Analysis Of Prescribing Patterns Research Articles

Analysis of Prescription Pattern of Anti-diabetic Medications in a Teaching Hospital in North India.

This retrospective observational study aimedto comprehensively analyse the clinical profile and treatment modalities of patients diagnosed with type 2 diabetes mellitus (T2DM) who were treatedat a tertiary care centre. The study included a cohort of 300 individuals who sought medical care at the hospital from January 2023 to January 2024. The analysis primarily examined parameters such as the mean number of anti-diabetic medications per prescription, the proportion of various categories of anti-diabetic medications prescribed, the predominant class and type of anti-diabetic medications prescribed, and the proportion of anti-diabetic medications prescribed from the essential drug lists. The age distribution demonstrated that 52.0% of participants were above 60 years old, showcasing a substantial elderly representation. Gender distribution emphasized a male predominance at 65.0%, highlighting potential gender-specific implications in type II diabetes. The blood profile analysis of patients with T2DM revealed a range of values for key parameters. Fasting blood glucose levels ranged from a minimum of 101 mg/dL to a maximum of 359 mg/dL, with a mean of 180.01 mg/dl. The comprehensive analysis of anti-diabetic drug utilization, based on the total number of units prescribed, sheds light on the diverse treatment approaches employed for managing diabetes mellitus (DM). Insulin, comprising 31.3% of the total units, plays a pivotal role in glycemic control, with both regular and biphasic formulations contributing significantly at 26.3% and 9.3%, respectively. Among the 300 patients, the overall utilization of anti-diabetic drugs reveals that 38.7% of individuals are using a combination of insulin with oral anti-diabetic drugs, while 61.3% are relying on oral anti-diabetic drugs alone. The most frequently prescribed drug combinations for diabetes management include sulphonylurea with biguanides, emerging as the most prevalent combination with 22 occurrences. The study's findings contribute valuable insights into the socio-demographic profiles and anti-diabetic drug utilization patterns among diabetes patients.

Analysis of prescription pattern and adverse drug reactions of drugs used in Urinary Tract Infection in reproductive age group (15-44 years) women in a Tertiary Care Hospital in Central India: An observational retrospective study

Background Urinary tract infection is considered a common bacterial infection. Nowadays there is an increase in the irrational and inappropriate use of drugs. Adverse drug reactions have been reported to be a main cause of morbidity, hospital admission, and sometimes death. For this, it is very important to do the analysis of prescriptions and to see the adverse drug reactions due to the prescribed drugs. Objective 1. To determine the prescribing pattern of drugs used in urinary tract infections of the reproductive age group (15-44). 2. To identify adverse reactions due to drugs used for UTI of reproductive age group (15-44). 3. To observe the pattern of combination therapy for urinary tract patients of reproductive age group. 4. To analyze the Fixed Drug Combination. Methods It is a retrospective observational study. Data will be collected from 175 prescription papers. Data will be collected from the medical record section. The study will include prescriptions of UTI for Females of the reproductive age group (15-44 years).

Evaluating the Impact of Interventions and Improvements in Outpatient Intravenous Infusion Therapy at a Hospital in China: A Comprehensive Analysis of Prescription Patterns and Safety Measures.

The excessive use of intravenous infusion in China was once a serious problem, but in recent years, attention has been paid to the phenomenon, and the government has implemented several policies to solve the problem, which has been gradually improved. This study focuses on evaluating the impact of ongoing interventions and improvements in outpatient intravenous infusion therapy. From January 2016 to December 2022, we conducted a study to gather annual data on intravenous infusion prescriptions. A data questionnaire, encompassing information on departments, clinical diagnosis, and infusion drugs, was developed for this purpose. We analyzed the changing trends of Top 10 clinical departments with higher intravenous infusion usage rates and Top 10 drugs used. We also evaluated the compliance of intravenous infusion prescriptions with management regulations and drug instructions, for further intervention in the future. The analysis of intravenous infusion prescription rates revealed a gradual decrease from 10.89% to 5.63%. This reduction was statistically significant (P < 0.05). High levels of intravenous infusion use were consistently observed in emergency surgery and emergency medicine. Commonly administered drugs via infusion included antibacterial drugs, tumor medications, proton pump inhibitors, and injections of traditional Chinese medicine. Inappropriate prescriptions are often characterized by issues related to drug dosage, usage, indication, and selection. Trend analysis of unreasonable types revealed significant improvements in "Diagnosis incomplete/unwritten", "Solvent selection", "Dosing frequency", and "Treatment without indication" (P < 0.05). The findings of this study indicate a gradual improvement in the situation regarding intravenous infusion. However, there are still prevalent instances of unreasonable practices that need to be addressed.

