Drug prescribing pattern in dermatology outpatient department at a tertiary care teaching hospital of North India – A cross-sectional survey-based study

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.

Drug utilisation study in surgery outpatient department at Ashwini Rural Medical College, Kumbhari, Solapur

Background: Drug utilization studies should be regularly conducted to increase therapeutic efficacy, decrease adverse effects and provide feedback to prescribers to promote the rational use of drugs. Systematic audit of prescriptions in Surgery Outpatient Department are very few in India. This study was conducted to study drug prescription pattern in Surgery Outpatient Department (OPD) in Ashwini Rural Medical College, Kumbhari.Methods: Six hundred prescriptions were screened and analyzed as per the study parameters at Surgery OPD of Ashwini Rural Medical College, Kumbhari. Study parameters like demographic profile of the patient like age, sex and diagnosis were recorded. Also groups of drugs commonly prescribed, number of drugs per patient, drug profile and drawbacks of prescription if any were recorded and analyzed. The percentage of the drugs prescribed by generic names and from the essential drug list was calculated.Results: Most common group of drugs prescribed by physicians were drugs for peptic ulcer (27.26%), followed by antimicrobials (20.89%). The average number of drugs prescribed per patient was 2.98. Drug prescription by generic name was low (8.82%). The incidence of polypharmacy was common occurrence and some prescriptions had small drawbacks like absence of diagnosis, absence of doctor’s signature, absence of patient age etc.Conclusions: Prescribing by generic name and from the essential drug lists should be encouraged. Training sessions on the correct method of writing prescriptions are needed.

A world health organization core drug use indicator based prescription study in the dermatology outpatient department of a tertiary care teaching hospital of central South India

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.

Drug utilization research: a review

Data from drug utilization research is an invaluable resource for all stake holders involved in drug and health policies. Drug utilization is “marketing, distribution, prescription and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences”. Research on drug utilization includes factors related to prescribing, dispensing, administering and intake of medication and its associated events. The ultimate purpose of drug utilization research is to estimate the optimal quality of drug therapy by identifying, documenting, analysing problems in drug utilization and monitoring the consequences. It encourages the prescribers to prescribe correct drug at appropriate dose and affordable price. It contributes to the knowledge of rational use of drugs in the society; whether the drug is being prescribed appropriately, whether the drug is taken in correct dosage, whether the drug is available at affordable price or misused. It provides valuable feedback about the rationality of the prescription to the doctors. It also assesses whether an intervention affects the drug use in the population by examining the outcomes of different types of intervention given to improve rationality in drug use. Drug utilization research can be qualitative or quantitative and can be done by various methods. This review highlights the understanding of various aspects, different designs and WHO guidelines for conducting drug utilization research.

Patterns of drug use and drug dispensing in dermatology outpatient prescriptions in a tertiary care teaching hospital

Background: Periodic assessment of drug prescribing and dispensing pattern in a hospital facility shall play a major role in avoiding the inappropriate use of drugs which leads to potential hazards and expenses for the patients.Methods: The objective of the study was to analyse the patterns of drug use and dispensing in dermatology outpatient prescriptions from a tertiary care teaching hospital in south India. Data were collected over a period of one month from patients attending dermatology outpatient department by scrutinizing 100 prescriptions and analyzed using WHO formulated 揷ore drug use indicators� like the format, prescribing pattern and rationality of prescriptions.Results: The total number of drugs prescribed in 100 prescriptions was 233 i.e. on average 2.33 drugs were prescribed per patient. The patient's name and age were mentioned in all the prescriptions while diagnosis, dose, route of administration, dosage form, duration of therapy and prescriber's identity was written in 43.29%, 68.04%, 69.07%, 100%, 49.48% and 63.91% prescriptions respectively. Out of all drugs, 42.91% were generic drugs and 57.08% were from National Essential Drug List of India. Steroids (18.02%) were the most common group of drugs used, followed by keratolytics and emollients (15.87%). Most of the drugs were given by topical route (47.63%).Conclusions: A prescription by a doctor is a reflection of physicians� attitude towards the disease and the role of drug in its treatment. It also provides an insight into the nature of health care at that facility. Interventions to rectify over proper prescription format and prescription of generic drugs are necessary to further improve rational drug use in this facility.

An empirical study on the rational drug use in outpatients from different levels of health facilities in Sichuan Province / 药学实践杂志

Objective To evaluate the current situation of rational drug use in medical facilities at all levels in Sichuan province by means of empirical research via WHO /INRUD selected drug use indicators SDUIs .Methods Six sample cities in Sichuan Province was extracted ,in which 1 to 3 tertiary hospitals ,1 to 3 secondary hospitals ,5 community health service cen-ters and 5 township hospitals were selected .Prescription indicators were indicated by collecting outpatient prescriptions from sample medical facilities which contained 30 prescriptions per month of every January ,April ,July and October from January 2012 to April 2015 .Results The average number of drugs was 3 .02 per prescription .The percentage of drug generic name used in prescription drugs was 90 .33％ .The percentage of antimicrobial use was 40 .09％ .The percentage of injections used was 14 .46％ .The percentage of essential drugs used among prescription drugs was 83 .27％ .The percentage of essential drugs used was 93 .05％ .Average fee amount all prescriptions was 66 .04 yuan .Conclusion Some of the indicators was of good ra-tionality ,but there were still some unreasonable phenomena .

