Drug Utilization Research Research Articles

Study to Assess the Drug Consumption and Rationality in the Prescription of Outpatients Undergoing Periodontal Treatment

Drug utilisation research is essential in clinical practice because it serves as the foundation for implementing changes to drug dispensing rules at the local and national levels. The ultimate goal of such a study is to make drug usage more reasonable. This prospective cross-sectional study aimed to collect data on drug utilisation among dental patients from Himachal Pradesh's Department of Periodontics to identify possible targets for improving drug prescribing habits. After applying inclusion and exclusion criteria, data were collected prospectively from a total of 849 medical records of patients. The patient's information included their OPD number, age, sex, health problem description, and prescription parameters, including medicine name, route, strength, dose form, quantity, duration, investigations, provisional diagnosis, and therapy. Prescriptions were analysed using WHO core drug indicators and WHO ATC/DDD approach to calculate drug consumption. The most prescribed antibiotic was amoxicillin, separately or in combination. The number of DDD consumed and the DDD/1000 population/day was the maximum for vitamins, followed by antibacterial and non-steroidal anti-inflammatory drugs. The average number of drugs per encounter was 2.2. The percentage of encounters with an antibiotic in prescription was very high i.e., 72.3%. Only 37.6% of medications were prescribed, from NLEM 2015, and 14.60% generic names were prescribed. The dental practitioners did not adhere to WHO prescribing guidelines. The lowered number of prescriptions for generic names was a subject of worry

Antibiotic Surveillance in Pediatric Intensive Care Unit of a Secondary Referral Healthcare Setting in South India

Background: Due to their maturing immune system and close proximity to one another, children are more liable to acquire and transmit infections than adults. Despite frequent antibiotic use in children, the primary focus of antibiotic drug utilization research to date has been the adult population. 
 Objective: This study aims to evaluate the antibiotic utilization in a 5 bedded pediatric intensive care unit of a secondary referral hospital in south India. 
 Material and methods: The cross-sectional observational study approved by the institutional ethics committee and institutional review board of six months duration was performed on patients of both genders admitted to the PICU of age 1 month to 18 years, with at least one antibiotic administration. 
 Results: In a total of 84 PICU admissions, 96.43% were treated empirically. A total of 583 medications were prescribed, out of which 28.3% were antibiotics. In our study, amoxiclav, ceftriaxone and linezolid were observed to have a normal PDD: DDD ratio within limits. 95.24% was the survivor rate during the study.
 Conclusion: The outcome of PICU antibiotic surveillance was found rational in relation to a 95.24% survival rate, but WHO DUS metrics calculation of PDD: DDD ratio forecast there is more under-utilization, as dose calculation in paediatrics is weight-based. In this regard, extensive research in exploring the new modalities like point prevalence survey, proportions of days covered, days of therapy; and antibiotic acquaintance by limiting wasted drug weight in pediatric patients is highly recommended to ensure optimized and rational antibiotic use.

Drug Utilization Study in Outpatient Department of Ophthalmology in Tertiary Care Hospital

Background The advancement in drug development and availability of newer drugs has improved overall health services including decrease in mortality and hospital stay. Along, it has brought negative impacts such as polypharmacy and associated adverse drug reactions and antimicrobial resistance. Drug utilization research is an essential approach to understand the drug use pattern, identify the early signs of such irrational drug use and to improve quality of drug use.
 Objective To study the drug utilization pattern in the Ophthalmology Outpatient department (OPD) of Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH).
 Method A descriptive, cross sectional study was conducted from March 2019 to August 2019 in patients attending OPD of Ophthalmology in Dhulikhel Hospital, Kathmandu University Hospital. Prescriptions of 311 patients were analyzed using World Health Organization (WHO) International Network of Rational Use of Drug (INRUD) and additional other indices. The descriptive data was presented in mean and standard deviation.
 Result The average number of drugs per prescription was 2.10±1.35. Out of total 311 prescriptions, drugs prescribed in generic name were 152 (23.30%). Total antibiotics encountered were 247 (37.90%) and total drugs prescribed from National Essential Medicine List (NEML) were 371 (56.90%). Antibiotics 247 (37.90%) were the most commonly prescribed drugs followed by lubricants 146 (22.40%).
 Conclusion Practice of polypharmacy was very high. Most of the drugs were prescribed in brand names and antibiotics were the most frequently used drugs.