Unveiling the Therapeutic Landscape of Oseltamivir: Exploring Drug Utilization, Adverse Reactions and Interactions with Comorbidities-A Prospective Study

Objective: This study aimed to investigate adverse drug reactions (ADRs) associated with Oseltamivir in the presence of various co-morbidities. The objective was to analyze prescription patterns, administration rationale, and ADR prevalence among patients receiving Oseltamivir for therapeutic or preventative purposes. Material and Methods: The study, conducted over six months at St. Philomena’s Hospital in Bengaluru, involved patients of all ages and genders. Ethical approval secured, the research gathered data from diverse sources for 140 patients. Naranjo’s scale was employed for causation, severity, and preventability assessments of Oseltamivir-related ADRs. Descriptive statistics were utilized to compare ADR frequencies between patients using Oseltamivir for prevention and those for therapeutic purposes. Results: The study revealed a 3.57% incidence of Oseltamivir-related ADRs, with co-morbidities contributing to 2.8% of cases, predominantly associated with hypertension. The research shed light on the importance of monitoring ADRs, particularly in the context of co-morbidities during Oseltamivir treatment. Conclusion: This research underscores the importance of monitoring ADRs in the context of co-morbidities during Oseltamivir treatment. The prevalence of hypertension as the most common co-morbidity highlights the need for careful prescription practices, especially for individuals with underlying medical conditions. These findings provide valuable insights into optimizing Oseltamivir usage in diverse patient populations.

Prescribing Pattern of Antimicrobial Agents in Patients with Pelvic Inflammatory Disease in a Tertiary Care Hospital at Rural Part of Western Nepal

Introduction: Antibiotics are the most frequently prescribed drugs in patients with Pelvic Inflammatory Diseases. Appropriate antibiotic prescriptions in health care institutions are an important element in quality of care, infection management and cost control.&#x0D; Aims: To analyze prescription pattern of antimicrobial agents in patients with pelvic inflammatory diseases.&#x0D; Methods: This quantitative cross-sectional study was conducted including 300 patients' prescriptions, at Karnali Academy of Health Sciences Jumla Nepal for period of six months during August 2021 to January 2022. This study was based on medication utilization form, which was designed on basis of World Health Organization core drug use indicator format.&#x0D; Results: Females were in ages from 12 to 69 years, with mean of 30.46 ± 18.71 years. Chronic Pelvic inflammatory Disease was most prevalent in 20–29 age group (47%) while, lowest in 60–69 age group (1.67%). The total number of prescribed drugs was 796 averaging 2.65 drugs per prescription. The most commonly prescribed antimicrobials were azithromycin (30.15%), tinidazoles (25.25%) and ofloxacin (8.16%). Only 15.5% of drugs were prescribed with generic names and all were from essential list of medicines. 92.8% of prescriptions were administered orally, while 7.8% parenteral. However 76.34% of prescriptions were considered irrational.&#x0D; Conclusion: The high prevalence of irrational prescriptions suggests need for interventions to improve healthcare provider's adherence to established treatment guidelines. Dominance of specific drug classes underscores importance of tailoring treatments to the specific pathogens involved in Pelvic Inflammatory Disease. Suggesting potential room for improvement inadherence to evidence-based guidelines.

