MATERIALS AND METHODS

For looking at the pattern of physicians' prescriptions, the subcommittee of computer and data analysis of NCRUD was formed and developed a data warehouse and application software in order to gather and analyze prescription data for measuring RUD indicators and to develop strategies for promoting rational drug use. The data warehouse called “Noskhehpardaz (RX Analyzer)” was tested for its validity and reliability in a pilot study in Mashhad University of Medical Sciences in 1996. Currently the software is in use by universities and health services all over the country. Steps in looking at the pattern of physicians’ prescriptions by local committees are as follows:

After above stages, a geographic information system is used to draw a comprehensive picture and illustrate the spread of the problem at national level.

RESULTS

More than 200 million prescriptions, equal to 70% of all prescriptions in the country with an acceptable spread were collected and analyzed by RX Analyzer software. Table 1 is one of the possible outputs of the software that demonstrates national level and comparative information regarding the yearly number of prescriptions between 1998 to 2009. The software also allows calculation of other figures such as national mean items per prescription and mean cost of prescription in Iranian currency units (each US$ equating roughly to 10,000 Iranian Rials), the percentage of prescriptions contain antimicrobial drugs, parenteral drugs and corticosteroids as well as the other drug categories as shown in Table 1. To calculate the above and other indicators, all data included information of physicians, pharmacies and patients, drug's name, dosage form and number prescribed were all entered continuously into the software. In this way the system give report in many forms such as:

According to the above data, feedback forms for physicians were developed that is shown in Fig. 1.

Table 1:	Trend of prescriptions' indicators in Iran evaluated between 1998 and 2009

Fig. 1:	The main page of the feedback form, *Threlkeld and Hagemann (1996)

DISCUSSION

NCRUD has 14-year experience in collecting and data analyzing of physicians prescriptions at both national and local levels. In the early years it was important to inform policy makers about national and local drug use patterns and to indicate and highlight gravity of problems in key areas. In the next step, different types of interventions were implemented to improve irrationality in drug use. More recently it has been necessary to look at the impact of those interventions on drug use patterns.

Looking at the experiences of other countries shows such services to optimize drug-related health outcomes by identifying and promoting drug prescribing and use. For example National Prescribing Service in Australia has been established to implement a quality use of medicines service as part o f the National Medicine Policy in mid 1998 as an independent public company that was funded almost exclusively by the Federal Government (Weekes et al., 2005) and also the Canadian Optimal Medication Prescribing and Utilization Service (COMPUS) which was launched in March 2004, by the Canadian Coordinating Office for Health Technology Assessment (CCOHTA) to achieve the above goal.

Considering the mean of items per prescription as an important indicator among rational drug use indicators, the findings of this study indicate a descending trend for this indicator from 4. 25 in 1998 to 3. 22 in 2009. Given the large number of medicines that prescribed in each year, even the small reduction in prescribing would be worthwhile. For instance, a 5% reduction in prescribing would result in a saving of 235 million pound in the United Kingdom and $A1 40 m in Australia annually (O’Connell et al., 1999).

Pattern of prescriptions is influenced by many factors and implementing interventions for improving and promoting rational drug use is the need for corporation between different sectors involved in the health field. One of the most important items is cost-effectiveness studies that is rare in most of developing countries. To make a feasible national policy decision, information on burden of expenses to the insurance companies or the government should be also collected and paid enough attention. Such studies would clarify which class of drugs are misused and thus should be regulated properly. The examples are drugs like diphenoxylate tablet (Farshchi et al., 2012) or nitroglycerine ampule (Nikfar et al., 2011).

CONCLUSION

Availability of information on prescriptions can facilitate audit and feedback. It is therefore recommended that decision-makers place a greater emphasis on the use the database in evaluating the impact of corrective interventions.

ACKNOWLEDGMENTS

This study is the outcome of an in-house non-financially supported study. Authors would like to thank the experts of National Committee of Rational Drug Use and the RUD committees of the universities for their assistance in collecting data. The assistance of Ahmadali Mostoufi for his technical support is highly appreciated.