Drug utilisation among older inpatients in a teaching hospital in Western Nepal.

INTRODUCTION: The proportion of the elderly population in Nepal, though low, is steadily increasing. Studies on drug utilisation among geriatric patients in Western Nepal, a region with the highest proportion of the elderly in all of Nepal, are lacking. The present study was carried out at the Manipal Teaching Hospital, a 700-bed teaching hospital in Pokhara, Western Nepal. METHODS: The study was carried out from June 1, 2005 to May 31, 2006 using case records of discharged patients aged 60 years and older. This was an observational study that utilised a retrospective case notes review methodology. The microorganisms isolated on culture and their antibiotic sensitivity patterns were studied. Drug consumption was measured by the defined daily dose (DDD) per 100 bed-days. The mean cost of the drugs was calculated. The percentage of drugs prescribed by generic name and the percentages of fixed-dose combinations used were noted. The basic demographic information of older inpatients, drug utilisation patterns, drug consumption using DDD, organisms isolated and their antibiotic sensitivity patterns, and the mean cost of the drugs were studied. RESULTS: A total of 548 patients were admitted. Hypertension, acute exacerbation of chronic obstructive pulmonary disease and cancer were the most common illnesses among the patients. The mean number of drugs consumed by each patient was 7.73. Escherichia coli and Pseudomonas aeruginosa were the most common microorganisms isolated. Ranitidine, multivitamins, amlodipine, ipratropium and dextrose normal saline were most commonly prescribed. The DDD per 100 bed-days of ranitidine and omeprazole (highest values) was 33.48 and 3.51, respectively. The mean cost of drugs was USD26.6, and antibiotics accounted for around 40 percent of the cost. CONCLUSION: The use of a high number of drugs, and of parenteral drugs and intravenous fluids, is a common problem. The prescription of generic drugs is low. Guidelines for the use of drugs in the elderly are required and further studies are needed on this issue.

Can drug utilization help in promoting the more rational use of medicine? Experiences from Western Nepal.

Drug utilization research describes the extent, nature and determinants of drug use in populations and aims to facilitate the more rational use of medicines. The departments of Pharmacology and Clinical Pharmacy at the Manipal College of Medical Sciences, Pokhara, Nepal are committed to promoting the more rational use of medicines. The departments run a Drug Information Center and a Pharmacovigilance Center in the teaching hospital. Over the last eight years, the departments have conducted drug utilization studies in the teaching hospital and the community. A few of these were of the intervention type and drug use was studied before and after the intervention. Members of the departments are on the hospital Drug and Therapeutics Committee. Educational initiatives to improve prescribing have been carried out in a few instances. Restricting the number of brands in the hospital pharmacy and creation of a hospital drug list has been carried out. The impact of these initiatives has been studied only in a few cases. Generic prescribing was found to be low. The educational initiatives to improve prescribing had only limited success. The hospital is in the process of framing antimicrobial use guidelines for various departments. A hospital formulary is under preparation. The influence of drug utilization studies on the prescribing patterns has been low to moderate. The department of Clinical Pharmacy runs a Medication Counseling Center in the hospital and teaches appropriate use of medicines to patients. The studies and initiatives to promote the more rational use of medicines should be continued and strengthened.

Prescribing patterns in the orthopaedics outpatient department in a teaching hospital in Pokhara, western Nepal.