Prescribing Pattern of Antimicrobials for Respiratory Tract Infections among Paediatric population in a Multi- Speciality Teaching Hospital

Respiratory Tract Infection (RTI) is one of the leading causes of paediatric mortality. Majority of RTIs are viral in origin. Bacterial pathogens associated with upper and lower respiratory tract infections are Streptococcus pneumoniae, Haemophilus influenza and Moraxella catarrhalis. Antibiotics are considered as the key drugs of choice for the treatment of many infections and they are most commonly prescribed drugs in paediatric department of RTI. Antibiotic regimen should be selected based on presumed causative pathogen. In view of the higher burden of RTI among paediatrics in this area, a study is taken up to analyse the prescribing pattern of antibiotics in RTI. The prospective study was conducted for a period of 6 months. Case records of 156 patients were selected based on the study criteria. A suitably designed data collection form was used to collect the required data. Statistical analysis was done using Microsoft Excel.In this study, there was a slight female predominance (50.64%) and the most prevalent age group was 0 - 3 years (44.88%). LRTI (55.77%) was extensively distributed among the study population in which WALRTI constituted the highest (25.65%). Penicillin (33.15%) class of antibiotics were the most preferred followed by cephalosporin (30.97%). Amoxicillin-clavulanate (26.02%) and Ceftriaxone (21%) were the highly prescribed antibiotics among penicillin and cephalosporins respectively. Majority of patients received antibiotics intravenously. Monotherapy was encouraged in 66.64% of patients. It is essential to improve the utilisation of drugs and therefore analysis of prescription pattern should be carried out frequently to enhance the quality of prescriptions. The study results aim at focusing the importance of strategies that have to be implemented to rationalise the use of medications in paediatrics. Drug utilization studies are vital to promote optimal use of antimicrobials to ensure the best clinical outcome and to address the concern of antimicrobial resistance.

A Research on Clinical Pharmacists' Assessment of Drug-Related Problems in Patients with Chronic Kidney Disease

The study focused on chronic kidney disease (CKD), emphasizing the need for early screening and treatment to prevent its progression. Conducted on 65 CKD patients, this prospective observational research aimed to analyze prescription patterns and identify drug-related issues (DRIs). Using the Pharmaceutical Care Network Europe categorization V 5.01, the study evaluated prescriptions and categorized DRPs. The participant group comprised 65 individuals, predominantly male (69.03%), with an average age of 44. The two primary comorbidities were diabetes mellitus (29.78%) and hypertension (34.97%). Notably, the average prescription count was 10, suggesting polypharmacy. Antibiotics emerged as the most commonly prescribed medication (13.98%). The study found medication interactions to be the most frequent DRP (48.54%), followed by drug choice problems (18.43%), dosage issues (8.36%), drug usage complications (10.46%), adverse reactions (1.24%), and other issues (11.28%). Lack of knowledge (42.16%) and the drug use process (30.81%) were identified as the leading causes of DRPs. The research underscores the critical role of continuous identification and management of DRPs by healthcare professionals to enhance patient health and quality of life, potentially leading to better clinical outcomes for CKD patients.

Prescription pattern analysis of Type 2 Diabetes Mellitus: a cross-sectional study in Isfahan, Iran

