European Journal of Clinical Pharmacology

, Volume 67, Issue 10, pp 1035–1044 | Cite as

Use of ATC to describe duplicate medications in primary care prescriptions

  • Chiao Mei LimEmail author
  • Faridah Aryani Md Yusof
  • Sharmini Selvarajah
  • Teck Onn Lim
Pharmacoepidemiology and Prescription



We aimed to demonstrate the suitability of the Anatomical Therapeutic Chemical Classification (ATC) to describe duplicate drugs and duplicate drug classes in prescription data and describe the pattern of duplicates from public and private primary care clinics of Kuala Lumpur, Malaysia.


We analyzed prescription data year 2005 from all 14 public clinics in Kuala Lumpur with 12,157 prescriptions, and a sample of 188 private clinics with 25,612 prescriptions. As ATC Level 5 code represents the molecule and Level 4 represents the pharmacological subgroup, we used repetitions of codes in the same prescription to describe duplicate drugs or duplicate drug classes and compared them between the public and private clinics.


At Level 4 ATC, prescriptions with duplicates drug classes were 1.46% of all prescriptions in private and 0.04% in public clinics. At Level 5 ATC, prescriptions with duplicate drugs were 1.81% for private and 0.95% for public clinics. In private clinics at Level 5, 73.3% of prescriptions with duplicates involved systemic combination drugs; at Level 4, 40.3% involved systemic combination drugs. In the public sector at Level 5, 95.7% of prescriptions with duplicates involved topical products.


Repetitions of the same ATC codes were mostly useful to describe duplicate medications; however, we recommend avoid using ATC codes for tropical products for this purpose due to ambiguity. Combination products were often involved in duplicate prescribing; redesign of these products might improve prescribing quality. Duplicates occurred more often in private clinics than public clinics in Malaysia


Duplicate prescribing Duplicate drugs ATC Combination drugs 



We thank the Director General of Health for permission to publish findings of this study and thank all doctors and pharmacists who participated in the NMUS.

Conflict of interest

This research was conducted by data from National Medicines Use Survey (NMUS). NMUS was sponsored by a grant from Ministry of Health (MRG Grant Number 00311). The authors of this paper work in the Ministry of Health, Malaysia. Pharmaceutical Services Division manages pharmacists and the drug formulary of Ministry of Health.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Chiao Mei Lim
    • 1
    Email author
  • Faridah Aryani Md Yusof
    • 2
  • Sharmini Selvarajah
    • 1
  • Teck Onn Lim
    • 1
  1. 1.Clinical Research CentreMinistry of Health MalaysiaKuala LumpurMalaysia
  2. 2.Pharmaceutical Services DivisionMinistry of Health MalaysiaPetaling JayaMalaysia

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