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Background: Prescribing drugs are an important skill which needs to be continuously assessed and refined accordingly. Many drugs especially antimicrobials and fixed dose combinations that maybe irrational are being prescribed. Hence, this study was undertaken to analyze the rational prescribing guidelines in post-operative patients which will help doctors to update their knowledge and improve their attitude toward selecting cost effective treatment. Aim and Objectives: The aims of this study were as follows: (i) To evaluate prevailing prescription trends and (ii) to evaluate rationality of prescriptions in post-operative cases of surgery, orthopedics, obstetrics, and gynecology (OBG), and Otorhinolaryngology (ORL) departments. Materials and Methods: A prospective observational study was conducted in post-operative wards of departments of surgery, orthopedics, ORL, and OBG of Dr. B. R. Ambedkar Medical College and Hospital, Bengaluru. The study duration was 15 months from December 2018 to March 2020 with a sample size of 2000. Results: In the present study, female preponderance (54.4%) was seen. Majority of the drugs (77.3%) were prescribed under brand name. The most common group of drugs prescribed was non-steroidal anti-inflammatory drugs (135%) and the antibiotic was Cephalosporins (77.5%). As per the World Health Organization (WHO) core prescribing indicators, 6.25 were the average drugs per prescription. Conclusion: According to the WHO core prescribing indicators, polypharmacy was observed and prescribing by generic name was also less. However, there was no irrational use of antibiotics in post-operative cases in our study which reduces the chances of development of antibiotic resistance. Practice of prescribing drugs from the essential drugs list (EDL) was less. The study suggests incorporating educative initiative, development of drug policy, and an EDL-based hospital formulary to ensure rational use of medicines.
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Background: Polytherapy and comorbidities are a significant component of drug prescriptions in type 2 Diabetes mellitus (T2DM) patients. Irrational prescriptions and increased cost and number of drug therapies in T2DM put a considerable burden on patients as well as health authorities. Drug utilization studies are a very important tool in the evaluation of such prescriptions for logistical planning and medical audit of a health care setup. Aims and Objectives: To determine the drug utilization patterns of Antihyperglycaemic agents in diabetic patients attending medicine outpatient department and to assess average cost per prescription and to assess the economic implication. Materials and Methods: A prospective observational drug audit was carried out between January 2017 to June 2018 to determine drug utilization patterns of antihyperglycemic and other agents in T2DM patients attending medicine outpatient department of Konaseema Institute of Medical Science General Hospital, Amalapuram. The data were assessed using the World Health Organization indicators for drug utilization and analyzed using mean percentage and Chi-square tests. Value of P < 0.05 was taken as significant. Results: Metformin had highest Defined Daily Dose of 0.77 and was the most common drug prescribed both as monotherapy (14%) and in combination therapy with glimepiride (42.5%). Amlodipine (15.5%) was the most common non-diabetic drug prescribed in our patients. Average number of drugs per prescription was 3.05, while average number of antihyperglycemic agents per prescription was 1.81. Average cost per prescription was under rupees 50 in 30% of patients and all drugs were prescribed by their brand names. Conclusion: Metformin should be available in sufficient quantities in health care system for T2DM patients and drugs should be prescribed by generic names to reduce cost of drug treatment.
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Background: Drug utilization studies (DUS) provide insight into recent trend of drug usage and facilitate rationality of prescribed drugs. Few DUS have been conducted in ophthalmology. Aim and Objective: To analyse the prescription pattern in outpatients of the ophthalmology department at a tertiary care teaching hospital. Materials and Methods: A prospective, observational and cross-sectional study was conducted at GCS Medical College Hospital and Research Centre, Ahmedabad. All patients who visited ophthalmic outpatient department were enrolled and necessary data were recorded regarding drugs prescribed in pre-defined case record form. Data analysis was carried out using Microsoft Excel. Results: A total of 388 prescriptions were analysed. Average number of drugs and fixed-dose combinations (FDCs) per prescription were 2.47 (95% CI, 2.29–2.64) and 0.44 (95% CI, 0.36–0.51), respectively. Drugs were prescribed in different dosage forms with eye drops being the most common (95.1%) followed by tablet (12.3%), ointments (8.5%), capsules (2.8%), syrup (1.1%), and injections (0.3%). One or more dosage forms were seen per prescription. Total 957 drugs were prescribed, out of which drugs with brands name and generic name were 88.4% and 11.6%, respectively. Total FDCs prescribed were 17.5%. Overall, 43.5% of prescriptions had antibiotics ranging from 1 to 5 per prescription and 25% of antibiotics were seen out of total drugs. Conclusion: Most of the drugs prescribed were in the form of drops. FDCs and antimicrobial use have been increasing in the management of ophthalmic diseases. Less numbers of drugs were prescribed by generic names.
