Drug utilization study in ophthalmology outpatients at a tertiary care teaching hospital

Glaucoma Drug Prescription Pattern in North India: Public vs Private Sector Hospitals

Background

Glaucoma is an optic neuropathy associated with characteristic structural damage to the optic nerve and associated visual dysfunction that may be caused by various pathological processes. A number of pharmacological agents are used to reduce the intraocular pressure (IOP), involving the usage of two or three medications concurrently. Literature is sparse regarding prescription patterns of antiglaucoma drugs, especially regarding variability in public sector vs private sector hospitals. Drug utilization studies can add insight for crafting rational, affordable, and ocular surface friendly prescriptions.

Aim

This study assessed the prescription pattern in glaucoma patients of a public sector, tertiary care hospital vs a private sector tertiary care hospital.

Materials and methods

In this retrospective study, pertinent data of diagnosed and labeled glaucoma patients were reviewed. Data collected included demographic details, type of glaucoma, number and nature of drugs prescribed, whether innovator or generic drugs were prescribed, if fixed-drug combinations (FDCs) and preservative-free formulations were prescribed. The prescription patterns between the two sectors were compared, as were the prescription patterns between primary open-angle glaucoma (POAG) and primary angle-closure disease (PACD).

Results

A total of 336 prescriptions were evaluated (216 from public sector, group I; 120 from private sector, group II). Travoprost 0.004% was the most prescribed antiglaucoma medication in both group I (30.09%) and group II (38.33%). Brimonidine and brinzolamide (14.17%) was the most prescribed combination in group II, while Brimonidine with Timolol (7.87%) in group I. In group I, Timolol and Travoprost were the most prescribed medications for both PACD and POAG.

Conclusion

This study showed that both public sector as well as private sector tertiary care centers prescribe antiglaucoma medications in tune with current principles of rational drug use. Preservative-free drugs were preferred in both the groups for better adherence.

How to cite this article

Bhartiya S, Ichhpujani P, Parmar UPS, et al.Glaucoma Drug Prescription Pattern in North India: Public vs Private Sector Hospitals. J Curr Glaucoma Pract 2024;18(1):16-22.

Safety of topical ophthalmic antibiotics in pregnant women with hordeola, chalazia, blepharitis, or bacterial conjunctivitis: propensity score analyses

OBJECTIVE

To investigate the association between exposure to topical ophthalmic antibiotics during pregnancy and adverse neonatal outcomes.

METHODS

In this retrospective cohort study, we identified pregnant women with hordeola, chalazia, blepharitis, or bacterial conjunctivitis from 2005 to 2018 using the Japanese Medical Data Centre Claims Database. From the eligible women, we extracted women who were dispensed no topical antibiotics during the first trimester (non-antibiotic group), women who were dispensed topical fluoroquinolones alone at least once (fluoroquinolone alone group), and women who were dispensed any single type of antibiotic (single-antibiotic group). We compared the frequency of congenital anomalies (CA), preterm birth (PB), low birth weight (LBW), and the composite outcome of these three between the fluoroquinolone and non-antibiotic groups and between the single-antibiotic and non-antibiotic groups, using propensity score adjustment.

RESULTS

A total of 891 eligible women were identified. In the fluoroquinolone (n = 409) and non-antibiotic (n = 309) groups, CA occurred in 6.8% and 6.8%, PB in 2.4% and 3.2%, LBW in 2.9% and 3.2%, and the composite outcome in 10.5% and 11.3%, respectively. Analysis using propensity score adjustment showed no significant difference between the groups in the frequency of CA (adjusted odds ratio, 1.15; 95% confidence interval, 0.61-2.18), PB (0.80; 0.30-2.17), LBW (1.08; 0.45-2.63), or the composite outcome (1.12; 0.67-1.87). Comparison of the single-antibiotic and non-antibiotic groups showed similar results.

CONCLUSIONS

Topical ophthalmic antibiotics for hordeola, chalazia, blepharitis, or bacterial conjunctivitis during the first trimester were not associated with increased adverse neonatal outcomes.

Cost Analysis and Rational Use of Anti-Glaucoma Therapy in a Tertiary Hospital in Ghana

Introduction

Glaucoma is the leading cause of irreversible blindness worldwide. In Ghana, 19.4% of all blindness recorded is due to glaucoma. Reducing intraocular pressure medically (using eye drops) is the evidence-based therapeutic option.

Objective

To determine the rational use and undertake cost analysis of anti-glaucoma drugs among patients attending clinic at the Lions International Eye Centre (LIEC), Korle-Bu Teaching Hospital.

Methods

In this cross-sectional study, we reviewed all prescriptions presented to the pharmacy unit from 01/12/2015 to 31/03/2016. The dispensed drops were classified, and all anti-glaucoma drugs were identified. This was followed by cost analysis.