BackgroundPatients with Type 2 Diabetes Mellitus (T2DM) are at a higher risk of polypharmacy and more susceptible to irrational prescriptions; therefore, pharmacological therapy patterns are important to be monitored. The primary objective of this study was to highlight current prescription patterns in T2DM patients and compare them with existing Standards of Medical Care in Diabetes. The second objective was to analyze whether age and gender affect prescription patterns.MethodThis cross-sectional study was conducted using the Iran Health Insurance Organization (IHIO) prescription database. It was mined by an Association Rule Mining (ARM) technique, FP-Growth, in order to find co-prescribed drugs with anti-diabetic medications. The algorithm was implemented at different levels of the Anatomical Therapeutic Chemical (ATC) classification system, which assigns different codes to drugs based on their anatomy, pharmacological, therapeutic, and chemical properties to provide an in-depth analysis of co-prescription patterns.ResultsAltogether, the prescriptions of 914,652 patients were analyzed, of whom 91,505 were found to have diabetes. According to our results, prescribing Lipid Modifying Agents (C10) (56.3%), Agents Acting on The Renin-Angiotensin System (C09) (48.9%), Antithrombotic Agents (B01) (35.7%), and Beta Blocking Agents (C07) (30.1%) were meaningfully associated with the prescription of Drugs Used in Diabetes. Our study also revealed that female diabetic patients have a higher lift for taking Thyroid Preparations, and the older the patients were, the more they were prone to take neuropathy-related medications. Additionally, the results suggest that there are gender differences in the association between aspirin and diabetes drugs, with the differences becoming less pronounced in old age.ConclusionsAlmost all of the association rules found in this research were clinically meaningful, proving the potential of ARM for co-prescription pattern discovery. Moreover, implementing level-based ARM was effective in detecting difficult-to-spot rules. Additionally, the majority of drugs prescribed by physicians were consistent with the Standards of Medical Care in Diabetes.

Analysis of prescription pattern and evaluation of possible drug related problems in acute kidney injury patients

Introduction: Drug-induced acute kidney injury (AKI) is a significant cause of morbidity and mortality, accounting for 8% to 60% of in-hospital AKI cases. Impaired renal function leads to the accumulation of drugs and their metabolites in the body, increasing the nephrotoxic burden and the risk of AKI. Objective: The study aims to assess the necessity of appropriate dosage adjustment in patients with acute kidney injury (AKI) and the utilization of previously nephrotoxic drugs. Method: A prospective observational study was conducted among Acute Kidney Injury patients for a period of about 6 months. The collected data were analyzed using SPSS v.20. Pearson’s chi-square tests, correlation, and linear regression analysis were employed to examine the collected data. Results: A study of 207 patients revealed that 97% were prescribed antibiotics, with penicillin being the most common (46.9%). Cephalosporin and piperacillin/tazobactam were prescribed to 38.80% and 37.81% of patients, respectively. Concerningly, only 24% of prescriptions for acute kidney injury (AKI) patients were appropriate, while 86.9% and 58.4% exhibited overdosing and contraindications. More than half of the AKI patients (114 out of the total) had previously used nephrotoxic medications, potentially contributing to their kidney injury. Improved dosage adjustment practices in AKI treatment and monitoring of nephrotoxic drug use are crucial to prevent renal complications. Conclusion: The study’s findings emphasize AKI development, drug patterns, antibiotics and nephrotoxic drugs highlighting the importance of awareness and effective management of AKI.

Prescription analysis emphasizing on medication adherence of antibiotics for lower respiratory tract infection.

Antibiotics are choice of drugs in patients with respiratory infections. Irrational use of antibiotics is an important public health issue faced on daily basis by the community and the individual. Keeping this in consideration, the current study investigates the prescription pattern of antibiotics in lower respiratory tract infection in general population.The objectives of the study include prescription pattern analysis of antibiotics for LRTIs in general population and to evaluate adherence to antibiotic treatment.This was a hospital based prospective observational study conducted between November 2021 to April 2022 in the department of general medicine and pediatrics. Compliance to various antibiotics was scrutinized by using MMAS 4 scale. Patient demographics, laboratory details, prescribed antibiotics, duration of hospital stay were gathered over a period of 6 months.A total of 200 patients were involved in the study, out of which 53% were males and 47% were females. A total of 2127 drugs were prescribed in 200 patients (10.6 drugs/prescription). Ceftriaxone was the most commonly used antibiotic followed by azithromycin and piperacillin/tazobactam. The most frequently diagnosed disease was Bronchopneumonia (41%) followed by A/E COPD (28%). Evaluation of medication adherence resulted in 58% high and 11% poor adherence. The number of antibiotics prescribed was found to be rational but prevalence of polypharmacy should be prevented. Medication adherence decreases as the frequency of antibiotic increases, so it is recommended to lower the frequency of drugs as possible to enhance the compliance.

