|BRIEF RESEARCH ARTICLE
|Year : 2018 | Volume
| Issue : 2 | Page : 156-158
Assessment of drug prescribing pattern using world health organization indicators in a tertiary care teaching hospital
Sartaj Hussain1, Suraj Singh Yadav2, Kamal Kumar Sawlani3, Sanjay Khattri4
1 Junior Resident, Department of Pharmacology and Therapeutics, King George's Medical University, Lucknow, Uttar Pradesh, India
2 Senoir Resident, Department of Pharmacology and Therapeutics, King George's Medical University, Lucknow, Uttar Pradesh, India
3 Associate Professor, Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
4 Professor, Department of Pharmacology and Therapeutics, King George's Medical University, Lucknow, Uttar Pradesh, India
|Date of Web Publication||14-Jun-2018|
Department of Pharmacology and Therapeutics, King George's Medical University, Lucknow - 226 003, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
This cross-sectional study was carried out to assess drug prescribing pattern at a tertiary care teaching medical institute. One thousand prescriptions were randomly collected and analyzed using the world health organization prescribing indicators. The average number of drugs per prescription was 2.91. The percentage of drugs prescribed by generic name, from the essential drug list (National) and as fixed dose combinations (FDCs) was 10.05%, 22.57%, and 49.22%, respectively. The total percentage of encounters with antibiotics, injectables, and FDCs was 19.70%, 2.20%, and 73.60%, respectively. The most common group of drug prescribed was gastrointestinal tract drugs (26.38%) followed by Vitamins and Minerals (23.12%), cardiovascular system drugs (11.56%) and antimicrobials (9.63%). The prescribing practices were not appropriate as they consist of polypharmacy, lesser prescription by generic name, and overprescription of FDCs. There is a need for improvement in the standards of prescribing patterns in many aspects.
Keywords: Essential drug list, fixed-dose combinations, World Health Organization
|How to cite this article:|
Hussain S, Yadav SS, Sawlani KK, Khattri S. Assessment of drug prescribing pattern using world health organization indicators in a tertiary care teaching hospital. Indian J Public Health 2018;62:156-8
|How to cite this URL:|
Hussain S, Yadav SS, Sawlani KK, Khattri S. Assessment of drug prescribing pattern using world health organization indicators in a tertiary care teaching hospital. Indian J Public Health [serial online] 2018 [cited 2021 Sep 25];62:156-8. Available from: https://www.ijph.in/text.asp?2018/62/2/156/234509
Prescription pattern monitoring studies are drug utilization studies with main focus on the rational use of drugs in populations. The definition of rational use of medicines – “Patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period, and at the lowest cost to them and their community.” The World Health Organization (WHO) core indicators help to improve the prescribing patterns and thus promote the rational use of drugs in a healthcare facility. It is needed to assess the rational prescribing skill of the clinicians, and this can be done by conducting periodic prescription audit. This study described the drug prescribing pattern in the tertiary care center of Northern India.
A cross-sectional study was carried out in the outpatient department (OPD) of Medicine, at King George's Medical University, Lucknow, a tertiary care teaching and research institute in North India over a period of 1 month. The study was approved by the Institutional Ethics Committee.
During this study, we have followed WHO document “How to investigate drug use in health facilities”, according to which at least 600 encounters should be included in a cross-sectional survey, with a greater number if possible. A total number of 1000 patients of either gender, above 15 years of age visiting the outpatient department for the first time were selected randomly for the study. Patients coming for follow-up, referral patients, seriously ill patients, not willing to give informed consent and mentally disabled patients were excluded from the study. The data were analyzed to find out the prescribing patterns in the hospital using the WHO prescribing indicators.
The WHO prescribing indicators 
- Average number of drugs per encounter
- Percentage of drugs prescribed by generic name
- Percentage of encounters with an antibiotic prescribed
- Percentage of encounters with an injection prescribed
- Percentage of drugs prescribed from the essential drugs list (EDL) or formulary.
