Medication use pattern and quality assessment of psychiatry outpatient department prescriptions of a tertiary care hospital

Background: Psychiatric illness is a major but often underreported health burden. The field of psychopharmacotherapy is continuously evolving therefore needs monitoring to prevent irrationality. In this setting, authors analyzed the prescribing pattern of psychotropic drugs while simultaneously monitoring prescription quality in a tertiary care teaching private hospital.Methods: A 6 month-prospective observational study was conducted in psychiatry out-patient department. Prescription pattern was analyzed using World Health Organization (WHO) drug use indicators. The quality of the prescriptions was assessed as per prescription writing guidelines issued by The Department of Health and Family Welfare, Government of West Bengal.Results: Of the 745 prescriptions analyzed, depression and psychosis constituted the bulk of diagnosed cases irrespective of any gender predominance. The average number of psychotropic drugs per prescription was 2.85±1.48. Antidepressants, sedative-hypnotic and anxiolytics are most commonly prescribed drugs. 37.58% of psychotropic drugs were given as fixed dose combination, most common being risperidone with trihexyphenidyl. Only 2.91% of the drugs were prescribed in generic name whereas 53.99% were enlisted in national essential medicine list 2015. Polypharmacy and therapeutic duplication were noted in 41% and 26.84 % of prescriptions and dose, duration and frequency were not mentioned in 2.68%, 53.02% and 19.00% of the prescription respectively.Conclusions: Use of psychotropic drugs follows closely with different treatment guideline, though routine uses of central anticholinergics with atypical antipsychotics are not recommended. Despite high utilization of NLEM, more generic prescribing, correct prescription dosing schedule, avoidance of polypharmacy and non-Judicious use of multivitamin FDCs may significantly improve treatment outcome.

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Psychotropic drug utilization in psychiatric outpatient department of a tertiary care teaching hospital in India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20171274 ◽

2017 ◽

Vol 5 (4) ◽

pp. 1612

Author(s):

Mohanraj Rathinavelu Mudhaliar ◽

Ishrar Shaik Mohammad Ghouse ◽

Priyanka Sadubugga ◽

Swaroop Reddy Narala ◽

Vidyasagar Chinnakotla ◽

...

Keyword(s):

Psychotropic Drug ◽

Psychotropic Drugs ◽

Psychiatric Illness ◽

Tertiary Care ◽

Real Life ◽

Psychotropic Medications ◽

World Health ◽

Fixed Dose ◽

Care Hospital ◽

Prescribing Pattern

Background: Although psychotropic medications have had a remarkable impact on psychiatric practice that legitimately can be called revolutionary, their utilization and consequences on real life effectiveness and safety in actual clinical practice need continuous study.Methods: The current retrospective study of six months’ duration was designed to assess the utilization of antipsychotics and its prescribing pattern in a tertiary care hospital of south India, which included prescriptions of patients suffering from a psychiatric illness with at least one psychotropic drug of all ages and both sexes.Results: Out of 150 cases reviewed, 46% were of schizophrenia, where male (60.67%) at higher incidence of psychiatric illness, and maximum patients were under the age group of 29-39 years (54.67%). In present study of 355 prescribed drugs 72.67% were psychotropic medications. As per World Health Organization/International Network for Rational Use of Drugs (INRUD) drug use indicators average number of drugs per prescription (2.37%), average number of psychotropic drugs per prescription (1.72%), psychotropic drugs prescribed as Fixed Dose Combinations (FDCs) was 26.36%, and percentage of drugs prescribed by generic name (91.08%). In our study, 48.09% of psychotropic drugs were utilized in the treatment of schizophrenia, diazepam (17.06%) was the only psychotropic medication distributed in the management of all three observed psychiatric disorders and the study showed a higher utilization of psychotropic drugs as FDCs (25.98%) in the management of schizophrenia.Conclusions: The study advocated an overall rational utilization of psychotropic drugs with a fewer deviations due to socio-economic status of patients and prescription practices of healthcare providers.