Drug Prescription Pattern in Osteoarthritis in a Tertiary Care Teaching Hospital

Objective: Drug prescribing studies aim to provide feedback to the prescriber and to create awareness among them about rational use of medicines. The primary aim of drug utilization research is to facilitate the rational use of drugs in patients. Osteoarthritis is the most common form of joint disease and the leading cause of pain in elderly people. The aim of the study was to study the prescription pattern of drugs used in the management of osteoarthritis.
 Methods: A prospective observational study was conducted in a tertiary care hospital for period of 12 months in collaboration with the department of Orthopaedics. A total of 300 patients enrolled in the present study with fulfilling inclusion and exclusion criteria. Patients’ data was recorded in case report form and analysed to study the prescription pattern.
 Results: Out of the total 300 patients enrolled in this study, Osteoarthritis was found to be more common in females. In our study 58.3% of patients were females as compared to 41.7 % of male patients. Patients of age group 46-60 years (60%) were most commonly affected followed by 61-75 years (30.3%). Etoricoxib was the most commonly used NSAID in 28.3% of patients followed by Aceclofenac in 18%, combination of Aceclofenac and Paracetamol in 15.6% & combination of Tramadol and Paracetamol in 8.3% of patients.
 Conclusions: In our study it is seen that osteoarthritis affects females more often than males and the knee joint is the most commonly affected joint. Etoricoxib was the most prescribed drug because of good gastrointestinal tolerance.

Data Sources for Drug Utilization Research in Brazil-DUR-BRA Study.

Background: In Brazil, studies that map electronic healthcare databases in order to assess their suitability for use in pharmacoepidemiologic research are lacking. We aimed to identify, catalogue, and characterize Brazilian data sources for Drug Utilization Research (DUR). Methods: The present study is part of the project entitled, “Publicly Available Data Sources for Drug Utilization Research in Latin American (LatAm) Countries.” A network of Brazilian health experts was assembled to map secondary administrative data from healthcare organizations that might provide information related to medication use. A multi-phase approach including internet search of institutional government websites, traditional bibliographic databases, and experts’ input was used for mapping the data sources. The reviewers searched, screened and selected the data sources independently; disagreements were resolved by consensus. Data sources were grouped into the following categories: 1) automated databases; 2) Electronic Medical Records (EMR); 3) national surveys or datasets; 4) adverse event reporting systems; and 5) others. Each data source was characterized by accessibility, geographic granularity, setting, type of data (aggregate or individual-level), and years of coverage. We also searched for publications related to each data source. Results: A total of 62 data sources were identified and screened; 38 met the eligibility criteria for inclusion and were fully characterized. We grouped 23 (60%) as automated databases, four (11%) as adverse event reporting systems, four (11%) as EMRs, three (8%) as national surveys or datasets, and four (11%) as other types. Eighteen (47%) were classified as publicly and conveniently accessible online; providing information at national level. Most of them offered more than 5 years of comprehensive data coverage, and presented data at both the individual and aggregated levels. No information about population coverage was found. Drug coding is not uniform; each data source has its own coding system, depending on the purpose of the data. At least one scientific publication was found for each publicly available data source. Conclusions: There are several types of data sources for DUR in Brazil, but a uniform system for drug classification and data quality evaluation does not exist. The extent of population covered by year is unknown. Our comprehensive and structured inventory reveals a need for full characterization of these data sources.

Data sources for drug utilization research in Latin American countries-A cross-national study: DASDUR-LATAM study.

