Assessment of drug utilization evaluation and post-dispensing knowledge of ophthalmic medications: an explanatory sequential mixed-methods study at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Abstract

Background

Irrational prescription of medication is a common issue in clinical practice, particularly for eye disorders that can affect vision. This study aimed to assess the prescribing practices, drug utilization, and post-dispensing knowledge of ophthalmic medications at the University of Gondar Comprehensive and Specialized Hospital in Northwest Ethiopia.

Methods

An explanatory sequential mixed-methods study was conducted at the ophthalmology department of the University of Gondar Comprehensive Specialized Hospital from March 2024 to June 2024. Quantitative data were collected using an interviewer-administered structured questionnaire, and chart review was then entered into EpiData version 4.6 and analyzed using SPSS version 25. Descriptive statistics were computed and Binary logistic regression analyses identified factors influencing post-dispensing knowledge, with a significance level of p < 0.05 and results presented with 95% confidence intervals. Qualitative data were collected through in-depth interviews and analyzed thematically using OpenCode software version 4.2.

Results

Most respondents were elderly and male, with a higher prevalence of ocular diseases. Ophthalmic medications were predominantly solutions (53.2%), with antibacterial drugs (41.2%), especially Tetracycline, being the most common. Fixed-dose combination drugs were primarily steroid-antibiotic combinations. The average number of drugs per prescription was 1.43, with 90.37% of prescriptions being generic and 66.8% from the National Essential Drug List. Strength, dose, frequency, and duration were recorded in 68.3%, 31.5%, 92.4%, and 31.5% of the prescriptions, respectively. Post-dispensing knowledge was good in 38% of the patients, and 11.5% used medication in both eyes despite infection in only one. Patients with a diploma or higher education (AOR = 2.46, 95% CI 1.35, 4.46) were more likely to have better medication knowledge than those unable to read or write.

Conclusion

Most prescribing indicators were below the e World Health Organization’s recommended standards, except for the number of drugs per prescription and the dispensing time. In addition, most ophthalmic prescriptions lacked adequate and complete prescribing information, and most patients had insufficient post-dispensing knowledge. These findings highlight the urgent need to improve prescribing practices, enhance counseling, and implement targeted educational programs to ensure safer and more effective ophthalmic care.

Background

Irrational drug prescriptions remain a prevalent issue in clinical practice, particularly in developing countries where improper medication use poses a significant challenge to healthcare systems [1,2,3,4]. Globally, more than 50% of all medicines are prescribed, dispensed, or sold incorrectly, leading to substantial financial waste in the public and private sector [1, 5]. This inefficiency emphasizes the need for regular audits of drug utilization patterns to promote rational prescribing practices. Rational drug prescribing involves selecting an appropriate medication with the correct dosage, formulation, and duration, tailored to individual patient needs [6,7,8]. The complexity of ophthalmic treatments, in which even minor impairments can have substantial impacts on vision, underscores the critical importance of precision in prescribing [9]. To enhance therapeutic efficacy and patient safety, it is crucial to monitor prescribing practices regularly, ensuring that they align with evidence-based guidelines and address the specific needs of each patient [10,11,12].

The World Health Organization (WHO) and the International Network for Rational Use of Drugs (INRUD) have developed a set of standard drug use indicators to guide the assessment of prescribing practices [13]. These indicators allow for the evaluation of the quantity and qualities of medications prescribed and provide valuable insights into prescribing patterns and their consequences [14, 15]. In the context of ophthalmic care, improper prescription can result in adverse outcomes, ranging from temporary vision impairment to permanent blindness [16, 17]. In particular, the overuse of antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs) in ophthalmology is a growing concern, contributing to potential drug resistance and other ocular complications [18, 19]. NSAIDs can cause conjunctival hyperemia, stinging, corneal anesthesia, and severe complications like corneal ulcers and melts, while corticosteroids such as dexamethasone may elevate the intraocular pressure, thereby increasing the risk of glaucoma, even with short-term use [20,21,22,23]. Although topical ophthalmic medications are generally preferred for their localized effects and avoidance of systemic side effects, their irrational use can cause harm to the ocular surface, leading to structural changes in the conjunctiva and compromising overall eye health [24, 25]. Assessing post-dispensing knowledge among ophthalmic patients is crucial for improving medication adherence and therapeutic outcomes. However, studies, including those conducted in Ethiopia, highlight a knowledge gap often resulting from inadequate counseling and labeling, with individuals demonstrating poor knowledge of medication use [26, 27]. These shortcomings can hinder patients’ understanding of their prescribed medications, emphasizing the need for better education and clearer labeling to improve adherence and treatment success [27,28,29].

