Assessing prescriber adherence to standard treatment guidelines/essential medicines lists and resultant cost implications for anti-psychotic medicines in a public hospital in South Africa

Abstract

Prescriber non-adherence to Standard Treatment Guidelines (STGs) may lead to poor health outcomes and increased financial burden on the healthcare system. This study was undertaken to investigate the prescribing patterns of anti-psychotic medicines in terms of adherence to STGs and resultant cost implications in a public sector hospital in South Africa. A quantitative, retrospective and descriptive analysis was conducted at a district-level hospital in a rural area of KwaZulu-Natal. After ethics approval, prescription data was extracted from 133 files that met the inclusion criteria (adult chronic psychiatric patients) and compared against the STGs to evaluate prescribing trends, adherence to STGs and costs related to non-adherence. Prescriber adherence to guidelines was sub-optimal as only 50.4% of prescriptions adhered to STGs, 39.1% were non-adherent to STGs and 10.5% were undecided due to incomplete data. Cost analysis revealed that non-adherence to STGs resulted in an estimated annual loss of $1,751.97 (ZAR 25,911.64). Overall, prescribers demonstrated poor compliance with STGs, which directly contributed to unnecessary expenditure. As this study examined only one category of medicines, the overall impact of non-adherence and associated costs for the institution is likely to be far greater. Given that medicines represent major cost drivers in healthcare, strengthening prescriber adherence to STGs is essential for both cost containment and quality patient care.