Drug utilization research (DUR) contributes to inform policymaking and to strengthen health systems. The availability of data sources is the first step for conducting DUR. However, documents that systematize these data sources in Latin American (LatAm) countries are not known. We compiled the potential data sources for DUR in the LatAm region. A network of DUR experts from nine LatAm countries was assembled and experts conducted: (i) a website search of the government, academic, and private health institutions; (ii) screening of eligible data sources, and (iii) liaising with national experts in pharmacoepidemiology (via an online survey). The data sources were characterized by accessibility, geographic granularity, setting, sector of the data, sources and type of the data. Descriptive analyses were performed. We identified 125 data sources for DUR in nine LatAm countries. Thirty-eight (30%) of them were publicly and conveniently available; 89 (71%) were accessible with limitations, and 18 (14%) were not accessible or lacked clear rules for data access. From the 125 data sources, 76 (61%) were from the public sector only; 46 (37%) were from pharmacy records; 43 (34%) came from ambulatory settings and; 85 (68%) gave access to individual patient-level data. Although multiple sources for DUR are available in LatAm countries, the accessibility is a major challenge. The procedures for accessing DUR data should be transparent, feasible, affordable, and protocol-driven. This inventory could permit a comparison of drug utilization between countries identifying potential medication-related problems that need further exploration.

Drug utilization pattern at the cardiac surgical outpatient clinic in a tertiary care hospital at Goa

Background: Drug utilization research encourages rational drug prescribing practices and thus contributes to the contemporary use of drugs in the society. This study assesses the drug utilization pattern (DUP) at the cardiac surgical outpatient department of Goa Medical College hospital. We used the World Health Organization (WHO)-prescribing indicators to analyze the National List of Essential Medicines (NLEM) implementation as recommended in the National Drug Policy. Methods: We used a cross-sectional study design to analyze the DUP. We randomly selected 103 prescriptions dispensed to patients at the cardiac surgical outpatient during the study period. We critically examined these prescriptions for their consistency with WHO core drug use indicators. Results: The average number of drugs prescribed per person was 4.95. The most commonly prescribed top three drugs were antiplatelets (21.46%), beta-blockers (14.76%), and statins (13.78%). Most drugs were prescribed as single drugs (90.98%), whereas 9.02% were fixed-dose drug combinations (FDC). The combination of aspirin and clopidogrel was the most common prescribed FDC. The majority (72.44%) of the drugs prescribed were as per the NLEM 2015 list, whereas the generic name was low (2.8%). We measured Patient-Care Indicators and Facility-Specific Indicators also. The average consultation time and dispensing time were 7.76 and 3.23 min, respectively. The in-house pharmacy dispensed 82% of drugs. 93.75% of the key drugs were available in the facility. A copy of the essential drugs list was readily available in the facility. 96.67% of the patients knew the correct dosage of drugs. Conclusions: Anti-platelets and statins were the most commonly prescribed drugs. There was a high prescribing trend from the NLEM; however, the inclination to prescribe generic names was less. Patient-care and facility-specific indicators were also far from the optimal values except that of the average dispensing time.

EVALUATION OF RATIONAL DRUG USE BASED ON WORLD HEALTH ORGANIZATION CORE DRUG USE INDICATORS AT A PRIVATE HOSPITAL OF WESTERN INDIA: A CROSS SECTIONAL STUDY

Recent data from the National sample survey highlighted that many Indians prefer private hospitals over public hospitals for their healthcare needs. Hence, drug utilization research at private hospitals may help promote rational drug use, avoid risk to patient safety, and minimize pharmaceuticals wastage. The study aimed to evaluate the drugs prescription pattern using the World Health Organization (WHO)-recommended prescribing indicators at a private hospital in Pune, India. The study was an observational, prospective, and cross-sectional study conducted at the out-patient department of a private hospital in Pune, Maharashtra, India. Total 1023 prescriptions from October 2020 to May 2021 were studied using WHO drug prescribing indicators. Microsoft Excel and SPSS v26.0 was used to capture and analyse the data of the study. A total of 3954 drugs were prescribed in 1023 prescriptions. The average number of drugs prescribed per encounter was 3.9 (standard deviation: 1.3). Drugs prescribed by using the drug's generic name were 6.6%, the encounters with an antibiotic and an injection prescribed were 47.0% and 1.8%, respectively. The drugs prescribed from the Essential Drugs List (EDL) were 62.0%. Additionally, nonsteroidal anti-inflammatory drugs were prescribed the most (17.7%), followed by antacids (17.3%) and vitamins and supplements drugs (17.0%). The study highlighted deviations in prescribing practices compared to WHO standards. The study suggests a need to train the physicians and implement the WHO prescribing indicator on a trial basis in private hospitals to develop policies to achieve a long-lasting benefit.