Prescribing Patterns of Antibiotics Among The Pediatric Patients Attended The Outpatient Departments of The Tertiary Level Hospitals in Nigeria: A Cross-Sectional Study

Rationality analysis of the prescribing pattern of antibiotics for pediatric patients can help to point towards irrationality and can make a consensus among physicians for rational prescribing. This study was aimed at identifying the antibiotic prescription survey in pediatric outpatient prescriptions. This study was carried out in two hospitals namely; Usmanu Danfodiyo University Teaching Hospital, Sokoto, and General Hospital Katsina Nigeria during the period of October to December 2019. A total of 600 prescriptions cumulatively were used as a sample and were selected using the convenience sampling technique. For data collection, a self-designed data collection sheet was used. WHO / INRUD prescribing indicators were used for the analysis of prescription patterns. A total of 600 prescriptions (364 from UDUTHS and 236 from GHKS) were selected and used for the study. Most of the patients admitted to the two selected hospitals were male. The patient’s ages varied from a few months to 12 years, with the majority aged 4 years or less (61.0%) of age. From the 600 prescriptions evaluated, 1564 drugs (912 from UDUTHS and 652 GHKS) were prescribed. The average number of drugs per encounter in UDUTHS and GHKS were 3.0±0.4 and 3.2±0.7 respectively. The percentages of encounters with an antibiotic prescribed in both hospitals were similar: 32.1% for UDUTHS and 31.1% for GHKS. Most antibiotics were targeted at respiratory tract infections Roxithromycin 126 (21.0%) was the most frequently prescribed antibiotic and was prescribed by the proprietary name. This study has revealed inappropriate drug prescriptions in the pediatric outpatient in these hospitals. These include the low rate of prescriptions in generic names; extensive polypharmacy; and inappropriate prescription of antibiotics which could lead to drug-drug interaction and adverse drug reaction is also evident in these hospitals.

Prescription pattern analysis during pregnancy in a tertiary care hospital, Famagusta, north Cyprus

Background: Prescribing pattern in pregnancy population provide insights during drug profile and also minimizes the inherent risks due to unethical prescribing. The study aimed to evaluate the prescribing pattern of drugs among pregnant women. the irrational use of drugs is a concern for the present-day medical practice. Objectives: To evaluate and assess the FDA category drug use pattern using in pregnancy and to determine the percentages of pregnant women prone to possible teratogens, namely category C, D and X. Methodology: This was a prospective observational study at a tertiary care hospital. Famagusta, North Cyprus. All the medically relevant information was documented using a predefined data collection form and the case charts were also analyzed. Results: Drugs effecting in GIT were with the frequencies of 242 (18.5%) and it was found that the use of antibiotics and antiemetic drugs was also more common during pregnancy Out of 1333 drugs prescribed drugs according to the US FDA category is given below and 785 (58.88%) belongs to category B followed by 350 (26.25) in category A and least were in category D 4 (0.3%). Conclusions: Evaluating and assessing the prescribing pattern will minimize the teratogenicity and risk to the mother during pregnancy.

Prescription Patterns of Drugs Used in Patients with Coronary Artery Disease at Tertiary Care Hospital

Background: The Cardiovascular disease is emerging as one of the leading cause of morbidity and mortality worldwide. To determine the appropriateness of the prescriptions and various trends in treatment, so as to provide the basis for modification in the future drug usage in accordance with risk factors and clinical presentations and also assess the improvement of health-related quality of life of patients with coronary artery disease.&#x0D; Methods: A prospective, observational and cross-sectional study was conducted in Department of Pharmacology in collaboration with Department of Medicine of tertiary healthcare hospital. As per inclusion criteria, patients visiting Medicine Outpatient department (OPD) from November 2021 to January 2022 were enrolled in the study.&#x0D; Results: Total 360 prescriptions were analysed, most of them belonged to the age group of 61-75 years. The prevalence was higher in Females (54%) than males (46%). An average number of drugs per prescription was 4.5. All the drugs were prescribed by generic names. 90.63% drugs prescribed were included in World Health Organization (WHO) essential drugs list 2021. 98.40% drugs prescribed were included in National list of essential medicines (NLEM) 2015. Antiplatelets (99.44%) were the most commonly prescribed category of drugs, followed by hyperlipidaemic (96.67%).&#x0D; Conclusion: The overall analysis of prescription pattern suggests that most of the drugs were prescribed rationally according to current American College of Cardiology Federation/American Heart Association (ACC/ AHA) guidelines. The incidence of polypharmacy was in the normal limits as per WHO recommendation. Generic drugs were prescribed majorly, which promotes awareness amongst prescribers, supporting WHO policies.

