الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Health economics knowledge can play an important role in healthcare decision making during drug prescription to maximize the use of scarce healthcare resources. Physicians should understand and having knowledge regarding economic analysis in order to consider the economic effects of clinical decisions and address the problems facing healthcare system. However, physicians’ health economics knowledge remains poor in most scenarios, and still needs more effort to improve.
Limited knowledge and training of healthcare decision makers regarding health economics is one of the most important barriers to use of economic evaluations in healthcare decision making process.
In the current study, less than 10 % of physicians have attended health economics courses within the university education curriculum, this is concurrently with no one have engaged in any health economics related self-learning event since graduation, which is compatible with the result of subsequent knowledge score. Therefore there is a need for providing structured health economics education to physicians, researchers, and stakeholders that can help establish an integrated scientific community that can start applying health economic principles to healthcare decision-making.
The aim of present study is to study knowledge regarding basics of health economics, and appropriateness of drug prescriptions among physicians in Tanta University hospital, Egypt, as well as the following specific objectives:
1. To estimate the knowledge regarding basics of health economics among physicians at outpatient clinics.
2. To measure the appropriateness of drug prescription.
3. To identify possible determinants of knowledge and the appropriateness of drug prescription among the studied sample.
A cross-sectional study was conducted among 250 physicians, their ages were from 25 to 50 years, and 320 prescriptions present at the outpatient clinics pharmacy. Data collection was done using a predesigned structured interviewing questionnaire that was prepared by the researcher. Data collection included personal and demographic characteristics of physicians (Age, gender, marital status, years of experience, specialty, post graduate studies, occupation setting, health economics courses attended, and health economics study at university.) and knowledge regarding basics of health economics (Cost-benefit analysis (CBA), Cost-effectiveness analysis (CEA), Cost of Illness (COI), Evidence-based medicine (EBM), Economic Evaluation, Resources, Direct cost and indirect cost, Average cost, intangible cost and financial cost). Data entry and statistical analysis were done using the software Statistical Package for Social Sciences (SPSS) ver 21. Descriptive and analytical analyses were done.
The study revealed the following main results:
Personal and demographic characteristics:
- The age of the studied physicians ranged between 25 and 50 years with a mean value of 28.39. Near half (42%) of the physicians were in the age group between 27 - < 29 years, while the age of 30 years and more constituted 13% which is the least percent. Males constituted 55.20% and females were 44.80%.
- About 54% of studied physicians were single while 46% were married. Years of experience ranged between less than 5 years and more than 10 years with mean value 3.90, about 46.80% had less than 5 years of experience followed by from 5 - 9 years (46.4%), while more than 10 years represented 6.80%.
- About 22.40% of studied physicians were specialized in pediatrics followed by internal medicine, general surgery and tropical medicine (14.40%, 14% and 8% respectively).
- About 52% of studied physicians had no post graduate studies while 48% had post graduate studies. And almost all participants did not receive health economics education at university 92% except for only 8% who received this education.
Knowledge of studied physicians regarding basics of health economics:
- There was a statistically significant relation between age, years of experience, post graduate studies, occupation setting and physicians’ Knowledge regarding basics of health economics.
- Factors that are significantly associated with physicians’ knowledge regarding basics of health economics:
- Physicians with post-graduate studies had higher knowledge than those without post-graduate study.
- Factors that are significantly correlated with physicians’ knowledge regarding basics of health economics:
- Physicians who had health economics study at university had higher knowledge than those who had not.
- Physicians working in the pediatric department achieved a higher knowledge than those working in other departments.
- Physicians working in university hospital achieved a higher knowledge than those working in other settings.
- No physician had good knowledge regarding basics of health economics, the majority (71.60%) had poor knowledge followed by 28.40% who had moderate knowledge.
Appropriateness of drug prescriptions at the outpatient clinics:
- About 57.30% of pharyngitis prescriptions were without antibiotics, while 42.70% were with antibiotics.
- About 55.50% of patients’ bronchitis prescriptions were prescribed with an antibiotic, while 44.50% were without antibiotics.
- About 41.80% of patients’ bronchitis prescriptions represent the inappropriateness portion, while 58.20% represent the appropriate prescriptions portion.
- Almost two thirds 63% of proton pump inhibitors’ prescriptions were appropriate, while 37% only were inappropriate.
- About 22% of PPIs prescriptions, diagnosis written was gastroesophageal reflux disease (GERD) followed by H.pylori and Osteoarthritis by 18% and 12% respectively.
Association between studied physicians regarding health economics Knowledge and the appropriateness of drug prescription:
- There was no statistical significant association between physician’s knowledge and the appropriateness among pharyngitis and bronchitis prescriptions with a P-values of 0.737 and 0.150 respectively.
- There was a statistical significant association between total physician’s knowledge and the appropriateness of PPIs prescriptions (P= 0.003).
6.2. Conclusion
- The majority 71.60% had poor knowledge score followed by 28.40% with moderate knowledge and no physician had good knowledge.
- There was a statistically significant relation between age, years of experience post graduate studies, occupation setting and physicians’ Knowledge regarding basics of health economics.
- Physicians with post-graduate studies, those who received health economics studies, or those who worked in the pediatric department or working in a university hospital achieved a higher knowledge than their colleagues.
- It was shown that 58.20% of bronchitis’ prescriptions were appropriate, while 41.80% were inappropriate.
- It was shown that 63% of proton pump inhibitors’ prescriptions were appropriate, while only 37% were inappropriate.
- While there was a statistical significant association between total physicians’ knowledge and the appropriateness of PPIs prescriptions P-value = 0.003, there was no statistical significant association found between physicians knowledge and the appropriateness of pharyngitis and bronchitis prescriptions with (P-values of 0.737 and 0.150 respectively).
6.3. Recommendations
- Raising medical professionals’ knowledge regarding the economic evaluation approaches will enhance its use when they making decisions.
- Authorities that have an impact on physicians’ medical education and practice should raise the awareness and the level of basic health economics knowledge, training and education.
- Researchers:
1- Investigate the association between health economics knowledge and healthcare decisions needed and should cover how to cross that gap.
2- More research should be initiated in Egypt for better understanding and evaluating of health economics knowledge among physicians and other healthcare providers in different settings and places.
- Ministry of higher education and faculties of medicine:
1- Increase knowledge of physicians regarding basics of health economics during studying by encourage establishing a suitable study curriculum.
2- Application of health economics principles in clinical and preventive practice.
- Ministry of health and population:
1- Facilities’ managements should motivate the medical staff to consider health economics as one of the core medical proficiency competency tool beside the clinical experience.
2- Establish official guidelines providing more comparability and higher quality of clinical practice.