Pattern of drug prescription and utilization among Bam residents during the first six months after the 2003 Bam earthquake

The Utilization of Emergency Department and Outpatient Clinics among Evacuated Victims after the 2023 Turkey Earthquake

BACKGROUND

After the 2023 Turkey earthquake, thousands of people evacuated to different fields. Earthquake victims still need health care in the evacuation location. This study aims to determine the emergency department (ED) and outpatient clinic utilization characteristics of the evacuated earthquake victims outside the earthquake zone and to provide suggestions for planning the health care facilities in the regions where the evacuated earthquake victims will be placed.

METHODS

This retrospective, observational study was conducted in a tertiary university hospital from February 7, 2023 through February 20, 2023. All evacuated earthquake victims who presented to the study hospital were included in the study. Non-victim patients were included as the control group. Missing medical records were excluded. Demographic characteristics of the patients, outpatient clinics, International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) codes, and outcomes were recorded.

RESULTS

A total of 15,128 patients were included in the final analysis. Six-hundred-nine (4.0%) of the patients were evacuated victims. Three-hundred forty-six (56.8%) evacuated victims used the ED. One-hundred fifty-six (25.6%) earthquake victims were in the pediatric age group. Earthquake victims used the ED more than the control group in adult and pediatric age groups (22.5% versus 51.7% and 30.2% versus 71.8%; P <.001, respectively). Earthquake victims frequently presented to the hospital during night shifts in both age groups (P <.05). Pediatric victims were more hospitalized than the control group (4.8% versus 10.9%; P = .001). Diseases of the respiratory system were the most common emergency diagnosis of the victims in both age groups (26.5% and 57.1%, respectively). The most frequently used outpatient clinic was ophthalmology in both age groups (14.6% and 20.5%, respectively).

CONCLUSIONS

Evacuated victims, especially pediatric victims, used the ED more than other outpatient clinics. Diseases of the respiratory system were the most common emergency diagnosis of the victims, and the most frequently preferred outpatient clinic was ophthalmology. The most common diseases and frequently preferred clinics should be considered in planning health care for the evacuated earthquake victims.

Analysis of Pharmaceutical Demand in the Region for Chronic Medicine Users Using National Health Insurance Data: Examination for Disaster Preparedness in Hakui City, Ishikawa Prefecture

When large earthquakes occur over wide areas, in addition to damage to medical facilities, the disaster response capabilities of local governments are severely compromised. There is a very high possibility that the supply-demand balance of medicines will collapse within the disaster area, and that appropriate supplies of medicines will not be provided to disaster victims. Therefore, it is important to estimate in advance the quantity of pharmaceuticals that may be needed during disasters. In this study, the purpose is to clarify the quantity and quality of pharmaceuticals used by chronically ill patients by using Japanese National Health Insurance data regarding the issues mentioned above. The methodology used was to extract the status of pharmaceutical prescriptions based on receipt information from National Health Insurance data for Hakui, Ishikawa Prefecture, a small regional city in Japan, as the analysis target area. Through the analysis in this study, the quantity and quality of medicines supplied to chronically ill patients in Hakui, Ishikawa Prefecture, were clarified on a town-by-town basis.

Medication use in populations exposed to the 2010 Eyjafjallajökull eruption: an interrupted time series analysis

OBJECTIVES

To assess the trends in medication use indicative of physical and psychological morbidity following the 2010 volcanic eruption in Eyjafjallajökull immediately after and during a 3-year period following the eruption.

DESIGN

Population-based register study.

SETTING

Eyjafjallajökull eruption in Iceland, 2007-2013.

PARTICIPANTS

All residents in Iceland who received at least one medication dispensing were identified. Residents of exposed areas were classified into exposure groups (individual-level data) and residents in other parts of Iceland were included as a non-exposed group (aggregated data).

INTERVENTION/EXPOSURE

Eyjafjallajökull erupted on 14 April 2010 and continued for 39 days, producing heavy ash fall in South Iceland.

