Abstract
Background: Topical corticosteroids are among the most commonly prescribed skin preparations for the management of a plethora of inflammatory and allergic conditions. Objective: The main aim of this study is to assess the discrepancies in topical corticosteroid prescription patterns and practice recommendations among various healthcare professionals and to identify factors leading to such discrepancies. Methods: The current study is a prospective cross-sectional observational study that was conducted over a period of six months. A validated structured questionnaire was handed out to one hundred community pharmacists working in independent and chain pharmacies with only one pharmacist interviewed per pharmacy store. Prescriptions for topical corticosteroids over a period of six months were reviewed for discrepancies in prescription patterns between general practitioners and dermatologists in one hundred independent and chain community pharmacies included in the study. Results: The most commonly prescribed topical corticosteroid for initial treatment of mild symptoms of atopic dermatitis in children by general practitioners was hydrocortisone acetate (45%), followed by mometasone furoate (33%). In contrast, dermatologists prescribed mostly mometasone furoate (48%), for the aforementioned indications followed by combination products of topical corticosteroid with an antibiotic or an antifungal (22%) for children and adults. On the other hand, Pharmacists mostly recommended an emollient as an initial treatment. Only 14 % of pharmacists interviewed in the study recommended using the fingertip unit to quantify the proper amount of topical corticosteroids. None of the prescribers provided written instructions to patients in fingertip units. Interestingly, only 15% of pharmacists in the study were found to have adequate knowledge about topical corticosteroids use. Adequacy of knowledge was not significantly associated with age of the pharmacist (p value 0.447), gender (p value 0.628), years of experience (p value 0.288), and pharmacy degree (B.SC vs Pharm D, p value 0.444). Conclusion: This study shows that Physician and pharmacist adherence to clinical guidelines for safe prescription of topical corticosteroids was poor. Updating Physicians and pharmacists on practice guidelines is the most urgent recommendation to improve treatment of atopic dermatitis.
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