Coronary artery disease prescribing pattern and risk factor assessment in the patients undergoing angioplasty

Background: Coronary artery disease is caused by an obstruction in vascular supply to the heart. Angioplasty is a frequently used intervention for the management of CAD patients. Supportive and preventive therapies are additionally provided to these patients. Objective of current study was to assess the associated risk factors as well as prescribing trends in CAD patients.Methods: A prospective study was conducted in 88 patients undergoing coronary angioplasty. Patients were assessed for risk factors of CAD. Medication history of patients was recorded in case record form for analysis of prescribing trend and its rationality. Data were statistically analyzed using prism software.Results: In present study most of the CAD patients were male (80.68%) and mean age of patient was 59.19 years. Majority of patients (39.77%) were in age range of 61-70 years. Most common associated conditions at admission were hypertension and diabetes. In this study, BMI, stress, lack of exercise, hypertension, diabetes, family history of CVD were risk factors of CAD and significant correlation observed with risk factors and coronary artery disease. (p<0.05) Frequently prescribed drugs were antiplatelet, antibiotics, antihypertensive, antiulcer, antihyperlipidemic, antidiabetic agents. In 19.31% cases, drug interaction was detected out of which two cases recorded severe. Medical stents coated with everolimus, sirolimus were also prescribed.Conclusions: It was concluded that history of cardiovascular disease, hypertension, diabetes are major risk factors of CAD. Certain level of irrationality in the prescribing trend was observed. Proper patient counselling and care can help in preventing CAD and reduces health burden.

Impact of COVID-19 on corticosteroids and antibiotics prescribing in England: an interrupted time series analysis

Inhaled corticosteroids (ICS), prednisolone and antibiotics all play a crucial role in the management of respiratory diseases. The aim of this study was to analyse whether the declaration of the COVID-19 pandemic affected prescribing rates, as public health measures were implemented to reduce transmission of SARS-CoV-2. Monthly practise-level prescribing data published by NHS Digital were analysed. At the point, the COVID-19 outbreak was declared a pandemic, ICS prescriptions rose significantly. This was followed by a decrease in ICS and prednisolone prescribing in the following months. There was no difference in the antibiotic prescribing trend.

Managing the misuse potential and risk of psychological harm from gabapentinoids in primary care in New Zealand

ABSTRACTGabapentinoid prescribing is increasing in New Zealand. International evidence suggests that this prescribing trend is followed by increasing harms, including misuse, dependence, overdose, and psychological harms including suicidal thoughts or behaviours. However, there is limited guidance for prescribers on how to manage these potential harms. Here, we summarise the current international literature and identify three main risk factors that can be used for screening purposes when considering prescribing a gabapentinoid, to identify patients that may be at greater risk of harm. Based on current knowledge of harms, we provide guidance to prescribers on monitoring patients taking gabapentinoids. Finally, we summarise the evidence regarding tapering, and highlight key knowledge gaps including other interventions, referral, and data from primary care populations.

Prescribing patterns in the management of arthritis in a rural tertiary care teaching hospital

Background: Based on 2003 National Health Insurance Scheme (NHIS) data, a projected 67 million (25%) adults aged 18 years or older will have arthritis and 25 million (37%) of those will have arthritis-attributable activity limitations by the year 2030. Objective of this study is to know the prevalence of different types of arthritis, current trends of drug prescribing patterns in its management and to create awareness about rational use of drugs in a rural tertiary care hospital.Methods: This was an observational study of drug prescriptions among 100 arthritis patients in a tertiary care teaching hospital, India. Patients diagnosed with arthritis with or without co-morbidities were enrolled in the study considering the inclusion and exclusion criteria with a verbal informed consent.Results: Out of 100 arthritis cases, prevalence of Osteoarthritis (OA) was seen more than Rheumatoid arthritis (RA). Osteoarthritis was more commonly seen in males and RA in females. Arthritis was more prevalent in the age group of 36-65 years. Oral route was the most preferred route of administration of drugs and Nonsteroidal anti-inflammatory drugs (NSAIDs) were the first choice. Vitamin D3+ calcium was the most commonly prescribed drug in arthritis. Diclofenac was the most commonly used drug for monotherapy in OA and methotrexate in RA.Conclusions: In this study, some patients diagnosed with RA were treated with NSAIDs as first line and no Disease Modifying Anti-Rheumatic Drugs (DMARD) were given. This irrational prescribing trend should be changed. Non-pharmacological treatment has a qualitative role in treating arthritis and should be advised instead of multiple drug therapy.

