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Objective To improve the quality of prescriptions and promote the rational drug application of Dingqing Tablets by investigating the outpatient prescriptions in a tertiary A hospital. Methods A total of 4 796 prescriptions of outpatient pharmacy patients from August 1, 2020 to August 1, 2021 were extracted from the hospital information system by the hospital information software, focusing on the analysis of indications, usage and dosage, drug interaction, etc. Results 10 departments including hematology department and geriatrics department were used Dingqing Tablets, and the irrationality was mainly manifested in the superposition of drug flavors and drug interactions. Conclusion Dingqing tablets were widely used in clinic and had remarkable curative effect. However, there are certain risks in the use of Dingqing tablets. It is necessary to add medication education and supervision to promote the safe and rational use of drugs in clinic.
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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.
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ObjectiveTo analyze the clinical application characteristics of prescription preparations for external use in the Chinese pharmacopoeia 2020 edition （hereafter abbreviated as the Pharmacopoeia）. MethodThe topical functions， usage， dosage， dosage form， application method， and prescription of the preparations for external use in the Pharmacopoeia were analyzed. ResultThe Chinese pharmacopoeia 2020 edition includes a total of 138 prescription preparations for external use， the specific clinical usage， dosage， administration method， and efficacy evaluation of which remain unclear. These preparations can be used to treat a wide range of diseases. Specifically， the use in orthopedics and traumatology （36 preparations， accounting for 26.09%） is dominant， followed by that in internal medicine， surgery， and throat. The major application method is directly applying to the diseased area （35 preparations， 25.36%）. The main dosage forms are ointment （40 preparations， 28.99%） and powder （24 preparations， 17.39%） and others include liniments， suppositories， tinctures， and sprays. The clinical usage and dosage of these preparations are mostly unclear. Only 48 preparations （34.78%） are recorded with clear dosage and frequency of use， and 45 preparations （32.61%） have neither clear dosage nor frequency of use. The 138 prescription preparations for external use include 211 single medicines， of which 44 single medicines can be used alone. The single medicines are mostly used for heat clearing （48 preparations， 22.75%）. ConclusionThe Chinese pharmacopoeia 2020 edition （Volume I） records a large number of prescription preparations for external use， and the number shows an increasing trend. However， the usage， dosage， and efficacy evaluation criteria of these preparations remain to be improved and need in-depth research.
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Objective:With the aid of the Inheritance Support System of Traditional Chinese Medicine V2.5 （TCMISS V2.5），to study the experience and prescription rules of professor WANG Jie in the treatment of frequent ventricular premature complexes，and inherit his clinical experience in diagnosis and treatment. Method:Professor WANG Jie's medical records and prescriptions for frequent ventricular premature complexes from 2016 to 2020 were collected and sorted out. Improved mutual information method，association rules，complex system entropy clustering，and unsupervised entropy hierarchical clustering were used to analyze the nature and flavor，channel tropism，concerted application rules，pair and combination of herbs for statistics， association rules analysis and discovery of new prescriptions. Result:A total of 122 prescriptions of professor WANG Jie on the treatment of frequent ventricular premature complexes were collected. 110 herbs，mostly with pungent and sweet flavors，were mainly on spleen channel and also on heart，kidney，liver，lung，and stomach channels. Cinnamomi Ramulus，Paeoniae Alba Radix<italic>，</italic>Os Draconis<italic>，</italic>Ostreae Concha<italic>， </italic>Glycyrrhizae Radix<italic>，</italic>and Jujubae Fructus<italic> </italic>had the highest frequency in use. The high-frequency herbal pair was Cinnamomi Ramulus-Paeoniae Alba Radix（116 times， accounting for 95.08%），the commonly used corner drugs were Cinnamomi Ramulus<italic>-</italic>Os Draconis<italic>-</italic>Ostreae Concha<italic> </italic>（108 times，88.52%），Cinnamomi Ramulus<italic>-</italic>Paeoniae Alba Radix<italic>-</italic>Ostreae Concha （106 times， 86.89%），Cinnamomi Ramulus<italic>-</italic>Paeoniae Alba Radix<italic>-</italic>Os Draconis （106 times，86.89%）. Commonly used herbal pair was<italic> </italic>Aucklandiae Radix-Amomi Villosi Fructus. The core prescription herbs included Cinnamomi Ramulus<italic>-</italic>Paeoniae Alba Radix<italic>-</italic>Os Draconis<italic>-</italic>Ostreae Concha<italic>-</italic>Glycyrrhizae Radix<italic>-</italic>Jujubae Fructus<italic>-</italic>Zingiberis Recens Rhizoma<italic>-</italic>Achyranthis Bidentatae Radix<italic>-</italic>Codonopsis Radix<italic>-</italic>Astragali Seu Hedysari Radix<italic>-</italic>Cistanches Herba-Poria<italic>-</italic>Ziziphi Spinosae Semen. Conclusion:Professor WANG Jie's prescription for the treatment of frequent ventricular premature complexes is Guizhi Jia Longgu Mulitang，and the main herbs are Cinnamomi Ramulus，Paeoniae Alba Radix，Os Draconis，Ostreae Concha，Glycyrrhizae Radix，and Jujubae Fructus. The final prescription could be adjusted according to the diseases and symptoms of patients.
