Factors Affecting Family Physicians’ Drug Prescribing: A Cross-Sectional Study in Khuzestan, Iran

Document Type : Original Article


1 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

3 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran


Rational prescription is a considerable issue which must be paid more attention to assess the behavior of prescribers. The aim of this study was to examine factors affecting family physicians’ drug prescribing.
We carried out a retrospective cross-sectional study in Khuzestan province, Iran in 2011. Nine hundred eighty-six prescriptions of 421 family physicians (including 324 urban and 97 rural family physicians) were selected randomly. A multivariate Poisson regression was used to investigate potential determinants of the number of prescribed drug per patient.
The mean of medication per patient was 2.6 ± 1.2 items. In the majority (91.9%) of visits a drugs was prescribed. The most frequent dosage forms were tablets, syrups and injection in 30.1%, 26.9%, and 18.7% of cases respectively. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and antibiotics were 29.7% and 17.1% of prescribed drugs respectively. The tablets were the most frequent dosage forms (38.6% of cases) in adult’s patients and syrups were the most frequent dosage forms (49% of cases) in less than 18 years old. Paracetamols were popular form of NSAIDs in two patients groups. The most common prescribed medications were oral form.
In Khuzestan, the mean of medication per patient was fewer than national average. Approximately, pattern of prescribed drug by family physicians (including dosage form and type of drugs) was similar to other provinces of Iran.