Antimicrobial – The term “antimicrobial” is used for drugs that are classified as antibacterials, antimycotics, antiparasitics, and antivirals.
Antibiotic – The term “antibiotic” is used for penicillins and other antibacterials while antimycotics, antimycobacterials, antivirals, and antiparasitics are exempted from it.
The percentage of males was 54.70%, and that of females was 45.30%. The average number of drugs per prescription was 2.91 (range 1–9, standard deviation [SD] 1.30). The mean age of the patients was 41.12 years (range 15–80, SD 15.90).
In most of the prescriptions, three drugs were prescribed (31.90%), followed by two drugs (24.30%), four drugs in 21.30% prescription, and one drug in 13.70% of prescriptions, more than four drugs were prescribed in 8.80% of prescription. There was not a single prescription where in no drug is prescribed.
The total number of drugs prescribed by its generic name was 293 (10.05%) and the drugs given by their brand name were 2622 (89.95%). Antimicrobials constituted 9.63% of total drugs and antibiotics were 7.13% of total drugs. The total number of encounters with antibiotics was 19.70%. Routes of drug administration were mostly oral (97.60%) followed by inhalational (1.65%) and injectables were least (0.75%). The total number of encounters with injectables was 2.20%. Drugs are prescribed from the National EDL (2015) was 22.57%. The total number of drugs prescribed as fixed-dose combinations (FDCs) was 49.22%, and the total number of encounters with FDCs was 73.60% [Table 1].
|Table 1: World Health Organization prescribing indicators in the current study|
Click here to view
The most common group of drugs prescribed was gastrointestinal tract (GIT) drugs (26.38%) followed by vitamins and minerals (23.12%), cardiovascular system drugs (11.56%), antimicrobials (9.63%), central nervous system drugs (8.47%), respiratory system drugs (7.82%), musculoskeletal drugs (6.89%), endocrine system drugs (1.17%) and other drugs (1.47%).
Among GIT drugs, the most common drug prescribed was FDCs of proton-pump inhibitor (PPI) (8.30%) followed by PPI alone (7.51%), laxative and purgatives (3.12%), antacids (1.47%), drugs for functional GIT disorders (1.37%), drugs for bile and liver therapy (1.30%), H2 receptor inhibitors (1.27%), antidiarrheals (0.78%), antiemetics (0.65%), and digestives (0.61%).
Among vitamins and minerals, the most common drug prescribed was various multivitamin, minerals and antioxidants and their FDCs (13.21%) followed by calcium and Vitamin D and their FDCs (6.21%) and iron, Vitamin B12, and folic acid and their FDCs (3.70%).
Among antimicrobial drugs, the most common drug prescribed was antibacterials (7.13%) followed by antimycobacterials (1.33%), antiparasitics (0.89%), antimycotics (0.24%), and antivirals (0.14%). Among antibiotics, the most common drug prescribed was various antibiotic FDCs (1.85%), followed by quinolones (1.82%), macrolides (1.75%), cephalosporins (0.65%), penicillins (0.41%), aminoglycosides (0.27%), and others (0.37%).
As per the results of this study, the average number of drugs prescribed per prescription was 2.91, which was higher than the standard value (1.6–1.8). In some Indian studies, the average number of drugs per encounter has been reported in the range of 2.8–3.2,,, [Table 2].
|Table 2: Comparison of the World Health Organization prescribing indicators obtained in current study with other Indian studies|
Click here to view
Polypharmacy was clearly visible in our data. Polypharmacy can be prevented if the treatment should be based on diagnosis rather than clinical symptoms.
Drugs were prescribed by generic names in only 10.05% of prescriptions, which was much lower than the standard value (100%). This figure is very low as compared to other Indian studies in which the range has been reported between 46.2% and 100%,, [Table 2]. The prescribing behavior of doctors is often influenced by medical representatives of pharmaceutical companies, and this may lead to increase in drug prescription by brand names. The generic prescribing would rationalize the use of drugs and reduce the healthcare cost.