MAIN OUTCOME MEASURES

Using interrupted time series analysis, we examined annual and quarterly changes in medicine use, measured as number of dispensed defined daily dose (DDD) per 1000 individuals. We calculated the level shift (immediate change) and change in slope from pre-eruption to post-eruption (long-term change) in medication dispensing.

RESULTS

Among exposed residents, there was a 6% decrease (95% CI -7% to -4%) in the annual number of dispensed DDDs 1-year post-eruption in the overall medication class, including analgesics (-5%, 95% CI -6% to -3%), hypnotics and sedatives (-9%, 95% CI -11% to -7%) and respiratory medications (-7%, 95% CI -9% to -5%; -8%, 95% CI -11% to -4%). Simultaneously, there was a 9% decrease (95% CI -14% to -4%) in the overall medication class among non-exposed residents. Moreover, among exposed residents, we observed change in slope of -4% (95% CI -7% to -1%) in the overall medication class, including for analgesics (-6%, 95% CI -8% to -3%) and other respiratory drugs (-10%, 95% CI -16% to -4%).

CONCLUSION

Our findings indicate that the eruption did not lead to increases in medication dispensing among residents of exposed areas, rather decreases for some medicine classes. The results should be interpreted with caution since the content of each eruption differs.

Exploring Pharmacists' Roles during the 2019-2020 Australian Black Summer Bushfires

Background: Australians are no strangers to sudden natural disasters, such as bushfires. The effects of a natural disaster can devastate local communities and health care services. Currently, limited research has explored the role of the pharmacist during a natural disaster. This study explores the role of the Australian pharmacist during the 2019/2020 Black Summer Bushfires. Methods: Semi-structured phone interviews were conducted with ten community pharmacists who worked through the Black Summer Bushfires whose daily tasks and work environment were directly affected by the bushfires. Thematic analysis using NVivo^®, a qualitative data analysis software was conducted. Results: Analysis of the transcripts generated six main themes: collaboration; trauma and mental health; power and communication; acute presentations; triaging and emergency prescribing. Pharmacists worked in close collaboration with doctors and members of the local community. They provided triaging services, timely health advice about chronic health problems, and managed acute issues, including wound and burn management and mental health support in traumatic conditions, sometimes without power and communication amenities. The challenges presented to pharmacists during the bushfires warranted creative and flexible approaches at times. Conclusion: This study highlights the need for mental health support and training for pharmacists, provisional prescribing privileges, and a clearer set of contingency regulations and legislation related to emergencies and natural disasters. Further research is warranted to gain greater insight into the roles undertaken by Australian pharmacists during natural disasters and their autonomy in decision making processes during such times.

Antibiotic prescribing in inpatient and outpatient settings in Iran: a systematic review and meta-analysis study

Background

Antibiotic prescribing is common worldwide. There are several original studies about antibiotic prescribing in the healthcare setting of Iran reporting different levels of prescribing. The aim of this systematic review and meta-analysis was to determine the prevalence of antibiotic prescribing in both inpatient and outpatient settings in Iran, an example of a developing country.

Methods

To identify published studies on antibiotic prescribing, databases such as ISI, Scopus, PubMed, Google Scholar, and Electronic Persian were searched in Iran till January 2020. Eligible studies were those analyzing original data on the prescription and use of antibiotics in outpatient or inpatient settings in Iran. Moreover, all studies that used an intervention to improve antibiotic prescribing were included. The quality of the included studies was assessed using self-administered quality assessment criteria. The meta-analysis of prevalence of antibiotic prescribing was conducted based on the meta-analysis of observational studies in epidemiology guidelines. To calculate pooled rates, the random-effects model was used.