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Background: Drug utilization studies are an important tool in evaluating the rationality of therapeutic practice and also it is said to improvise the therapeutic use of drugs. The present study will be undertaken to evaluate the drug utilization pattern in the department of Radiotherapy.Methods: This was a prospective, observational study that was undertaken in the department of Radiotherapy in a tertiary care teaching hospital. The study was conducted for a period of 6 months after obtaining permission from Institutional Ethical Committee. The study was conducted among cancer patients undergoing radiotherapy. The data was collected from the patient case records and was analyzed as per the WHO prescribing indicators.Results: In the present study it was observed that the average number of drugs prescribed per encounter was 7.7. The drugs prescribed by generic name were 41.4%. Percentage of encounters with an antibiotic prescribed was 100. Percentage of encounters with an injection prescribed was 20.5%. Percentage of drugs prescribed from essential drugs list was 35.8%.Conclusions: Drug utilization studies helps in modifying the prescription pattern and helps in making the drug usage more rational.
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INTRODUCTION - Drug utilization studies assess appropriateness of pharmacotherapy. Rheumatoid arthritis (RA) is an autoimmune disease, which, if untreated, may result in degradation of joints. OBJECTIVE - To evaluate the prescribed drugs according to WHO drug use indicators. METHODS - Data collected included Demographics, details of medications prescribed for RAand other co-morbidities. RESULTS – Average no of drugs per prescription were 4.98 ± 1.21. Methotrexate was prescribed to every patient. Percentage of patients prescribed Single DMARD, Two DMARDS and Three DMARDS were 10%, 48% and 42% respectively. 99.38% and 90.68% of the Drugs for RA were prescribed from NLEM 2015 and 20th WHO Model List of Essential Medicines (March 2017) respectively.75.9% drugs were prescribed by Generic name. CONCLUSION –The standard treatment guidelines for treatment of RAare followed. Drugs were mostly prescribed from the Essential drug lists. Majority of the drugs have been prescribed by generic names.
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Background: Fixed dose drug combinations (FDCs), are combinations of two or more active drugs. It should be used when the combination has an established advantage over single drug in efficacy, safety and compliance. The World Health Organization (WHO) lists only 19 of such combinations. But Indian market is filled with hundreds of FDCs which were not approved leading to irrational use. This study was focused on finding out the fixed dose combination of antimicrobial agents used in the post-operative general surgery ward of a tertiary care teaching hospital.Methods: After getting approval from institutional human ethics committee the prescriptions of patients admitted during April 2013 to March 2014 were analyzed. Demographic data, FDC prescribed by surgeons, Dose, Frequency, Duration, Route, Formulation, Brand or generic drugs, Adverse events due to use of FDC were collected and SPSS version 17 was used for statistical analysis. Fixed dose combinations were used in 90 Patients. The most commonly used FDC were ampicillin with Cloxacillin (43) followed by amoxicillin with clavulanic acid (22), cefoperazone with sulbactam (19) and piperacillin with tazobactam (6). A common drug used in combination along with FDC was metronidazole and aminoglycoside. The irrational combination seen in this study was ampicillin with Cloxacillin (8.88%) of the total FDC which is not approved by DCGI or FDA.Results: In this study out of 145 drugs used, 41drugs were administered three times a day, 90 drugs were given two times a day and 14 drugs were given once a day dosing. 53 patients received FDCs for prophylaxis and 37 patients for treatment purpose. All FDCs were prescribed in brand names. No adverse drug reaction was observed in this study.Conclusions: Consultants should undergo continuing medical education (CME) on newer drug combinations and their adverse drug reactions which will be evidence-based rather than to rely on representatives.