Outpatient cardiovascular diseases and diabetes medicines dispensing in the population with government health insurance in Syria between 2018 and 2019: a retrospective analysis

BackgroundLow- and middle-income countries bear the highest burden of non-communicable diseases (NCDs) mortality and morbidity. Syria has undergone an epidemiological transition from infectious diseases to NCDs in the past decades. Despite the high prevalence of cardiovascular diseases (CVDs) and diabetes in Syria, little is known about medicines utilization or prescriptions for these diseases. The aims of this study are to present the patterns and rates of dispensing medicines used for CVDs and diabetes among patients with government health insurance in Syria and examine age, sex, and regional variation in the dispensing of these medicines.MethodsOutpatient data from June 2018 to May 2019 on dispensed medicines for 81,314 adults with government health insurance were obtained. The dispensing rate was expressed as the number of defined daily doses (DDDs) per 1000 beneficiaries per day (DID). The DID is a measurement that is used in drug utilization research to control for differences or changes in population size between or within countries. The number of DIDs was adjusted according to beneficiaries’ sex, age, and governorate.ResultsBeneficiaries received 302.09 DIDs of CVDs medicines and 35.66 DIDs of diabetes medicines, including 0.96 DID of insulin (2.99% of the total of diabetes medicines). CVDs and diabetes medicine dispensing rates were low during the study period and included very low rates of insulin dispensing compared to the dispensing rates of these medicines in other countries in East Mediterranean Region or in Europe. We found lower dispensing rates of CVDs medicines among female beneficiaries (249.59 DIDs) than male beneficiaries (388.80 DIDs). Similarly, the dispensing rates of diabetes medicines among female beneficiaries (29.42 DIDs) were lower than those among male beneficiaries (45.98 DIDs). In addition, there were lower rates of CVDs and diabetes medicines and very low to no dispensing of insulin in some governorates that were partly controlled by the Syrian government compared to other governorates that were completely or mostly controlled by the Syrian government.ConclusionsAdditional efforts are needed to raise awareness about the prevention and management of CVDs and diabetes especially among females in Syria and consider cultural issues that might influence access to healthcare services. There is a crucial need to address the political and geographical challenges caused by the conflict which have limited access to CVDs and diabetes medicines in some regions in Syria.

Assessment of Prescription Pattern of Drugs Prescribed in the Outpatient Department of a Private Orthopedic Hospital – A Cross-sectional Study

Background: Drug utilization research (DUR) is vital in the health sector as it offers insight into the efficacy of drug use. The findings of DUR studies can help set goals for the rational use of drugs and health-care funds distribution. Objective: The objective of this DUR study was to evaluate the prescription pattern of drugs prescribed in the outpatient department (OPD) of a private orthopedic hospital. Settings and Design: The study was a cross-sectional, prospective, and observational study conducted at the OPD of a private orthopedic hospital. Materials and Methods: The study was carried out over a 6-month duration (from October 2020 to March 2021) at the OPD of a private orthopedic hospital and studied 609 prescriptions using the World Health Organization (WHO) recommended prescribing indicators. Statistical Analysis Used: Microsoft Excel and SPSS version 26.0 were used to capture and analyze the data of the study. Results: A total of 3082 drugs were prescribed in 609 prescriptions. The average number of drugs prescribed per encounter was 5.1 (SD = 1.9). Drugs prescribed using generic name of the drug were 2.6%, the encounters with an antibiotic and an injection prescribed were 39.4% and 7.1%, respectively. The drugs prescribed from the essential drugs list were 38.9%. In addition, vitamins and supplements (32.1%) were prescribed the most followed by analgesics (24.2%) and antacids (16.6%). Conclusions: The study highlighted the inadequate compliance with the WHO recommended prescribing indicators and suggested a need to train physicians and spread awareness about writing rational prescriptions, benefitting the patient.