Results

A total of 54 studies (39 outpatients and 15 inpatients) were included in this study. The median of antibiotic prescribing in the outpatient and inpatient settings accounted for 45.25% and 68.2% of patients, respectively. The results of meta-analysis also showed that the antibiotic prescribing accounted for 45% of prescriptions in outpatient settings and 39.5%, 66%, and 75.3% of patients in all wards, pediatrics wards, and ICU wards of inpatient settings, respectively. The most commonly prescribed antibiotic classes in outpatient settings were penicillins, cephalosporins, and macrolides, while in inpatient settings, these were cephalosporins, penicillins, and carbapenems. There were seven studies using interventions to improve antibiotic prescribing pattern. It should be mentioned that intervention in a study had a statistically significant effect on improving antibiotic prescribing (p < .05).

Conclusion

Prevalence of antibiotic prescribing in Iran is high. Our findings highlight the need for urgent action to improve prescription practices. It seems that developing a national plan to improve antibiotic prescribing is necessary.

A study on the factors affecting the prescription of injection medicines in Iran: a policy making approach

Background and Aim:

Inappropriate prescribing injection medicines can reduce the quality of medical care, patient safety, and leads to a waste of resources. Sufficient evidence is not available in developing countries to persuade policy-makers to promote rational drug prescription.

The objective of this study is to assess some factors affecting the prescription of the injection medicines in Iran.

Methods:

In this descriptive-analytic study, the data of 91,994,667 selected prescription letters were collected by the Ministry of the Health and Medical Education (MOHME) throughout the country at the year 2011 which were analyzed through a logarithmic regression model.

Results:

Results of the study show that the percentage of the prescription letters containing injection items varied from 27 percent (in Yazd) to 57 percent (in Ilam). Also the impact of price on the prescription of the injection medicines was not significant (P=0.55). But the impact of the prescription of antibiotics and corticosteroid on injections were significant (P>0.05) and equal 0.44 and 0.65 respectively.

Conclusion:

Increasing price of injection medicines as a policy towards reducing consumptions cannot be a successful policy. But reducing the use of antibiotics and corticosteroids can be a more effective policy to reduce the use of injection medicines.

Response to the Bam earthquake: a qualitative study on the experiences of the top and middle level health managers in Kerman, Iran

INTRODUCTION

The 2003 Bam, Iran earthquake resulted in high casualties and required international and national assistance. This study explored local top and middle level managers' disaster relief experiences in the aftermath of the Bam earthquake.

METHODS

Using qualitative interview methodology, top and middle level health managers employed during the Bam earthquake were identified. Data were collected via in-depth interviews with participants. Data were analysed using thematic analysis.

RESULTS

Results showed that the managers interviewed experienced two main problems. First, inadequacy of preparation of local health organisations, which was due to lack of familiarity of the needs, unavailability of essential needs, and also increasing demands, which were above the participants' expectations. Second, inappropriateness of delivered donations was perceived as a problem; for example, foods and sanitary materials were either poor quality or expired by date recommended for use. Participants also found international teams to be more well-equipped and organised.

CONCLUSIONS

During the disaster relief period of the response to the Bam earthquake, local health organizations were ill prepared for the event. In addition, donations delivered for relief were often poor quality or expired beyond a usable date.

The quality of prescription drug utilization five years after the 2003 Bam earthquake

PURPOSE

Few reports considering drug use among earthquake survivors exist. The present study aims to examine the Bam earthquake's impact on prescribing patterns and drug use among residents five years post-disaster.

DESIGN/METHODOLOGY/APPROACH

In this study, 297,104 prescriptions, issued by general practitioners in Bam city in 2008, were investigated for drugs/prescriptions, drug name, drug category, using WHO appropriate general practice prescribing indicators.

FINDINGS

Mean drugs per prescription was 3.1. Drugs affecting the central nervous system were the most frequently used among Bam residents, representing 25.1 per cent, followed by antimicrobials, respiratory, cardiovascular and gastrointestinal tract drugs. Benzodiazepines were the most frequently used central nervous system drugs (15.8 per cent) followed by narcotic analgesics and tricyclic antidepressants. Penicillins (6.4 per cent) and cephalosporines (2.3 per cent) were the most frequently used antimicrobial drugs.