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Objective: To evaluate the clinical pharmacist role in the prescription analysis, drug interaction and the impact of patient counseling in type 2 diabetes mellitus patients. Methods: A prospective study was conducted in 203 type II Diabetes Mellitus patients for a period of 6 mo in the Diabetology department. Prescriptions were analyzed and self-care assessment for good health practices were collected using a questionnaire and the adherence scores were calculated. Patient counseling was provided to the patient and a follow up was done using the same self care assessment questionnaire. Results: Out of 203 patients, 86 multiple therapy, 68 dual therapy and 49 monotherapy were observed. Glimepiride+Metformin (54), a combination of short acting and intermediate-acting insulin (41) was the most commonly prescribed drugs. Out of 1102 drugs, 488 were anti diabetic drugs, 35 were antibiotics, 579 were other drug classes prescribed. The drug interactions were reported. The adherence score shows a highly significant impact after counseling. Conclusion: The results of the current study helps to understand the changes in prescription pattern, drug interactions and the impact of patient counseling by a clinical pharmacist.
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Writing a prescription is a combination of science and art. Good quality prescriptions are a sign of prescriber’sexpertise. Analysis of quality of prescriptions can be carried out by various methods and by using certain toolsas well. Prescription Quality Index (PQI) is one such validated tool for analyzing the prescription quality. Thepresent study was undertaken on 2155 prescriptions to analyse the prescriptions of outdoor patients by usingPrescription Quality Index tool. Each prescription was evaluated by using questionnaire of PQI tool. The toolconsists of 22 questions, based on the answers of which a score was calculated for each prescription. Thena collective mean score for all the prescriptions was calculated. Depending upon individual scores, theprescriptions were graded in to poor, medium and high-quality prescriptions. The mean PQI score for all the2155 prescriptions was 28.94 ± 0.23. We found that 1015 (46.10 %) prescriptions were of poor quality, 46(2.13 %) were of medium quality and 1094 (50.77 %) were of good quality. The overall mean score of all theprescriptions falls in to the poor-quality prescription category according to PQI. It was concluded that therewere many lacunas that require the attention of prescribers in order to attain and maintain high standardprescription quality.
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Background: Drug utilization studies are used to analyze different aspects of the use of drugs and to implement methods of improving therapeutic quality. This study was conducted to study drug prescription pattern in Medicine Outpatient Department (OPD) in Ashwini Rural Medical College, Kumbhari. Methods: Six hundred prescriptions were screened & analyzed as per the study parameters at Medicine OPD of Ashwini Rural Medical College, Kumbhari. Study parameters like demographic profile of the patient like age, sex and diagnosis were recorded. Doctor details and patient details like age, sex and address were analyzed. Also, groups of drugs commonly prescribed, number of drugs per patient, drug profile and drawbacks of prescription if any were recorded and analyzed.Results: Most common group of drugs prescribed by physicians were Analgesics (21.84%), followed by Drugs for Peptic ulcer (17.92%) and Multivitamins/multimineral (14.70%). The average number of drugs prescribed per patient was 2.38. The incidence of Polypharmacy was common occurrence and some prescriptions had small drawbacks like absence of diagnosis, absence of doctor’s signature, etc.Conclusions: Authors conclude that most of the prescriptions which were analyzed at Ashwini Rural Medical College Hospital, Kumbhari, were according to the standard norms of WHO prescriptions and also most of the drugs prescribed were from the list of essential drug list. But still there is scope for improvement in prescription pattern.