Impact of clozapine as the mainstay therapeutical approach to schizophrenia and substance use disorder: A retrospective inpatient analysis

A retrospective study was conducted to analyze prescription pattern of clozapine in dual diagnosis inpatients' and to find out if there was any association between clozapine prescription and acute relapses either from psychiatric symptoms or from substance use disorder. All patients admitted at Lisbon's Psychiatric Hospital Center during a 4 months' period for psychiatric inpatient treatment with a dual diagnosis at discharge were selected and their clinical files were screened. From 536 patients, 17,5% had a dual diagnosis at discharge. Most frequent psychiatric diagnosis associated with substance use disorder was schizophrenia (50%), followed by major depression disorder (17%) and bipolar disorder (10,6%). Most frequent substance of abuse was alcohol, followed by cannabinoids, nicotine, cocaine, and opiates. At least one antipsychotic drug was prescribed to 85,1% patients, and clozapine was prescribed to 22,3%. There was a statistically significant association between clozapine prescription and prevention of acute relapses of psychiatric symptoms in dual diagnosis patients. Although there was no significant association between prescription of clozapine versus other antipsychotic drugs in the prevention of relapses of substance use, there was a larger than expected number of patients in clozapine that didn't have a relapse of substance use. • From 536 patients, 17,5% had a dual diagnosis at discharge. • Clozapine was prescribed to 22,3%. • Clozapine was associated with prevention of acute relapses of psychiatric symptoms. • A larger than expected number of patients in clozapine didn't have substance relapses.

Evaluation of Prescription Pattern and Medication Adherence in Patients with Alcoholic Liver Disease

Background: ALD is the most common cause of morbidity and mortality among patients. A patient’s Medication Non-Adherence may also interfere with the progression of Disease. Analysis of Prescription pattern in ALD helps to ensure the safety of the Patient by assessing the signs and symptoms of disease and its appropriate therapy. Thus, educating the patients regarding their clinical condition will have a significant role in reducing the severity of the disease. Aim: To assess the Prescription pattern, Medication Adherence and to identify the correlation between the medication adherence and the educational status in ALD patients. Materials and Methods: The Study was a Prospective Observational study carried out for a duration of Six months. Morisky Green Levine scale was the tool used to assess the medication adherence. Data was collected using a self-designed data collection form. Results: A Total of 160 Alcoholic subjects were assessed during the study period among which 65.62% of them were illiterate. Out of total cases 76.87 % of hepatoprotective drugs, 50.62% antiemetics, 38% vitamins and 11% of anti-ulcer drugs were prescribed among patients. It was found that there exist a relationship between educational status and medication adherence (P-value: 0.0021). Conclusion: The study helped to assess the different class of drugs, drugs used in different comorbid conditions and also to evaluate, identify and solve the problems associated with the Medication Non-Adherence of the patients.&#x0D; Keywords: Medication Adherence, Alcoholic Liver Disease, Rational Drug Therapy.