ORIGINALITY/VALUE

Results emphasize increased drug use for psychological disturbances and the need for strategies to improve mental health among disaster survivors.

Pain and natural disaster

The treatment for pain in emergency medicine is a matter of increasing interest. Available data indicate that in both normal conditions and during major-emergencies, the majority of healthcare providers are culturally and professionally unprepared to adequately treat acute pain conditions. In case of natural disasters, opioid drugs are often unavailable. Moreover, no guidelines or validated protocols provide adequate indications for the treatment for pain in case of massive emergencies. Training of the medical and nursing staff, in both formal and continuing, or on-the-job education is needed to adequately face a devastating emergency. Unfortunately, there is an inadequate level of training among healthcare professionals, even in highly seismic areas, and the source of aid is frequently limited, especially in the immediate aftermath of a disaster to those already present at the scene. Pain inadequately treated may modify the characteristics of the pain itself. Pain is no longer considered just a symptom, but itself becomes an autonomous pathology heavily influencing the social life and psycho-social aspects of a person. In the disastrous situation following an earthquake, an inadequate treatment of pain was the major violation of the psycho-physical integrity of individuals and a severe violation of their rights, as human beings and patients.

Pain after earthquake

INTRODUCTION

On 6 April 2009, at 03:32 local time, an Mw 6.3 earthquake hit the Abruzzi region of central Italy causing widespread damage in the City of L Aquila and its nearby villages. The earthquake caused 308 casualties and over 1,500 injuries, displaced more than 25,000 people and induced significant damage to more than 10,000 buildings in the L'Aquila region.

OBJECTIVES

This observational retrospective study evaluated the prevalence and drug treatment of pain in the five weeks following the L'Aquila earthquake (April 6, 2009).

METHODS

958 triage documents were analysed for patients pain severity, pain type, and treatment efficacy.

RESULTS

A third of pain patients reported pain with a prevalence of 34.6%. More than half of pain patients reported severe pain (58.8%). Analgesic agents were limited to available drugs: anti-inflammatory agents, paracetamol, and weak opioids. Reduction in verbal numerical pain scores within the first 24 hours after treatment was achieved with the medications at hand. Pain prevalence and characterization exhibited a biphasic pattern with acute pain syndromes owing to trauma occurring in the first 15 days after the earthquake; traumatic pain then decreased and re-surged at around week five, owing to rebuilding efforts. In the second through fourth week, reports of pain occurred mainly owing to relapses of chronic conditions.

CONCLUSIONS

This study indicates that pain is prevalent during natural disasters, may exhibit a discernible pattern over the weeks following the event, and current drug treatments in this region may be adequate for emergency situations.

Major earthquakes of the past decade (2000-2010): a comparative review of various aspects of management

Objectives:

This article sought to review and compare data of major earthquakes of the past decade and their aftermath in order to compare the magnitude, death toll, type of injuries, management procedures, extent of destruction and effectiveness of relief efforts.

Materials and Methods:

A retrospective study of the various aspects of management and aftermath of 5 major earthquakes of the past decade (2000–2010) was undertaken. This included earthquakes occurring in Bam Iran, Sichuan China, Port-au-Prince Haiti, Kashmir Pakistan and Ica Peru. A literature search was done via computer of published articles (indexed in Pubmed). The issues assessed included: 1)Local magnitude,2)Type of building structure 3)Time of the earthquake (day/time/season), 4)Time to rescue, 5)Triage, Transfer, and Treatment 6) Distribution of casualties (dead/ injured), 7)Degree of city damage, 8)Degree of damage to health facilities, 9)Field hospital availability, 10)International aid, 11)Air transfer, 12) Telecommunication systems availability, 13) PTSD prevalence, 14) Most common injury and 15) Most common disease outbreak.