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Rationality of Fixed Dose Combinations of Central Nervous System Drugs in a Tertiary Care Hospital

Journal of Drug Delivery and Therapeutics ◽

10.22270/jddt.v9i4-a.3387 ◽

2019 ◽

Vol 9 (4-A) ◽

pp. 15-18

Author(s):

B.P Anilasree ◽

K.P Anuroopa ◽

S Arun Jyothi ◽

T. Basila ◽

Swathi Saji

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Essential Medicine ◽

World Health ◽

Fixed Dose ◽

Care Hospital ◽

Health Organization ◽

The Individual

Objectives: To analyze the rationality of central nervous system fixed dose combinations used in a tertiary care hospital. Methodology: The study was an hospital based observational study. The data was collected from an annual drug compendium entitled “Hospital Drug List”. Fixed dose combinations (FDCs) enlisted in central nervous system (CNS) sections were selected for the study purpose. The active pharmacological ingredients (APIs) in FDC was checked for approval by Drug Control General of India (DCGI), World Health Organization (WHO) and essential medicine (EML)/national essential medicine list (NEML),both or none and all the ingredients (molecule, excipients) present in the FDC was checked whether banned or under any controversies in India as well as worldwide. Efficacy and safety of the individual active pharmacological ingredients (APIs) and their combination were searched. Details of each drug were collected [Generic name, Pharmacokinetics, Interaction affected, Pharmacodynamics, and Advantages of FDCs]. The data collected was analyzed by a tool to assess the rationality of fixed dose combinations which is pre-tested and validated by Shah et al., based on WHO guidelines. Result and Discussion: A total of 25 CNS FDCs were taken, on assessment of CNS FDCs 21 (84%) were found to be rational and 4 (16%) were found to be irrational with the mean rationality score of 7.2. By winding up, state of nonbeing, absenteeism of legality and effectiveness of the formulations appeared in to a peculiar combinations and inadequate practice. The approval process of these combinations by various committees should be robust. Keywords: Rationality; Fixed Dose Combinations; CNS Drugs; Safety and Efficacy.

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PRESCRIPTION PATTERN OF PSYCHOTROPIC DRUGS IN A PSYCHIATRY OPD OF A TERTIARY CARE HOSPITAL – A CROSS SECTIONAL STUDY.

10.36106/gjra/4813714 ◽

2021 ◽

pp. 191-194

Author(s):

Kishore M S ◽

Narendra Kumar ◽

S Sindhu

Keyword(s):

Psychotropic Drugs ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cross Sectional Study ◽

World Health ◽

Fixed Dose ◽

Care Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Prescription Pattern

Background: The expanding and challenging eld of psychopharmacology is constantly seeking new and improved drugs to treat psychiatric disorders. Psychotropic drugs utilization in actual clinical practice, effectiveness and safety in the real-life situation needs continuous study. Therefore, the study was undertaken to analyze the prescription pattern of psychotropic drugs. Methods: A Cross sectional study was conducted in the psychiatry out-patient department of a tertiary care hospital for 4 months. Diagnosis was made according to ICD-10 criteria. Prescription pattern was analyzed using World Health Organization (WHO) drug indicators. Results: Psychotropic drugs constituted 74.85% of the prescribed medication. Average number of the psychotropic drugs per prescription was 2.53. Percentage of prescriptions with injectable drugs accounted for 5.13%. 59.28% of the drugs were prescribed by generic names, while the rest were branded. 28% of prescriptions contained psychotropic FDCs (Fixed dose th combination). 78.65% of the drugs were from the WHO's 18 List of Essential Medicines. Among the total psychotropic drugs prescribed, antipsychotics (43.87%) were the most commonly prescribed class of drugs followed by antidepressants (23.32%), anxiolytics (22.13%) and the mood stabilizers (9.88%) were the least. Conclusions: Prescription pattern of the psychotropic drugs were in accordance to the recommendations of various treatment guidelines. Antipsychotics were the most commonly prescribed psychotropic drugs.