Results

A total of 588 prescriptions were captured, 27.3% (161/588) contained an anti-glaucoma medication. The mean number of anti-glaucoma medications was 1.71 of which 52.7% was prescribed to females. Prostaglandin analogs (PGA) were the most prescribed (37% (102/276)), followed by beta blockers (25.4% (70/276)), carbonic anhydrase group of medicines (16.3% (45/276)), combined beta blockers (11.2% (31/276)), alpha agonists (8.7% (24/276)) and miotics (1.4% (4/276)). The median (IQR) cost of anti-glaucoma therapy per prescription per month was GHC 65.00 (GHC38.5-GHC140) about [US$16.25 (US$ 9.6–US$35)]. Azopt (Brimonidine) was the most expensive with daily treatment cost of GHC 5.8 (about US$ 1.45), whilst the least expensive drug with a daily treatment cost of GHC 0.14 (about US$ 0.035) was timolol eye drops.

Conclusion

Prostaglandin analogs though expensive remain the most preferred treatment for managing glaucoma at the Korle-Bu Eye Centre in Ghana. This may adversely affect treatment among the poor since prostaglandins analogs are currently not covered by insurance.

Naturalistic Evaluation of Prescription Pattern in Glaucoma Clinic of a Tertiary Care Hospital: A Developing Country's Perspective

Background:

Glaucoma is a chronic, gradual and progressive eye disorder characterized by visual loss and involving the typical changes in optic nerves and associated structures. Currently, the mainstay treatment lies in the reduction of intraocular pressure (IOP) involving the usage of two or three medications concurrently. However, prescription pattern of antiglaucoma drugs remains largely unstudied so far. Therefore, there is a dire need of drug utilization studies to ensure rational prescribing for better treatment outcomes.

Aim:

This study was conducted to assess the prescription pattern in glaucoma patients to encourage rational use of drugs.

Materials and Methods:

The pertinent data of confirmed glaucoma patients were entered in a predesigned case record form (CRF) including patient demographic details, type of glaucoma, number of drug prescribed, drug dosage and dosage formulation with prior patient consent, and finally, the data were analyzed using Microsoft Excel.

Results:

A total of 247 glaucoma patients were recorded in the study. The mean SD number of drugs per prescription was 2.18 (1.68). Monotherapy was prescribed to 72 (29.15%) patients, and the most common monotherapy prescribed was timolol, whereas in fixed-dose combinations (FDCs), brimonidine and timolol FDCs were most commonly encountered. Furthermore, prescriptions consisting of generic drugs only and prescribed as per the National List of Essential Medicines (NLEM) were 48 (19.43%) and 41 (16.59%), respectively.

Conclusion:

This study showed the judicious use of medications in tune with principles of rational drug use in our center, and the rationale practices can be extended to the peripheral centers of the country for better drug utilization.

An analysis of the use of antimicrobial agents in outdoor patients of ophthalmology

OBJECTIVES

The study was aimed to analyze commonly used antimicrobials in outdoor patients of ophthalmology department.

MATERIALS AND METHODS

The study was an observational, cross-sectional study carried out in the Department of Pharmacology and Ophthalmology after approval from the head of departments and Institutional Ethics Committee. All the patients age 18 years and above who were prescribed antimicrobials and gave consent were included in study. Data were recorded in a case study form containing relevant patient information and results of general, ocular, and special examinations along with the details of antimicrobials prescribed. Data were analyzed according to the World Health Organization/International Network for Rational Use of Drugs indicators and appropriate statistical tests.

RESULTS

A total of 900 patients who were prescribed antimicrobial agents (AMAs) were included in the study. The most common chief complaint was diminution of vision (25.78%). The most common indication of use of AMAs was for treating ocular infections (50.22%). The most commonly prescribed antimicrobial group was fluoroquinolone (FQ) (63.8%) and the most common drug was moxifloxacin (35.95%). The most common dosage form of AMAs was eye drops (68.55%). The average number of drugs per encounter was 4.41. The percentage of encounters with injectables prescribed was 0.67%. The percentage of use of antibiotics was 100%. The percentage of total drugs and AMAs prescribed by generic name was 41.5 and 11.92, respectively. The percentage of antimicrobial drugs prescribed from essential drugs list was 34.24%. The mean duration of antimicrobial therapy was 7.2 ± 4.54 days.

CONCLUSION

More than half of the patients are prescribed multiple AMAs. Moxifloxacin, a newer generation FQ , was the most commonly prescribed AMA in our study. Educational interventions and strict adherence to hospital antimicrobial use policy are needed to restrict the use of AMAs and increase rational prescribing.

Pharmacoepidemiological Observational Study of Antimicrobial Use in Outpatients of Ophthalmology Department in North Indian Population

Background

Recognition of drug usage patterns provides the basis for improving safety and plummeting risks associated with their use. Thus, this study was undertaken to explore the drug usage pattern in ophthalmology with an emphasis on antimicrobial use at a tertiary care teaching hospital.

