RATIONALE USE OF MEDICINES IN OUTPATIENT PRACTICE IN KAZAKHSTAN: ASSESSMENT OF WORLD HEALTH ORGANIZATION INDICATORS

Abstract

Introduction: Rational use of medicines (RUM) is the cornerstone of safe, effective, and affordable outpatient care. We assessed how practices in Shymkent polyclinics align with WHO indicators. Objective: To evaluate WHO indicators for prescribing and patient care in the outpatient setting and to identify variability requiring targeted improvements. Materials and methods: A cross-sectional study based on WHO methodology (December 2024–April 2025) was conducted in 13 polyclinics. A total of 390 outpatient visits of patients were analyzed for patient-care indicators and 1300 prescriptions for prescribing indicators. Descriptive statistics, Welch’s ANOVA, and permutation χ²-tests were applied. Composite performance indices were constructed for benchmarking. Results: The mean consultation duration was 13.5±6.2 minutes (range 3–35 across centers; p<0.001). Dispensing time averaged 205±139 seconds (45–960; p<0.001). On average, 94.4% of prescribed medicines were dispensed; 86.4% of patients correctly knew their dosages, both showing significant inter-center variation. An average of 1.8±0.9 medicines was prescribed per visit; 100% by INN and from the EML. Antibiotics were prescribed in 3.4% of visits (0–8% across centers; p=0.01). Injections were used in 24.5% of visits (low variability; p=0.992). Composite indices identified center 9 as bestperforming in patient care and center 7 in prescribing; centers 2, 6, and 13 consistently lagged (e.g., in center 6 only 77% of medicines were dispensed, and dosage knowledge reached just 60%). Conclusions: Outpatient care in Shymkent demonstrates strengths - low polypharmacy, universal INN prescribing, alignment with essential medicines, and relatively low antibiotic use. However, key challenges remain: wide variability in consultation and dispensing times, insufficient patient counseling, stock-outs of medicines in some centers, and persistently high injection prescribing. Priority measures: Standardization of consultation and dispensing processes, reduction of unnecessary injections through clinical protocols and provider training, strengthening of pharmaceutical counseling and patient education, and ensuring equitable medicine availability - especially in underperforming centers.