Studies indicate that ophthalmology practices often deviate from the WHO/INRUD guidelines on rational medication use, highlighting the need for focused research in this field [28, 30,31,32,33]. This study aimed to assess the prescribing and drug utilization practices for ophthalmic medications, along with the post-dispensing knowledge of ophthalmic patients, at the University of Gondar Comprehensive and Specialized Hospital (UoGCSH) in northwest Ethiopia. Although drug usage studies are common in many healthcare fields, there is a paucity of research focusing on ophthalmic prescriptions in this region. By evaluating prescription patterns using WHO/INRUD drug use indicators, this study aims to identify existing gaps in ophthalmic drug use, provide feedback to prescribers, and contribute to the development of guidelines that foster rational drug use. This research is particularly timely because it will inform local healthcare strategies for improving patient care and ensuring cost-effective treatments, ultimately contributing to the broader goal of reducing the burden of ocular diseases and vision impairment in Ethiopia.

Methods and materials

Study design and period

An explanatory sequential mixed-methods study was conducted in the Ophthalmology outpatient department of the University of Gondar Comprehensive and Specialized Hospital (UoGCSH), a tertiary care teaching hospital in Gondar City, from March 2024 to June 2024. The quantitative part of the study focused on assessing the prescription and drug utilization practices of ophthalmic medication, while the qualitative study was employed to gain a deeper understanding of the factors identified in the quantitative phase and explore the perspectives and experiences of patients regarding ophthalmic care, medication use, and their understanding of eye health.

Study setting

The study was conducted at the UoGCSH, located in Gondar town, approximately 738 km northwest of Addis Ababa and 180 km north of Bahir Dar, within the Central Gondar administrative zone of the Amhara Regional State, Ethiopia. Established in 1954, UoGCSH is a tertiary referral hospital with over 950 beds, providing specialized medical care to nearly five million residents in the North Gondar zone and neighboring areas.

Population

Source population

The source population consisted of patients attending the Ophthalmology outpatient department of UoGCSH.

Study population

The study included adult ophthalmic patients with completed prescriptions who consented to participate during the data collection period. The exclusion criteria were emergency patients, those unable to communicate, and individuals with severe illnesses.

Sample size determination

Sample sizes were calculated using a single population proportion formula by considering the response distribution, P = 0.5 (50%), and at a 95% confidence interval, the marginal error was 5% for the two-tailed type-I error (Zα = 1.96). The sample size was 385. Finally, considering the potentia 10% nonresponse to the interview and/or missing or lost data on the patient’s medical record, 423 patients were approached in the final study [34].

Sampling procedure

A systematic random sampling method was used to select the participants. Approximately 1496 patients receive service in the outpatient department each month [35]. The patient’s follow-up registration book was used as a sampling frame. Among these patients, the sampling fraction, K, was calculated using the total number of patients in three months = 4488 (so K = 4488/423 ~ 11). The first patient was selected using the lottery method and the next patient was selected at 11 intervals on each day within the study period.

Data collection tool and procedure

Data were collected through face-to-face interviews using a pretested, structured questionnaire, supplemented by data abstraction from patient records and prescriptions [26, 27, 36]. The questionnaire, developed in English and then translated into Amharic and back into English by language experts for accuracy, was pretested with 5% of the sample at Felege Hiwot Referral Hospital, leading to necessary revisions. Five trained optometrists conducted the interviews, and the data collectors and supervisors received three days of training. Daily checks ensure data completeness, accuracy, and clarity.