Results:

The Bam earthquake had the lowest (6.6 Richter’s) and the Sichuan earthquake had the greatest magnitude (8.0 Richter’s). Mortality in Haiti was 212,000 and it was the deadliest earthquake of the past decade. Collapse of heavy clay roofing structures was a major cause of death in Iran and Pakistan. Earthquakes occurring at night and nonworking days carried a high death toll. The time to rescue and treat was the lengthiest in Haiti (possibly contributing to the death to injured ratio). However, the worst dead to injured ratios were in Bam (51%) and in Pakistan (47%); the best ratio was in China (15%). Iran and Pakistan suffered the highest percentage of damage to the health facilities (90%). Field hospital availability, international aid and air transfer were important issues. Telecommunication systems were best in China and worst in Pakistan. PTSD prevalence was highest in Iran. Respiratory infection was the most common infection following all 5 earthquakes.

Conclusions:

Earthquake damage, death toll, managerial protocols etc. vary in different countries and are influenced by many factors including the hour the earthquake hits and the day of the week. Additionally, social, structural and geographic factors as well as the medical, governmental and NGO respondents are influential. Engineered residential construction remains to be of importance in reducing mortality in developing countries. It is essential that hospitals, fire departments and police stations, water, telephone and electrical facilities be made earthquake proof.

Physician adherence to hypertension treatment guidelines and drug acquisition costs of antihypertensive drugs at the cardiac clinic: a pilot study

Prescribing pattern surveys are one of the pharmacoepidemiological techniques that provide an unbiased picture of prescribing habits. Prescription surveys permit the identification of suboptimal prescribing patterns for further evaluation. The aims of this study were to determine the prescribing trend, adherence of the prescribers to the guideline, and the impact of drug expenditure on drug utilization at the cardiac clinic of Penang Hospital, Malaysia. This was a cross-sectional study. Demographic data of the patients, diagnoses and the drugs prescribed were recorded. The average drug acquisition costs (ADAC) were calculated for each antihypertensive drug class on a daily and annual basis. Adherence to the guideline was calculated as a percentage of the total number of patients. A total of 313 individuals fulfilled the inclusion criteria. The average age of the study population was 59.30 ± 10.35 years. The mean number of drugs per prescription in the study was 2.09 ± 0.78. There were no significant differences in the demographic data. Antihypertensive drugs were used in monotherapy and polytherapy in 20.8% and 79.2% of the patients, respectively. Adherence to the guideline regarding prescription occurred in 85.30% of the patients. The lowest priced drug class was diuretics and the highest was angiotensin-receptor blockers. In conclusion, the total adherence to the guideline was good; the adherence percentage only slightly decreased with a co-existing comorbidity (such as diabetes mellitus). The use of thiazide diuretics was encouraged because they are well tolerated and inexpensive, and perindopril was still prescribed for diabetic patients since it is relatively cheap (generic drug) and its daily dosage is beneficial.

Respiratory and mental health effects of wildfires: an ecological study in Galician municipalities (north-west Spain)

BACKGROUND

During the summer of 2006, a wave of wildfires struck Galicia (north-west Spain), giving rise to a disaster situation in which a great deal of the territory was destroyed. Unlike other occasions, the wildfires in this case also threatened farms, houses and even human lives, with the result that the perception of disaster and helplessness was the most acute experienced in recent years. This study sought to analyse the respiratory and mental health effects of the August-2006 fires, using consumption of anxiolytics-hypnotics and drugs for obstructive airway diseases as indicators.

METHODS

We conducted an analytical, ecological geographical- and temporal-cluster study, using municipality-month as the study unit. The independent variable was exposure to wildfires in August 2006, with municipalities thus being classified into the following three categories: no exposure; medium exposure; and high exposure. Dependent variables were: (1) anxiolytics-hypnotics; and (2) drugs for obstructive airway diseases consumption. These variables were calculated for the two 12-month periods before and after August 2006. Additive models for time series were used for statistical analysis purposes.

RESULTS

The results revealed a higher consumption of drugs for obstructive airway diseases among pensioners during the months following the wildfires, in municipalities affected versus those unaffected by fire. In terms of consumption of anxiolytics-hypnotics, the results showed a significant increase among men among men overall -pensioners and non-pensioners- in fire-affected municipalities.