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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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OBJECTIVE： To investigate the situation and problems of clinical microecological preparations in pediatrics department of China， and to provide reference for rational application of microecological preparations in children. METHODS： Outpatient/emergency prescriptions of microecological preparations during Jan.-Mar. 2019 were retrieved from information system of 5 “Third Grade Class A” children hospitals， and were investigated and analyzed in respects of the type of microecological agents， age distribution， clinical diagnosis， drug combination， off-label medication， etc. RESULTS： A total of 74 210 outpatient/emergency prescriptions were collected， involving 18 kinds of microecological preparations. Among them， Clostridium butyricum combined viable powder ranked first （31 146， accounting for 41.97％）， followed by Brucella yeast powder （14 289， accounting for 19.25％） and Compound Lactobacillus acidophilus tablets （10 281， 13.85％）. The age of children was less than 18 years old， and the proportion of children aged 1-＜3 years old was the highest （33 753， 45.48％）. The most common clinical diagnosis was digestive tract diseases （54 009， 72.78％）， followed by respiratory infectious diseases （11 744， 15.83％）. In combination with microecological agents， there were Chinese patent medicine for invigorating the spleen and stomach （18 546， 24.99％）， antibacterial medicine （10 595， 14.28％） and oral rehydration salt Ⅲ （8 238， 11.10％）. Off-label drug use was found in 19 532 prescriptions （26.32％）， mainly manifesting as super-indications （15 590， 21.01％）， super-usage and dosage （8 098， 14.52％）， super crowd medication （48， 3.91％） was found in a few prescriptions. CONCLUSIONS： There is a high incidence of off-label use of microecological agents in children. Medical staff should standardize prescription behavior and promote rational use of drugs. At the same time， the improvement of the information of children’s medication in drug instructions to ensure the safety and effectiveness of children’s medication should be encouraged.
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OBJECTIVE:To provide reference for rational use of oxycodone and acetaminophen in outpatient and emergency department. METHODS:By retrospective study,the application of oxycodone and acetaminophen in outpatient and emergency de-partment of our hospital during 2013-2015 was analyzed statistically. RESULTS:During 2013-2015,there were 22654 outpatient and emergency prescriptions of oxycodone and acetaminophen in our hospital. The prescription number,amount and consumption sum of oxycodone and acetaminophen were increasing year by year. Top 3 clinical departments of oxycodone and acetaminophen in the list of prescription number were orthopedics department(78.34%),emergency department(15.52%)and oncology department (2.09%). The age of patients using oxycodone and acetaminophen mainly aged 19-64 years old(78.62%);the ratio of male to fe-male was 1:1.08. The amount of oxycodone and acetaminophen was 5 mg,mainly 4 times a day(86.91%). In all kinds of diagno-sis,knee osseous arthritis (47.26%),pain in waist and lower extremities (6.18%) and abdominal pain in dispute (5.92%) were top three. CONCLUSIONS:A large amount of oxycodone and acetaminophen were used in outpatient and emergency department of our hospital during 2013-2015;there is unreasonable drug use so that we need to strengthen management and standardize drug use.
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Objective To investigate the application of the parenteral nutrition prescriptions for tumor patients in a tertiary hospital .Methods In this cross-sectional study , the parenteral nutrition prescriptions of all tumor inpatients in a tertiary hospital were collected from May to June in 2015 .The general data of patients who had used parenteral nutrition , the types of parenteral nutrition products , as well as the ratio of energy to ni-rogen ( E/N) , glucose/lipid ( G/L) ratio, non-protein energy to nitrogen ratio , and liquid volume were recor-ded and analyzed .Results Parenteral nutrition prescriptions were collected from 528 patients and showed high irrationality.The nutrient insufficiency rate was nearly 58.3%.The E/N (100:1 ~200:1) accounted for 32.3%and the G/L ( 1:1 ~2:1 ) 20.6%.Conclusions The rational application of parenteral nutrition should be a priority in clinical settings .A clinical nutrition supporting team may be established in tertiary hospi-tals to guide the appropriate use of parenteral nutrition .
