TRENDS IN PRESCRIPTION PATTERN IN MEDICAL INDIAN ICU AND IT’S IMPACT ON PATIENT OUTCOME

Objective: The objective of this study is to evaluate the trends in prescribing pattern in medical ICU concerning patient age, gender, past, and current illness along with comorbidities for the evasion of polypharmacy and to improve patient outcomes. Methods: A prospective analysis of the case records of patients admitted to the ICU of Yashoda hospital in India was carried out. Results: 120 patients were evaluated, consisting of 77% male patients. The mean±SD of age is 53.81±14.63. The majority of the study subjects belonged to the age group of 50-67 y (32%) Most common causes for admission to the ICU were Respiratory diseases and Stroke. Diabetes mellitus and Hypertension are the most common co-morbidities identified. The total number of drugs used were 1502 during this study period. The average number of drugs per prescription is 12. The range is between 2-30. The average number of antibiotics per prescription is 3. Commonly prescribed drug classes were the GI agents in 100% of patients, followed by antimicrobial agents (AMAs) in 95.8% of patients. About 42.5% of patients received 3 antibiotics per day. 55 potential drug-drug interactions were interpreted in 46 patients. 30(55%) were moderate interactions 25(45%) were major interactions, which were addressed. De-escalation of antibiotics was seen in 29% of patients while escalation in 13%. The death rate is only 5% in our ICU setting. Conclusion: This prescription pattern study can provide a framework for continuous prescription audit in the ICU

Assessment of Antibiotic Prescription Pattern Using who Prescribing Indicators and Aware Categorization of Antibiotics

Background: Medicines play a crucial role in the healthcare delivery of a hospital. The appropriate use of medicines gives us assessment of the quality of health services being provided in a particular region. Aim: To evaluate the prescribing practices and antibiotic utilization patterns so that the extent of irrational use can be assessed by comparing them with published ideal values set by WHO. Study design: Retrospective, cross-sectional study. Place and duration of study: Teaching Hospital of Faisalabad: Independent University Hospital (IUH), from Jan 2018 to June/July 2018. Methodology: 200 cases were selected through systematic random sampling from medicine/surgery wards and pharmacy registers. The standard World Health Organization prescribing indicators and AWaRe categorization of antibiotics were used to assess the prescribing practices of physicians/surgeons. Published ideal standards for each of the indicators were compared with study findings to identify extent of irrational drug use. Results: Most of the facility indicators were met with. The Drug and Therapeutic Committee (DTC) was functional. The Standard treatment guideline booklets (STGs) and Essential Drugs List (EDL) of the hospital were available. 88% of the key drugs listed in EDL were available in stock. The expenditure on antibiotics compared to total medicines was 17%. Regarding prescribing indicators: the average number of drugs prescribed per encounter was 6 (optimal value 1.6–1.8). Average no of antibiotic per prescription amounted to almost 1 (0.925). % prescriptions with an antibiotic amounted to 72% (optimal value 20-26.8%).72% antibiotics were prescribed from the EDL formulary of the hospital (optimal value 100%). Conclusion: Regarding compliance with prescribing indicators and AWaRe categorization of antibiotics by WHO, significant deviation was observed. Education and training of physicians according to WHO parameters is required to ensure rational prescribing. Keywords: Prescription pattern, WHO Prescribing Indicators, AWaRe Categorization

Measuring Prescription Pattern of Nutraceuticals with Special Focus on Protein Supplements in Tier-1 Indian City

Nutraceuticals are playing vital role in today’s time given the recent changes in lifestyle, dietary patterns, and increased stress due to work related pressure. They can be organized in several ways depending upon its ease of understanding and application, i.e. for academic instruction, clinical trial design, functional food development or dietary recommendations. A study was carried out for a period of two months to assess the awareness and prescription pattern of nutraceuticals with reference to protein supplements and to evaluate factors that will drive the future demand. Responses were obtained from Doctors and chemists from a single metro city in India. The analysis was performed using descriptive statistics and frequency distribution valid percentage was calculated. Chi-Square test was performed to measure the association between the demographic factors to preferences for protein supplements. p- Value was calculated and α- value of 0.05 or less was considered significant. The results show that the maximum protein supplement was prescribed in the age group of 20-40 years. Doctors usually prescribe protein (44%) for convalescent followed by pre and post-operative cases (40%). Haematinics are the drugs, which are co-prescribed 30% of the times with protein. Responses from Chemists showed that self-prescription was prevalent amongst their buyer and many factors were identified which leads to self-prescription, amongst which buyer’s own previous experience was found to be significant (p-value-0.03). The study has helped to reveal the prescription pattern and practise of the doctors and of the factors leading to self-prescription.

A study on prescribing pattern and medication adherence in elderly COPD and bronchial asthma patients in a tertiary care teaching hospital

Background: Chronic obstructive pulmonary disease and bronchial asthma are common among elderly people and have become a major public health concern of today. The purpose of this study is to identify the prescription pattern and role of medication adherence in the COPD and bronchial asthma. Prescription pattern monitoring (PPMS) are mainly focus on prescribing, dispensing, administering of drugs they promote appropriate use of monitored drugs and reduction of abuse/misuse.Methods: A hospital based prospective observational study was conducted at department of medicine in Rajah Muthiah Medical College and Hospital. A total of 90 patients were enrolled based on inclusion and exclusion criteria and the data was collected using designed data collection form.Results: Out of 90 patients, male (81.10%) and female (18.90%) are reported with COPD and bronchial asthma. On prevalence 57 (63.34%) of patients with co-morbidities and without co-morbidities 33 (36.66%). Among co-morbidity patients, 38.90% of patients has type-2 diabetes mellitus. PPA indicate that cephalosporins (46.68%), macrolides (38.88%) class of antibiotic are used prominently along with corticosteroids of hydrocortisone 47 (62.66%) and prednisolone 28 (37.34%). 47 (62.66%) patients received expectorants and anti-tussive in that, Ipratropium bromide + levosalbutamol (50%) are commonly prescribed.Conclusions: This study concludes that COPD and bronchial asthma was most predominant in elderly patients and its treated with mainly antibiotics and corticosteroids with bronchodilators in the way of inhalers and nebulizers. The rational use of drugs and patient counselling reflects a better medication adherence.

