ABSTRACT
Background: The pattern of drug use in a hospital setting needs to be monitored intermittently to analyze their rationality. Aim and Objective: The aim of this study was to assess the prescribing pattern as per World Health Organization core drug use indicators. Materials and Methods: This is a prospective cross-sectional, single-center, and observational study. A total of 620 prescriptions were included and analyzed in dermatology outpatient attendees at a tertiary care teaching hospital. A predesigned pro forma was used to collect and compile data. All the statistical analysis was performed with the Microsoft Excel office 2019 version. Results: The average number of drugs per encounter was 4.03. The percentage of encounters with antibiotics was 33.38%. There was no prescription having an injection. The drugs prescribed by their generic names were 16.61%. Drugs prescribed from local institutional essential drugs list were 42.11%. Conclusion: Studies based on drug prescribing patterns are a very important tool not only to guide physicians to improve their prescribing habits but also for hospital administration to recognize the lacunae in drug prescribing and formulate guidelines to facilitate rational drug use.
ABSTRACT
Background: The fixed dose drug combinations (FDCs) of drugs is defined as product of two or more active ingredients in a defined composition. There is a need to study the pattern of prescription from time to time to evaluate their rationality. In this context we undertook this study to know the prescription pattern of FDC in our setting. To study the rationality of different prescribed FDCs.Methods: This is a prospective study which is carried out in NIMRA Institute of medical sciences which is a tertiary care teaching private hospital. For this study we have collected one thousand prescriptions of patients for 3 months that is from 10th March 2017 to 25th of June 2017 including both in-patients as well as outpatients. Selection criteria of patients mainly basing on their willingness to give prescriptions. Institutional ethical committee permission was taken for the study. The prescribed FDCs were compared with the essential drug list of FDCs approved by Drugs Controller General of India, July 2018. we have used descriptive statistics to analyze data. The percentage of FDCs used in each class and their contribution to overall FDCs were calculated.Results: In a total of 2952 drugs were prescribed, of this 747 were FDCs and 2205 were non FDCs. In the prescribed FDCs 89.2% drugs were rational and 10.8% drugs were irrational.Conclusions: From this study, we can conclude that 10.8% of irrational prescription of fixed dose drug combinations are prescribed in Nimra Institute of Medical Sciences which is a tertiary care teaching private hospital.
ABSTRACT
Background: Gynaecological diseases are common in India because of socioeconomic, hygienic and literacy problems. Gynaecological drugs are one of the strong selling drugs in pharmaceutical market. Drug utilization research facilitate appropriate use of drugs in patient, minimize the adverse event and lead to better patient outcome. So, the present study was carried out to examine the patterns of drug prescription.Methods: A retrospective, observational study was done by collecting the prescriptions of the patients who attended the Gynaecology out-patient department in our institute for the period of six months. Total 300 prescription were collected and analysed. Patient’s demographic data, total number and category of drugs prescribed, percentage of individual drug and their dosage forms, drugs prescribed by generic name, brand names and percentage of drugs prescribed from essential drug list were analysed.Results: The mean age of presentation was 36.6±10.98 years. Among infective group breast abscess were common and among non-infective cases dysmenorrhea was most common. Out of 754 drugs prescribed, minerals were most commonly prescribed (42.70%) followed by antimicrobials (24.53%). Tablet form were prescribed more commonly (96.02%) followed by capsules (2%) and injections (1.06%). The average no. of drugs per prescription was 2.51±1.26 SD. Percentage of drugs prescribed by generic name were 98.01% and drugs prescribed from essential drug list were 85.41%.Conclusions: The overall drug use pattern in our study correlates with various gynaecological diseases. Majority of the women from rural background depend on primary health services for gynaecological diseases in their areas so, strengthening of gynaecological health care services reduce the morbidity among the women from rural areas.
ABSTRACT
Background: This study was conducted to determine the drug utilization pattern among geriatric inpatients in general medicine department of the hospital.Methods: An observational, prospective study was conducted for a period of six months (November 2016 to April 2017) among 200 geriatric patients; demographic details, education, occupation, diagnosis and drug details were recorded. The drugs were categorized by anatomical therapeutic classification (ATC) and defined daily dose (DDD) was calculated. The World Health Organization (WHO) prescribing indicators were assessed.Results: The majority of the patients (59%) were in age group of 60-69 years. Cardiovascular diseases were common among geriatrics. Most commonly prescribed drug was Pantoprazole (81.7%). Drugs were assigned with ATC/DDD codes according to the guidelines of WHO. Drugs prescribed by their generic names were 56.64% and 43% of drugs that were included in the National Essential Medicines List.Conclusions: Clinical pharmacist have to collaborate and work together with physicians in selecting and adjusting the dose among geriatric population in order to reduce development of potential adverse drug reactions, serious drug related complications and drug interaction.