Factors associated with primary nonadherence to newly initiated direct oral anticoagulants in patients with nonvalvular atrial fibrillation.

BACKGROUND: Direct oral anticoagulants (DOACs) are widely used for the prevention of stroke in nonvalvular atrial fibrillation (NVAF); however, real-world primary nonadherence (failing to collect the first prescription) has been measured in very few studies. OBJECTIVE: To report primary nonadherence in NVAF patients who are newly prescribed DOACs and identify associated factors. METHODS: This observational retrospective cohort study used a large primary care database in Catalonia. Patients with NVAF who were newly prescribed a DOAC between January 2009 and December 2015 were identified, and primary nonadherence was measured by comparing prescribing records to pharmacy claims data. Multivariable logistic regression was used to determine associated factors. RESULTS: A total of 12,257 patients met the inclusion and exclusion criteria; of these, 1,276 (10.4%) were primary nonadherent. Primary nonadherence was found to be 12.8% for apixaban, 8.6% for dabigatran, and 10.8% for rivaroxaban. Multivariable logistic regression indicated higher odds of primary nonadherence with apixaban and rivaroxaban compared to dabigatran (apixaban: OR = 1.61, 95% CI = 1.39-1.87; rivaroxaban: OR = 1.28, 95% CI = 1.11-1.47). Patients aged at least 80 years showed lower odds of primary nonadherence compared to those aged less than 65 years (OR = 0.78, 95% CI = 0.66-0.93). A diagnosis of chronic kidney disease was associated with primary nonadherence (OR = 1.27, 95% CI = 1.08-1.50). Whereas, diabetes (OR = 0.85, 95% CI = 0.74-0.97), hypertension (OR = 0.79, 95% CI = 0.70-0.91), and stroke/transient ischemic attack (OR = 0.70, 95% C I =0.59-0.82) were inversely associated with primary nonadherence. CONCLUSIONS: Overall, 10.4% of patients prescribed DOACs were primary nonadherent, failing to collect the first prescription. The percentage could have serious implications for patient outcomes and the real-world cost-effectiveness of prescribing DOACs in NVAF. Rates of primary nonadherence and associated factors may provide useful information for the design and evaluation of adherence interventions. DISCLOSURES: No outside funding was received for this study. The data for this study came from the European Medicines Agency PE-PV project (Grant/Award Number EMA/2015/27/PH). The authors have nothing to disclose. A preliminary version of this work was presented at the European Drug Utilisation Research Group (EuroDURG) Conference, Szeged, Hungary, March 5, 2020.

The Relevance of Defined Daily Dose concept in Drug Utilisation Research: A Review

According to World Health Organisation (WHO), drug utilisation is defined as the marketing, distribution, prescription and the use of drugs in society with special focus on resulting medical, social and economic consequences and it has turned into a powerful scientific tool for ensuring the rational and cost-effective use of drugs. A standard method is required to identify and aggregate drug data. This manuscript provides an overview of the WHO Anatomical Therapeutic Chemical (ATC) classification and the associated measure, Defined Daily Dose (DDD), as a methodology for evaluating drug utilisation.
 Keywords: Drug utilisation research, Anatomical Therapeutic Chemical classification system, Defined Daily Dose, Rational drug use.

A Prospective Observational Study on Prescription Pattern and Its Efficacy in the Management of Osteoarthritis at Multispecialty Teaching Care Hospital