Main Subjects

  1. Cheraghali AM, Nikfar S, Behmanesh Y, Rahimi V, Habibipour F, Tirdad R, et al. Valuation of availability, accessibility and prescribing pattern of medicines in the Islamic Republic of Iran. East Mediterr Health J 2004; 10: 406-15.
  2. Takian A, Doshmangir L, Rashidian A. Implementing family physician programme in rural Iran: exploring the role of an existing primary health care network. Fam Pract 2013; 30: 551-9. doi: 10.1093/fampra/cmt025
  3. Khayati F, Motlagh MA, Kabir MJ, Kazemeini H, Gharibi F, Jafari N. The role of family physician in case finding, referral, and insurance coverage in the rural areas. Iran J Public Health 2011; 40: 136-9.
  4. Agenda of rural health insurance and Family physician plan in rural. Ministry of health, Islamic Republic of Iran, version 7.3; Cited 2005.
  5. Agenda of Family physician programme and referral system in urban. Ministry of health, Islamic Republic of Iran, version 02. Cited 2012.
  6. Stein FS. Family Medicine’s Identity: Being Generalists in a Specialist Culture? Ann Fam Med 2006; 4: 455-9.
  7. Rosser W. Sustaining the 4 principles of family medicine in Canada. Can Fam Physician 2006; 52: 1191-2.
  8. Forrest CB. Primary care gatekeeping and referrals: effective filter or failed experiment? BMJ 2003; 326: 690-5. doi: 10.1136/bmj.326.7391.692
  9. Jaruseviciena J, Levasseu G. The appropriateness of gatekeeping in the provision of reproductive health care for adolescents in Lithuania: the general practice perspective. BMC Fam Pract 2006; 7 16.  doi: 10.1186/1471-2296-7-16
  10. Soleymani F, Valadkhani M, Dinarvand R. Challenges and achievements of promoting rational use of drugs in Iran. Iran J Public Health 2009; 38: 166-8.
  11. World Health Organization (WHO). The selection and use of essential drugs: report of a WHO expert committee. WHO Technical Report Series No. 914. Geneva: WHO; 2003. 
  1. World Health organization (WHO). The rational use of drugs, Report of the Conference of Experts Nairobi, 25- 29 November 1985. Geneva: WHO; 1987.
  2. Prosser H, Walley T.  A qualitative study of GPs’and PCO stakeholders’views on the importance and influence of cost on prescribing. Soc Sci Med 2005; 60: 1335-46.
  3. Crigger N, Holcomb L. Improving Nurse Practitioner Practice through Rational Prescribing. J Nurse Pract 2008; 4: 120-5. doi: 10.1016/j.nurpra.2007.12.004
  4. Farrell VM, Hill VL, Hawkins JB, Newman LM, Learned RE Jr. Clinic for identifying and addressing polypharmacy. Am J Health Syst Pharm 2003; 60: 1830.
  5. Choonara L. Rational prescribing is important in all settings. Arch Dis Child 2013; 98: 720.  doi: 10.1136/archdischild-2013-304559
  6. Afifi AA, Kotlerman JB, Ettner SL, Cowan M. Methods for Improving Regression Analysis for Skewed Continuous or Counted Responses. Annu Rew Public Health 2007; 28: 95-111. doi: 10.1146/annurev.publhealth.28.082206.094100
  7. Famoye F, Wulu JT, Singh KP. On the Generalized Poisson Regression Model with an Application to Accident Data. J Data Sci 2004; 2: 287-95. 
  1. Neyaz Y, Qureshi NA, Khoja T & et al.  Physicians’ medication prescribing in primary care in Riyadh city, Saudi Arabia. Literature review, part 1: variations in drug prescribing. East Mediterr Health J 2011; 17: 126-31.
  2. de Bakker DH, Coffie DS, Heerdink ER, van Dijk L, Groenewegen PP. Determinants of the range of drugs prescribed in general practice: a cross-sectional analysis. BMC Health Serv Res 2007; 7: 132. doi: 10.1186/1472-6963-7-132
  3. Muijrers PE, Grol RP, Sijbrandij J, Janknegt R, Knottnerus JA. Differences in prescribing between GPs. Impact of the cooperation with pharmacists and impact of visits from pharmaceutical industry representatives. Fam Pract 2005; 22: 624-30. doi: 10.1093/fampra/cmi074
  4. Enwere OO, Falade CO, Salako BL. Drug prescribing pattern at the medical outpatient clinic of a tertiary hospital in southwestern Nigeria.  Pharmacoepidemiol Drug Saf 2007; 16: 1244-9.
  5. Auditor General for Scotland. Prescribing in general practice in Scotland. 2013. Available from: http://www.audit-scotland.gov.uk/docs/health/2013/nr_130124_gp_prescribing.pdf
  6. Buusman A, Andersen M, Merrild C, Elverdam B. Factors influencing GPs’ choice between drugs in a therapeutic drug group. A qualitative study. Scand J Prim Health Care 2007; 25: 208-13.
  7. Shayan Z, Shayan F. [Pattern of drug prescription in clinical wards of Motahari and Peymanieh hospital in Jahrom]. Medical Journal of Jahrom University of Medical Sciences 2006; 5: 44-50. [In Persian]
  8. Shamsi MM, Sepehri G, Farrokhi Noori MR, Mohsenbeighi M, Motevallizadeh HR. [Pattern of drug use among residents of Bam during the first 6 months after the 2003 earthquake]. Hakim Medical Journal 2008; 10: 27-33. [In Persian]
  9. Dinarvand R, Nikzad  A. [Condition of prescription and drug use in Tehran in 1998]. Hakim Medical Journal 2000; 3: 223-30. [In Persian]
  10. Alikhani A, Shahamat M, Ghafarian SH. [Survey on antibiotic prescription for under 14 year old outpatients children in general practitioner prescription in Yasuj]. Journal of Yasuj University of Medical Sciences 2006; 10: 91-83. [In Persian]
  11. Zareshahi R, Haghdoost AA, Asadipour A, Sadeghirad B. [Rational Usage of Drug Indices in the Prescriptions of Kerman Medical Practitioners in 2008]. Journal of  Rafsanjan University of Medical Sciences 2012; 11: 523-36. [In Persian]
  12. Mosleh A, Darbooy SH, Khoshnevis A, Mohammadi M. [Drug prescription based on WHO indicators: Tehran University of medical Sciences facilities with pharmacy]. Tehran University Medical Journal 2007; 65: 12-5. [In Persian]
  13. Ahmad Raza U , Khursheed T, Irfan M, Abbas M, Irfan UM.  Prescription patterns of general practitioners in Peshawar, Pakistan. Pak J Med Sci 2014; 30: 1-15
  14. Rahman M, Huq M, Rahman A. Study on the pattern of prescriptions available at rural households in Bangladesh. South East Asia Journal of Public Health 2011; 1: 12-6.
  15. Wang H, Li N, Zhu H, Xu S, Lu H, Feng Z. Prescription Pattern and Its Influencing Factors in Chinese County Hospitals: A Retrospective Cross- Sectional Study. PLoS One 2013; 8: e63225. doi: 10.1371/journal.pone.0063225
  16. Viktil KK, Blix HS, Moger TA, Reikvam A. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol 2006; 63: 187-95. doi: 10.1111/j.1365-2125.2006.02744.x
  17. Brager R, Sloand E. The Spectrum of Polypharmacy. Nurse Pract 2005; 30: 44-50.
  18. Sino CG, Sietzema M, Egberts TC, Schuurmans MJ. Medication management capacity in relation to cognition and self-management skills in older people on polypharmacy. J Nutr Health Aging 2014; 18: 44-9. doi: 10.1007/s12603-013-0359-2
  19. Payne RA, Abel GA, Avery AJ, Mercer SW, Roland MO. Is polypharmacy always hazardous? A retrospective cohort analysis using linked electronic health records from primary and secondary care. Br J Clin Pharmacol 2014; 77: 1073-82. doi: 10.1111/bcp.12292
  20. Zarowitz BJ, Stebelsky LA, Muma BK, Romain TM, Peterson EL. Reduction of high-risk polypharmacy drug combinations in patients in a managed care setting. Pharmacotherapy 2005; 25: 1636-45.
  21. Bjerrum L, Rosholm JU, Hallas J, Kragstrup J. Methods for estimating the occurrence of polypharmacy by means of a prescription database. Eur J Clin Pharmacol 1997; 53: 7-11.
  22. Kumari KI, Chandy SJ, Jeyaseelan L, Kumar R, Suresh S. Antimicrobial prescription patterns for common acute infections in some rural & urban health facilities of India. Indian J Med Res 2008; 128: 165-71.
  23. Karande S, Sankhe P, Kulkarni M. Patterns of prescription and drug dispensing. Indian J Pediatr 2005; 72: 117-21.
  24. Choi KH, Park SM, Lee JH, Kwon S. Factors Affecting the Prescribing Patterns of Antibiotics and Injections. J Korean Med Sci 2012; 27: 120-7. doi: 10.3346/jkms.2012.27.2.120
  25. Magzoub MA, Neyaz Y, Khoja T, Qureshi NA, Haycox A, Walley T. Determinants of physicians’ medication prescribing behavior in primary care in Riyadh city, Saudi Arabia. East Mediterr Health J 2011; 17: 160-6.