ABSTRACT
Background: Writing a prescription is a combination of science and art. Good quality prescriptions are a sign of prescriber’s expertise. World Health Organization has defined certain parameters to promote rational drug use in all countries. This study was designed to assess the prescription writing practices in a government tertiary care hospital in Haryana by using WHO prescribing indicators.Methods: A total of 2155 prescriptions were evaluated. Each prescription was evaluated for average number of drugs prescribed per patient per encounter, percentage of drugs prescribed by generic name, percentage of encounters with an antibiotic prescribed, percentage of encounters with an injection prescribed and percentage of medicines from Essential drug list prescribed. These indicators help us to check polypharmacy, practice of prescribing drugs by brand names, antibiotic overuse, preference of injectables and non-adherence to Essential drug list.Results: The average number of drugs prescribed per patient per encounter was calculated to be 3.25±0.24. The percentage of medicines prescribed by generic names was 35.89%. Percentage of encounters with an antibiotic prescribed was 48.21 % and with an injection prescribed was 1.85%. The percentage of medicines form NLEM was 76.36%.Conclusions: The values of WHO prescribing indicators obtained from this study show that there are some areas where the prescribers need to improve their prescribing practices.
ABSTRACT
Background: Irrational prescribing is a universal problem that may lead to inadequate response to medication therapy, poor patient compliance and increased adverse drug reactions ultimately leading to frequent hospital admissions. Hence this study was done to assess the drug utilization pattern using WHO core drug use indicators so that the recommendation can be made towards the rational prescribing.Methods: A sample of 3650 prescriptions was analysed prospectively to assess the drug utilization patterns in the dermatology OPD of a tertiary care teaching hospital of central south India.Results: The average number of drugs per prescription was 2.74 whereas 79.26% drugs were prescribed by generic names. Percentage of encounters with an antibiotic prescribed was 18.68%. Regarding use of injections, 3.26% prescriptions contains one or more injections. Percentage of drugs prescribed from essential drugs list was 78.37%. Average consultation time was lower (2.9 minutes) than recommended.Conclusions: The data from the present study indicates that prevalence of polypharmacy, inadequate consultation and dispensing time along with poor patient’s knowledge are the areas of medication therapy to be improved. Availability of essential drugs and key drugs in stock should be improved to achieve rational therapeutic goal. Further, continued medical education regarding the rational prescribing will definitely improve the standards of health care delivery.
ABSTRACT
Background: Older people are potentially at greater risk of medication error. Gaining insight into the prescribing pattern especially in eye diseases as they are a common problem in elderly, in order to identify prescribing related problems is the fundamental step in improving the quality of prescription and patient care.Methods: Prescriptions fulfilling inclusion criteria were collected from hospital Medical record department (MRD) and analyzed using the World Health Organization (WHO) core prescribing indicators for rationality of prescriptions.Results: Among 811 prescriptions analysed, 52.7% (428) were of male patients, those aged 60-70 years were 77.2% (626) and patients with only cataract constituted 77% (625). Prescriptions with oral antibiotics were 57.1% (334); topical antibiotics were 35.8% (429) and topical analgesics 46.2% (553). Out of 1182 FDCs noted, 59% (479) were found to be rational and 34.6% (281) were from Essential Medicines List 2014. Only 2% (61) drugs were prescribed using generic name while 64.06% (1606) of drugs were from the WHO Model List of Essential Medicines (April 2015). Average number of drugs per encounter was 3.7. Percentage of encounters with antibiotics was found to be 43.8% and no prescriptions with injections were noted.Conclusions: Although usage of antibiotics and topical drugs was conforming to WHO recommended standards, there is a need to improve prescription pattern by using generic names and drugs from Essential Drug List.
