Abstract
Objective: The objective of the study was to assess the drug-related problems (DRPs) and the World Health Organization (WHO) core prescribing indicators among stroke patients.
 Methods: A prospective observational study was conducted among stroke inpatients of Acute Medical Care and General Medicine Department of a tertiary care hospital located in Tirupati, Andhra Pradesh, India. A suitable data collection form was used to collect the data about demographics, clinical characteristics, WHO prescribing indicators, and DRPs. Descriptive statistics were used to represent the demographics, distribution of DRPs, and prescribing indicators in the study. Chi-square test was employed to test the significant association between the demographics and the occurrence of DRPs.
 Results: Among 174 patients included in the study, 89 had one or more DRPs. A total of 122 DRPs were identified in the study population. Drug interactions (48.4%) and adverse drug reactions (ADRs) (17.2%) were commonly observed DRPs. A significant direct association was observed between the occurrence of DRPs and number of comorbidities (p<0.001), polypharmacy (p<0.001), and hospital stay (p<0.05). The average number of drugs per prescription was 7.2. Of drugs prescribed, 67.6% were in their generic names. The percentage of encounters in which an antibiotic, injection was prescribed was 65.5% and 89.6% respectively. The percentage of drugs prescribed from an essential drug list was 91.2%.
 Conclusion: The rate of drug interactions and ADRs was high in treatment of stroke patients. Patients suffering from comorbidities, polypharmacy, and long hospital stay were positively associated with occurrence of DRPs in stroke. Regular monitoring and screening for drug interactions and ADRs were advised to reduce the burden DRPs in stroke patients admitted in a critical care unit.
Highlights
Ensuring patients’ safety has always been an important element of health and medical care for patients in any health-care settings
The primary aim of this study was to assess the prescribing patterns of medications based on the World Health Organization (WHO)-INRUD core prescribing indicators and to investigate the characteristics and frequency of drug-related problems (DRPs) among stroke patients admitted in a tertiary care teaching hospital
The study findings showed that the majority of the study subjects were males (115; 66.1%), residing in a rural location (83; 47.1%), suffering from at least one comorbidity (89; 51.1%), prescribed with 5 to 8 number of drugs (134; 77.0%), and diagnosed with ischemic stroke (143; 82.2%)
Summary
Ensuring patients’ safety has always been an important element of health and medical care for patients in any health-care settings. Irrational use of drugs can result in increasing the morbidity and mortality rates especially in chronic disease patients, waste of resources; increasing out-of-pocket expenses to the patients; and adverse drug reactions (ADRs) [2,3]. DRPs have been identified as one of the common in hospitalized patients and can result in morbidity and mortality which lead to unnecessary expenditure on healthcare costs [6,7]. The primary aim of this study was to assess the prescribing patterns of medications based on the WHO-INRUD core prescribing indicators and to investigate the characteristics and frequency of DRPs among stroke patients admitted in a tertiary care teaching hospital
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