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Background: Drug utilization studies (DUS) are used as potential tool in the evaluation of healthcare system. DUS are conducted to facilitate the rational use of drugs in populations. The indicators of prescription in practice measure the performance of health care provider in several key dimensions related to appropriate use of drug. Therefore, the present study was undertaken to analyze the prescription written by doctors in a Tertiary Care Hospital in rural area.Methods: Present study is a cross sectional, prospective and observational study. The study was conducted in a rural tertiary, teaching hospital at JIIU’s Indian Institute of Medical Science and Research, Warudi, Taluka Badnapur from January 2017 to September 2017 for duration of 9 months. Data was obtained from 300 prescriptions. Data was analysed as per WHO prescribing indicators.Results: Average number of drugs in the present study was found to be 2.85. Percentage of drugs prescribed by generic name is 13.48%. Percentage of encounters with an antibiotic prescribed 60%. Percentage of encounters with an injection prescribed 4.33%. Percentage of drugs prescribed from essential drugs list 72.91%.Conclusions: These types of studies help to design policy for rational use of drugs and motivation of physician for rational use of drugs.
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Pelvic inflammatory diseases (PID) is a noteworthy wellbeing concern prompting significant gynecological grimness among ladies in conceptive age gathering. Along these lines this review was attempted to dissect the medicine example of Antimicrobial Agents in patients experiencing Pelvic Inflammatory Diseases. Methods: A cross-sectional study was conducted at the Department of Gynecology & Obstetrics of World College of Medical Science and Research, Jhajjar, Haryana; for a period of 5 months during December 2016 to April 2017. A total of 210 prescriptions of clinically diagnosed PID cases from Outpatient Department (OPD) and Inpatient Department (IPD) were collected and analyzed in the department of Pharmacology based on Drug utilization WHO indicators. Results: Average number of AMAs per prescription was 2.26. Majority of patients prescribed were Antifungals (n=112, P=23.57%) followed by Fluoroquinolones (n=102, P=21.47%), Aminoglycosides (19.36%), Nitroimidazoles (16.0 %) and Doxycyclines (P=15.78%). Urinary antiseptics were the least prescribed class (3.78%). Individually, most commonly used agents of these is Clotrimazole + Tinidazole followed by Doxycycline and least prescribed was Nitrofurantoin. Conclusions: There was minimal difference between defined recommendations in standard treatment guidelines and the clinical use of antimicrobial agents. The only lacking part of this study was lesser use of generic drugs.
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Background: There is a need to introduce clinical pharmacology at the undergraduate level in order to improve rational prescribing of medicines. The present study was undertaken to analyze drug utilization pattern of genitourinary infections to teach certain basic skills to MBBS students which will form an integral component of practicing rational therapeutics. Methods: The retrospective study was conducted by Pharmacology Department in Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIM and HS). A total of 92 prescriptions were collected by second professional MBBS students and randomly evaluated for prescribing pattern using WHO drug indicators. Results: A total of 92 prescriptions were analyzed. Male:female ratio was 1.96:1. Age wise distribution was done: 0-15 years were 14 (15.21%), 16-30 years were 26 (28.26%), 31-45 years were 24 (26.08%), 46-60 years were 19 (20.65%), and >60 years were 9 (9.78%). A total of 260 drugs were prescribed. 116 (44.61%) antimicrobials, 70 (26.92%) antacids and antiemetics, 40 (15.38%) analgesics, 11 (4.23%) urinary alkalizers, 9 (3.23%) antifibrinolytics, and 14 (5.38%) miscellaneous drugs were prescribed. 144 (55.38%) injectable and 116 (44.61%) oral drugs were prescribed. Numbers of fi xed-dose combinations were 32 (34.78%). 2.82 drugs per prescription were prescribed. 171 (65.76%) drugs were prescribed from National List of Essential Medicines 2013 (NLEM 2013). Majority of drugs were prescribed by brand names. Conclusion: Majority of drugs were prescribed from NLEM 2013. The main purpose of undergraduate medical curriculum is to develop the requisite diagnostic and therapeutic skills of a basic doctor. It is only by drug utilization studies that burden of diseases and corresponding utilization of drugs can be measured.