CONCLUSIONS

Our study indicates that wildfires have a significant effect on population health. The coherence of these results suggests that drug utilisation research is a useful tool for studying morbidity associated with environmental incidents.

A reassessment and review of the Bam earthquake five years onward: what was done wrong?

INTRODUCTION

An earthquake measuring 6.6 on the Richter scale on 23 December 2003 devastated the city of Bam in southeastern Iran. During the response and recovery phases, considerable shortcomings were discovered. The dire situation in the affected area, a variety of urgently required interventions, and the large number of aid organizations involved brought about difficulties in management, coordination, and communication among authorities and aid organizations. This article highlights flaws in management in the various aspects of this disaster in order to assess what was done, and what should be done to overcome these shortcomings in future disasters.

METHODS

A retrospective review of the various aspects of management related to the Bam disaster was done via the assessment of files, multi-center studies, governmental data, and available literature from 2003-2008.

RESULTS

A review of the available data relevant to search and rescue operations and short-term aid provision revealed flaws in different aspects of disaster management including personnel, the transfer of the injured, availability medical supplies, treatment planning, problems concerning the composition of treatment forces dispatched to the region, distribution of tasks among treatment workers, transferring of equipment, availability of facilities, and lack of coordination among the organizations responsible for the management of the disaster. Most of the aforementioned issues have been addressed.

CONCLUSIONS

A comprehensive disaster management plan must not be limited only to the response phase, but rather must include: preparedness, recovery with optimal legislation and budgeting, improvement of healthcare facilities, and organized communication channels between the different governmental departments. This important issue has been addressed, and a disaster management organization under the supervision of the President has been established, developing a national search and rescue strategy and protocol for unified managerial organization, an alert system, an international disaster command system (under which search and rescue and emergency medical service teams can be deployed, increasing the efficacy and coordination of the arrival of foreign teams and the construction field hospitals), and developing a flowchart to coordinate international agencies and the domestic authorities in charge. Continuous education, training of the general population, conducting periodic exercise drills, and provision for prepared task force mobilization in disaster management all are important aspects of the management of disasters due to natural hazards.

The patterns of antihypertensive drug prescription by cardiologists in Kerman province of Iran, 2006

PURPOSE

This study was performed to evaluate the antihypertensive prescribing pattern by cardiologists in outpatients attending private clinics in Kerman province, Iran during 1 year period, 2006.

METHODS

Using random sampling method, 1102 prescriptions issued by cardiologists were investigated. The prescriptions of outpatients which contain at least one antihypertensive medication were separated for further analysis. Using World Health Organization (WHO) standard drug indicators, we evaluate the quality and quantity of prescriptions. The indices were compared between different sex groups by SPSS 11.5 software.

RESULTS

About 39% of the patients were male. The average age of the individuals was 57.3 +/- 13. The mean number of drugs per prescription was 2.84 +/- 0.7, but the average of antihypertensive drugs per prescription was 1.4 +/- 0.3, similarly in both sexes. The most prescribed drug class was beta-blockers (46.2%) followed by calcium channel blockers (CCBs) (19.2%), angiotensin-converting enzyme (ACE) inhibitors (13.7%), diuretics (10.3%), angiotensin receptor blockers (ARBs) (9.2%) and other antihypertensive agents (1.5%). Most of the hypertensive patients (69.6%) were treated with a single drug while 31.4% of the patients received more than one drug. There was not a significant gender difference between the types of drug class used. Statins and acetyl salicylic acid (ASA) were prescribed as cardiovascular disease preventive drugs in 10.2 and 38% of hypertensive patients, respectively.

CONCLUSION

The mean numbers of drugs per prescription by cardiologists in Kerman province of Iran were not in agreement with WHO standard drug use indicators. Lower using rate of diuretics, statins and ASA need a comprehensive reassessment of the medical management of hypertensive patients.