PRESCRIPTION PATTERN ANALYSIS OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS IN TERTIARY CARE HOSPITAL

Objective: The aim of the study was to analyze the prescription pattern of non-steroidal anti-inflammatory drugs (NSAIDs) and to identify the commonly used NSAIDs and their drug-related problems (DRPs). Methods: A prospective and cross-sectional study on prescription pattern analysis of NSAIDs was conducted for the period of 6 months. Results: Prescriptions of 150 patients containing at least one NSAIDs were analyzed. About 56% of the prescription were prescribed for males and 44% prescription were female. NSAIDs were more prescribed for below 60-year age group (47%) but were most frequently used by 61–70-year age group (21%). Subjects were regularly prescribed with acetaminophen (95%) and diclofenac (22%). Among all the prescriptions, (19%) of the prescriptions contained NSAIDs in the form of fixed dose combinations (FDCs). About 37% of prescriptions had other analgesic coprescribed along with NSAIDs amid which tramadol was in majority (22%). Prescription was also coprescribed with antibiotic (90%) and gastroprotective agents (GPAs) (97%) that consisted of pantoprazole belonging to the class of proton pump inhibitors which was the persistently prescribed GPA (86%). Due to coprescription, (3%) suspected drug-drug interactions (DDIs) were observed. Conclusion: The goal of studying prescribing patterns was to monitor, assess, and, if required, advise changes in medical practitioners’ prescribing behavior to offer quality medical treatment and reasonable drug use. The prescribing pattern was rational and in accordance with national list of essential medicine (NLEM-2015) but was not in accordance with the World Health Organization (WHO) model list of essential medicines.

Ondansetron use in nausea and vomiting during pregnancy: A descriptive analysis of prescription patterns and patient characteristics in UK general practice.

AimsThe objective of this study was to describe ondansetron drug utilization patterns during pregnancy to treat nausea and vomiting in pregnancy (NVP). Moreover, we aimed to describe the maternal factors associated with NVP and antiemetic use.MethodsThe data consist of pregnancies with a live birth(s) within an IMRD‐UK registered GP practice. Descriptive statistics were used to investigate patterns of ondansetron use in pregnancy and to describe maternal characteristics associated with NVP and antiemetic drug utilization. We differentiate first‐ from second‐line use during pregnancy using antiemetic prescription pathways.ResultsThe dataset included 733 633 recorded complete pregnancies from 2005 to 2019. NVP diagnosis and ondansetron prescription prevalence increased from 2.7% and 0.1% in 2005 to 4.8% and 2.5% in 2019 respectively. Over the period 2015–2019, the most common oral daily dosages were 4 mg/d (8.5%), 8 mg/d (37.1%), 12 mg/d (37.5%) and between 16 and 24 mg/d (16.9%). Prescription of ondansetron was initiated during the first trimester of pregnancy in 40% of the cases and was moderately used as a first‐line therapy (2.8%), but preferred choice of second‐line therapy. Women with mental health disorders, asthma and/or prescribed folic acid were more likely to experience NVP and use antiemetics in pregnancy than their counterparts.ConclusionThis study confirms that ondansetron is increasingly used off‐label to treat NVP during pregnancy, also in the first trimester and before other prescription antiemetics have been prescribed. Several maternal comorbidities and folic acid use were more common among women experiencing NVP and using antiemetics, including ondansetron.

Difference in rural and urban Medicare prescription pattern for Parkinson’s disease in Hawai‘i

BackgroundMedical management of Parkinson’s Disease (PD) is becoming complex. Increasing evidence suggests that patients have better outcomes when they are managed by neurologists. However, access to neurologists can be limited in rural areas. Analysis of prescription pattern can provide insight into access gap rural patients face. MethodsThis retrospective observational study used National Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use Files from 2013 to 2018. Query was made for levodopa, dopamine agonists and other antiparkinsonian medications. The data elements obtained included drug name, number of prescribers, prescriber specialty, number of claims, number of standardized 30-day Part D prescriptions, and number of Medicare beneficiaries in the state of Hawai‘i. Individual prescribing providers were categorized as urban or rural based on their cities of practice. Prescription patterns of urban and rural providers in Hawai‘i as well as difference in provider specialty were compared, using standardized 30-day prescriptions as the primary measure of utilization. ResultsPractice patterns differed between rural and urban areas. In rural Hawai‘i, Rytary, Rotigoitne and selegiline were rarely prescribed. Levodopa percentage was higher in urban Hawai‘i. In urban Hawai‘i, 74.4% of the prescriptions were provided by movement disorders and general neurologists. In rural Hawai'i, 25.1% of the prescriptions were written by neurologists and 74.9% by general practitioners. ConclusionsIn the state of Hawai‘i, there is an urban–rural access gap to neurologists as evidenced by Medicare prescription pattern. Further study is needed to understand the reasons for rural–urban differences in prescription patterns and their impact on outcomes.