Prescription Pattern and Off-Label Use of Antipsychotics in a Middle Eastern Population

Background: Understanding the prescription pattern of medications in a population can help reveal the potential usage scenarios, including off-label prescriptions, and the need for precision medicine implementation. Therefore, the aim of this study was to assess the prescription pattern and off-label use of antipsychotics in the Qatari population.Methods: We performed a cross-sectional study of Qatari patients who received antipsychotic prescriptions from the major healthcare providers in the country during the 2-year period between June 2018 and May 2020. The number of patients, prescriptions dispensed, and clinical indications were collected and statistical analysis using chi-square test was conducted.Results: Among the 9,349 Qatari patients prescribed with antipsychotics during the study period, the majority were female (57%; p < 0.001) and were in the age categories 20–39 and 30–39 years (both 22%; p < 0.001). Among the 35,938 antipsychotic prescriptions dispensed, second-generation antipsychotics were the most highly prescribed (59%), specifically, quetiapine (16%) and olanzapine (12%), but the first-generation antipsychotic prochlorperazine (13%) was also highly prescribed. Most of the indications of antipsychotics (69%) were for off-label use such as for controlling chronic diseases, sleeping disorders, benign paroxysmal positional vertigo and irritable bowel syndrome.Conclusion: Non-mental health and off-label prescriptions of several antipsychotics were observed. Integration of this data with pharmacogenomic and clinical outcome data will help in determining the course of action for implementing personalized and precision medicine in the country and beyond.

Antibiotics Prescription Patterns among Dentists in Lahore, Pakistan

Background: Odontogenic infections are one of the main causes of patients visit to a dental office. Antibiotics are magical drugs that have revolutionized the 20th Century in their ability to treat infectious diseases, increasing the life expectancy of individuals. Antibiotics prescription is a common practice among dental professionals and according to an estimate by Centre for Disease Control (CDC) and American Dental Association (ADA), over prescription of antibiotics is seen in 30-50% of the cases. Aim: To assess and compare (no comparison) the antibiotic prescription pattern among general dentists and specialty dentists in Lahore, Pakistan. Methodology: A cross sectional survey was conducted amongst dentists working in the teaching institutions and in the private clinics of Lahore. A pre-piloted questionnaire survey adopted from Jagan et al with slight modifications was used. In this descriptive study 300 practicing dentists were selected using consecutive sampling with a 5% level of significance and margin of error Results: Total 300 filled questionnaires were collected. Almost 84% of the dentists were less than 30 years old while 13% were between 31-40 years old. Of the participants 65.3% were females and 34.7 percent were males. Dental infections associated with gross swelling or associated with closure of the eye were the most common reasons for prescription of antibiotics. Almost 62% of the dentists would give antibiotic if any delay in treatment is anticipated. Almost 50% of the dentists would prescribe antibiotics for periapical abscess and cellulitis. Conclusion: There is a trend towards over prescription of antibiotics by dentists without following the standard guidelines. Emphasis on the correct prescription strategies of antibiotics at the undergraduate level and more awareness should be created as continuing dental education programs for practicing dentists. Keywords: Antibiotics, Dentists, Prescription Pattern.

Assessment of Prescription Pattern Prescribed to Patients Affected by Rheumatoid Arthritis: A Cross Sectional Health Survey Conducted in Different Hospitals of Bangladesh

Introduction: Rheumatoid arthritis (RA) is a systemic autoimmune disease that affects the joints with variable degrees of severity depending on the patient. As it is a chronic disease and patients have to go through medication for a long period of time, choosing the proper drug is very crucial to avoid irrational use of drug. The present study was designed to evaluate the usual prescription pattern that are prescribed by the physicians, and unveiling the scenario of patient care treating for arthritis. Materials and Methods: The current survey-based research study was conducted in seven divisional areas of Bangladesh. Data was collected for Five months periods from September 2020 to January 2021. This cross-sectional study was carried out at a variety of private and governmental hospitals. The study included 300 individuals who had been on antirheumatic medicines for at least six months. Patient demographic details, prescribed drugs, adverse drug reactions, and use of complementary and substitute medicine were used to analyze the pattern of drug use. Results and Discussions: The results of the study found that most of the patients are from 40 to 60 years of age. The number of drug prescribed ranges from 3 to 8, with an average of 6.1 medicines per prescription. The most used Disease-modifying antirheumatic drugs (DMARDs) were tofacitinib, glucocorticosteroids were prednisolone and NSAIDs were Aceclofenac group. None of these drugs were prescribed as generic names, rather proprietary names were used. Conclusion: Most of the patients are treated with more than one drug to fight against arthritis. So the incidence of drug interaction should be observed carefully. Moreover, both the prescriber and patient should be aware of ensuring rationale use of drug.