Nationwide surveillance for Telmisartan alone or with combination at real world therapy in Indian patients with hypertension (START)

Background: Angiotensin receptor blockers (ARBs) are amongst the most preferred class of antihypertensive as reported at various evidences or guidelines. However, choice amongst ARBs differs between practicing physicians in real-life scenario. This survey aimed to understand the usage preferences of telmisartan therapy alone and in combination for treating hypertension (HT) among practitioners at various clinical settings in real-life scenario in India.Methods: A cross‑sectional survey was conducted with a pre-validated survey questionnaire consisting of 15 questions pertaining to the telmisartan and its combination usage in HT management. Total 498 registered medical practitioners (mostly physicians and cardiologists) had participated in survey. They were approached for seeking their perception, opinions, and prescribing behaviour. Categorical data was summarized by number (n) and percentage (%) in each category. Data were summarised in frequency tables.Results: Key findings from the data analysed were as follows: Around 20-40% of patients been reported to have co-morbid hypertension and diabetes as reported by the majority of the physicians. Preferred class of drug in patients with hypertension with diabetes reported to be ARB. Around 90.36% of doctors reported that telmisartan was the most preferred ARB in patients with hypertension associated with high cardiovascular risk. Around 90.76% of doctors reported for their preference for telmisartan in patients with hypertension for 24-hr BP control. Around 82.93% of doctors preferred telmisartan in patients with hypertension and stroke/post-MI status.Conclusions: Indian healthcare practitioners prefer telmisartan as the most preferred ARB either alone or in a combination in patients with hypertension, including those with comorbidities.

REDuction of Antibiotic RESistance (REDARES) in urinary tract infections using treatments according to national clinical guidelines: study protocol for a pragmatic randomized controlled trial with a multimodal intervention in primary care

Background Urinary tract infections (UTIs) are a common cause of prescribing antibiotics in family medicine. In Germany, about 40% of UTI-related prescriptions are second-line antibiotics, which contributes to emerging resistance rates. To achieve a change in the prescribing behaviour among family physicians (FPs), this trial aims to implement the guideline recommendations in German family medicine. Methods/design In a randomized controlled trial, a multimodal intervention will be developed and tested in family practices in four regions across Germany. The intervention will consist of three elements: information on guideline recommendations, information on regional resistance and feedback of prescribing behaviour for FPs on a quarterly basis. The effect of the intervention will be compared to usual practice. The primary endpoint is the absolute difference in the mean of prescribing rates of second-line antibiotics among the intervention and the control group after 12 months. To detect a 10% absolute difference in the prescribing rate after one year, with a significance level of 5% and a power of 86%, a sample size of 57 practices per group will be needed. Assuming a dropout rate of 10%, an overall number of 128 practices will be required. The accompanying process evaluation will provide information on feasibility and acceptance of the intervention. Discussion If proven effective and feasible, the components of the intervention can improve adherence to antibiotic prescribing guidelines and contribute to antimicrobial stewardship in ambulatory care. Trial registration DRKS, DRKS00020389, Registered 30 January 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00020389.

A Review on The Impact of Pharmaceutical Promotions on Prescribing Behaviour

Doctors may not be aware of how much promotion they are exposed to. This is both the most difficult area to research and the most important. Therefore, as much as possible, research on the effect of promotion on behaviour should avoid relying on self‐report data to show causal relationships. Self‐report data are appropriate for finding out what people think is happening, or how they want to present themselves to others, but in this area, that may be far from the reality. This review looks at the evidence for several different possible effects of promotion on behaviour. These are the impact of promotion on individual prescribing behaviour, on overall drug sales, and on requests for formulary additions; the effect of DTCA on consumers’ decisions, the effect of promotion on the content of continuing medical education courses, and the impact of industry funding on research outcomes.

