Prescribing practices for hypertension and diabetes mellitus in government and private clinics in Barbados - abstract

ABSTRACT

A random sample of prescriptions for hypertension (485) and diabetes mellitus (843) was taken from the Queen Elizabeth Hospital dispensary and a large private dispensary. Prescribing practices were compared for Special Benefit Service patients, private patients paying full cost of their prescriptions, hospital "walk-in-clinic" patients and hospital outpatients' clinic patients. The major differences in prescribing for hypertension were lower use of beta-blockers in the hospital clinics (12 and 16 percent) than in private offices (33 and 28 percent); higher use of methyl dopa by "walk-in" clinic doctors (28 percent); higher use of diruetics in hospital clinics (56 and 49 percent) than in private offices (39 and 47 percent); a surprisingly high use of methyl dopa by "walk-in" clinic doctors (28 percent); higher use of vasodilators in hospital outpatients (11 percent) than in private clinics (5 percent); and higher use of all other drugs by private doctors. The major differences in prescribing for diabetes mellitus were the very low use of insulin in private (4 percent) and "walk-in" clinic (2 percent) patients compared with hospital outpatients (22 percent) and benefit service patients (25 percent); high use of chlorpropamide by private doctors (54 percent); high use of glibenclamide in the "walk-in" clinic (33 percent) and higher metformin use at the hospital (32 and 27 percent) than in private clinics (21 and 20 percent). There was a consistent trend for use of less drugs per patient in private offices, and there was a significantly lower age range of patients attending private offices, compared with those attending hospital clinics and utilising the Drug Benefit Service. Prescription costs were not strikingly different, but private prescription costs appeared to be kept low by using less drugs of greater cost. These data indicate an important place for education/intervention strategies for doctors in therapeutics, to improve prescribing practices, particularly in private and "walk-in" casualty type settings (AU)