Drug prescription pattern of outpatients in a tertiary care teaching hospital in Tamil Nadu

The effect of prescription patterns on the performance of the pharmacy department of a Regional Referral Hospital, Uganda

Background

Poor drug prescription patterns (PP) result in irrational medicine use, avoidable stock outs and drug expiries.

Objective

This study primarily assessed the effects of PP on the performance of the pharmacy department (PD) of Mbarara Regional Referral Hospital (MRRH) Uganda.

Methods

This was a mixed method cross-sectional study conducted in the outpatient department (OPD) of MRRH, questionnaires were administered to 86 prescribers and 300 patient prescriptions were reviewed. Ethical clearance was granted and informed consent of patients. Data were analysed, presented in the form of graphs, tables.

Results

The overall prescription fill rate was 60.5%, being higher among dental officers and lower among those who did not adhere to generic prescribing and EML. Medical officers made most prescriptions at 69.3%. Prescriptions with four (47.1%) and six (17.5%) medicines respectively were made by clinical officers. Of the 300 prescriptions, 76% adhered to the Essential Medicines List (EML), 62% used generic name including 87.3% from dental officers and 52.9% by clinical officersThe overall prescription fill rate was 60.5%, being higher among dental officers and lower among those who did not adhere to generic prescribing and EML. Medical officers made most prescriptions at 69.3%. Prescriptions with four (47.1%) and six (17.5%) medicines respectively were made by clinical officers. Of the 300 prescriptions, 76% adhered to the Essential Medicines List (EML), 62% used generic name including 87.3% from dental officers and 52.9% by clinical officers.

Conclusion

Prescription pattern affected the performance of the PD of MRRH, calling for its continued monitoring to ensure that guidelines are upheld, EML and UCG are availed and utilized.

Prescription auditing and assessment of medication adherence patterns in patients with diabetic foot ulcer

Background

Diabetic foot ulcer (DFU) is a serious infectious disease, which can be managed very well through proper medication, but if left untreated it may lead to amputation of the affected area leading to permanent immobility which will compromise the patient's quality of life.

Objective

To carry out prescription auditing and to assess medication adherence patterns among DFU patients.

Materials and methods

A prospective interview-based study was carried out in the surgery department among inpatients aged above 18 years diagnosed with a DFU. A disease specific medication adherence questionnaire consisting of 15 questions was developed, validated and implemented among 65 patients. All the relevant data were analyzed and subjected to statistical analysis.

Results

The majority (49.2%) of the population had an intermediate adherence pattern followed by high adherence (43%) during the first visit, later the reassessment after the counseling, reports a gradual increase in adherence pattern. Prescription auditing reveals the intensity of drug burden, on an average a prescription might carry 8 drugs and more than 95.3% of prescribed drugs were in injectable form.

Conclusion

This study highlights the depth of drug burden through prescription auditing and the necessity of proper patient counseling and educating the patient about the importance of medication adherence for limiting disease progression.

Assessment of WHO core drug use indicators at a tertiary care Institute of National importance in India

Rational prescribing of medicines is an important aspect of drug prescribing which helps in safe and efficacious and cost-effective drug treatment for patients. WHO Prescription indicators are intended to evaluate the services provided to the population concerning the rational use of medicines. The study aims to study prescription practices and rational use of medicines in the department of Internal medicine, using WHO prescribing indicators in a tertiary care teaching institute of national importance. A total of 50 prescriptions were digitally photographed and analysed for prescription practices and rational drug use, using standard WHO core prescribing indicators. A total of 301 drugs with multiple and diverse diagnoses were used. Statistical analysis was done using SPSS 22 version. The average number of drugs per prescription was 3.48%. It was found that only 13.79% of prescriptions have generic names, whereas 27.58% of patient encounters had at least one drug from the National List of Essential Medicine, 6.8% of prescriptions have antibiotics and 0.7% of prescriptions were injections. The number of prescriptions with fixed drug combinations was 27.55%. Indicators such as percentage of the National List of Essential Medicine, fixed drug combinations and prescribing with a generic name are used. Hence, we will suggest regular prescription audit practices and conducting CMEs and training workshops for clinicians for the rational use of medicines in all healthcare settings to succeed in the rational use of medicine.

The magnitude of prescribing medicines by brand names in a tertiary hospital, Mwanza, Tanzania

Background:

Globally, one of the most common causes of irrational use of medicines is brand-name prescribing. The consequence of prescribing medicines using brand names is an economic burden on patients and society. Thus, this study aimed to investigate the magnitude of prescribing medicines by brand names in a tertiary hospital in Mwanza, Tanzania.

Methods:

A retrospective cross-sectional study was conducted between April 2020 and March 2021 at the Bugando Medical Centre. Data were collected from electronic prescriptions (outpatients) and medical files (inpatients). The data were analyzed using STATA version 14. A Chi-square test was conducted to examine the relationship between different categorical variables. p-Values of less than 0.05 were considered statistically significant.

