PIH15 - Cost Implications Of Inappropriate Prescribing Of Anti-Malarial Therapy For Treatment Of Undifferentiated Febrile Illness Among Elderly

Abstract

Inappropriate prescribing coupled with adverse effects results in grave health outcomes in elderly leading to increased morbidity, mortality and wastage of financial and human resources which could have been deployed for better use. However, in developing countries physicians at times ignore parasitological diagnosis and presumptively treat fever as malaria leading to its over-treatment and drug resistance. India being second aged population country where majority belongs to lower socioeconomic strata, it is important to identify this pattern, contributing reasons, cost implications and to develop interventions to prevent their occurrence and improve health outcomes. The study aims to determine the pattern, predictors and cost implications of inappropriate prescribing of anti-malarial therapy among elderly in-patients. A prospective observational study was performed over a period of 18 months at the Department of Internal Medicine. Fever case-management of all included patients were studied to identify inappropriate anti-malarial prescriptions without confirmed diagnosis. Root cause analysis was performed to characterize inappropriate prescribing along with economic implications. During the study period, 403 (N, 47%) fever cases were reported among 863 in-patients of which only 36% (145) received a malaria test. Although 94% (137) of the cases returned negative results, 32% (44) of these patients were irrationally prescribed with anti-malarial drugs sans confirmed diagnosis with injectable artesunate (61%) and chloroquine (32%) for an average of 4 days resulting in 41% overdoses and 38% under doses. Direct cost associated was estimated to be USD 1,167.71. Female bedridden patients with fever and chills ≤ 3 days with normal hematological parameters, liver and renal function tests were more likely prescribed with anti-malarials. These patients had fewer co-morbidities, lower mortality, longer survival rate and longer hospitalization (p<0.05). Through geriatric pharmaceutical care services, clinical pharmacist can reduce inappropriate prescribing and prevent possible adverse effects without hampering the health related quality of life.