The study collected sociodemographic data, prescription details, and ophthalmic medication types. The prescribing patterns were analyzed using WHO indicators, (Supplementary file 3) including the average number of drugs prescribed per prescription, percentage of generic drugs prescribed, and antibiotic use. The dependent variable was post-dispensing knowledge, which assessed the effectiveness of the dispensing process [27, 28]. While there is a considerable amount of research on Knowledge, Attitudes, and Practices (KAP), there is a limited body of data specifically focused on the tool we used to measure post-dispensing knowledge in this study area. To address this gap, we referenced previous studies that employed the same tool to measure outcomes. We then used their classification methods as a guide to assess and categorize post-dispensing knowledge in our study, ensuring consistency and validity in our approach (Supplementary file 2). The Independent variables included sociodemographic characteristics, eye problems and medication use history, drug prescription information, and prescriber information.

For the qualitative component of the study, key informants were identified, and informed consent was obtained before their participation. The study explored barriers to effective ophthalmic care and medication understanding, with themes focusing on patients’ lack of awareness and education about medications, age-related concerns about eye health, and trust in simplified prescriptions. Additional sub-themes included perceptions of affordability and trust in generic medications, overuse of antibiotics, confusion over prescription instructions and, lack of confidence in treatment plans. Furthermore, challenges in post-dispensing knowledge and literacy-related issues hindered patients’ understanding and proper use of medications. The principal investigator conducted face-to-face interviews using a semi-structured interview guide questionnaire (Supplementary file 1). Each interview lasted approximately 35 min. To ensure accuracy, all interviews were audio-recorded and transcribed verbatim. The key informants included ophthalmologists, optometrists, medical doctors, pharmacists, and patients, who were chosen for their relevant roles and insights into the study context. The semi-structured interview guide was designed to gather detailed responses through probing questions tailored to the participants’ areas of expertise. Separate questionnaires were used to collect comparable position-specific information from each group of informants. This approach ensured a nuanced understanding of the reasons influencing unused medicines, providing complementary qualitative data to enrich the quantitative findings.

Operational definitions

Good post-dispensing knowledge

In this study, this refers to respondents scoring below the mean on questions assessing their understanding of medication frequency, dose, administration, and how to administer the medication.

The scoring system is based on a binary classification, with “Yes” scored as 1 and “No” as 2. The total score ranges from 9 to 18. A score equal to or below the mean indicates good knowledge, while scores above the mean suggest poorer knowledge.

Percentage of drugs prescribed by generic name

This was computed by dividing the number of drugs prescribed by generic name by the total number of drugs prescribed, multiplied by 100.

Percentage of drugs prescribed from an essential drug list

This was computed by dividing the numbers of drugs prescribed that are in the essential drug list by the total number of drugs prescribed, multiplied by 100.

Average consultation time

This was computed by dividing the total time for consecutive consultations in minutes by the number of consultations.

Average dispensing time

This was computed by dividing the total time for dispensing medicines to a sequence of patients in seconds by the number of encounters.

Data analysis

The data were thoroughly checked, coded, and cleaned for inconsistencies and missing values before being entered into EpiData version 4.6.0.0. After processing, the data were exported to SPSS version 25 for analysis. The WHO drug use indicators, including the mean number of drugs per encounter, the percentage of drugs prescribed by generic name, the percentage of encounters with antibiotics prescribed, and the percentage of drugs prescribed from the national essential drug list, were analyzed, along with the dispensing time and counseling time. Descriptive statistics (mean, frequency, proportion, 95% confidence interval, and standard deviation) were used to summarize the data. Bivariate and multivariate logistic regression analyses were performed to identify the independent variables associated with the dependent variable. The independent variables included sociodemographic characteristics, eye problems and medication use history, drug prescription information, and prescriber information. Independent variables with a p-value < 0.2 in the bivariate analysis were included in the multivariate model. The Hosmer-Lemeshow goodness-of-fit test (p = 0.815) confirmed the model’s adequacy. Statistical significance was set at a p-value < 0.05.

For qualitative analyses, the first step involved the transcription of the recorded interviews verbatim. The transcripts were then translated into English for further analysis. After the translation was completed, four investigators (AFB, TTA, GWG, AK, and SAW) independently developed initial codes based on the qualitative data. In cases where there were uncertainties or doubts regarding the coding, five additional authors (ATG, HSA, DG, and ATB) were involved in the decision-making process. Any disagreements in the coding were resolved through discussion before the final analysis commenced. To ensure the accuracy and completeness of the qualitative findings, the research team conducted a thorough verification process. This involved reviewing the participants’ responses in detail and familiarizing themselves with the data, making careful notes where necessary to ensure a comprehensive understanding of the findings. The translated data were analyzed thematically using the OpenCode software version 4.2 or handled manually. The initial codes were developed based on the original terms and concepts identified during the transcription and translation process. These codes were subsequently reviewed, discussed, and validated by the research team to ensure consistency and reliability. From the open codes, sub-themes were generated to organize the data into meaningful categories. The main themes then emerged through an iterative process of identifying patterns and relationships between the subthemes.