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Background: The objective of this study was to evaluate the prescription pattern of drugs in pregnancy induced hypertension in a tertiary care hospital. Methods: A retrospective observational study was conducted by department of Pharmacology in collaboration with the Department of Obstetrics in Kamineni Institute of Medical Sciences, Narketpally after taking permission from the Institutional Review Board. WHO basic indicators were indicators were used for studying the prescribing pattern of drugs. Results: Out of the total prescriptions studied the most commonly prescribed antihypertensive was Methyldopa, followed by Nifedipine. Amlodipine, Atenolol and Magnesium sulphate were the other drugs prescribed. Majority drugs prescribed were from category B and C. Single drug therapy was prescribed in 46.94% patients. The use of fixed dose combinations was low. Conclusion: The incidence of single drugs therapy and two drugs was high. Irrational prescriptions were few. The present pattern of prescriptions can be improved by advocating rational drug prescription and awareness regarding safe use of drugs to the obstetricians.
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The APACHE (Acute Physiology and Chronic Health Evaluation) is a prognostic scoring system for classifying patients in Intensive Care Unit (ICU) on the basis of physiological scores and chronic health status. The chances of survival increase with a decrease in score. AMAs play a major role in management of such illnesses and dramatically improve patient outcome. This study has been undertaken to study the AMA utilization patterns in ICUs. Data was collected from 49 patients admitted in Surgery and Neurosurgery ICUs after IEC approval. The average number of AMAs used was 3.36 per patient. The highest use of AMAs was 4.3 in group VI of APACHE scoring system. Cephalosporins was the most commonly prescribed AMA group. The preferred route of administration was intravenous route. Feedback from this study would help both the prescribers and institutional authorities to review their prescribing practices and modify if necessary to facilitate better health care delivery.
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Information provided to patients about medication is important for the success of the treatment, since the lack of such information is one of the main reasons why patients fail to take medicines as prescribed. The aim of this study was to verify patients' awareness about prescribed drugs distributed at the Grão Pará (Santa Catarina) primary healthcare unit after a medical appointment. One hundred and eleven patients were interviewed, seventy after a medical appointment and forty-one after drugs were distributed. Patient awareness was tested by asking questions about the name, usage, dosage, length of treatment, side effects, and precautions. After a medical appointment 28.5 percent of patients were classified as having a good level of awareness, 17.1 percent fair and 64.4 percent insufficient. After drugs were distributed 4.9 percent of patients were classified as having a good level of awareness, 87.8 percent fair and 7.3 percent insufficient. The majority of those interviewed had a low level of awareness about the use of the prescribed drugs. Results after drugs were distributed were better in comparison to results after a medical appointment, suggesting the importance of the pharmacist in informing patients about the correct use of drugs.
As orientações sobre medicamentos fornecidas aos pacientes são fundamentais para o sucesso do tratamento, uma vez que a ausência delas é uma das principais causas do uso incorreto dos medicamentos. O objetivo deste estudo foi verificar o conhecimento dos pacientes sobre seu tratamento medicamentoso, após consulta médica e dispensação, realizadas na unidade básica de saúde do município de Grão Pará, em Santa Catarina. Foram entrevistados 111 indivíduos, 70 após a consulta médica e 41 após a dispensação dos medicamentos. O nível de conhecimento foi verificado mediante perguntas relativas ao nome do medicamento, indicação, dose, frequência de uso, duração do tratamento, efeitos adversos e precauções. Após a consulta médica, 28,5 por cento foram classificados com nível bom de conhecimento; 17,1 por cento, regular; e 64,4 por cento, insuficiente. Após a dispensação, 4,9 por cento dos pacientes foram classificados com bom nível de conhecimento; 87,8 por cento, regular; e 7,3 por cento, insuficiente. A maioria dos entrevistados não possui bom nível de informação para a administração de medicamentos. Os resultados encontrados após a dispensação foram melhores que os resultados encontrados após a consulta médica, o que sugere a importância do farmacêutico na orientação dos pacientes para a correta utilização dos medicamentos.
