International Nonproprietary Names prescription in a specialized public hospital in Egypt

Background: International Nonproprietary Names (INN) is prescribing the name of the active ingredient. Objective: This study aimed to investigate INN prescription rates and perceived barriers towards INN prescribing at a public Ministry of Health and Population (MOHP) hospital specialized in treating infectious diseases in Egypt. Methods: A retrospective chart review was conducted in a 280-bed specialized Ministry of Health Hospital in Alexandria, Egypt. Medications were described either as brand or generic based on WHO Essential Medicines List (EML) classification system and the Egyptian National Formulary. All physicians with prescribing authority in study hospital were administered a questionnaire composed of two sections. The first section explored the socio-demographic and work characteristics of the physicians, and the second section listed the barriers towards INN prescription. Results: Out of the 400 medical records reviewed, 2279 drugs were prescribed. About half of the medications (52.61%) were prescribed in INN. The medicines which were most frequently prescribed in INN were electrolytes solution (99.5%), laxatives (98.6%), and vitamins and minerals (85.2%) and coagulation medicines (82%). Other medications were exclusively prescribed in brand names as antispasmodics, antidiarrheal, dermatology and vascular insufficiency medications. Only 38.75% were trained using INNs to designate medications, about half of physicians (48%) reported that they rarely use INNs in their practice. The most frequently listed reasons for not prescribing in INN prescribing perceived by physicians were physicians being not familiar with INN (79.0%), doubts about the efficacy, safety, or quality of generic drugs (52.0%) and absence of educational programs regarding INN use (47.0%). Conclusion and Relevance: The current study illustrates only half of the prescriptions are prescribed using INN. A multifaceted approach using explicit policy for obligating INN prescription, together with educational sessions for physicians about the value of INN prescription and the bioequivalence of generic medications to their brand counterparts.