Results

A total of 423 participants were approached for the study, with 410 consenting to participate, yielding a response rate of 96.9%. The majority of visitors to the ophthalmic outpatient department were male, accounting for 243 (59.7%), and most participants, 244 (59.5%), resided in urban areas (Table 1).

Table 1 Sociodemographic characteristics of the respondents at the University of Gondar Comprehensive and Specialized Hospital, Ethiopia, 2025 (n = 410)

Eye problems and medication use history of respondents

Of the patients with eye problems and a history of medication use, 182 (44.4%) reported experiencing eye issues, and 102 (24.9%) were using anti-allergy medications. Furthermore, 41.3% of the ophthalmic prescriptions included antibiotics, whereas 66.8% of the prescribed drugs were sourced from the Ethiopian National List of Medicines (ENLM), and 5% of the prescriptions were in the form of injections. Additionally, 47 (11.5%) patients used medications for both eyes, even if only one eye was affected (Table 2).

Table 2 Eye problems and medication use history of respondents at the University of Gondar Comprehensive and Specialized Hospital, Ethiopia, 2025 (n = 410)

Respondents’ drug prescription information

Of the 410 prescriptions, 9 (2.2%) had recorded diagnoses, 282 (68.3%) included strength, and 129 (31.5%) specified the duration. The mean (± SD) number of drugs per prescription was 1.43 (0.694), with a minimum of 1 and a maximum of 5 drugs. Among the fixed-dose combination (FDC) drugs, Zoxan D was the most commonly prescribed drug, accounting for 15 prescriptions (3.7%). In terms of pharmacist dispensing practices, 260 prescriptions (63.4%) were dispensed within 1 to 2 min. Additionally, approximately 90.37% of the drugs were prescribed by their generic names (Table 3).

Table 3 Drug prescription information of respondents at the University of Gondar Comprehensive and Specialized Hospital, Ethiopia, 2025 (n = 410)

Respondent’s prescriber information

Out of the total 410 prescriptions, 89.5% included the prescriber’s name, 91% contained their signature, and 90% had the date. Additionally, 20% of the prescriptions were issued by nurses (Table 4).

Table 4 Prescriber information of respondent’s prescriptions at the University of Gondar Comprehensive and Specialized Hospital, Ethiopia, 2025 (n = 410)

Post-dispensing knowledge of the respondents

Among the study respondents, 260 (63.4%) were aware of the treatment and pain relievers, while 155 (37.8%) knew the storage locations (Table 5). The post-dispensing assessment showed that 38.3% had good knowledge and 61.7% had poor knowledge (Fig. 1). In the prescription ophthalmic department, 270 (53%) were in solution form, and 126 (27%) were ointments (Fig. 2). Additionally, 41.2% of the prescriptions were antibiotics, while 21.7% were anti-glaucoma medications (Fig. 3).

Table 5 Post-dispensing knowledge of respondent at the University of Gondar Comprehensive and Specialized Hospital, Ethiopia, 2025 (n= 410)

Fig. 1

Post-dispensing knowledge of respondents at University of Gondar Comprehensive and Specialized Hospital, Ethiopia, 2025 (n = 410)

Fig. 2

Percentage of dosage forms of prescription in the ophthalmic department at the University of Gondar Comprehensive and Specialized Hospital, Ethiopia, 2025 (n = 410)

Fig. 3

Percentage of class of drug prescribed in the ophthalmic department at the University of Gondar Comprehensive and Specialized Hospital, Ethiopia, 2025 (n = 410)

Factors associated with respondents’ post- dispensing knowledge

In the binary logistic regression model, age, sex, and educational status of the respondents were significantly associated with post-dispensing knowledge. The multivariate logistic regression analysis revealed that respondents with a diploma or higher education (AOR = 2.46, 95% CI 1.35, 4.46) were more likely to have better knowledge than those who were unable to read and write (Table 6).