As infectious diseases are more prevalent in the developing countries, WHO anticipates that 20.0%–26.8% of prescriptions would contain an antibiotic. In the present study, the total number of encounters with an antibiotic was 19.70%, which is near about standard value (20.0%–26.8%). This figure is low as compared to other Indian studies, in which have even reported in the range 20%–72.8%,,,, [Table 2]. The irrational use of antibiotics leads to increased risk of adverse drug events, increase in antimicrobial resistance, and higher health-care cost.
The total number of encounters with injectable was 2.2%, which is lower than standard value (13.4%–24.1%). This figure is low as compared to other Indian studies., However, two Indian studies have reported figures of 0.17 and 0.2%, [Table 2]. The use of injectables should be reduced in the developing countries so that the healthcare associated infections such as HIV, hepatitis and other blood-borne pathogens can be prevented.
The percentage of drugs prescribed from the EDL of India was 22.57%, which is much lower than the standard value (100%). This figure is low as compared to other Indian studies, in which have even reported in the range 45.7%–90.3%,,,,, [Table 2]. The reason behind this could be the lack of knowledge and awareness of the essential drug list.
FDCs were used in 73.60% of prescriptions. This figure is comparatively higher than other Indian studies., The large number of irrational FDCs is available in the Indian pharmaceutical market. These irrational FDCs increase the risk of adverse drug events and increase the health-care cost.
The situation of rational use of drugs as per the WHO prescribing indicators was not up to the mark. The prescribing practices were not appropriate as they consist of polypharmacy, lesser prescription by generic name, lack of knowledge of the EDL, and overprescription of the FDCs. There is an urgent need of improvement in the standards of prescribing patterns in many aspects. The prescriptions should include more generics. The FDCs should be prescribed only when it is rational and required. To improve the quality of care, there should be a well-formulated action plan. Recommendations to change the ongoing prescribing practices should be based on the Standard Treatment Guidelines, EDL, and antibiotic policy or by following the information, education, and communication interventions. The study has a few limitations like the study was conducted only in a single department with limited sample size and time limitation. The WHO prescribing indicators measure what is prescribed to the patients, but not the rationality of prescriptions as per standard treatment guideline. The time period of the study was limited (1 month). Despite a few limitations, this study can help to create awareness about the rational use of drugs. It is recommended that this study should be conducted on a larger scale to have a clearer picture of the situation.
Authors are thankful to Mr. Durgesh Yadav for technical help during the study. Authors are thankful to participants for giving consent to perform this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organization. How to Investigate Drug use in Health Facilities: Selected Drug use Indicators. WHO/DAP. Vol. 1. Geneva: World Health Organization; 1993. p. 1-87.
Brunton L, Chamber B, Knollman B, editors. Goodman & Gilman's the Pharmacological Basis of Therapeutics. 12th
ed. New York: McGraw-Hill; 2011. p. 1365-81.
Lalan BK, Hiray RS, Ghongane BB. Drug prescription pattern of outpatients in a tertiary care teaching hospital in Maharashtra. Int J Pharm Biol Sci 2012;3:225-9.
Karande S, Sankhe P, Kulkarni M. Patterns of prescription and drug dispensing. Indian J Pediatr 2005;72:117-21.
Hazra A, Tripathi SK, Alam MS. Prescribing and dispensing activities at the health facilities of a non-governmental organization. Natl Med J India 2000;13:177-82.
Krishna J, Goel S, Singh A, Roy A, Divya DC, Shamsi MS. Evaluation of prescription pattern and drug dispensing from a pediatric outpatient department of a tertiary care hospital. Indian J Sci Res 2015;6:113-7.
Tekur U, Kalra BS. Monitoring an interventional programme of drug utilization in a health facility of Delhi. Indian J Med Res 2012;135:675-7. [Full text]
Abidi A, Gupta S, Kansal S, Ramgopal. Prescription auditing and drug utilization pattern in a tertiary care teaching hospital of Western UP. Int J Basic Clin Pharm 2012;1:184-90.
[Table 1], [Table 2]