Table 4

Review of prescribing practice studies in upper-middle-income and high-income settings27

StudyStudy methodNumber of patient encounters or number of prescribing encounters (denominator)Age of patientsSetting (Number of sites for calculation of variation (SD))Average number of drugs prescribed (per patient encounter or prescribing encounter) (SD across sites unless otherwise specified)Percentage of drugs prescribed generically (SD across sites unless otherwise specified)Percentage of patients prescribed antibiotics (of patient encounter or prescribing encounter) (SD across sites unless otherwise specified)Percentage of patients prescribed micronutrients (of patient encounter or prescribing encounter) (SD across sites unless otherwise specified)Percentage of patients prescribed injections (of patient encounter or prescribing encounter) (SD across sites unless otherwise specified)Percentage of drugs prescribed from EDL (SD across sites unless otherwise specified)
Europe
 Italy (2009)34Retrospective analysis of prescriptions from national database561237 prescription encounters (selected from 923353 children seen or not)<14 yearsNon-hospital outpatient prescriptions3.2 (Median 3)*NS90 (NS)*NSNSNS
 Bulgaria (2004)21Prospective, cross-sectional study1874 patient encounters<14 years8 paediatric outpatient clinics2.6 (NS)NSNSNSNSNS
 France (2004)211990 patient encounters2 paediatric outpatient clinics2.7 (NS)NSNSNSNSNS
 Russia (2004)212194 patient encounters6 paediatric outpatient clinics2.9 (NS)NSNSNSNSNS
 Slovakia (2004)211495 patient encounters28 paediatric outpatient clinics2.6 (NS)NSNSNSNSNS
 Spain (2004)214711 patient encounters50 paediatric outpatient clinics1.5 (NS)NSNSNSNSNS
North America
 USA (2002)35Retrospective study analysing data from National Ambulatory Care SurveyNS<5 yearsOffice-based physiciansNSNS252 per 1000 patient encounters (95% CI, 224 to 279)†NSNSNS
6517 patient encounters over a 2 year period (1999–2000)<15 yearsNSNS234 per 1000 patient encounters (95% CI, 210 to 257)†NSNSNS
 USA (2005)36Retrospective study analysing data from National Ambulatory Care Survey1986 patient encounters per 1000 adults over a 2 year period (2001–2002)18+Outpatients at office-based physicians, emergency departments or hospital departmentsNSNS15.3 (NS)NSNSNS

  • Patient encounters refer to studies in which the denominator was the number of visits to a healthcare practitioner whether drugs were prescribed or not; prescribing encounters refer to those studies where at least one drug was prescribed during a visit.

  • *Overall mean and SD.

  • †Denominator adjusted, hence not given as percentage.

  • NS, not specified