Table 6 Bivariate and multivariate logistic regression analysis of factors associated with post dispensing knowledge of respondents at University of Gondar Comprehensive and Specialized Hospital, Ethiopia, 2025 (n = 410)

Qualitative results

The investigator interviewed 10 key informants, including ophthalmologists, optometrists, medical doctors, pharmacists, and patients. The thematic analysis resulted in ten subthemes, which were grouped into one key theme. The theme was about challenges. Qualitative responses from the respondents provide valuable insights into the challenges they face regarding ophthalmic care, medication use, and their understanding of eye health. These responses reflect the lived experiences of individuals in a developing country with limited access to information about their medical conditions and treatment options. Through these responses, we can gain a deeper understanding of the barriers that hinder optimal medication use and the need for improved patient education and counseling.

Barriers to effective ophthalmic care and medication Understanding

Theme 1: lack of awareness and education

Most participants don’t know how much difference there is between the generic and brand-name products. Many people were not aware of the benefits of the generic option and asked to explain it to them. Many were told to trust their healthcare provider’s recommendations. But they had not reviewed the medications they had been prescribed, they said. This is what the experts have to say:

“I don’t know much about the difference between brand-name and generic medicines. The doctor always gives me the medication, and I take it without asking too many questions. Sometimes I wonder if the cheaper generics work as well, but I’m never really given an explained that.” (Female, 45 years old, Teacher)

Theme 2: age-related concerns and the perception of eye health

Many respondents indicated that eye health problems were related to their natural aging process, i.e., those related to issues commonly associated with older age, such as cataracts. Many participants expressed a concern for their eyesight to be at a lower level of health, especially for eye conditions related to aging, and they were concerned about incurring surgery in the future. One participant responded:

“I have been struggling with my vision for some time now, especially in the bright sunlight. I think it’s because of my age. In our community, many older men have similar problems with their eyes, like cataracts. I worry that soon I might have to go undergo surgery, too.“ (Male, 70 years old, Farmer)

Theme 3: trust in simplified prescriptions

Many of the participants preferred to receive lower doses of medicines through a simplified prescription because they were less likely to run into problems with their medications and it was cheaper. It also established increased trust in their physicians; it was easier and less confusing to manage, one participant shared:

“When I go to the pharmacy, the doctor usually gives me just one or two medications. I find it easier to manage, and it’s not too expensive for me to buy. I feel like I can trust the doctor more when they give me fewer medicines because it feels more manageable.” (Male, 60 years old, Shopkeeper)

Theme 4: perceived affordability and trust in generic medications

The participants usually noted that generic drugs were cheaper and that they thought they had the same health benefits as their brand-name counterparts. Also being reassured by pharmacists was an important factor in forming trust, one respondent explained.

“When I go to the pharmacy, the doctor always writes the generic name on the prescription. I can usually buy the medicine at a much lower price than if it were a brand name. The pharmacist always explained it to me, and I trust that it will work the same.” (Female, 45 years old, Teacher)

Theme 5: antibiotic overuse and lack of understanding

Respondents expressed concern over the use of antibiotics, particularly for conditions related to the eyes. There was a general lack of understanding about when antibiotics are necessary, and some speakers admitted that they chose to take antibiotics because their health care providers recommended it. Best described by the following excerpts:

“When I go to the doctor for eye problems, they always give me antibiotics. I don’t know if I always need them, but I take them because the doctor says so.” (Male, 58 years old, Healthcare Provider)

Theme 6: confusion over the prescription instructions

A recurring challenge faced by healthcare providers is the lack of clear instructions regarding the duration of medications, leading to confusion about treatment plans. In some cases, unclear or incomplete prescription details make it difficult for providers to make well-informed decisions about a patient’s care. As one healthcare provider noted:

“Sometimes, I get confused about how long a patient should continue their medication, but we don’t always get clear instructions in the prescription. It’s difficult to make decisions without knowing the full treatment plan.“ (Male, 45 years old, Healthcare Provider)

Theme 7: lack of confidence in the treatment plans

Lack of confidence in treatment plans can be associated with incomplete or unclear information, which can reduce the trust between the healthcare provider and the patient.