Prescription Auditing of Patients Admitted at Psychiatry ward of a Tertiary Care Hospital of Western UP

Introduction: The World Health Organization (WHO) proposed core-prescribing indicators for prescription audit and drug utilization studies. The focus of Indian studies has mainly been on the WHO core-prescribing indicators such as the range and number of drugs per prescription. Critical evaluation of prescriptions including rational auditing of prescriptions of patients admitted at Psychiatry Ward of Jawaharlal Nehru Medical College Hospital, A.M.U., Aligarh, from the period of 31/05/2013 to 30/05/2015. Materials and Methods: Permission for retrospective study to access medical records of the past 2 years of all patients admitted in the Psychiatry ward from 31/05/2013 to 30/05/2015 was obtained from the competent authority. Prescriptions of 44 patients (26 female, 18 male) were available in the Central Record Section during this period. The following parameters were taken to analyse and audit prescriptions as per WHO prescribing indicators: 1) Patient details, 2) Mention of diagnosis, legibility & spelling mistakes, 3) Details of the consultant, 4) Use of antibiotics/antipsychotics by various routes, 5) Provision of proper instructions to patients and 6) Additional parameters - Percentage of prescriptions with nutritional supplements and antacids. Results: Only 36% of prescriptions contained the full names of patients, while age, sex and address were present in 84.09% of the prescriptions. 100% prescriptions were found written with complete diagnosis and contained the signature of the concerned doctor. None of the prescription had the doctor’s contact number. A mean number of 3.18 drugs were written per prescription. All prescriptions were legible and 2.27% contained spelling mistakes. Insufficient instructions for both oral and injectable drugs were mentioned on all prescriptions. Conclusion: As per WHO laid guidelines, study related to drug use indicators are simple as a supervisory tool to assess prescribing patterns by individual doctors. These prescription studies provide scope to improvement in prescribing patterns and promotion of rational use of drug among practitioners.

Prescribing activities at district health care centers of Western Odisha.

Background: Currently, rational use of drugs is a major issue in public health care. Rational use of medicines is important for decreasing the cost of therapy, avoiding drug interactions or drug reactions, improving compliance, etc. Studies from different parts of the world have shown different results regarding the rational use of drugs. We conducted this study to know the pattern of prescription and rational use of drugs in rural areas of Odisha to create awareness and knowledge among health care providers, medical students, and public. Methods: This was a prospective study and conducted on 450 prescriptions collected from two district health care centers of Odisha state. These prescriptions collected randomly over 2-month period. Data analyzed according to prescribing indicators formulated by World Health Organization. Results: We found that average number of drugs per encounter was 2.9. 68% drugs were prescribed by generic name. Use of antibiotics (47.7% cases) and injections (8% cases) were frequent. Conclusion: Our fi nding shows deviation from the rational use of medicines in some aspect. We suggest that there should be strict regulatory guidelines and local policy for implementing rational drug use.

Prescription pattern of drugs in pregnancy induced hypertension in a tertiary care hospital.

Background: The objective of this study was to evaluate the prescription pattern of drugs in pregnancy induced hypertension in a tertiary care hospital. Methods: A retrospective observational study was conducted by department of Pharmacology in collaboration with the Department of Obstetrics in Kamineni Institute of Medical Sciences, Narketpally after taking permission from the Institutional Review Board. WHO basic indicators were indicators were used for studying the prescribing pattern of drugs. Results: Out of the total prescriptions studied the most commonly prescribed antihypertensive was Methyldopa, followed by Nifedipine. Amlodipine, Atenolol and Magnesium sulphate were the other drugs prescribed. Majority drugs prescribed were from category B and C. Single drug therapy was prescribed in 46.94% patients. The use of fixed dose combinations was low. Conclusion: The incidence of single drugs therapy and two drugs was high. Irrational prescriptions were few. The present pattern of prescriptions can be improved by advocating rational drug prescription and awareness regarding safe use of drugs to the obstetricians.

Drug utilization study of antihypertensives in obstetric practice in a tertiary care hospital.

Objectives: To evaluate the drug utilization of antihypertensive in obstetric practice two tertiary care hospitals in Gulbarga city. Material & Methods: A prospective cross-sectional study was conducted for 2 years in obstetric departments of Government General Hospital and Sangameshwar Teaching Hospital, Gulbarga. W.H.O. basic drug indicators were used for studying the prescribing trends and interviewing the patients. Results: A total of 200 prescriptions were studied and the average number of drugs per prescription was 2.47. 1.89% of generics and 49.59% of essential drugs were prescribed. 98.15% were non generic names used. The average consulting time given per patient was 9 mins 8 secs. 69.5% of the patients knew their dosage schedule and this was related to their education status. 13% were irrational prescription. The frequency of use of Nifedipine was highest followed by Benzathiazide + Triamterene, Amlodipine, Furosemide, Methyldopa and Spiranolactone etc. The use of the safest drug, Methyldopa was among only 4% of patients. 66.28% of prescribes drugs were available in hospital pharmacy. Conclusion : The incidence of poly pharmacy was high. Patient compliance is good only among educated patients. Irrational prescriptions were few. The availability of drugs in the hospitals was not satisfactory. The present healthcare can be improved by advocating rational drug prescribing patient education and improving the facilities in the hospitals.