GPs’ perceptions of their relationship with the pharmaceutical industry: a qualitative study

BackgroundThe pharmaceutical industry invests heavily in promoting medications to physicians. This promotion may influence physicians’ prescribing behaviour and lead to inappropriately increased prescribing rates.AimTo understand GPs’ experience of interacting with the pharmaceutical industry, and explore their views and perceptions of the impact of this interaction in general practice in Ireland.Design & settingA qualitative design was used, and GPs practicing in Ireland were eligible.MethodA combination of purposive and snowball sampling techniques was applied and semi-structured interviews were conducted. Thematic analysis was used to develop themes from the data.ResultsTwenty-one GPs and one GP trainee participated. Five themes were developed: GP and pharmaceutical industry interface, the industry’s methods of influence, the uncomfortable relationship between GPs and industry, GPs’ perceptions of being unconsciously influenced, and GPs’ lack of knowledge of relevant regulations. Participants interacted with pharmaceutical representatives in their surgery and through continuing professional development (CPD). Reported methods of influence included biassed information and the offer of gifts. Most participants felt their prescribing was unconsciously influenced. A minority felt that they were only influenced in a way that improved their prescribing.ConclusionThe study shows that there can be a lack of clarity among GPs about relevant regulations and about the potential impact of interactions with the pharmaceutical industry on prescribing. Education of trainees and GPs has the potential to address this. Restrictions on interactions with the pharmaceutical industry may also play a role, although alternative CPD funding sources would need to be established.

To Identify Patterns of Drug Usage among Patients Who Seek Care in Psychiatry Outpatient Department of a Tertiary Care Hospital in Srinagar, Jammu and Kashmir, India

Background: An examination of drug use is done in a particular setting, searching for drug use that isn't fair. At the population level, the use of psychotropic drugs for mental illness can be an effective way of identifying and tracking the level of treatment for these conditions. They also provide information on ethical drug use, informed by the currently available information on a medication's benefits and risks. Objective: A major objective of the research was to gather data on patterns of drug use in the psychiatry outpatient department of a tertiary care hospital in Srinagar, Jammu & Kashmir, India. Methodology: The drug use research was performed in a tertiary care hospital in Srinagar, Kashmir, India, in a psychiatry outpatient clinic. This research was observational, cross_sectional, and open_ended in nature. All patients who attended the Psychiatry OPD and fulfilled the inclusion criteria over the course of a six_month cycle were included in the study. Results: Over a period of six months, 600 patients from the psychiatry outpatient department of a tertiary care hospital in Srinagar, Jammu & Kashmir, India were assessed. All patients were classified into seven age groups: up to 14 years old (A), 15 to 25 years old (B), 26 to 35 years old (C), 36 to 45 years old (D), 46 to 55 years old (E), 56 to 65 years old (F), and over 65 years old (G). Clonazepam was the most commonly prescribed medication (152 cases), followed by olanzapine (132 cases), lorazepam (105 cases), and escitalopram (92 cases). Conclusion: Measuring drug use in treatment centres not only explains drug use rates and prescribing behaviour, but it also helps in the identification of causes of polypharmacy and the problems associated with it. Making a habit of setting standards and gauging the quality of clinical treatment using performance feedback should become standard clinical protocol.

Immediate and delayed antibiotic prescribing strategies used by Australian early-career general practitioners.

