This paper confirms that limited knowledge of harms overuse is a key driver of overuse of medications in low- and middle-income countries. Citation, abstract and a comment from me below.
CITATION: Bull World Health Organ. 2023 Jan 1;101(1):36-61D. doi: 10.2471/BLT.22.288293. Epub 2022 Oct 31.
Overuse of medications in low- and middle-income countries: a scoping review.
Albarqouni L et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9795388/
ABSTRACT
OBJECTIVE: To identify and summarize the evidence about the extent of overuse of medications in low- and middle-income countries, its drivers, consequences and potential solutions. METHODS: We conducted a scoping review by searching the databases PubMed®, Embase®, APA PsycINFO® and Global Index Medicus using a combination of MeSH terms and free text words around overuse of medications and overtreatment. We included studies in any language published before 25 October 2021 that reported on the extent of overuse, its drivers, consequences and solutions.
FINDINGS: We screened 3489 unique records and included 367 studies reporting on over 5.1 million prescriptions across 80 low- and middle-income countries - with studies from 58.6% (17/29) of all low-, 62.0% (31/50) of all lower-middle- and 60.0% (33/55) of all upper-middle-income countries. Of the included studies, 307 (83.7%) reported on the extent of overuse of medications, with estimates ranging from 7.3% to 98.2% (interquartile range: 30.2-64.5). Commonly overused classes included antimicrobials, psychotropic drugs, proton pump inhibitors and antihypertensive drugs. Drivers included limited knowledge of harms of overuse, polypharmacy, poor regulation and financial influences. Consequences were patient harm and cost. Only 11.4% (42/367) of studies evaluated solutions, which included regulatory reforms, educational, deprescribing and audit-feedback initiatives.
CONCLUSION: Growing evidence suggests overuse of medications is widespread within low- and middle-income countries, across multiple drug classes, with few data of solutions from randomized trials. Opportunities exist to build collaborations to rigorously develop and evaluate potential solutions to reduce overuse of medications.
COMMENT (NPW): ‘Globally, most prescribers receive most of their prescribing information from the pharmaceutical industry and in many countries this is the only information they receive.’ World Medicines Report, WHO (2011 - there is no evidence that things are any better today) The profit motive of the pharmaceutical industry requires that health professionals prescribe *more* medicines, whether or not they are needed and whether or not they cause harm. As we have heard from Massimo Serventi and others, there are of course other drivers of overuse, including perverse financial motives of individual health professionals, but I find it shocking that our collective efforts to inform prescribers and users of medicines are so inadequate. Meanwhile the British National Formulary, loved by many in the anglophone world and arguably the best guide to rational prescribing, remains locked behind a paywall and antimicrobial resistance (driven by overuse) is progected to kill 10 million people a year by 2050.
Best wishes, Neil
Joint Coordinator HIFA Project on Information for Prescribers and Users of Medicines http://www.hifa.org/projects/prescribers-and-users-medicines
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org