ABSTRACT
Objective: The study was carried out to generate research on drug utilization pattern in paediatric patients in government headquarters hospital, Tiruppur, Tamilnadu, India using world health organization (WHO) and international network for rational use of drugs (INRUD) core indicator. Methods: The core prescribing indicators of the world health organization was used to assess the appropriate use of drugs. Index of rational drug prescribing (IRDP) developed by Zhang and Zhi was also used to find out the performance of a health care system in terms of drug utilization. Results: Out of 859 drugs in 200 cases the highest prescribed drug class is antibiotics 304(35.39%) and the majority of drugs were administered in injectable form 412(47.94%). It was analysed that a majority of prescriptions 117(58.5%) were discharged in between 4-7 d. 161(80.5%) patients were dismissed after completion of treatment. On analysing world health organization (WHO) prescribing core indicators, the average number of drugs per prescription was 4.29 which is higher than double the average number (i.e., 2). This indicates poly-pharmacy practice. 97.78% of drugs were prescribed were the generic name and percentage of encounters with antibiotic prescribed was 90.5% which is thrice greater than world health organization (WHO) standard<30%. Prescribing of injections is not within the world health organization (WHO) recommended range<20% and it was far higher showing 97.5% which is essential for paediatric inpatients. The prescribing practice in paediatric ward is in complete adherence to national essential drug list (EDL) or formulary. The mean value of the index of rational drug prescribing (IRDP) obtained was 3.09 which is very similar to that of optimal value world health organization (WHO). Conclusion: Prescription by generic name, prescribing drugs from essential drug list (EDL) and free government supply are encouraging findings in this hospital. The result shows poly-pharmacy and overuse of antibiotics are the areas to be concerned. The better clinical outcome shows rational prescribing is practised well.
ABSTRACT
Background: Medicines are an integral part of healthcare. More than one drug is frequently used for treatment of either single ailment or multiple co-morbid conditions. Sometimes, two or more drugs are combined in a fixed ratio into a single dosage form, which is termed as fixed dose combinations (FDCs).Methods: This prospective observational study was carried out in the patients admitted in various medical and surgical wards of Chirayu hospital associated with Chirayu medical college of Bhopal district for a period of 3 months. The prescribed FDCs were collected from the case sheet of the admitted patients. Patients of all ages and both sexes were included in the study.Results: The total numbers of prescriptions from teaching hospital were 475, out of which 373 patients (78.52%) were prescribed FDCs. The first four most preferred FDCs were B complex preparations followed by pantoprazole + domperidone, Diclofenac+Paracetamol and Chlorpheniramine+Pseudo-ephedrine+Paracetamol.Conclusions: In present study total 11types of FDCs were prescribed, out of 11 FDCs prescribed; only 1 type was enlisted in the essential drug list of WHO and Govt. of India. In only 4 types of FDCs there is scientific justification for combining ingredients. Most of FDCs do not have scientific justification for combining the ingredients. It is the need of the time that hospitals should constitute drugs and therapeutics review committees to promote rational prescription of FDCs.
ABSTRACT
Background: Geriatric population due to the age related changes in pharmacokinetics and pharmacodynamics and the presence of comorbidities is vulnerable to drug interactions, adverse effects and high cost of therapy. This necessitates a periodic review of DU pattern in the geriatric population to ensure safe and effective treatment for them. The present study was undertaken to evaluate the DU pattern for medical conditions among the geriatric population in the Orthopaedic outpatient department (OPD) of a tertiary care hospital in Kerala.Methods: In this cross sectional observational study conducted in the Orthopaedics OPD of a tertiary care hospital, prescriptions were collected from patients attending the Orthopaedics OPD randomly over a period of 6 months. Out of these, prescriptions of male and female patients of age more than 60 years were sorted and analysed using World Health Organization drug prescribing indicators as well as additional parameters and the data was presented in the form of frequency and percentages using tables and charts.Results: A total of 800 prescriptions were collected and studied of which 76 (9.5%) belonged to patients from the geriatric population. Majority of the patients were in the age group of 61-70years (52.63%). Spondylosis (42.10%) was the most common indication for patients attending Orthopaedics OPD. Average number of drugs per prescription was 3.05 with a range between 1 and 5. Only 5.17% drugs were prescribed using generic name. Utilization from the essential drug list was 39.65%. The percentage of encounters in which an antibiotic and injection prescribed was 0% and 10.34% respectively. Of the total drugs prescribed 35% were FDCs. The most routinely prescribed drugs among the various classes were NSAIDs 34% followed by gastroprotectives (25%). The assessment of prescriptions with regard to completion and legibility was satisfactory.Conclusions: Current study pointed out deficiencies like polypharmacy, low prescribing of drugs by generic names, low prescribing of drugs from the essential drug list and higher use of FDCs. Use of antibiotics and injections was satisfactory and acceptable. Legibility and completion of prescription format was largely satisfactory. Proper strategies to rectify these deficiencies can ensure safe and effective treatment for geriatric patients.