Results:

Of 851 prescriptions analyzed, 416 (48.9%) contained medicines prescribed using brand names. Compared to outpatient units, the proportion of prescriptions with medicines prescribed by brand names in inpatient units was significantly higher (58.5% vs 39.1%), p < 0.001. The most frequently prescribed medicines by brand names were Ampiclox (ampicillin + cloxacillin), 35.2%, Buscopan (hyoscine butylbromide), 8.7%, and Amoxyclav (amoxicillin + clavulanic acid), 7.7%.

Conclusion:

Prescriptions written with brand names were found to be common, especially among fixed-dose combinations (FDCs), according to the current study. Governments, institutions, and other stakeholders should support and encourage the use of generic names in prescription writing because it saves money for patients and health care systems. This calls for Tanzania’s government to prioritize the development and implementation of generic prescribing policies.

A cross-sectional study on current prescription trends and errors in outpatient department of a Bangladeshi secondary care district hospital

Context:

The rational prescription leads to a healthy and good-quality life of a patient. Irrational, inappropriate, and unnecessary prescriptions are major therapeutic issues in Bangladesh, which can cause severe consequences.

Aim:

This cross-sectional study was conducted to evaluate the prescription patterns and errors as well as to review the most frequently prescribed drug classes among outpatients at a secondary hospital in Pabna, a district of Bangladesh.

Methods:

A total of 400 prescriptions were reviewed from March 2019 to May 2019. In this study, statistical data analysis was implemented by IBM SPSS Statistics V22 and data revealed in frequencies, mean, and percentage. Spearman's rank correlation coefficient was calculated to show the correlation between bivariate coded variables.

Results:

The results revealed that majority of the prescription were prescribed for females (73.5%) where proton-pump inhibitors (PPIs), analgesics, vitamins, and single antibiotics were most frequently prescribed medicine for the female patients compared to male patients. Almost half of the collected prescription contained four medicines (47%). Maximum number of prescriptions contained two (30.5%) essential drugs and among 1402 medicines of 400 prescriptions, antiulcerants were most frequently prescribed medicine (23.32%) where esomeprazole was highly prescribed generic drug (44.75%). Moreover, Spearman's rank correlation coefficient suggested that PPIs and analgesics were frequently prescribed medicines at a time for the patients (0.182). According to the age group, the study also got some significant variations in prescribing pattern. However, most common prescription errors were prescriber's name not mentioned (100%), diagnosis not mentioned (96.75%), dose not indicated (15.41%), and wrong drug name (0.36%).

Conclusion:

Findings of the current study represent the existing prescribing trends of different therapeutic classes of drugs and common prescription errors in a secondary health facility of Bangladesh. From this study, it is observed that physicians prescribed rationally in some cases but need to ensure rationality in all prescriptions. Continuous monitoring of drug use, development of prescribing guidelines, and training are recommended to ensure and implement good-quality prescribing practices for promoting the rational and cost-effective use of drugs.

Antibiotic prescribing among patients with severe infectious diseases in two private sector hospitals in Central India - a time series analysis over 10 years

BACKGROUND

Antibiotic resistance is an emerging problem caused due to antibiotic use. In countries with high rates of infectious diseases, antibiotic resistance is a frequent cause of mortality. The aim was to analyse antibiotic prescribing practices between 2008 and 2017 in a teaching (TH) and a non-teaching (NTH) hospital, as typical hospitals of low- and middle-income countries, and to compare antibiotic prescribing for severe infectious indications for which empiric antibiotic treatment is recommended.

METHODS

Data from adult patients registered at two Indian private-sector hospitals with one of the following indications: epiglottitis, pneumonia, peritonitis, pyelonephritis, cellulitis, erysipelas, septic arthritis, endocarditis, meningitis or sepsis; were included and analysed. Antibiotic prescription data was analyzed using the World Health Organization's (WHO) Anatomical Therapeutic Chemical classification system and the Defined Daily Doses. Chi-square and linear regression were used to compare the data between groups. Time series analyses were conducted using linear regression. P-values < 0.05 were considered significant.

RESULTS

In total, 3766 patients were included, 2504 inpatients in the NTH and 1262 in the TH, of which 92 and 89% patients, respectively, were prescribed antibiotics. Sixty-one percent of total prescriptions in the TH and 40% in the NTH comprised the access category of antibiotics (i.e. the first-choice of treatment according to the WHO). The WHO's second-choice of treatment, the watch category, comprised 29 and 40% of total prescriptions in the TH and NTH, respectively. Prescribing of fixed-dose combinations (FDCs) of antibiotics was significantly higher in the NTH (18%) than in the TH (8%, P < 0.05). Prescribing of watch antibiotics and FDCs increased significantly in both hospitals between 2008 and 2017 among patients with pneumonia, cellulitis and peritonitis (P < 0.05).

CONCLUSIONS

Prescribing of watch antibiotics and FDCs of antibiotics increased over time at both hospitals, indicating under prescribing of access antibiotics and more prescribing of second-choice antibiotics. The results can be used to highlight the areas of improvement in similar settings. Implementing diagnostic routines and local prescribing guidelines could improve the prescribing practices.