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OBJECTIVE:To investigate drug combination in outpatient prescriptions of hypertension patients in our hospital, provide reference for rational drug use in clinic. METHODS:The outpatient prescriptions of patients diagnosed as hypertension dur-ing Jan. 1st to Feb. 1st in 2015 were collected from the hospital. The prescriptions of two or more than two drugs were screened, and the prescriptions of drug combination containing CYP enzyme substrate,inhibitor or inducer were recorded. Guided by metabol-ic enzymology theory,the potential metabolic drug interactions in prescriptions were evaluated on the basis of relevant literature and data reports. RESULTS:Totally 1042 prescriptions were consulted. The prescriptions of the combined medication were 551, and the potential metabolic drug-drug interactions were detected at 249 prescriptions,accounting for 45.2％. Main CYP enzyme sub-types were CYP3A4,CYP2C9,CYP2C19 and CYP2D6. Totally 214 prescriptions were correlated with CYP3A4,accounting for 85.9％ of drug interaction prescriptions;CYP3A4 substrate combined with substrate in 199 prescriptions,with inhibitor in 27 pre-scriptions,and with inducer in 11 prescriptions. Totally 27 prescriptions were correlated with CYP2C9,accounting for 10.8％ of drug interaction prescriptions;CYP2C9 substrate combined with substrate in 8 prescriptions,and with inhibitor in 20 prescriptions. Totally 27 prescriptions were correlated with CYP2D6,accounting for 10.8％ of drug interaction prescriptions;CYP2D6 substrate combined with substrate in 15 prescriptions,and with inhibitor in 12 prescriptions. Totally 4 prescriptions were correlated with CYP2C19,accounting for 1.6％ of drug interaction prescriptions;CYP2C9 substrate combined with inhibitor in 2 prescriptions, and with inducer in 2 prescriptions. CONCLUSIONS:Many metabolic drug-drug interactions are detected in the outpatient prescrip-tions of hypertension patients in our hospital. In order to improve the rationality and safety of the prescription,clinicians and phar-macists should pay attention to the drug combinations with drug-drug interactions which have been reported in the existing litera-ture,and choose similar drugs without or with little interactions.
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OBJECTIVE:To provide scientific reference for rational,effective and economical drug use in pediatric depart-ment. METHODS:A total of 9771 prescriptions were randomly selected from children's branch of our hospital during May 2012-Apr. 2016. Those prescriptions were analyzed statistically in respects of drug type,prescription cost,utilization rate of injec-tion,utilization rate of essential medicine,clinical diagnosis,irrational drug use,use of antibiotics,etc. RESULTS:Among 9771 prescriptions,2.91 types of drugs were used in each prescription,and each prescription expended 77.10 yuan;utilization rate of in-jection was 57.11％,and that of national essential medicine was 67.80％. Respiratory tract disease was main disease (84.17％). There were 284 irrational prescriptions(2.91％),including 156 non-standard prescriptions,165 unsuitable prescriptions and 65 ex-traordinary prescriptions. Utilization rate of antibiotics was 18.25％,among which that of Cefoxitin sodium injection was the high-est(15.48％),but its utilization index was the lowest(0.58). The detection rate of microorganism isolated from bronchitis patients was in low level(45.10％). CONCLUSIONS:The rate of qualified prescription in the children's branch of our Hospital is higher than the requirement of the former Ministry of Public Health concerning the rate of qualified prescription >95％;utilization rate of antibiotics and injection are both in high level. In the future,it is necessary to strengthen prescription evaluation and promote stan-dard and rational use of drugs so as to guarantee safe,effective and economical use of drugs in clinic.
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Objective To review the usage of narcotic drugs at outpatient and emergency pharmacy in order to promote rational narcotic drug use .Methods A total of 2 940 narcotic prescriptions from outpatient and emergency pharmacy in our hospital during January to June ,2014 and 2015 were collected .Three parameters (the prescription department ,DDDs and DUI) were analyzed statistically .Results Six narcotic drugs were involved ,including three injections ,two tablets and one ex-ternal patch .Emergency Department ,Radiotherapy Department and Analgesia Department are the top three high usage depart-ments .Morphine sulfate sustained-release tablet had the highest DDDs .DDDs of pethidine hydrochloride injection during Janu-ary to June ,2015 was significantly reduced compared to the same period in 2014 .DUI of morphine sulfate sustained-release tablet and bucinnazine hydrochloride tablets increased to some extent .Conclusion The usage of narcotic drugs at outpatient and emergency pharmacy in our hospital was basically reasonable .A few physicians still had problems in proper indication and dosage with narcotic drug use .The specific training programs need to be in place for those physicians .
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Background: The pattern of drug use in people hospitalized with a primary diagnosis of psoriasis has never been studied previously in India. The aim of the study was to characterize the prescription pattern of people admitted to hospital with psoriasis so that rational prescribing could be promoted among dermatologists. Methods: Case files belonging to 32 patients, admitted in the Department of Dermatology with psoriasis, of a tertiary care teaching hospital in Kerala, over a period of 1-year were retrieved with the assistance of the medical records department. The data thus obtained was analyzed using descriptive statistics. Results: The average age of patients who were admitted with psoriasis was 49.9 years, and their average duration of hospital stay was 7.96 days. A total of 296 formulations were prescribed to 32 patients. Out of 296 formulations, only 10 (3.37%) were generic and rest 286 (96.62%) branded. Fixed dose combinations consisted of 32.43% (96/296) of the prescribed formulations. Psoriasis vulgaris (56.25%) was the most common cause for admission. Of all the prescribed medications, 4 (1.35%) did not contain clear instructions for the route of administration. Strength was clearly mentioned in only 89 (30%) of the preparations. In 98% of the prescriptions, the exact dose was missing. Conclusions: The study reveals various deficiencies which exist in the prescribing pattern of drugs for management of psoriasis. Educational interventions among the doctors as well as students should be carried out to promote rational drug use.