Background: osteoarthritis is a severe clinical condition in elderly patients. Almost any bone can fracture as a result of the increased bone fragility of osteoarthritis.
 Aim and Objective of study: The principle aim of drug utilization research is to facilitate the rational use of drugs in an individualized patient. To Study current prescription pattern and its efficacy to manage osteoarthritis.
 Methodology: This study was a prospective observational study and conducted over a period of six month from October 2015 to March 2016. Patients diagnosed with arthritis with or without co-morbidities were enrolled in the Study considering the inclusion and exclusion criteria. The main sources of data collection were OPD file and case sheets of patients.
 Results: In this study 148 patients were enrolled, 105 (70.9%) female patients and 43 (29.1%) male patients were participated. Out of 148 study participants 60 (40.54%) patients from age group 51-65 years, followed by 54 (36.48%) patients from age group 36-50 years. In the study population 94 (63.51%) patient were suffering osteoarthritis of both knee, 29 (19.59%) patients were suffering osteoarthritis of right knee and 25 (16.89%) patients were having osteoarthritis of left knee. X-ray report were representing in study population, in 44 patient reports were shows degenerative change seen in both knee, 08 patient report were shows degenerative change seen in right knee. In our study out of 148 patients, 92 (62.16%) patients prescribed NSAIDs, 25 (16.89%) patients prescribed Analgesic, 05 (03.37%) patients were prescribed Opioid analgesic, 11 (07.43%) patients were prescribed supplements and 15 (10.13%) patients received other class of drugs. Among the study population 112 (75.67%) patients were received oral route of drugs and 36 (24.32%) Patients were prescribed topical preparation. The visual analogue scale has been categorized as follows 0-3 Mild pain, 4-7 Moderate pain and 8-10 severe pain. In visual analogue scale initially 16 patients were suffering mild pain, but after treatment it was 93 patients suffering mild pain. The facial pain scale has been categorized as follow 0 = very happy, no hurt, 2 = hurts just a little bit, 4 = hurts a little more 6 = hurts even more, 8 = hurts a whole lot, 10 = hurts as much as you can imagine. Among 148 study participants 14 patients were having final Facial pain score 0, 67 patients were having a final Facial pain score 2 and 3 patients having Initial Facial Pain score 2, 42 patients were having a final Facial pain score 4 and 42 patients having Initial Facial pain score 4, 19 patients were having a final Facial pain score 6 and 63 patients having Initial Facial pain score 6, 06 patients were having final Facial pain score 8 and 33 patients having Initial Facial pain score 8, 07 patients having Initial Facial score 10.
 Conclusion: The principal aim of drug utilization research is to facilitate the rational use of drugs in an individualized patient. For the individual’s patients, the rational use of a drug implies the prescription of the well documented drug at optimal dose, together with the correct information, at an affordable price.

Application of the anatomical chemical system/defined daily doses: Challenges and way forward for resource-limited countries.

The Anatomical Therapeutic Chemical Classification/Defined Daily Doses (ATC/DDD) methodology is a WHO gold standard for ensuring systematic Drug Utilization Research (DUR) and has been mainly used in the developed world. This article examines the challenges and way forward for using this methodology in resource-limited countries. The ATC/DDD is superior over other methods employed in DUR as it offers a unified medicines regulation and management system at all care levels. The ATC/DDD allows access to standardized and validated information on DUR by: assessing patterns of utilization, defining optimal use levels, identification of gaps, aggregating and analysing statistics for reporting adverse drug reactions, as well as assisting in developing rational medicines use interventions and monitoring their outcomes. Application of the ATC/DDD methodology is crucial for improved patient management, optimal consumption of national pharmaceutical budgets and policy formulation in resource-limited countries.

Patterns of Antimicrobials Prescribed to Patients Admitted to a Tertiary Care Hospital: A Prescription Quality Audit.