ABSTRACT
This cross-sectional study was carried out to assess drug prescribing pattern at a tertiary care teaching medical institute. One thousand prescriptions were randomly collected and analyzed using the world health organization prescribing indicators. The average number of drugs per prescription was 2.91. The percentage of drugs prescribed by generic name, from the essential drug list (National) and as fixed dose combinations (FDCs) was 10.05%, 22.57%, and 49.22%, respectively. The total percentage of encounters with antibiotics, injectables, and FDCs was 19.70%, 2.20%, and 73.60%, respectively. The most common group of drug prescribed was gastrointestinal tract drugs (26.38%) followed by Vitamins and Minerals (23.12%), cardiovascular system drugs (11.56%) and antimicrobials (9.63%). The prescribing practices were not appropriate as they consist of polypharmacy, lesser prescription by generic name, and overprescription of FDCs. There is a need for improvement in the standards of prescribing patterns in many aspects.
ABSTRACT
BACKGROUND: Currently establishment of public pharmaceutical companies became an issue for securing stable supply of national essential drugs in order to respond appropriately to national public health crisis. Pharmacy students as future pharmacists need to be interested in drug related issues under the discussion in our society. This study aimed to investigate perceptions of pharmacy students on the national drug supply strategy through public pharmaceutical companies. METHODS: A 20-items questionnaire designed for this study was used. Pharmacy students nationwide were enrolled in July 2017. They responded to questions through on-line survey program. Data were analyzed descriptively. RESULTS: 160 students from 26 pharmacy schools participated. 5th and 6th grade students accounted for two-thirds, and one third aspired future jobs in pharmaceutical industry. Among responders, 71.3% was unaware of current national essential drugs, 52.5% did not know the Rare and Essential Drug Center, and 91.9% was unaware of the legislation on the supply and management of essential drugs. 82.5% favored the establishment of public pharmaceutical companies. 80.6% agreed that government should intervene in pharmaceutical market for ensuring drug accessibilities, 73.8% agreed that public pharmaceutical companies make possible to reach a goal of stable supply of pharmaceuticals, and 85.1% agreed that active compulsory license by public pharmaceutical companies is necessary. CONCLUSION: We found that pharmacy students recognized the need for governmental control to achieve social values of pharmaceuticals. More attention and participation of the pharmacy students as well as pharmacists in the process of national debate on public pharmaceutical companies are expected.
ABSTRACT
Background: Undergraduate medical students acquire knowledge about use of drugs during teaching sessions related to prescription of drugs. Appropriate selection of drugs from the available list of numerous formulations requires skill. This can be imparted using the concept of personal drugs (P-drugs). Knowledge of the price of drugs is important consideration in selection of drug. This paper describes method of introducing medical student to the concept of P-drugs, essential drug list (ED list) and economic aspects of drug utilization. Methods: Students are divided into groups, guided by faculty member. Each group is allotted a clinical case scenario with specific questions; students have to select suitable drugs which can be prescribed. They also have to search for the suitable drug included in the ED list and price of different brands of the same drug. The work done by the group is presented as a report to the whole class. Results: Each group presented the list of P-drugs and ED list and price of the drugs for the selected cases viz.: pharyngitis, urinary tract infection, hypertension, diabetes mellitus. After collecting the information on these aspects each group selected the most appropriate drug for the clinical condition allotted to them. Comparison of prices of various brands provided opportunity to learn about economic aspects of drug use. Conclusion: This method of study using patient oriented problems is a useful method to impart knowledge to medical students about concept of P-drugs, ED list and economic aspects of using drugs.
ABSTRACT
Objective : Fixed drug combinations are a major marketing strategy in India but it can compromise the rational use of medicines. In this study we compared the fixed drug combinations and dosage forms in the hospital pharmacy before and after introducing the essential drug list. We also compared the Hospital Essential Drug List (HEDL) 2011 with the World Health Organization (WHO) Essential Drug List (EDL) 2011 and the National Essential Drug List of India (NEDL) 2011. Methods : The study was done in a secondary level care charity hospital at Anantapur, AP with a bed size of 315 and an average OP per day of 1200– 1700 visits. We compared the three essential drug lists (HEDL, WHOEDL and NEDL) and the hospital drug list before introducing EDL. Drugs which were present in NEDL and not present in the HEDL were also screened. Microsoft excel was used to tabulate the results and for graphs. Results : The number of medicines used in the hospital before and after the introduction of the HEDL was 1627 and 424 respectively. On comparison, WHOEDL 2011 have 350 and NEDL of India have 348 medicines. While preparing the HEDL, 46 double drug combinations decreased to 15 and 9 triple drug combinations decreased to 1. In the case of injections, 20 double drug combinations decreased to 6 and 1 triple drug combination increased to 2. The number of tablets, capsules, injections, syrups, powders and inhalers was reduced to almost half. The great reductions were in 51 ointments to 9, 69 drops to 5, 11 paste to 0, 21 solutions to 3 and 14 creams to 1. The dosage forms removed included elixirs, insulin pens, gums, paste, paints, gargles and mouthwashes. Conclusions : There was drastic reduction in the number of medicines and dosage forms when the HEDL was implemented. Many of the fixed drug combinations were also removed for improving the rational use of medicines. The WHO essential drug list 2011, national essential drug list of India 2011 and the hospital essential drug list 2011 were comparable with few exceptions.
