Assessment of Prescribing Practices in Overactive Bladder Pharmacotherapy across Different Specialties of India : A Prescription Trend Analysis

Purpose : To assess the temporal prescription patterns of overactive bladder (OAB) pharmacotherapy based on the prescription trend analysis amongst Indian clinicians. Methods : IQVIA (Quintiles and IMS Health) secondary sales audit (SSA) and prescription audit for antimuscarinics and beta-3 adrenoceptor agonist (mirabegron) from 2014 to 2022, were analyzed. Prescribers overlap analysis for solifenacin and mirabegron among Indian urologists was also analyzed. Results : Urologists’ prescription rates of OAB drugs were 65% in 2016 and 52% in 2022. The rate of OAB medication prescription by non-urologists was highest among surgeons (17%), followed by consultant physicians (9%) and gynecologists (8%) in 2022. In addition, among OAB medication prescription rates for antimuscarinics were 100% in 2016 and 56% in 2022 whereas for mirabegron, it was 0% in 2016 and 44% in 2022. The proportion of prescribers of OAB medication among urologists was 38% in 2016 and 33% in 2022. Exclusive prescribers of solifenacin were 748 in 2018 and 715 in 2022 at the urologist, whereas for mirabegron, it was 961 in 2018 and 1475 in 2022. Conclusions : Urologists remained a top prescribing specialty for OAB drugs, although prescription share increased among surgeons and consultant physicians. OAB medicines prescriptions by urologists are shifting from solifenacin to mirabegron. The results of this study could further help clinicians, to design the optimum treatment approach in OAB patients according to their need, which can help to lower antimuscarinic side effects, improves treatment adherence, and improves patient’s QoL.

A cross-sectional e-survey to map clinical practice of electrocardiogram use as a screening tool in outpatient department: India office electrocardiogram e-survey

Background:Early detection of electrocardiogram (ECG) abnormalities in high risk cardiovascular patients with routine ECG screening is the need of the hour. The aim of the e-survey was to understand the use of ECG in high risk cardio-metabolically deranged patients at outpatient departments (OPDs) by Indian physicians.Methods:A cross-sectional India office ECG (IOECG) e-survey was conducted using Google form questionnaire from November 2021 to December 2021 among Indian physicians. Survey results were collected and analysed using Google form survey tool.Results:We received total of 1863 responses. The results of the survey showed that while 90% of physicians agreed to the necessity of doing 12 lead ECG of cardio-metabolically deranged patients, only 61% of all physicians could perform ECG screening in less than 40% of high risk cardio-metabolic patients mainly, due to several practical challenges. Among physicians, 40.2% physicians believed that 12 lead ECG was too time consuming, 35.8% physicians believed that the unavailability of ECG device was common reason while 27.5% physicians believed that there was a lack of trained staff. Majority of physicians (69.7%) agreed to use point of care ECG device which can be a solution for more screening of such patients whether symptomatic or asymptomatic. According to the survey, 88.7% physicians would appreciate if a portable handheld ECG device was made available to facilitate screening in their practice.Conclusions:There is a need of the portable handheld ECG device which helps physicians to screen large number of cardio-metabolically deranged patients in their busy OPDs.

A single-centre, observational, retrospective study to evaluate coexistence of cardiovascular comorbidities and obstructive sleep apnoea in South Indians using apnea link air home sleep testing device

Background:The aim of thestudy was to explore whether there is a relationship between Cardiovascular (CV) comorbidities and the prevalence and severity of Obstructive sleep apnea (OSA).Methods:Secondary data analysis of 146 patients with suspected sleep-disordered breathing was conducted who were presented to the department of medicine, KIMS Hospital, Hyderabad, from June 2021 to November 2021. Participants aged ?18 years were included in the analysis. Demographic details, clinical history, comorbidities, medication history, were analyzed. AHI score, ODI (Oxygen desaturation index) score and average O2saturation were recorded with the help of a home sleep testing device. Data were entered and analyzed with Epi info 7.Results:The overall prevalence of OSA was 78.8% in patients with suspected sleep-disordered breathing. Prevalence of mild, moderate, and severe OSA was 28.8%, 15.1%, and 34.9%, respectively. Proportions of diabetes and hypertensionwere significantly high among patients with obstructive sleep apnea. Correlation analysis revealed a weak positive linear relationship (r=0.14) between the number of risk factors and the AHI score.Conclusions:Thisstudy showed high prevalence of OSA among out patients presented with suspected sleep disordered breathing. Hypertension, diabetes and obesity were highly prevalent CV comorbidities among South Indian patients diagnosed with OSA.