IntroductionRational use of antimicrobial agents is necessary to prevent the emergence of drug resistance. This study aims to assess the prescription pattern of antibiotics using the Anatomic Therapeutic Chemical Classification (ATCC)/Defined Daily Dose (DDD) metrics in real-world practice.MethodsA retrospective audit of antibiotics prescribed to patients admitted to a tertiary hospital over 20 months. The demographics and clinical information of patients were collected. The ATCC/DDD system was used to classify antibiotics. The DDD per 100 bed-days was calculated and the quality of prescription, including generic and parenteral formulation use, was evaluated.ResultsNine-hundred ninety-four prescriptions were analyzed. The average number of antibiotics prescribed was 2±1. Only 23% of the patients had confirmed cases of bacterial infection. Imidazole derivatives (J01X) were the most prescribed antibiotics (68.8 DDDs per 100 bed-days) followed by cephalosporins (45.0 DDDs), beta-lactams (35.3 DDDs), fluoroquinolones (30.9 DDDs), and macrolides/lincosamides (14.4 DDDs). Sulphonamides/trimethoprim (4.7 DDD), aminoglycosides (0.8 DDD), penicillin (0.3 DDD), and carbapenems (0.1 DDD) were the least prescribed. Metronidazole was the most prescribed drug (34.2%). Generic names and parenteral formulations were used in 55% and 72% of antibiotics prescribed.ConclusionThe continued low generics prescribing calls for interventions to be put in place to improve prescribing quality. Parenteral formulation prescribing encountered was very high, though this may not be unexpected in in-patients, it is vital to curtail the use of parenteral formulations so as to minimize the risk of infection.Irrational antibiotics prescription remains a serious concern in Nigeria. Drug utilization research using the ATCC/DDD metric is helpful in monitoring trends of drug use over time. This will help improve antibiotics stewardship and promote the rational use of antibiotics.

Data transparency for building a stronger healthcare system: A case study from Argentinean administrative drug utilization data sources.

In order to compile an inventory of national data sources for drug utilization research (DUR) in Argentina and to verify publicly available data sources, we performed a cross-sectional study that sought to identify national and provincial databases of drug use. In July 2020, we searched the websites of government institutions, carried out a systematic query of bibliographic databases for "drug utilization research" conducted in Argentina, and conducted a survey with local experts. Data collected included: the institution responsible for the database, population covered, accessibility, source of the data, healthcare setting, geographic information, and whether data were individual or aggregated. Descriptive analyses were then performed. We identified 31 data sources for DUR; only one was publicly and conveniently accessible. Five published aggregated data and provide more detailed access by formal request. Only seven sources (23%) reported national data, and most (n=29) included only data from the public healthcare sector. Although data sources for DUR have been found in Argentina, limited access by researchers and policymakers is still an significant obstacle. Increasing health data transparency by making data sources publicly available for the purpose of analyzing public health information is crucial for building a stronger health system.

Drug prescribing pattern of antifungal drugs for local fungal infections in a tertiary care hospital: MAMC, Agroha

Background: Drug utilization research or studies are the powerful exploratory tools to ascertain the role of drugs in the society which refers to the marketing, distribution, prescription and use of drugs with special emphasis on the medical, social and economic consequences. Periodic prescription audit in form of drug utilization study is a way to improve the quality of prescription and promote rational prescribing.Methods: This was a prospective and an observational study. Prescriptions included all newly diagnosed patients with cutaneous fungal infection of both sexes who attended dermatology OPD. Factors considered were sociodemographic parameters and WHO prescribing indicators.Results: 1000 prescriptions were analysed of patients between 18 to 65 years of age with cutaneous fungal infections. The average number of drugs per encounter was 3.68. The percentage of drugs prescribed by generic name was 50.33% and the percentage of drugs prescribed from NLEM was 20.93%.Conclusions: This study indicates that prescribing practices of drugs in tertiary care hospital can be improved by promoting generic name drug prescribing, prescribing drugs from NLEM and by reducing polypharmacy.

Implications of a defined daily dose fixed database for drug utilization research studies: The case of statins in Portugal.