PRESCRIBING TREND AMONG HOSPITALIZED PEDIATRIC PATIENTS IN PRIVATE SECTOR HOSPITAL: A PROSPECTIVE OBSERVATIONAL STUDY IN NADIAD, INDIA

Objectives: Purpose of this study was to analyze the prescription pattern among the hospitalized pediatric patients in private sector hospital. Methods: The study was conducted from January 2018 to April, 2018 at Shaishav Hospital, Nadiad, Gujarat, India, and 178 patients were included into the study. Results were obtained by applying the World Health Organization (WHO) prescribing indicators as well as Indian Academy of Pediatrics List of Essential Medicines (IAP-LEM). Results: During the study period, infectious disease such as pneumonitis, bronchitis, enteric fever, gastroenteritis, and dehydration were the dominant disease among the patients. Average number of drugs per prescription was four but in many of prescription, poly-pharmacy has shown. Antibiotic agents were the most prescribed drug (38.6%) among different classes of drugs. Use of the parenteral route of drug administration was used beyond the range stated by the WHO (59% prescriptions vs. 13–24% WHO range). We found that doctor followed IAP-LEM (in 99.78% cases) for prescribing as well as for dosing also, which was very impressive. Conclusions: As this study indicates, there is a need of development of evidence-based treatment protocols for common disease condition for the rational use of medication, especially for an antibiotic medication.

1008. The Reduction of Fluoroquinolone Prescribing in Rural Vermont Hospitals

Background In 2017 The Joint Commission required all hospitals irrespective of size to implement antimicrobial stewardship programs (ASPs) using the CDC core elements (CE) for antimicrobial stewardship (AS). Critical access and rural community hospitals have struggled with developing effective ASPs. Many ASPs seek to reduce fluoroquinolone (FQ) prescribing due to its high risk for drug-drug interactions, risk of Clostridioides difficile infection, and numerous side effects, including five black box warnings from the FDA. Methods We contracted with the Vermont Department of Health to help rural VT hospitals develop ASPs that are compliant with the CDC CE for AS. Six of Vermont’s 13 hospitals were recruited between June – December 2017 (Table 1). Each hospital obtained antibiotic usage (AU) data in grams (g)/1000 (1k) patient-days (PD) from their electronic medical record (EMR), starting from January 2017. All identified FQ as frequently prescribed antimicrobials. Each hospital had unique interventions to decrease FQ prescribing (Table 1), including orderset changes and pharmacist intervention. Monthly combined FQ (ciprofloxacin + levofloxacin) administration data were collected in g/1K PD. AU data from each hospital were summed and expressed as total FQ g/1000 patient-days. The FQ prescribing trend was analyzed by linear regression. Results Prior to implementing ASP, there was a combined FQ rate of 69 g/1K PD. After 20 months of ASP interventions, combined FQ prescribing decreased to 26 g/1K PD (Figure 1, R= 0.9797, P < 0.001). This trend is also significant for each individual FQ: ciprofloxacin (R=0.8364, P < 0.05) and levofloxacin (R= 0.9801, P < 0.01). Conclusion Rural and critical access hospitals can have successful antimicrobial stewardship programs. We have shown that rural hospitals in Vermont (1) can extract AU data from their EMR, (2) develop interventions to decrease high use antimicrobial agents, and (3) be successful in decreasing FQ prescribing in less than 2 years. Disclosures All authors: No reported disclosures.

Sociodemographic profile of patients and prescribing trend of drugs in organophosphate poisoning at tertiary care teaching hospital in Central India: a descriptive study

Background: India is an agrarian country, where pesticides are most widely used in farming. Monsoon dependent agricultural practices are common in India. In present study socioeconomic class and prescribing pattern of commonly used drugs in organophosphate poisoning in indoor setting at tertiary care hospital is evaluated. The aim of the study was to evaluate prescribing trend of drugs and socioeconomic class of patients in organophosphate poisoning in monsoon season.Methods: Prospective observational study was conducted at Medical Intensive Care Unit (MICU) and Medicine Wards for 4 months at 540 bedded tertiary care teaching hospital.Results: Total 64 diagnosed cases were enrolled and analyzed in present study (n=64). Maximum number of cases (57.81%) were male followed by female (42.18%). Most of the cases (37.50%) were from the age group of 21-30 years. 49 (76.56%) patients were of primary intentional poisoning followed by 15 (23.43%) patients of accidental poisoning. Most common drugs prescribed were atropine, pralidoxime, cefotaxime and ranitidine. The average amount of atropine and pralidoxime used per patient/day were 37.89±63.63 mg and 10.07±26.87 gm respectively.Conclusions: Present study revealed that young male adults with low socioeconomic class from rural background were prone for intentional organophosphate poisoning in central India.