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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.
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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.
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There are only 22 varieties of pediatric drugs in National Essential Drug Catalogue (2018 Edition), including five chemicals and 17 Chinese patent medicines (13 prescriptions). Chinese patent medicines are widely used to treat pediatric diseases. The formulations of Chinese patent medicines are mostly derived from ancient classic prescriptions, based on the theory of syndrome differentiation and treatment of traditional Chinese medicine. The instruction of Chinese patent medicine as a document to guide the use of medicines, the specification and integrity of it directly affects whether Chinese patent medicine is used safely and effectively. This paper investigates the instructions of pediatric Chinese patent medicines in National Essential Drug Catalogue (2018 Edition) comparing with the relevant requirements of the United States and Japan, analyzes the toxicity and contraindication of Chinese patent medicines for pediatrics, summarizes the problems existing in these instructions, and puts forward some suggestions. The result shows that there are few kinds of proprietary Chinese patent medicines for pediatrics. There exist common shortcomings in the instructions of Chinese patent medicines for pediatrics, such as unlabeled contents, unnormalized indications, unclear usage and dosage, unknown contraindications and unclear precautions. This study provides a basis for further perfecting the instructions of Chinese patent medicines, and it is helpful to promote the safe and rational use of medicines for children.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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OBJECTIVE:To provide reference for promoting the rational use of essential drugs in primary medical institutions. METHODS:Twenty-three rural primary medical institutions(8 township health centers,15 village clinics)were randomly selected from 2 poverty-stricken counties in Chongzuo city of Guangxi Zhuang Autonomous Region. The utilization of essential drugs was investigated and analyzed statistically through exporting hospital information system data and on-site interviews. RESULTS:The utilization rate of essential drugs in sample township health centers was 72.4％,and the amount of essential drugs accounted for 78.3％. The utilization rate of variety from National List of Essential Drug was 36.9％,which in the Autonomous Regions Essential Drug List Supplement was 47.2％(utilization rate of chemical drugs was 53.9％,and that of Chinese patent drugs was 39.7％). The utilization rate of essential drugs in sample village clinics was 64.4％;utilization rate of variety from National List of Essential Drug was 18.3％, which in the Autonomous Regions Essential Drug List Supplement was 10.5％. The amount of 5 major categories accounted for 47.9％ of total amount of chemical agents,among which that of antimicrobial agents took up the highest proportion,being 35.9％. Among top 10 drugs in the list of amount,there were 8 national essential drugs and 4 antimicrobial agents. There were 2.90 kinds of drugs in each outpatient prescription averagely in sample township health centers;the average proportion of antibiotic prescription was 43.0％;the cost of each prescription was 33.12 yuan in average. CONCLUSIONS:The utilization rate of essential drugs in primary medical institutions is lower than the requirements of policy. There are great difference in utilization rate between chemical agents and Chinese patent drugs of township hospital in Autonomous Regions Essential Drug List Supplement. The cost proportion of antimicrobial agents is high. The rationality of prescription drug use still needs to be improved. It is suggested to guarantee essential drugs supply,adjust Autonomous Regions Essential Drug List Supplement in time,control the price of main categories and strengthen antimicrobial agent use monitoring so as to further promote rational drug use.
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OBJECTIVE:To provide reference for the construction of suitable evaluation index system for the implementation of National Essential Medicine System in community health service center.METHODS:The frame of evaluation index system was designed by theoretical analysis,literature study and expert interviews methods.Delphi method was used to establish evaluation index system for National Essential Medicine System in Shanghai community health service center.Analytic hierarchy process was adopted to determine the weights of indicators at all levels.RESULTS:The positive coefficients of the two rounds consultations were 88.24％ (15/17) and 86.67％ (13/15).The authority coefficient of structural index,processing index and result index in the first round consultation were 0.68,0.68 and 0.69,respectively,which showed that the authority degree was higher.The coefficient of concordance in the second round consultation was higher than the first round (the indexes of structure,process and result in two rounds consultation were 0.286,0.306,0.193 and 0.345,0.358,0.337,respectively),which indicated the expert opinions were highly consistent.Established evaluation index system consisted of 3 fiust-level indexes,13 second-level indexes and 27 third-level indexes.CONCLUSIONS:The selected experts were representative,the consultation results were reliable,established evaluation index system was rational and the setting of weights was scientific.Also this study was a methodological exploration.
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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.
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Objective:To systematically evaluate the influence of the implementation of essential drug policy ( EDP) on prescrip-tion use rate of antibiotics in primary hospitals. Methods:Based on CNKI, Wanfang and VIP of China journal databases, all litera-tures were adopted including the data of the prescription use rate of antibiotics in primary hospitals. RevMan5. 3 and Stata 12. 0 soft-ware were used to conduct the Meta analysis. Results:Totally 43 literatures were included in the study according to the evaluation se-lection criteria. After the implementation of EDP, the prescription use rate of antibiotics in primary hospitals was decreased, and com-pared with that before the implementation of EDP, the risk difference value was significant [RD= -0. 03,95%CI( -0. 04,-0. 03), P<0. 000 01], while the use rate was still high (46. 16%). The result of Egger’s test indicated the publication bias of the 43 litera-tures was not significant (P=0. 571). However, there was high heterogeneity(I2 =94%,P<0. 000 01)among the different studies. Based on the classification of hospital type and different areas, the results of sub-group analysis showed the differences of study methods in the literatures and regional implementation measures of EDP contributed to the high heterogeneity among the different studies. Con-clusion:In order to reduce the heterogeneity of studies, a unified evaluation criteria for the research quality of the cross-section survey should be established. And special policies related to EDP should be taken to effectively decrease the use rate of antibiotics in primary hospitals.
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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.
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Background: Fixed dose combinations (FDCs) refer to products containing two or more ingredients used for a particular indication in a single dosage form. Prescribing FDCs has become a routine affair in medical practice. There has been increase in the irrational FDCs in the recent past by leaps and bounds. The pharmaceutical companies are luring the physicians to prescribe their products even when they are not needed by the patients. The Indian laws too are not properly defined to grant marketing approvals of FDCs. Hence the rationality of a FDC has become one of the most controversial and debatable issues in general practice. Methods: We hence decided to analyze the existing FDCs in Indian market and study their rationality. Results: We observed that, although many brands of FDCs available are essentially rational as per WHO and Indian essential drugs lists, the irrational FDCs easily outnumber the rational ones. Hundreds of rational FDCs are also available which are not included in WHO or Indian essential drugs lists. A few FDCs with incorrect doses were also noted. Irrational FDCs not only cause more adverse drug reactions but the antibiotic FDCs are responsible for increasing the chances of resistance. A few of these are discussed for their irrationality. Conclusions: It is the need of the hour to raise our voice against the growing list of irrational FDCs and try to reduce the magnitude of this problem by sensitizing the undergraduates, the interns as well as the practitioners regarding their efficacy, safety, suitability, rationality and cost benefit.
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To provide suggestions for perfecting essential drug centralized bidding and purchasing system. Methods:Using literature method to analyze comparatively essential drug bidding purchasing implement plans of 30 provinces in China. Results:Bidding mode in most provinces was double envelope system. Most evaluation methods did not distinguish the quality level, while there were great differences among provincial evaluation standard and scores of economic, technical and business bidding. Conclusion: To explore scientific and reasonable evaluation standard, it needs to establish an authoritative evaluation system for reference, choose the objective index as far as possible and properly increase the amount of bidding manufacturer.
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OBJECTIVE: To compare the security, convenience and price of the package of basic infusions in different regions, different economic conditions and different natural environment in medical institutions at all levels in our country.