Materials and Methods

An observational study was conducted in the Department of Ophthalmology, Hakeem Abdul Hameed Centenary Hospital, Jamia Hamdard, New Delhi, India for 9 months. Newly registered patients visiting the Outpatient Department for curative complaints were included. All drugs prescribed were recorded, including dose, route, dosage form, frequency of administration, indications for prescription, and duration of therapy, and the data was audited using the indicators prescribed by the World Health Organization.

Result

A total of 600 prescriptions were analyzed. The number of drugs prescribed was 1097 with an average drug per prescription being 1.8. The most common disorders diagnosed were infective conjunctivitis (21.5%) followed by stye (5.5%). Drugs were prescribed in different dosage forms with eye drops (72.6%) being the most common. Drugs were predominantly prescribed by brand name (100%). Antimicrobials (44.7%) were the most commonly prescribed drugs followed by lubricants (17.5%). Moxifloxacin (53.5%) was the most commonly prescribed antimicrobial agent. Of the antimicrobials prescribed, 89.6% were prescribed topically. Average total cost per prescription was 113 INR.

Conclusion

The study concludes with an overall impression of rational prescription in terms of prescribing in consensus with the recommended treatment protocol of ocular diseases. Nevertheless, health-care professionals should be encouraged to prescribe by generic name. Creating awareness regarding selection of drugs from essential drug list to reduce the drug cost is the need of the hour. Last but not least, updating knowledge regarding appropriate antimicrobial use and the development of discreet strategies for their use should be implemented to steer clear of antimicrobial resistance.

Assessment of core drug use indicators using WHO/INRUD methodology at primary healthcare centers in Bahawalpur, Pakistan

Background

Proper utilization of medicines is a critical component of pharmaceutical care plan. The aim of this study was to assess drug use pattern at ten primary healthcare centers (PHCCs) of the Bahawalpur district of the Punjab province of Pakistan by employing the WHO/INRUD core drug use indicators.

Methods

This was a descriptive, non-experimental and cross-sectional study. For the prescribing indicators, 1000 prescriptions (100 prescriptions per PHCC) were systematically sampled out of the total 290,000 prescriptions written during January to December 2014. A total of 300 randomly selected patients (30 per PHCC) and 10 pharmacy personnel (one per PHCC) were observed and interviewed to investigate the patient-care and facility-specific indicators, respectively. We used published ideal standards for each of the WHO/INRUD indicators.

Results

Among the prescribing indicators, the average number of drugs per encounter was 3.4 (SD = 0.8) (optimal range = 1.6–1.8), the drugs prescribed by the generic name were 71.6% (optimal value = 100%), the encounters with an antibiotic prescribed were 48.9% (optimal range = 20.0–26.8%), the encounters with an injection prescribed were 27.1% (optimal range = 13.4–24.1%) and the drugs prescribed from the Essential Drugs List (EDL) were 93.4% (optimal value = 100%). Among the patient-care indicators, the average consultation time was 2.2 min (SD = 0.8) (optimal value ≥10 min), the average dispensing time was 38 s (SD = 12.1) (optimal value ≥90 s), the percentage of drugs actually dispensed was 90.9% (optimal value = 100%), the percentage of drugs adequately labeled was 100% (optimal value = 100%) and the patients’ knowledge of correct dosage was 62.1% (optimal value = 100%). Among the facility-specific indicators, all PHCCs had a copy of the EDL and the key drugs available in the stock were 82% (optimal value = 100%).

Conclusions

Irrational use of drugs was observed in all healthcare facilities. This study necessitates the need to implement the WHO/INRUD recommended 12 core interventions to promote rational use of medicines.

Drug utilization study in medical emergency unit of a tertiary care hospital in north India

Objective. To generate data on the drug utilization pattern and cost of drug treatment and to determine the rationality of prescriptions. Methods. A retrospective cross-sectional drug utilization study was conducted in the medical emergency unit of our hospital. Patient case records were reviewed to extract data on the pattern of drug use. Cost of drug treatment for the emergency visit was calculated by referring to the cost mentioned in Monthly Index of Medical Specialties and the rationality of prescriptions was evaluated using WHO core indicators of drug utilization. Results. 1100 case records were reviewed. Majority of patients received proton pump inhibitors followed by multivitamins. The median cost per prescription was 119.23$ (7.32$-7663.46$). Majority (49.9%) of drug cost was driven by antibiotics alone. An average of 4.9 drugs was prescribed per prescription. There were 14.89% encounters with antibiotics. 75.17% of the drugs were given as injectables and only 29.27% of the drugs were prescribed as generics. Conclusion. There is need to rationalize the drug therapy in terms of increasing prescribing of drugs by generic name and to avoid overuse of PPIs and multivitamins in emergency unit. Also the hospital pharmacy should be encouraged to procure more cost effective alternative antibiotics in future.