title: General Practitioners' Prescribing Patterns at Primary Healthcare Centers in National Health Insurance, Gezira, Sudan.
abstract: BACKGROUND
  The appropriate use of medicines is essential for the provision of quality health services, patient safety, and the rational use of health resources. In Sudan, general practitioners (GPs) provide 80 % of insured patients' health services. Pharmaceutical service costs have been increasing since 2010.
  
  
  OBJECTIVE
  We aimed to use the World Health Organization (WHO) and International Network for the Rational Use of Drugs prescribing indicators to assess prescription quality among GPs in different types of primary healthcare centers (PHCCs) within the National Health Insurance Fund (NHIF) in Gezira State, Sudan.
  
  
  METHODS
  We followed established WHO guidelines to conduct a cross-sectional retrospective study. The study was carried out over 6 months and involved 197 GPs with valid prescriptions, representing 90 % of the total study population of 220 GPs. We collected a systematic random sample of 100 prescriptions for each GP and used Stata 12 to analyze the 19,700 prescriptions.
  
  
  RESULTS
  The mean ± standard deviation number of medications was 2.55 ± 1.32 per patient; 46.32 % of drugs prescribed were generics; 54.71 % of prescriptions were for antibiotics and 12.84 % were for injectable formulations; and 81.19 % of prescribed medicines were from the NHIF medicines list. The overall Index of Rational Drug Prescribing (IRDP) indicator was 3.39, and the average cost per prescription was 40.57 Sudanese pounds (SDG). Disregarding prescriptions for antibiotics, the prescribing quality of GPs in NHIF facilities was farther from optimal prescribing practice than those in State Ministry of Health-owned facilities and facilities owned by private groups, universities, and non-governmental organizations.
  
  
  CONCLUSIONS
  The present study provides strong evidence of irrational prescribing practice among GPs, with significant disparities, particularly in terms of antibiotic overuse, generic drug underuse, and adherence to the NHIF medicines list.
authors.affiliation: National Health Insurance Fund, Khartoum, Sudan.
authors.forename: Bashir Mohamed Elmahi
authors.initials: BM
authors.lastname: Yousif
authors.affiliation: Centre for Health Economics, Faculty of Economics, Chulalongkorn University, Phayathai Road, Bangkok, 10330, Thailand. siripen.s@chula.ac.th.
authors.forename: Siripen
authors.initials: S
authors.lastname: Supakankunti