“Without the details, it’s hard difficult be confident that the treatment plan is clear and safe for the patient.“(Male, 38 years old, Healthcare Provider)

Theme 8:- patient misuse due to misunderstanding

Misuse of medication by patients can also result from misunderstandings, where patients use habitual or preconceptional behavior instead of being told what to do, with unintended consequences for that behavior. Here is what experts have to explain concerning misuse of medication:

“Some patients use the medication in both eyes out of habit or fear of spreading the infection, despite being instructed otherwise.“(Male, 43 years old, Healthcare Provider)

Theme 9: challenges in post-dispensing knowledge

Post-dispensing challenges arise when patients receive medication quickly but lack clear instructions on how to use it properly. As one student noted,

“I was given the medication quickly, but I didn’t really understand how to use it properly.“ (Female, 20 years old, Student)

Theme 10: literacy-related challenges in understanding medication instructions

“Patients with lower literacy often struggle to understand the instructions, and there is not enough time to explain everything thoroughly” (Healthcare Provider)

Patients with lower literacy levels often face difficulties in understanding medication instructions, leading to confusion and potential misuse. As one healthcare provider explains, “Patients with lower literacy often struggle to understand the instructions, and there’s not enough time to explain everything thoroughly.”

On the other hand, patients with higher education tend to ask more informed questions, which aid their understanding.

“Higher-educated patients can ask more informed questions, which helps them understand better”  (Healthcare Provider)

Discussion

Medications are crucial for enhancing human health and well-being. However, to achieve optimal outcomes, it must be used safely, effectively, and rationally, by the WHO’s recommended core drug use indicators [4, 37].

The WHO recommends that the number of drugs prescribed per prescription should be no greater than two to minimize the risk of drug-drug interactions, reduce treatment costs, and improve patient adherence [38]. In this study, the average number of drugs prescribed per prescription was 1.43, which is consistence with WHO guidelines and is lower than the findings from Dhaka [36], in which the average was 2.68. The result is also consistent with local studies, such as one by Boru Meda, which recorded an average of 2.2 drugs per prescription [26]. A lower number of medications are particularly important in resource-limited settings, where simplifying prescriptions enhances patient comprehension, reduces medication errors, and ensures more rational use of medicines, ultimately improving healthcare outcomes [39, 40]. The qualitative finding supports this result, and the KI stated: When I go to the pharmacy, the doctor usually gives me just one or two medications. I find it easier to manage, and it’s not too expensive for me to buy. I feel like I can trust the doctor more when they give me fewer medicines because it feels more manageable. World Health Organization (WHO) also recommends prescribing medications by generic names because this practice reduces treatment costs, minimizes errors, and prevents confusion from similarly named brand drugs [7, 41]. In this study, 90.3% of ophthalmic prescriptions were written using generic names, which is consistent with findings from Boru Meda (89%) [26] and higher than the rates in Dhaka (0.97%) [36] and Gondar (86.5%) [27]. Prescribing generic drugs not only ensures affordability for patients, particularly in resource-limited settings, and enhances patient safety by reducing the risk of medication errors [42].

The high prevalence of antibiotics in ophthalmic prescriptions, as observed in this study (41.3%), is concerning, as it significantly exceeds the World Health Organization’s (WHO) recommended range of 20–26.8% of prescriptions [43]. The excessive use of antibiotics in this study is consistent with findings from Dhaka (42.4%) [36] but higher than those from Borumeda (32.7%) [26] and lower than studies in Jimma (59.7%) [1] and Gondar (67.3%) [27]. The over prescription of antibiotics, especially in ocular conditions, raises critical concerns about the potential for developing antibiotic resistance, which can undermine the effectiveness of future treatments and lead to more severe, difficult-to-treat infections [44].