OBJECTIVES: Information on the utilization patterns of drugs in the orthopaedics outpatient department (OPD) are lacking in hospitals in western Nepal. The present study was carried out to obtain demographic information about the respondents selected for analysis, information on the average number of drugs prescribed and the average cost of drugs per prescription. The prescriptions were critically analyzed using predetermined criteria. MATERIALS AND METHODS: The study was carried out over a four-month period (01.09.2002 to 31.12.2002) at the Manipal Teaching hospital, Pokhara, Nepal. The percentage of encounters with an injection or an antibiotic prescribed was noted. The percentage of drugs prescribed from the Essential drug list of Nepal and the mean cost of drugs per prescription was calculated. RESULTS: 1238 patients attended the orthopaedics OPD during the study period. 186 prescriptions were randomly selected for analysis. The mean number of drugs per prescription was 1.9. Low backache was the most common reason for attending the OPD. Nonsteroidal anti-inflammatory drugs (NSAIDs) were the most commonly prescribed drug group. Diclofenac and meloxicam were the most commonly prescribed drugs. Mean cost of drugs was 166.2 Nepalese rupees. Injections and antibiotics were prescribed in 16 (8.6%) and 7 (3.8%) encounters respectively. 51 prescriptions (27.4%) had various problems. Absence of diagnosis on the prescriptions and the duration of treatment were most commonly observed. CONCLUSIONS: Percentage of prescribing by generic name was low. Educational sessions for the doctors at different levels to encourage prescribing by generic names and on correct writing of prescriptions may be considered. Studies covering a larger number of patients and for a longer time period are required. A greater number of patients can be studied, seasonal variations can be overcome and drug utilization can be measured quantitatively.

Prescribing patterns among paediatric inpatients in a teaching hospital in western Nepal.

INTRODUCTION: Infants and children constitute a large proportion of the population in developing countries. In Nepal, studies on drug use patterns in the paediatric age group are lacking in hospitals in the western region. The present study was carried out to obtain demographical information and information on the prescribing patterns of drugs. The antibiotic sensitivity patterns of commonly-isolated micro-organisms and the mean cost of drugs were obtained. METHODS: The study was carried out over a four-month period (December 1, 2003 to March 31, 2004) at the Manipal Teaching Hospital, a tertiary care hospital in Pokhara, western Nepal. The case records of patients discharged from the paediatrics ward during the study period were analysed. Mean number of drugs prescribed was calculated. The percentage of admissions that were prescribed antibiotics was determined. RESULTS: 356 patients were admitted during the study period, of which 228 were male. The median duration of hospitalisation was four days. The mean number of drugs prescribed per admission was 4.5. 789 drugs (48.9 percent) were prescribed by the parenteral route. Antibiotics were prescribed in 249 admissions (69.9 percent). Staphylococcus aureus, Escherichia coli, and Acinetobacter species were the common organisms isolated, and were resistant in some cases to the commonly-used antibiotics. The mean (+/- standard deviation) cost of drugs per admission was 5.4 (+/-1.6) US dollars. CONCLUSION: Prescribing by generic name should be encouraged. Use of parenteral antibiotics was high and route conversion programmes should be instituted. Use of antibiotics for predominantly viral infections should be reduced. Treatment guidelines for common conditions should be formulated.

Medication counseling center in a teaching hospital.

Patient compliance is often not achieved during drug therapy. Many reasons including lack of patients' understanding regarding medication and disease, poor socioeconomic pattern, unavailability of drugs are attributed to this situation. Providing counseling to patients can improve their understanding regarding medication, disease and life style modifications which in turn improves compliance. Medication counseling centers are one of the means to counsel the patients. The study was conducted to analyze the performance of such a center at Manipal Teaching Hospital, a teaching hospital in Western Nepal. Patients were counseled as per the Omnibus Budget Reconciliation Act-1990 guidelines and data were collected from the documentation form of the center and analyzed. Results indicated that 84.5% of the patients were directed to the medication counseling center by the pharmacists. Nearly one quarter of the population was either asthmatic or chronic obstructive pulmonary disease patients. Bronchodilators were found to be the major therapeutic category of drugs and were found in 26.7% of the patients. Among the various counseling aids, placebo inhalers were used in 45.1% of the patients. The counseling pharmacists dedicated an average time period of 6-10 minutes in about 42.1% of the patients. Language was found to be the major barrier while counseling 16.5% of the patients. The study concluded that the medication counseling center can play a definite role in enhancing patients' understanding about medications and disease pattern, which in turn may improve patient compliance.