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Self prescription

ABSTRACT.

Background. Self-prescription is becoming a normal routine for most people with minor illness with belief that they can treat themselves, in some rare care can result into worsening of the health condition of an individual.

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Objectives. To identify factors influencing self-prescription by non-medical personnel and the community awareness of the complications that can occur, to know the commonly self-prescribed Drugs, to identify most illness that people prefer to treat themselves as well as to determine the general likelihood of drug prescription.

Methodology. It will be a cross sectional study to be done at Dar es salaam, it will involve the sample size of about 100 volunteers in equal male to female ration obtained by simple random sampling method fromTemeke, Iala and Kinondoni districts only non-medical personnel will be part of the study. Study will take about 3 weeks to complete. Questionnaire will be the main study tool to obtain data and analysis will base on the objectives using data analysis software.

Budget. The estimated cost for the research is 420″,000/=

1.0 INTRODUCTION

Self-medication can be defined as the way human prescribe themselves or their friends and relatives with commonly used drugs to treat symptoms or signs that they are suffering at that particular time without a physician consultation. (1).This act can be done by both medical and non-medical personnel. The act of self-medication is among the regular practice believed to decrease huge burden to medical care takers, reducing the time spent for seeing health practitioner as well as cost but the real thing is it requires a certain level of knowledge to make it reasonable and helpful(1).

It is legal for medical personnel to make prescriptions as they have much knowledge on the medications and their side effects. However most of non-medical personnel have this do prescribe themselves and their beloved seeking for relief from the symptoms they suffer without having much knowledge and possible side effects that can be resulted. Drugs are made up chemicals that targeted to modify body functioning and thus once used in reckless manner can interfere potential body activities and resulting into a life threatening condition and thus using drugs require someone who know when, how and what drug to use at a particular time. Normally human do have self-care trying to maintain their well-being and prevent themselves from diseases by exercise, balanced diet, life style moderation as well as self-medication (2) but majority have overseen this habit and go beyond their limitations trying to find much details from different sources including internet for their illness and medicate themselves(2 ).

The general medical council requires practitioners when in providing medical care they must provide medications or prescriptions only when they have an adequate knowledge drug or prescription and that accordance to the patient’s condition will satisfy the need of the patient and assuring recovery including providing effective and best treatment basing on the available evidence(3).

The AMA ethical code limits even a physician to self-prescribe or treat themselves or their immediate relatives (4).

LITERATURE REVIEW.

Different studies have shown that there are several factors that influence self-medications including education, social economic status gender and availability of medications (5).

Studies also the act of self-medication is among both health and non-health practitioners with the main use of self-medications including treatment of fever, headache, allergy, flu, cough, body and back ache, stomach ache some minor trauma and infections. (6).

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Study done in Pakistan showed that 51% of the people in the study do self-medication and this being a leading cause of economic loss and health problem (7).

Moreover there are several studies have put forward to give out different factor that makes people to self-prescribe themselves, among the highly mentioned factors include: economic factors where it cost much to have private doctor consultation, highly bureaucratic procedures to attain medical care from hospitals, distance factors to reach the medical care places, long time waiting at hospitals to get the medical care, patients evaluation regarding them as minor illness such that they don’t see the necessity for seeking medical care (2).

The study conducted in Sudan on the rational usage of drugs have given out the recommendations so that to defeat reckless self-prescription, among the recommendations includes:- to regulate laws and review drugs action to the body, to provide the training and reference materials to adapt self-prescription to meet local needs, educating pharmacist, NPA should construct standard operation on the care, pharmacy should first meet the appropriate demand to utilize the health of their clients and should not keep income as their principle interest and lastly to widen the usage of health insurance to minimize cost and reliance of self-prescription (9).

There are some good outcomes resulted from self-prescription as Self-prescription help the healthcare systems to facilitate better usage of clinical skills, accelerates access to drugs and contribute in minimizing prescribed medication costs related with national health interventional programs. In addition to advantages there are hazards being reported which include:- wrong self-diagnosis, inability to make a proper choice of medications, failure to identify possible risks that can be resulted, inability to know the contraindications, warnings, mode of action, precaution, proper storage, interaction as well as dose interval. Most people don’t know about adverse drug reactions, they also miss knowledge on the proper route of administration, sometimes they overdose themselves due to desire to recover as early as possible, prolonged drug use can also be harmful, some drugs lead to dependence, withdrawal effect and abuse which can harm the patient and lack of knowledge on food to drug interactions.(10)

CONCEPTUAL FRAMEWORK.

Many times people get sick and need an immediate medical care to alleviate the symptoms or the illness they suffer. This cycle continues and as people fear of worsening of their health condition they tend to find alternative way to achieve immediate care and thus opting self-prescription and sometimes they do have a stock to keep their commonly purchasing drugs for common illness they suffer at their homes.

STATEMENT OF THE RPOBLEM.