Given the discrepancies between PDDs (prescribed daily doses) and DDDs (defined daily doses), we aimed to assess the extent of error in the results of an 18-year population-level study on statin utilization in Portugal. The Portuguese regulatory agency provided data for the period 2000-2018 on statin dispensing (C10AA). The DDDs were gathered from the ATC/DDD database. DDDs were calculated by the DDD year-by-year approach (DDDYEAR ) and by the DDD last-year approach (DDDLAST ). PDDs were calculated according to the year-by-year approach (PDDYEAR ). Statin annual utilization rates per 1000 inhabitants per day were also calculated. Percent errors were calculated for PDDYEAR and DDDYEAR units. The DDDYEAR approach revealed decreases in the consumption of atorvastatin, fluvastatin, lovastatin, pravastatin and simvastatin in 2009, when their DDD was modified. Conversely, the results from both DDDLAST and PDDYEAR approaches indicated gradual changes in the actual consumption of all statins in Portugal. Before 2009, atorvastatin, pravastatin and simvastatin utilization was greatly overestimated by DDDYEAR /1000 inhabitants/day. The average dose of lovastatin prescribed in the past 18years (20mg) was below the assigned DDDs during the study period, varying from 30mg to 45mg. Conversely, the PDD for fluvastatin was above the DDD values (ranging from 40mg in 2000 to 70mg in 2016). For atorvastatin, pravastatin and simvastatin, national PDDs were above the assigned DDD until the DDD modification in 2009. A more dynamic system, based on national and annually updated DDDs, should be able to reduce discrepancies between DDDs and PDDs and the bias in utilization studies.

Prescription Pattern, follow-up pattern, and medication adherence in psychiatric outpatients

Background: Drug utilization research on psychotropic drug use facilitates rational prescriptions in psychiatric patients. Low follow-up rates and nonadherence to psychotropic medications are key challenges in psychiatry. The objective of this study was to determine the prescription pattern of psychotropic medications, the follow-up pattern, and medication adherence in psychiatric outpatients. Materials and Methods: In this retrospective observational study, the prescription pattern and number of follow-ups were abstracted for each new psychiatric outpatient for a period of 6 months from the time of the first assessment. In addition, medication adherence was assessed using a secondary database analysis. A continuous measure of medication acquisition (CMA) was calculated and those patients with CMA of 0.8 or more were considered adherent. Results: A total of 317 patients were included in the study. At the first visit, 198 patients (62.46%) were prescribed two psychotropic medications. Out of the total sample, 157 (49.53%) were prescribed once-daily medication and 151 (47.63%) received twice-daily medication. During the follow-up visits, the primary medication was changed in 40 (12.62%) patients and polypharmacy was used in 23 (7.26%) patients. After the initial visit, 138 (43.53%) patients did not come for even a single follow-up visit. Only 50 (15.77%) patients had a medication prescription for at least 80% of the study period. Conclusion: Olanzapine, escitalopram, sertraline, and clonazepam were the most commonly prescribed psychotropic medications. Most patients were prescribed two psychotropic medications which included one benzodiazepine. However, polypharmacy was an uncommon practice. Follow-up rate and medication adherence were poor across different diagnostic categories.

Drug utilization pattern and appropriateness of prescription in IPD geriatric patients in a tertiary care teaching hospital

Background: Drug utilization research provides insights into different aspects of drug use and drug prescribing such as pattern, quality, determinants and outcomes of drug use. Polypharmacy is considered to be hazardous for the elderly, because of their greater vulnerability to drugs and multiple drug use. Prescription of potentially inappropriate medications (PIMs) has been found to be a common cause of morbidity and mortality among the geriatric population and has necessitated the creation of criteria for the safe use of medicines among them. Objectives of the study were to assess the drug utilization pattern in geriatric patients and analyse their prescriptions as per the World Health Organization (WHO) core prescribing indicators and STOPP and START criteria.Methods: An observational, cross-sectional study was conducted from May 2019 to August 2019 in inpatient department of general medicine of VIMSAR, Burla. Prescriptions of ≥65 year patients were collected and documented by active surveillance from the medicine ward.Results: Majority of the patients were in age group of 65-75. Stroke is the more common comorbidities among geriatric population. Average number of medication per prescription is 5.42. About 78.74% of drugs are injectable. The percentage of antibiotics prescribed to patient is 27.75%. Based on STOPP criteria potentially inappropriate medications PIM is 7% and START criteria PIM is 29%.Conclusions: Our study suggests that prevalence of polypharmacy was high which is usually unavoidable in geriatric patients and less PIM is suggestive of adherence to WHO core prescribing indicators, and prescription of drugs as per STOPP and START guidelines are indicative of scope for improvement.