Factors Influencing Rational Use of Psychotropic Medicines in Mathari National Teaching and Referral Hospital in Nairobi, Kenya

Abstract

The World Health Organization recommends a focus on the six building blocks of a health system in order to strengthen health systems. The focus of this study was medicines, vaccines and technologies, with rational use of medicines of the psychotropic variety being the area of interest. If the drugs are not used rationally it will adversely affect equity, quality, affordability and efficiency of the health care system. It is evaluated that, in low-income and middle-income countries, 80% of people with genuine psychiatric issues do not get the treatment that they require. Accessibility of the psychotropic medicine may be one of the elements that is attributed to inappropriate use of these medicines and is seen to lead to inflated treatment costs, mortality, and morbidity and may be a reason for undesirable drug reactions or discouraging psychosocial impact. According to the Ministry of Health, Kenya Mathari National Teaching & Referral Hospital is faced with non-availability of psychotropic medications already on the essential drugs list. The main focus of the study was to assess the health care provider’s perspective on factors influencing rational use of psychotropic medicines in Mathari National Teaching & Referral hospital in Nairobi, Kenya. This was an institutional based cross sectional descriptive study. A target population for this study was 125 prescribers and dispensers who worked at Mathari National Teaching and Referral hospital at the time of study. For the study, simple random sampling was used to draw a sample size of 96 respondents. A structured five-point Likert scale questionnaire was used to collect the data; the data was analysed using SPSS version 23. Results showed that, 58(62%) were female, 45(49%) were 31-40 years old, 60(65%) were doctors and 47(51%) held a Bachelor's Degree, The coefficient of correlation of prescribing practices (r=0.397, p<0.001), patient care factors (r=0.289, p=0.005), health facility factors (r=0.446, p<0.001) and complementary factors (r=0.313, p=0.002) showed a positive and significant relationship with rational use of psychotropic medicines. In a combined relationship Prescribing factors (p=0.006), Health Facility factors (p=0.011) and Complementary factors (p=0.009), all had a significant influence on the appropriate use of psychotropic medicines. Efforts to improve the rational drug use would call for prioritized improvement of health facility factors focusing on the supply chain, followed by prescribing factors, complementary factors and finally the patient care factors. This study recommends that: Prescribers and dispensers ought to be provided with policy guidelines for rational drug use, these are the guidelines for standard treatment and a list of essential medicines, in addition to the available medicines list. Training on the rational use of psychotropic medicines for staff needs to be undertaken frequently. In addition, new staff should undergo induction training on the rational drug use as part of the orientation process. Continuous education on use of Essential medicines should be incorporated in health training institutions /hospitals. NHIF ought to consider covering mental health as part of the benefit package to enhance affordability of psychiatric services.