Analysis of the prescribing pattern of antidepressants and the side effects in depression patients.

Major depressive disorder (MDD) is a mental disorder characterized by impairment in mood regulation, loss of interest or pleasure, feelings of guilt, low self-worth, disturbed sleep and appetite, feelings of tiredness, and poor concentration. It is estimated to be the third leading cause of disability and about 350 million people suffer from depression worldwide. Treatment selection include consideration of the patient's personal history of medication response, side effects, drug preference, coexisting psychiatric disorders, accessibility, cultural, social, and situational factors. The main objectives in this study are to analyze prescription pattern of antidepressants, to assess treatment outcomes and partial remission in depression, and to evaluate the side effects in patients receiving antidepressant medications. The investigators will obtain the patient demographic data, disease information, medical issues, and other relevant patient information by interviewing them and referring patient medical records in the hospital (both inpatients and outpatients) documented in a self-designed case report form along with assessment of Hamilton Depression Rating Scale (HMDR), Patient Health Questionnaire (PHQ-9), and Morisky Green Levine Medication Adherence questionnaire (MGLMAQ). Adherence to medications was assessed using Morisky Green Levine Scale in 70 previously diagnosed subjects. Most of the subjects (32.85%) were found to have low adherence to medications, whereas 20.00% were highly adherent. There was a high rate of antidepressant discontinuation without consultation with physician. A closer communication between patients and physicians should be encouraged to enhance persistence to medications and improve outcomes. Recognition of depression as a significant risk factor for noncompliance with medical treatment carries the potential to improve medical practice, reduce patient disability, enhance patient functioning, and improve healthcare outcomes.

Inappropriate antibiotic use for respiratory infections in outpatient settings

Background: Overuse of antibiotics is a significant problem in low- and middle-income countries where recommended treatment guidelines are not routinely practiced, resulting in antimicrobial resistance. Acute respiratory tract infections, mostly viral in origin, remain the clinical category for most commonly prescribed antibiotics. Due to the lack of local evidence about antibiotic prescribing trends in such infections, this study was conducted to evaluate the prescribing patterns in general and antibiotic prescribing trends specifically in prescriptions with the diagnosis of acute respiratory infections in district Mirpur of Azad Kashmir.&#x0D; Patients and methods: A prospective cross-sectional study carried out in the Department of Pharmacology and Therapeutics, Army Medical College, Rawalpindi, and outpatient departments of public health facilities in district Mirpur, Kashmir, from Aug to Oct 2020. Data were collected from 10 different public health facilities in District Mirpur, Kashmir including, three rural health centers (RHC) and five basic health units (BHU). Prescribing pattern analysis by objective observations of the prescriptions after patient-physician encounter against the World Health Organization defined core prescribing indicators. The appropriateness of antibiotic use was analyzed against clinical practice guidelines. IBM SPSS Statistics for Windows, Version 26 was used for data analysis. Descriptive analysis was done to find frequencies and percentages for categorical data and means and standard deviation for continuous data.&#x0D; Results: Total number of prescriptions evaluated was 144. Number of prescriptions containing antibiotics was 118 (82%) (standard, 20 - 26.8%). Inappropriate use of antibiotics was seen in 78% of cases where no antibiotics were indicated. The average number of medicines per prescription was 3.11 (standard, 2.1), whereas 79% of medicines prescribed were from the national essential medicine list (standard, 100%). Only 2.5% (standard, 100%) of the medications were prescribed with generic names.&#x0D; Conclusion: This study shows an inappropriate and overuse of antibiotics for acute respiratory tract infections, indicating a lack of adherence to core prescribing indicators and clinical guidelines by the physicians in outpatient clinics of Mirpur.