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Prescribing pattern in patients of asthma visiting outpatient departments of a tertiary care hospital: a cross-sectional, observational study

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20170818 ◽

2017 ◽

Vol 6 (3) ◽

pp. 587

Author(s):

Nitant Trivedi ◽

Hemangini R. Acharya ◽

Manish J. Barvaliya ◽

C. B. Tripathi

Keyword(s):

Average Cost ◽

Tertiary Care ◽

Treatment Guideline ◽

Oral Route ◽

Brand Names ◽

Beta Agonist ◽

Fixed Dose ◽

Care Hospital ◽

Prescribing Pattern ◽

Cross Sectional

Background: Objective of the study was to evaluate the prescribing pattern in patients of asthma visiting outpatient departments.Methods: Collected prescriptions were analyzed for demographic variables, proportions of various comorbid conditions, average number of drugs per prescription, average number of anti-asthmatic drugs per prescription, proportion of prescription with antibiotics, fixed dose combinations, and generic/brand names, proportion of formulations utilized, proportion of concomitant medications and possible drug interactions, average cost per prescription, average cost of antiasthmatic drugs per prescription, proportion of irrational prescription and adverse drug reactions.Results: Total 139 prescriptions were evaluated. Deriphyllin was the most commonly prescribed anti-asthmatic drug followed by beta agonist- steroid combination. Majority drugs were prescribed by inhalational route. Deriphyllin, and dexamethasone were prescribed by oral route and salbutamol was by both oral and inhalational route of administration. Antibiotics were prescribed to 24 patients. Possible drug interaction with deriphyllin was found in 15 prescriptions. Average cost per prescription was Rs. 193.4 (95%CI: 171.6-215.3).Conclusions: Prescribing pattern of asthma in our hospital shows more use of anti-asthmatic drugs. Standard treatment guideline should be followed. Role of methylxanthine in long term management of asthma should be justified.

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A prospective observational study of prescription pattern in a tertiary care teaching hospital of Jharkhand

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20195267 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2620

Author(s):

Abha Kumari ◽

Keshav Kumar ◽

Manju Gari ◽

Kumari Pallavi ◽

Subhankar Choudhury

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Care Delivery ◽

Tertiary Care ◽

Health Care Delivery System ◽

World Health ◽

Fixed Dose ◽

Prescribing Pattern ◽

Prescribing Practice ◽

Health Organization

Background: Prescription error and irrational prescribing are the avoidable problems imposed on health care delivery system from prescriber side which must be addressed. Periodic prescription audit helps to curtail the error and irrational prescribing.Methods: A prospective observational study was conducted on patients visiting various Outpatient Department of RIMS, Ranchi, Jharkhand on all working days at 11:00 AM to 12:00 PM from 1 August 2018 to 31 July 2019. Various aspects of collected prescriptions were analyzed by using World Health Organization (WHO) prescribing indicators.Results: In this study, out of 700 prescriptions collected, 76 were excluded. Out of total 624 patients analyzed, 382 (61.28%) were male and 242 (38.72%) were female. 48 (7.69%) patients belonged to ≤18, 464 (74.36%) to 19-64 and 112 (17.95%) to ≥65 years of age group. Tablet (71%) was the most common dosage form. None of prescriptions were having registration number of the doctor. 242 (38.78%) prescriptions did not have a diagnosis duly written. The total no. of drugs prescribed in 624 prescriptions was 2176. Only 32 (5.13%) prescriptions were found to have medicines prescribed in block letters. Antibiotics (29%) were the most common class of drugs prescribed. Average number of drugs per prescription was 3.47. Only 48 (2.20%) drugs were prescribed by their generic name while total of injectables prescribed were 102 (4.68%). Total number of drugs from NLEM was 848 (38.97%). 196 (9.00%) drugs were fixed-dose combination.Conclusions: In our study, we found deficiencies in various parts of prescriptions. Prescribing pattern was not in accordance with WHO recommendation for prescribing practice.

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PRESCRIPTION AUDITING BASED ON THE WORLD HEALTH ORGANIZATION (WHO) PRESCRIBING INDICATORS IN OUTPATIENT DEPARTMENT OF A TEACHING HOSPITAL IN KERALA

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2021.v14i5.41305 ◽

2021 ◽

pp. 147-151

Author(s):

DHANYA T H ◽

SANALKUMAR K B ◽

ANDREWS M A

Keyword(s):