Prescribing oneself is beneficial only if the symptoms resolve and there is no any side effect. Only when the symptoms fails to reside or adverse side effects that are probably resulted from the drugs used is where you can recognize the consequences of self-prescription by non-medical personnel. It is clear physician have knowledge of their prescriptions and their targets to the patients basing on what they intend to achieve for the well-being of the patients. Drugs requires specific route of administration, proper prescription and patients adherence for them to work more effectively. With self-prescription by non-health practitioner there is a great gap of understanding what being an appropriate medication to use and by what amount at which time interval. Prescribers most of times rely on their knowledge of what drugs treat and the administration route but they miss important issues like what dose should be used, what are the adverse effects of this drugs, at what interval of time should another intake be made, what are the drug interactions with other drugs and food as well and thus possible complications may arise from any of the category which now emphasize the application of medical knowledge before doing any prescription. Improper use of drugs can be fatal.

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RATIONALE OF THE STUDY.

By knowing factors that influence non health practitioners to prescribe themselves will pave a way to its reduction and possibly formulation of health intervention on proper prescription that will help to improve the well-being of the people.

The community has to understand the necessity of seeking medical care from medical practitioners and not deal with their illness them-selves as can result into worsening of their health condition.

All have to understand that the knowledge of drug prescription doesn’t fall under individual authority except for all with knowledge on drug prescription, thus people should have much respect on drug and clearly should separate drugs from other commodity that they usually buy.

By identifying what drive self-prescription it will be easily to intervene and adhere the community to proper prescription.

OBJESCTIVES OF THE STUDY.

Broad objectives.

To identify factors influencing self-prescription by non-medical personnel and the community awareness of the complications that can occur.

Specific objectives.

To know the commonly self-prescribed drugs.

To identify most illness that people prefer to treat themselves.

To determine the general likelihood of drug prescription.

METHODOLOGY.

Study design

It will be a cross sectional study to have an observation on the population so as to sort out the presence and the likelihood of self-prescription in the community.

Study setting.

The research will take place at Dar es salaam region Tanzania mainland. It will involve 3 councils in it, that is Ilala municipal council, Temeke as well as kinondoni district.

Study population.

The residents of Dar es salaam region Tanzania will be involved in the research. Inclusion criteria of the sample population will be only those who are 18 year or above, both sexes, all level of education living in the city. The exclusion criteria will be all medical or health related practitioners or students including interns at different medical fields these will be not part of the study.

Sampling method.

A simple random sampling method will be used to obtain respondents who will participate in responding to the questionnaire, equal chances of selection of the sample will be considered to provide equality.

Sample size.

Dar es salaam has a total of approximately 4.4milion individuals (8). The research will include total of 100 volunteers to respond to the questionnaires, 30 will be obtained from Ilala, 30 from Temeke and 40 from Kinondoni. The sample size will be equivalent to 0.00023% of the total population in Dar es salaam. In each district the size will be gender sensitive that the number of female to male will be the same.

Study duration and work plan.

Total of 3 weeks will be extensively used to complete the research in October/ November 2019. 2 weeks will be used for data collection and analysis and the remaining 1 week will be used for writing report. Only the working days of the week will be used for study.

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Study tools and methods.

It will use questionnaires as the main source of obtaining data from the volunteering respondents. The questionnaire will be in a Swahili language to offer understanding to all respondents. The questionnaire will have a total of 15 multiple choice questions on printed papers where respondent will fill under guidance. Time expected to be spend per individual is a maximum of 30 minutes.

Data analysis plan.

Analyzed data will include proportion of factors influencing self-prescription, data on community knowledge of the consequences of self-prescription. The statistics of the most self-prescribed the illnesses that commonly individual used to self-prescribe themselves as well as the side effects that individual that they commonly face after self-prescription. More over data on the preference of prescription between by medical practitioner and self-prescription will also be analyzed.

Ethical considerations.

Ethical mode of conducts will be observed. Each respondent will be informed on the course of the research and only those who are willing by themselves will join the study after they are satisfied with the information. Privacy will be the priority to keep respondents information’s, there will be no pictures taken from respondents, voice notes or videos from them. More over there will be no space even for writing the respondents name to keep respondents out of doubt of responding their truth on the questions asked. All bureaucratic procedures will be observed to give the permission to do research and meet the respondents.

Study limitations and mitigations.

Limitations. Only individuals who are not on the medical care from the health professional are in the study and that no data will be earned from even outpatients or admitted patients on self-prescription. However if there were part of the study the results could have been different. Excluding non-medical personnel in the sample/ the study also limit availability of some relevant information that could be potential. Few sample size compared total size of the population available whereas the greater the sample the greater the relevant results to be obtained. Also participants may fail to understand and respond well to questionnaire.

Study mitigations. Additional study tools may be added expecting errors from the respondents so they will exceed the sample size before going to the field

Time schedule of activities.

The first 2 weeks of data collection.

4 days at Kinondoni District council

Day 1 9:00 – 11:30 am 11:30 – 12:00am 12:00 – 3:00pm

Introducing myself to local government and start interviewing Short break Continue with interview

Day 2 Continue with interview Short break Continue with interview

Day 3 Continue with interview Short break Continue with interview

Day 4 Continue with interview Short break Continue with interview

3 days at Ilala district council.

Day 1 Introducing myself to local government and start interview Short break Continue with interview

Day 2 Continue with interview Short break Continue with interview

Day 3 Continue with interview Short break Continue with interview

3 days at Temeke district council.

Day 1 Introducing myself to local government and start interview Short break Continue with interview

Day 2 Continue with interview Short break Continue with interview

Day 3 Continue with interview Short break Continue with interview

Last 1 week.

In the last week all the data obtained will be analyzed and the report will be written.

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