Our study found that only 9 out of the total prescriptions included a diagnosis, with 97.8% lacking this information, which is an improvement over studies from Gondar (99.7%) [27] and Borumeda (99.8%) [26], where similar high proportions of prescriptions lacked diagnostic details. However, this result is still a concerning result compared to Dhaka [36], where 21.17% of prescriptions lacked a diagnosis. Including diagnoses on prescriptions is essential for ensuring that pharmacists can actively engage in addressing pharmaceutical and therapeutic issues, ultimately enhancing pharmaceutical care and improving therapeutic outcomes [9]. In this study, the dose and frequency of drug administration were recorded in 31.5% and 92.4% of the prescriptions, respectively, whereas the duration of therapy was noted in only 31.5% of the cases, revealing a significant gap in prescription quality. The absence of therapy duration in 68.7% of prescriptions may compromise patient safety and therapeutic effectiveness. A complete prescription, including the patient’s name, age, sex, diagnosis, rational drug treatment with a minimal number of drugs, appropriate dosage form, frequency of administration, and therapy duration is crucial for ensuring safe and effective treatment, as it reduces the risk of errors and improves patient outcomes [45, 46].

The WHO recommends that prescription information should be 100% complete to ensure safe and effective treatment [46]. However, our study found that only 89.5%, 91%, 64.6%, and 90% of the prescriptions included the name, signature, qualification, and date of the prescriber, respectively. While this is lower than the results from Dhaka [36], it shows relatively better adherence compared to other studies in Ethiopia [26, 27]. These findings highlight a significant gap in prescription completeness because essential elements such as diagnosis and therapy duration were often missing. As one healthcare provider noted, without all the details, it’s hard to be confident that the treatment plan is clear and safe for the patient.

The findings reveal a significant association between post-dispensing knowledge and the educational status of patients. Those with a diploma or higher education were 2.46 times more knowledgeable about their ophthalmic medications than illiterate patients. This disparity can be attributed to the lack of dedicated counseling spaces and the limited time allocated for counseling, particularly for patients with lower literacy levels. In a resource-limited setting like Ethiopia, where healthcare resources are constrained, these factors hinder effective patient education. As a key informant noted, Patients with lower literacy often struggle to understand the instructions, and there’s not enough time to explain everything thoroughly, while another mentioned that Higher-educated patients can ask more informed questions, which helps them understand better. This underscores the need for targeted interventions to enhance counseling for illiterate patients and allocate more time for patient education, ensuring equitable access to healthcare information and better treatment outcomes.

This study highlights key challenges in the management of ophthalmic medication in resource-limited settings like Ethiopia. Although the average number of drugs prescribed per prescription aligns with the WHO guidelines, significant gaps in prescription completeness, such as missing diagnoses and therapy durations, could compromise patient safety. Additionally, the brief counseling times, which are far below the WHO recommendations, limit patient understanding, particularly among those with lower educational levels. Qualitative data showed that patients with higher education levels were better able to comprehend their ophthalmic medications, emphasizing the need for tailored counseling. The overuse of antibiotics and improper self-medication further underscore the need for improved prescribing practices and patient education. These findings emphasize the need for improved prescription quality, counseling, and adherence to national guidelines to ensure effective treatment and reduce medication-related risks in ophthalmic care. Healthcare services should focus on promoting the rational use of medicines through the development of effective intervention strategies. Regular training for health professionals on rational medicine use is essential, and key medicines should be consistently available in stock year-round. In addition, continuous monitoring and assessment should be conducted to identify gaps and take appropriate actions.

Limitations

The study had a few limitations. It was a single-center design, which limits the generalizability of the findings. The analysis excluded pediatric patients or inpatient data, and prescription rationality was not assessed. Additionally, the study’s short duration restricted its ability to capture seasonal prescribing variations. Furthermore, no specific theoretical framework was used to conduct the thematic analysis, which could be considered a limitation. Despite these limitations, the study provides baseline data for future comparisons with similar studies at the state and national levels.

Conclusions

This study found that most prescribing practices did not meet the WHO/INRUD standards, particularly in prescribing completeness and patient education. Antibiotic use, generic drug prescriptions, and adherence to the National Drug List were below recommendations. Although the number of drugs per prescription and dispensing time followed the guidelines, antibiotic overuse and incomplete prescriptions were common. Patient knowledge of their medications was low, with fewer than half demonstrating a good understanding, especially among those with lower educational levels. These findings highlight the need to improve prescribing, counseling, and educational programs to enhance patient understanding, adherence, and ophthalmic care quality.

Recommendation

Healthcare services should focus on promoting the rational use of medicines through the development of effective intervention strategies. Regular training for health professionals on rational medicine use is essential, and key medicines should be consistently available in stock year-round. In addition, continuous monitoring and assessment should be conducted to identify gaps and take appropriate actions.