Background: Antibiotics are overused for non-pneumonia acute respiratory tract infections (ARTIs). Aim: To establish prevalence and explore associations of antibiotic prescribing strategies used by Australian early-career GPs for non-pneumonia ARTIs. Design and Setting: Cross-sectional analysis of data, September 2016 to December 2017, from the Registrar Clinical Encounters in Training cohort study. Method: Multinomial logistic regression of antibiotic prescribing (“no prescribing”, “immediate prescribing”, or “delayed prescribing”) to manage an ARTI. Results: Of 7,156 new ARTI problems, no antibiotics were prescribed for 4,892 problems (68%), antibiotics were prescribed for immediate use for 1,614 problems (23%) and delayed antibiotics were used for 650 problems (9%). “Delayed prescribing” was used in 22% of otitis media, 16% of sinusitis, 13% of sore throat, 11% of acute bronchitis/bronchiolitis, and 5% of upper respiratory tract infection (URTI). “Delayed prescribing” was used for 29% of all prescriptions written. “Delayed prescribing” and “immediate prescribing” were associated with markers of clinical concern. “Delayed prescribing” was associated with longer duration of consultation and with fewer problems dealt with in the consultation. Conclusion: Australian early-career GPs use “no prescribing” for ARTIs substantially more than established GPs, but, except for URTIs, still prescribe antibiotics in excess of validated benchmarks. They may use “delayed prescribing” more often than European GPs. They may use “delayed prescribing” to manage diagnostic uncertainty and, possibly, conflicting influences on prescribing behaviour. Consequently, the use of “delayed prescribing” may enable a transition to an environment of more rational antibiotic prescribing for ARTIs.

THE RATIONALITY OF DRUG PRESCRIPTIONS AT THE GYNAECOLOGY DEPARTMENT IN A TERTIARY CARE TEACHING HOSPITAL IN KELANTAN

The aim of this study is to assess the rational prescribing pattern of drugs for pregnant women using World Health Organization (WHO)/International Network for Rational Use of Drugs (INRUD) core drug prescribing indicators. A one-year retrospective research design from (October 2016–September 2017) was used to review pregnant women prescriptions from their medical records at Hospital Universiti Sains Malaysia (HUSM). A structured data collection form using WHO/INRUD document on prescribing indicators was used. Data was sorted and categorised according to the US Food and Drug Administration (USFDA) pregnancy classification systems and Anatomical Therapeutic Classification (ATC). Then, data was compared with the references values of WHO/INRUD. Descriptive analysis were performed using SPSS version 20. A total of 741 medical files met the study inclusion criteria. The average number of prescribed drugs per prescription and the percentage of prescribed drugs from hospital formulary list and health ministry list were within the acceptable range listed by WHO. Whereas, the percentage of pregnant women with antibiotics and injection drugs were lower than normal values 17.67% and 8.23%, respectively. Percentage of prescribed drugs from categories C and D were 13.8% and 2.8%, respectively. Whereas 24.8% of prescribed drugs were from unclassified risk category. On the other hand, multivitamins preparations were the highest category of prescriptions 17.7%. Injections and number of antibiotics per encounter were lower than the recommended range listed by WHO. However, a great caution and careful prescribing behaviour of physicians were noticed at gynaecology/obstetric departments and most of the prescribed medications were rational and safe during pregnancy.

Development and Pilot of an Interactive Online Course on Antimicrobial Stewardship in Companion Animals

A holistic approach to antimicrobial use (AMU) and prescribing is needed to combat the problem of antimicrobial resistance (AMR). Previously, an antimicrobial stewardship programme (ASP) was developed, introduced, and evaluated in 44 Dutch companion animal clinics, which resulted in an optimization of AMU. As a follow-up to this, an online course was developed to promote awareness of AMU, AMR, and responsible antimicrobial prescribing. The aim of this paper is to describe the development and pilot, including evaluation, of this course, which will be disseminated more widely among Dutch companion animal veterinarians. The interactive programme consists of a major e-learning component and two online, face-to-face meetings. The course comprises five different parts corresponding with five consecutive weeks. Theory on several topics is offered, for example on AMU and AMR in general, Dutch regulations and guidelines on veterinary AMU, behavioural change, and possible methods to quantify AMU. Additionally, several assignments are offered, for example to reflect upon one’s own current antimicrobial prescribing behaviour. Interactive discussion and peer-to-peer learning are promoted. Since September 2020, the course has been offered in a pilot phase, and the feedback is promising. Evaluation of the pilot phase will result in recommendations for further optimization and dissemination.

Correction to: Impact of safety warnings for fluoroquinolones on prescribing behaviour. Results of a cohort study with outpatient routine data

A correction to this paper has been published: https://doi.org/10.1007/s15010-021-01616-7