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Female , Humans , Male , Middle Aged , Health Literacy , Prescription Drugs , Appointments and Schedules , Drug PrescriptionsABSTRACT
A adesão ao tratamento farmacológico em doenças crônicas como a hipertensão arterial, é fundamental para o controle, prevenção de complicações e diminuição da mortalidade. Identificar os fatores que levam a não adesão ao programa de controle de hipertensão arterial, em Unidades Básicas de Saúde de Campo Grande, MS e produzir um modelo de predição desta condição foi o objetivo do presente estudo. Utilizou-se o método de caso-controle, aninhado a coorte de pacientes cadastrados no programa, no período de 2002 a 2005. Foi utilizada regressão logística tendo como variável-resposta ?adesão ao programa?. As associações significativas identificadas na análise univariada foram: características socioeconômicas, da doença, do tratamento e as relacionadas ao programa. Para prever a adesão, mantiveram-se no modelo as seguintes variáveis: dificuldade em ir ao programa, renda familiar, presença de diabetes, escolaridade e viver com companheiro. Com base no modelo, a probabilidade do paciente ser classificado corretamente como aderente, é de aproximadamente, 80% e como não aderente, 67%. O modelo identifica precocemente, pacientes vulneráveis à não adesão ao programa propiciando que este institua medidas voltadas aos prováveis, não aderentes.
Adherence to the pharmacological treatment of chronic diseases such as arterial hypertension is decisive in their control, in preventing complications, and in decreasing mortality rates. To identify factors that led patients to drop out of an arterial hypertension control program available at local district clinics of the government-run National Health Service in Campo Grande, MS, Brazil, and to design a model to predict adherence. A nested case?control study was conducted on subjects selected from within a cohort of patients enrolled in the above program, from 2002 to 2005. Binary logistic regression was used, with ?adherence to program? as the binary response variable. Data were subjected to logistic regression analysis to generate a model capable of predicting adherence. Factors identified: difficulty in going to the venue where the program was available, family income, presence of diabetes, level of education and living with a partner. When the logistic regression model was used, the probability of a patient being correctly classified as adherent and nonadherent was approximately 80% and 67%, respectively. The model enables early identification of patients prone to nonadherence to the control program, thus making it possible to implement measures directed at potentially nonadherent participants.
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Humans , Health Programs and Plans , Hypertension/prevention & controlABSTRACT
O medicamento tem se convertido em elemento importante na recuperação e garantia da qualidade de vida; no entanto, há riscos evitáveis associados a seu uso. Neste contexto, o objetivo deste trabalho foi analisar as publicações de estudos de utilização de medicamentos quanto aos tipos de resultados obtidos e suas contribuições para as intervenções terapêuticas. Foram analisados 27 artigos sobre estudos de utilização de medicamentos selecionados nas bases de dados Scielo e Lilacs em relação a objetivos, tipo de estudo, população e amostra selecionada, métodos de estudo e resultados mais relevantes. Os resultados dos artigos analisados foram discutidos a partir das categorias analíticas, criadas através da seleção dos temas emergentes da análise, prevalência do consumo de medicamentos, fatores relacionados ao uso de medicamentos, automedicação, organização dos serviços de saúde, percepção do medicamento e adesão à terapia. De forma geral, as sugestões dos autores restringiram-se à necessidade de prestar informação ao paciente. Conclui-se que as informações construídas pelos estudos de utilização de medicamentos podem ser o caminho inicial para a mudança tão almejada nas práticas profissionais.
With the advancements in pharmacotherapy, medicaments turned into important elements and powerful tools in the recovery and maintenance of health and quality of life. However, there are risks associated with their use that can be minimized by investing in drug utilization studies. The objective of this study is to analyze publications in the field of drug utilization with regard to the kinds of results obtained and their contribution to therapeutic interventions. Twenty seven studies on drug utilization selected from the Scielo and Lilacs bases were analyzed as refers to their objectives, kind of study, selected population and sample, methods used and most relevant results. The results of the analyzed papers were discussed according to their analytic categories, prevalence of medicine consumption, factors related to the use of medicines, self-medication, the organization of the health services, perception of the medicament and adherence to therapy. In most cases, the suggestions of the authors were limited to the need of informing the patient. It is concluded that the information constructed by the drug utilization studies could be the beginning of the desired change in the professional practices.