking drugs were not written in 63.8%, 55.4%, 18.5% and 10.9% of prescriptions respectively. On average each prescription included 3.32 drugs. Most frequently prescribed drug classes included analgesics (61.7%), anti-infective agents (57.2%), multi-vitamins (37.8%) and gastrointestinal drugs (34.4%). We found 206, 130, 105 and 101 different brands of anti-infective agents, gastrointestinal drugs, analgesics and multivitamins being prescribed. CONCLUSION: We observed a high number of average drugs per prescription mostly using brand names, and over-prescription of analgesics, antimicrobials, multivitamins and anti-ulcer drugs. Quality of written prescriptions was poor in terms of completeness.