Tertiary Care ◽

Essential Medicine ◽

Outpatient Department ◽

World Health ◽

Fixed Dose ◽

Care Hospital ◽

Research Committee ◽

Cross Sectional ◽

Prescribing Indicators

Objectives: The objectives of the study were to study the pattern of major drug groups prescribed, assess the Rational Prescription pattern by measuring the WHO Core Prescribing Indicators and to assess the quality of the prescriptions by assessing the legibility of prescription in the outpatient department of a tertiary care hospital. Methods: It was an analytical cross-sectional study done in hospital pharmacy for a period of 6 months. Approval from Institutional Research Committee and Institutional Ethics Committee was taken before starting the study. Sample size was taken as 1020. Results: One hundred and twenty prescriptions were analyzed. About 49% prescriptions were of males and 54% of females. Mean age of the patients were 46 years. A total of 3557 medicines were prescribed in 1020 prescriptions. Due to lack of legibility, we were unable to decode 122 medicines out of 3557 medicines prescribed. The dosage forms prescribed were; oral 87.4%, injections 1.4%, inhalational agents 0.4%, and topical agents 10.8%. Average number of medicines per prescription was 3.5. Percentage of medicines prescribed by generic name was 45%. Percentage of antibiotics per prescription was 24.8%. Percentage of injections per prescription was 4.8%. Percentage of medicines prescribed as per NATIONAL essential drugs list (EDL) was 3.2% and as per the WHO EDL was 2.6%. Percentage of fixed dose combinations (FDCs) was 6.5%. Conclusion: It was evident that polypharmacy was present as indicated by the average number of medicines prescribed. Medicines prescribed by generic name and from Essential Medicine List were less in number. Antibiotics and injections prescribed was in conformity with the WHO recommended values, which means that there was no irrational use of antibiotics and unwanted use of injectables. Percentage of FDCs was 6.5%. Most commonly prescribed drug was Ranitidine as per our study. Hence, as per this study, prescribers did not follow prescribing core indicators of the WHO closely, except for two indicators. The quality of prescriptions with respect to legibility and clarity was found to be optimal.

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Evaluation of drug promotional literatures in a tertiary care hospital setting in South India

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20211648 ◽

2021 ◽

Vol 10 (5) ◽

pp. 527

Author(s):

Ravi H. Kudthni ◽

Fazeel Zubair Ahmed ◽

Sangala Srimanth Madanna ◽

Samba Siva Raju Derangula ◽

Pothuru Anil Kumar

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Hospital Setting ◽

Endocrine System ◽

Medical Practitioner ◽

World Health ◽

Fixed Dose ◽

Care Hospital ◽

Health Organization ◽

Many Sources

Background: The drug promotional literature is one of many sources for seeking information about the drugs to the busy medical practitioner. The aim of current study was to assess drug promotional literatures as per world health organization, criteria and categorize them and to analyse the claims in presented in DPL.Methods: Current study is a descriptive study in which pharmaceutical promotional materials were collected from selected out-patient departments of a tertiary care hospital, Kurnool. Printed drug promotional literatures for modern drugs were collected and an assessment was made whether the advertisements adhered to WHO criteria for medicinal drug promotion.Results: A total of 271 drug promotional literatures were collected. Information about the single drug was given in 127 (46.9%). 144 (53.1%) DPLs contain fixed-dose combination. Majority of drug promoted in collected DPLs were miscellaneous group 83 (30.8%) followed by antimicrobials 55 (20.3%) and blood and cardiovascular drugs 37 (13.1), gastrointestinal drugs 23 (8.5%), drugs acting on endocrine system 23 (84.5%). Generic name was mentioned in 229 (84.5%) while brand name was mentioned in 271 (100%) of DPL.Conclusions: The study concluded that the drug information provided in the promotional brochures can be incomplete and unreliable. Hence a physician should not rely solely on the DPL provided by medical representatives. All brochures circulated among prescribers must undergo a strict process of assessment regarding information provided, especially related to efficacy and safety.

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An evaluation of fixed dose combinations and it’s practices at medicine department of tertiary care hospital, Nepal

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20200197 ◽

2020 ◽

Vol 6 (2) ◽

pp. 67

Author(s):