Prescription pattern of alpha blockers in the treatment of benign prostatic hyperplasia in India: a paper based survey

Background: Benign prostatic hyperplasia (BPH) is the most common urological condition. The treatment of BPH depends on the severity of symptoms which aims to improve symptoms, lower the risk of progression and improve quality of life. The aim of this survey was to understand the prescription pattern of alpha blockers in the treatment of BPH among clinicians of India.Methods: A cross-sectional questionnaire-based survey was conducted between September to December 2018. Data regarding the management of BPH using ?-blockers were filled by clinicians and collated for data analysis using appropriate statistical test.Results: Total of 1764 clinicians’ responses was collected and the result was analysed. According to the survey, 47.68% of clinicians felt that severity of the BPH symptoms is most common deciding factor for medical management of BPH. For the pharmacological management of BPH patients, around 58% of clinicians opted for ? blockers monotherapy as a preferred option. Among ? blockers, 65.14% of clinicians preferred tamsulosin as first line therapy for management of BPH patients. In this survey, 81.75% of clinicians believed that tamsulosin offers highest persistence rate among commonly prescribed ? blockers. Looking at the switching to a second ?-blocker, 75.45% of clinicians felt that tamsulosin shows the highest return rate following initiation of a second ?-blocker. More than 90% of clinicians felt that favourable efficacy or tolerability of tamsulosin is due to its highest persistence and highest return rates.Conclusions: Tamsulosin is the most commonly preferred and prescribed ?-blocker by Indian clinicians due to its favourable efficacy or tolerability.

Drug utilization pattern of antiseizure drugs and their adverse effects in the pediatric population, in a tertiary care hospital attached to a medical college.

Background: Epilepsy is “a condition characterized by recurrent (two or more) seizure, unprovoked by any immediate identifi ed cause.” The desired outcome of antiseizure drug (ASD) therapy is to be seizure-free throughout the rest of life. The objective was to study the utilization pattern and adverse drug reactions (ADRs) associated with the use of ASDs in pediatric outpatients in epilepsy clinic. Methods: This cross-sectional, observational and single center study was carried out over a period of 1 year in 430 pediatric patients. Analyzed data included demographic details and drugs prescribed in respective seizure types along with ADRs due to ASDs. Results: In a total 430 patients analyzed, seizure were most commonly observed in boys (69.8%) in 6-10 year of age (45.3%), with a positive family history in (16%), with no specifi c cause of seizure in (71.6%), with most common type was focal seizure in (62.3%), which was mainly treated with carbamazepine (73.8%). Most common ADR was irritability (32.2%) with Valproate being main drug. 87.3% ADRs were in “ possible” as per World Health Organization causality assessment scale, 94.9% ADRs were “mild” as per Hartwig and Siegel severity assessment scale and 98.3% ADRs were “preventable” as per Schumock and Thornton preventability scale. Conclusion: Focal seizure was most common type of seizure observed mainly in boys of 6-10 year with carbamazepine as mainly prescribed drug. Use of appropriate ASDs in the majority of patients as per guidelines, has decreased number of ADRs in our study. Prescribing drugs were mainly from essential drug list and by generic names.

Adverse drug reaction monitoring in psychiatric outpatient department of a Tertiary Care Hospital.

Background:Pharmacovigilance in psychiatry units can play vital role in detecting adverse drug reactions (ADRs) and alerting physician to such events, thereby protecting the user population from avoidable harm. Objective: To assess the suspected ADRs profile of psychotropic drugs in psychiatry OPD of a tertiary care hospital and its comparison with available literature data as well as to create awareness among the consultant psychiatrists to these ADRs profile. Materials and Methods: A prospective study was conducted in the psychiatry OPD. Thirty five consecutive patients per day were screened irrespective of their psychiatric diagnosis for suspected ADRs on 3 fixed days in a week from January 2011 to December 2011. CDSCO form was used to record the ADRs. Causality was assessed by WHO causality assessment scale while severity was assessed using Hartwig and Siegel scale. Results: Out of 4410 patients were screened, 383 patients were suspected of having at least one ADR. Thus, 8.68 % of our study population reported ADRs. Of 407 events recorded, 369(90.60%) were “probable” and rest “possible” according to WHO-UMC causality assessment scale. According to Hartwig and Siegel scale, 268 ADRs (65.85%) were “moderate” category. Twenty one different kinds of ADRs were noted. Conclusion: This study enables to obtain information on the incidence and frequency of ADRs in the local population that allows opportunity for education to the physicians to improve the patient’s quality of life.

Pattern of adverse events following immunization in an Indian teaching hospital.

Background: Vaccination is an essential component of the public health programs and among most cost effective medical intervention. Vaccines like other pharmaceutical product are not entirely risk free; while most known side effects are mild and non-serious. But some vaccines have been associated with very rare but serious side effect. So, there is a need of a surveillance program to monitor and record such events. Aims & Objective: To detect adverse events following immunizations (AEFI) in children and find vaccine responsible for them. Material and Methods: A one year, prospective, vaccine safety study was undertaken in 2011 covering a pediatric population who were administered vaccines. A two-phase telephone survey of all patients was conducted, comprising of an initial call at 1 week and a follow-up call at 30 days after the vaccine administration date. All AEFI were recorded in Vaccine Adverse Event Reporting System (VAERS) form. Results: Of a total sample of 4320 children, ranging in age from 0 to 14 years, 10110 vaccine doses were given. Each child received 2.34 vaccines on an average. Out of 4320 children, 899 children (20.8%) suffered 1003 AEFI. The most frequent types of adverse reactions to vaccines were fever (34.33 per 1000 doses), excessive crying (30.95 per 1000 doses) and injection site swelling (18.57 per 1000 doses). AEFI rate per 1000 doses was 99.2%. Conclusion: Most of the adverse events reported were mild and non-serious. Establishment of national AEFI database can be a worthy long term goal in Indian context.