ABSTRACT
OBJECTIVE:To promote essential drug list into practice.METHODS:Relevant problems on the selection of National Essential Drug List were explored and analyzed.RESULTS & CONCLUSION:There are some problems on coordination of safety and effectiveness of drugs,price and the selection of traditional Chinese medicine.The advantage of first choice of essential drugs is not reflected completely.Large or small problems exist in selection process and individual drug verification.There was low credibility of drug evaluation.On the whole,the selection and formulation of essential drug list should be adjusted and improved continuously to guarantee the requirement of public medication.
ABSTRACT
OBJECTIVE:To promote the adjustment of National Essential Drug List and implementation of Essential Drug List. METHODS:National Essential Drug List was compared with Essential Drug List issued by WHO. Retrieved from statistical results conducted by State Food and Drug Administration, the problem that there were large number of drug in China while little category were included in National Essential Drug List was analyzed, according to practice in China. RESULTS & CONCLUSION: Drug enterprises increased the dosage form and category of preparation blindly because of huge raw drug market, various dosage forms and weak administration to drug enterprises. The characteristics of drug were cheap, high quality, acceptance by state, which decided that the category of drug in Essential Drug List should not be too much. It is necessary to adjust Essential Drug List as the change of situation so as to meet the requirement of public health.
ABSTRACT
OBJECTIVE:To provide suggestion and advice for the selection and utilization of essential drug. METHODS:WHO standards for the selection of essential drug and the formulation process of National Essential Drug?Part for Primary Medical and Health Institutions (2009 edition) were analyzed. The significance of theory and methods of pharmacoepidemiology in the selection, utilization and performance evaluation of essential drug were put forward. RESULTS & CONCLUSION:National essential drug should be selected according to evidence-based medicine and pharmacoeconomics based on pharmacoepidemiology, in order to take advantage of a drug epidemiology-based evidence-based medicine and drug selection based on economics, the study concludes. Dialectical thinking about safety and effectiveness of essential drug should be conducted.
ABSTRACT
OBJECTIVE:To probe into the application of pharmacoepidemiology in safety study of TCM injection for sale in order to provide new idea for the study of TCM injection for sale. METHODS:Based on reported ADR events caused by TCM injection in recent year,the main approaches of pharmacoepidemiology were introduced to analyze the safety of TCM injection for sale. RESULTS & CONCLUSION:Pharmacoepidemiology is the main mean for safety study of TCM injection for sale and important basis for the selection of essential drug in China. Descriptive study can provide testimony for countermeasure in the early stage of ADR and analytical study can be used for the selection and detection of etiological hypothesis. Many other methods of pharmacoepidemiology can be used as approaches for safety study of TCM injection for sale.
ABSTRACT
OBJECTIVE:To review the selection process and methods of WHO Essential Drug List and to analyze the problem and challenge of the selection and evaluation of National Essential Drug List in order to provide suggestion for the selection and evaluation of essential drug list in China. METHODS:The selection process of previous National Essential Drug Lists were compared with that of National Essential Drug Lists(2009 edition)and WHO Essential Drug List. The problem and limit of National Essential Drug List were found out to put forward countermeasure. RESULTS:The prominent problem of the selection and evaluation of National Essential Drug List were as follows:the categories of drugs were changed significantly and including of some drugs was not supported by scientific evidence. There was no indirection and standard for the evidencebased selection and evaluation of essential drug. CONCLUSION:Aiming at the problem of the selection and evaluation of National Essential Drug List,evidencebased evaluation research is conducted to establish indirection and standard for the selection of essential drug list and database. Professionals and institutions for evidencebased evaluation and selection of essential drug list should be established to promote evidencebased evaluation and selection of National Essential Drug List and make more scientific decision.
ABSTRACT
OBJECTIVE: To explore the coexistence of "Medical Insurance List" and "Essential Drugs List". METHODS: A comparative similarities and differences analysis of the scope, role, to develop the basis for the implementation of the effectiveness between the "medical insurance directory" and "Essential Drugs List" was carried out. RESULTS & CONCLUSION: The new edition of "Essential Drugs List" is to ease the contradiction of coexistence in long-term, but they are difficult to reconcile in short-term.