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OBJECTIVE:To improve the safety and effectiveness of total parenteral nutrition(TPN),and to provide reference for clinical rational use. METHODS:1400 TPN prescriptions in PIVAS from Jan. to Jun. 2013 were analyzed statistically in re-spects of rationality and stability. RESULTS:Among 1400 TPN prescriptions,there were 433 prescriptions of unreasonable glu-cose-lipid ratio(30.93%),782 prescriptions of unreasonable hot-nitrogen ratio(55.86%),443 prescriptions of unreasonable liquid amount(31.64%),1 261 prescriptions of unreasonable total calorie(90.07%)and 383 prescriptions of unreasonable treatment du-ration (27.36%). CONCLUSIONS:TPN prescription design is reasonable,but there are still some problems as low calorie,too high or too low hot nitrogen ratio,improper electrolyte dosage,improper duration of nutrition support. Clinicians should accurately assess the nutritional status of patients to design the prescriptions rationally and improve clinical safety and effectiveness of TPN. Pharmacists should further ensure the reasonableness of the prescription by prescription checking.
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OBJECTIVE:To consolidate the results of special antibacterial drug rectification so as to improve the rational medi-cation of antibacterial drugs. METHODS:By using the method of retrospective analysis,the antibacterial drug application data in 2011(before rectification and initial stage of rectification),2012(middle stage thereof)and 2013(later stage thereof)were sum-marized,compared and analyzed. RESULTS:After special rectification(Jan. 2011 vs. Dec. 2013),the utilization rate of antibacte-rial drugs in perioperative period for class I incision decreased from 80.42% to 24.49%. That of antibacterial drugs in emergency treatment decreased from 53.79% to 36.23%. The examination rate of microbial samples in inpatients who would use special-grade antibacterial drugs increased from 16.12% to 94.17%. The use intensity of antibacterial drugs by inpatients decreased from 70.28 DDDs/(100 persons·d) to 27.44 DDDs/(100 persons·d). The utilization rate of antibacterial drugs by inpatients decreased from 65.99% to 46.45%. CONCLUSIONS:Special rectification has remarkable effects on rational clinical application of antibacterial drugs. Regulation and evaluation should be strengthened to maintain the effects and continuously improvement should be made.
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Objective To provide suggestion and reference for standardizing irregular usage of drug prescription in hospi‐tal .Methods Prescriptions of outpatient section and emergency room in Heshan People′s Hospital were extracted from January to June 2013 .The behavior of irregular usage drug prescription was statistically analyzed according to the content of drug in‐structions .Results 63 irregular usage of drug prescriptions were found ,involving off‐indication use ,overdose ,change in med‐ication method and route of administration ,and usage beyond the scope of intended patient population .Conclusion irregular usage of drug prescription is common in outpatient section and emergency room ,w hich putting patient medication at risk .We recommend that medication management standards should be developed as soon as possible by the relevant departments to en‐sure patient′s safety .
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OBJECTIVE:To provide reference for further formulation of the rational use of vancomycin. METHODS:Retro-spective analysis was conducted on the related information of discharged patients who intravenously used vancomycin from Jun. 2013 to Dec. 2014. RESULTS:178 patients were enrolled,with average age of 59.6 and 73.60% male,who were mainly with lung infectious(74.72%). Support examinations were sufficient before using of vancomycin. 66.29% patients were empirically giv-en vancomycin with pathogenic detection rate of 85.39%. 71.91% patients were conducted therapeutic drug monitoring with only 47.54% of first blood samples achieved the target range. CONCLUSIONS:Vancomycin application is generally rational in our hos-pital. However,issues like duration of empirical therapy,rational therapeutic monitoring,and individualized start dosing still need to be noticed.
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Objective To put forward suggestions or measures for prescription standardization through analysis of prescription of TCM decoction pieces in outpatient of our hospital. Methods Totally 2400 outpatient prescriptions were randomly selected in 2013, in order to carry out statistical analysis on non-standard prescription and analyze existing problems. Results There were 177 non-standard prescriptions, accounting for 7.38%of 2400 prescriptions. Conclusion Unreasonable medicine use in prescription of outpatient exists. Communication between pharmacists and physicians about prescription should be strengthened, prescription review system should be refined, and norms of prescription should be promoted, with a purpose to ensure the safety of medicine using.