RESUMO
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.
RESUMO
Background: Prescription quality can be a direct predictor of the net outcome of a health care deliveryeffort. Quality of prescription may be considered as a cumulative matrix of multiple components of aprescription on the basis of their relative importance. Prescription quality index is a recognized tool inclinical medicine for multiple purposes including the prediction of health care intervention outcome.Objectives: Considering the importance of prescription quality among every system of medicine, anattempt was made to design a prescription quality index for Ayurveda.Materials and methods: The Prescription Quality Index for Ayurveda was designed through item selectionfollowing a thorough literature search and was validated through multiple peer group discussions. Finaldraft of index containing 38 individual items carrying different scores as per their importance in theprescription was subjected to a pilot test upon 1576 indoor prescriptions generated in 2015 at StateAyurvedic College Hospital, Lucknow.Results: The study revealed large information gaps in the components of the prescription where it wassupposed to be noted by the prescribers. These gaps in the Ayurvedic prescriptions were most significantin the areas pertaining to Ayurvedic fundamentals of clinical examination, disease diagnosis and Ayurvedic drug intake methods.Conclusion: Prescription Quality Index for Ayurveda was found useful in underlining the gaps betweenthe ideal and generated prescriptions. This can be utilized as a useful tool to evaluate the quality ofAyurvedic prescriptions by seeing their adherence to the standard prescription template.© 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
RESUMO
Background: Diarrhoea is a major public health problem in children worldwide. It continues to be a major health challenge, especially in developing countries, despite the availability of regularly updated standard treatment guidelines. Non-compliance to such guidelines by the physicians has been a long standing story. The treatment is often marred with incapacitating prescription of drugs besides neglecting even the basic tenets of good prescribing. As a result, the quality of such prescriptions for diarrhoeal disorders in children remains poor. To gauge the magnitude of this problem in this setup towards possible corrective measures, the study was aimed to audit prescription practices in the management of acute and persistent diarrhoea in hospitalised children up to five years of age.Methods: An observational study was conducted in 100 patients of either gender in the age group up to 5 years admitted with acute and persistent diarrhoea. A detailed medical history from the parents/guardians and the details of prescription from the time of admission till the discharge of the patient were obtained. Quality of prescriptions was analysed using prescription quality index (PQI) tool, a validated comprehensive tool described by Hassan et al in 2010. Based on this tool, prescription with the total PQI score of ? 31 were interpreted as poor quality, scores with 32 to 33 as medium quality and scores 34 to 43 as high quality with a possible maximum score of ��.Results: Based on the PQI tool for 100 children, 60 prescriptions were found to be of poor quality. Only 2 prescriptions were of medium quality, whereas 38 prescriptions were in high quality range. Average mean盨D score of prescriptions with poor quality was 25.2�48, ranging from 21 to 31. The mean盨D of prescriptions with medium quality was observed to be 32�and for prescriptions of high quality was 38.07�28. The total average mean score of all prescriptions was 30.23�50. Poor quality prescriptions were particularly observed for the patients with the diarrhoea with No dehydration.Conclusions: Prescription appropriateness in spite of available guidelines continues to be a big challenge in the adequate management of patients with diarrhoeal disorders under the age group of five years in a tertiary care centre in India.
RESUMO
Background: Prescribing quality is a matter of major concern worldwide. This study was carried out to determine the quality of prescribing in chronic diseases at primary health care (PHC) and secondary health care (SHC) settings using the new prescription quality index (PQI) tool. Methods: A cross-sectional observational study was carried out at four PHC and two SHC facilities in Anand district of India. Patients attending these facilities for at least 3 months were included. Complete medical history and prescriptions received were noted. Total and criteria wise PQI scores were derived for each prescription. Prescriptions were categorized as poor (score of ≤31), medium (score 32-33), and high quality (score 34-43) based on PQI total score. The internal consistency of PQI was measured using item total correlation and Cronbach’s α so as to validate it in our settings. Data were analyzed using Statistical Package for Social Science 20. Results: A total of 134 prescriptions were collected and evaluated for quality of prescribing. Mean age of patients was 60.6 ± 13.5 years. Mean PQI score was 23.60 ± 9.3 with 71.6% prescriptions being of poor quality. Quality of prescribing did not differ at PHC and SHC (P>0.05). Of 22 criteria, PQI score was strongly correlated with drug indication, drug effectiveness, evidence-based prescribing, unnecessary duplication, duration of therapy, and cost (P<0.01). PQI total score was negatively correlated to the number of drugs per prescription. Cronbach’s α for the entire 22 criteria were 0.90. Conclusion: PQI was found to be a reliable tool for assessment of prescribing quality in chronic diseases.
RESUMO
As interações medicamentosas são fatores de risco para a ocorrência de reações adversas a medicamentos. Este estudo teve o objetivo de avaliar as interações medicamentosas potenciais em prescrições da atenção primária de Vitória da Conquista (BA), visando preencher a lacuna de conhecimento sobre essa temática no Brasil. Foram coletadas informações sobre diversas variáveis de prescrições oriundas da atenção primária e as interações medicamentosas avaliadas a partir dos bancos de dados do Medscape e Micromedex(r). Verificou-se ainda a frequência de polifarmácia e associação desta com a ocorrência de interações medicamentosas. Os resultados mostraram frequência de 48,9% de interações medicamentosas, 74,9% delas de gravidade moderada ou maior, e 8,6% de prescrições em polifarmácia que, em teste qui-quadrado, mostrou associação positiva com ocorrência de interações medicamentosas potenciais (p < 0,001). As prescrições oriundas da atenção primária de Vitória da Conquista (BA) apresentaram uma alta frequência de interações medicamentosas, porém faz-se necessária a análise de outros fatores de risco para ocorrência destas nesse nível de atenção à saúde.
Drug interactions are risk factors for the occurrence of adverse drug reactions. The risk for drug interactions includes factors related to prescription that are intrinsic to the patient. This study sought to evaluate the potential drug interactions in primary care prescriptions in Vitória da Conquista in the state of Bahia to fill the knowledge gap on this topic in Brazil. Information about several variables derived from the primary health care prescriptions was collected and drug interactions were evaluated based on information from Medscape and Micromedex(r) databases. Polypharmacy frequency and its association with the occurrence of drug interactions were also evaluated. Results revealed a 48,9% frequency of drug interactions, 74,9% of moderate or greater severity, 8,6% of prescriptions in polypharmacy that in the chi-square test showed a positive association with the occurrence of drug interactions (p < 0,001). Prescriptions from primary care in Vitória da Conquista in the state of Bahia showed a high frequency of drug interactions, however it is necessary to analyze other risk factors for their occurrence at this level of health care. .