Rajeev Shrestha ◽

Sushmita Gurung

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Essential Medicine ◽

Brand Names ◽

World Health ◽

Fixed Dose ◽

Care Hospital ◽

Vitamin Supplements ◽

Medicine Department ◽

Essential Medicine List

Background: A large proportion of fixed dose combinations (FDCs) are manufactured and used widely in Nepal. This study aimed to evaluate the FDCs and its utilization in medicine department of tertiary care hospital.Methods: A cross-sectional study was conducted for 50 days among admitted patients in the medicine department of tertiary care hospital, Nepal. A predesigned form was used to collect the data at the time of patient discharge. Only the oral FDCs were selected for study. Microsoft Excel 2007 was used for statistical analysis and data were presented as number and percentage in tabulated and figure forms. Results: Oral FDCs were used in 27.08% of admitted patients. A total of 295 FDCs were prescribed in 208 patients with 44 FDC items in 58 different brand names. Categorically, the most commonly used FDCs were of analgesics (34.24%) followed by antibiotics (25.76%) and vitamin supplements (22.71%). The 27.27% of FDCs prescribed contain more than two active pharmaceutical ingredients (APIs) up to nine and the highest number of APIs were found in vitamin supplements. All FDCs were prescribed in the brand names. The very few 2.27% and 4.55% of FDCs were prescribed from the essential medicine list of Nepal and world health organization, respectively.Conclusions: The use of FDCs listed in essential medicine list was very poor. Similarly, generic prescribing was also zero. The regulatory body must study the rationality of FDC before production, marketing, importing, and utilization in hospital.

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Analysis of Essential Medicines Used for Emergency Care in Pakistan

Pakistan Journal of Surgery and Medicine ◽

10.37978/pjsm.v1i1.113 ◽

2020 ◽

Vol 1 (1) ◽

pp. 75-77

Author(s):

Talha Khalid ◽

Amna Khokhar ◽

Naseem Jehan ◽

Umar Sultan ◽

Arooj Fatima

Keyword(s):

Health Care ◽

Health Care Systems ◽

Tertiary Care ◽

Essential Medicine ◽

Essential Medicines ◽

World Health ◽

Care Hospital ◽

Care Needs ◽

Cross Sectional ◽

Health Organization

Introduction: According to the World Health Organization (WHO), essential medicines (EM) have the ability to meet the health care needs of maximum individuals. High accessibility to essential medicines (EM) was proposed under the Millennium Development Goal. The access to high quality, suitable, and inexpensive essential medicines is an essential constituent of health care systems. Methodology: This retrospective cross-sectional observational study was performed at Jinnah Hospital Lahore from February 2018 to November 2018, for analysis of essential medicine usage in a public sector tertiary care hospital of Pakistan. The data were collected from records of patients admitted in the emergency department. Results: Drugs prescribed per encounter were estimated to be 3. Most patients got a single antibiotic, and cephalosporin was the most commonly prescribed antibiotic. Conclusion: The concept of essential drugs has gained high acceptance, but the EMs should be prescribed logically, appropriately and should be in line with WHO guidelines.

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Prescribing pattern of ophthalmological medication in geriatric inpatients of a tertiary care hospital

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20191580 ◽

2019 ◽

Vol 8 (5) ◽

pp. 940

Author(s):

Sudhindra Prathap A. ◽

Radhika M. S. ◽

Reethesh Kumar Rai

Keyword(s):

Tertiary Care ◽

Essential Medicines ◽

World Health ◽

Care Hospital ◽

Prescribing Pattern ◽

Essential Drug List ◽

Topical Analgesics ◽

Male Patients ◽

Health Organization

Background: Older people are potentially at greater risk of medication error. Gaining insight into the prescribing pattern especially in eye diseases as they are a common problem in elderly, in order to identify prescribing related problems is the fundamental step in improving the quality of prescription and patient care.Methods: Prescriptions fulfilling inclusion criteria were collected from hospital Medical record department (MRD) and analyzed using the World Health Organization (WHO) core prescribing indicators for rationality of prescriptions.Results: Among 811 prescriptions analysed, 52.7% (428) were of male patients, those aged 60-70 years were 77.2% (626) and patients with only cataract constituted 77% (625). Prescriptions with oral antibiotics were 57.1% (334); topical antibiotics were 35.8% (429) and topical analgesics 46.2% (553). Out of 1182 FDCs noted, 59% (479) were found to be rational and 34.6% (281) were from Essential Medicines List 2014. Only 2% (61) drugs were prescribed using generic name while 64.06% (1606) of drugs were from the WHO Model List of Essential Medicines (April 2015). Average number of drugs per encounter was 3.7. Percentage of encounters with antibiotics was found to be 43.8% and no prescriptions with injections were noted.Conclusions: Although usage of antibiotics and topical drugs was conforming to WHO recommended standards, there is a need to improve prescription pattern by using generic names and drugs from Essential Drug List.

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