Essential Drug List Research Articles

Cost-effectiveness analysis of encorafenib and binimetinib combination as first-line treatment for metastatic or unresectable <i>BRAF</i> V600-mutated metastatic melanoma in Russia

Objective: to perform a cost-effectiveness analysis of using encorafenib and binimetinib combination in the first-line therapy for metastatic or unresectable BRAF V600-mutated melanoma in the Russian Federation. Material and methods. The comparators included “dabrafenib + trametinib” combination and vemurafenib monotherapy, which are listed in the Russian clinical guidelines and the Vital and Essential Drugs List. Since “encorafenib and binimetinib” combination demonstrated superior overall response rate compared to “dabrafenib + trametinib” and vemurafenib monotherapy, the method of cost-effectiveness analysis was used. We developed a disease progression model based on data from the COLUMBUS randomized control trial and published network meta-analysis. The model was used to calculate the direct medical costs associated with the considered alternatives over a 3-year modeling horizon. We compared the incremental cost-effectiveness ratio for “encorafenib + binimetinib” vs. “dabrafenib + trametinib” to the same ratio calculated for “dabrafenib + trametinib” vs. vemurafenib monotherapy.Results. Mean costs of using “encorafenib + binimetinib” combination over a 3-year period, considering the discontinuation of treatment as the disease progresses, was 6,547,693.07 rubles. Meanwhile, it was 5,962,742.52 rubles for “dabrafenib + trametinib” and 2,581,781.45 rubles for vemurafenib monotherapy. The incremental cost-effectiveness ratio of “encorafenib + binimetinib” vs. “dabrafenib + trametinib” was 3,846,818.71 rubles per 1 patient with a response to therapy. This was 85.14% lower than the same ratio estimated for “dabrafenib + trametinib” vs. vemurafenib monotherapy (25,890,022.64 rubles per 1 patient with a response to therapy).Conclusion. The “encorafenib + binimetinib” combination is a cost-effective treatment method for patients with unresectable or metastatic BRAF V600-mutated melanoma in the Russian Federation.

Assessment Of Most Common Infectious Diseases And Medicines Prescribed In The Health Posts Of Dhading District

Background: Infectious diseases are the communicable or transmissible diseases which are mainly caused by presence of pathogenic agents like (bacteria, virus, fungi, protozoa) in the individual host. Globally the infectious diseases contribute for 32.3% of total death and in Nepal about 70% health related problems and death are caused by infectious disease. This study was aimed to find out most common infectious diseases and medicines prescribed in its management in the health posts of Dhading district. Method: A Descriptive Cross-sectional study was conducted in three health posts of Dhading district namely Naubise health post, Bhumesthan health post and Mahadevbesi health post. 450 data were collected from record room of health posts from Shrawan 2077 to Asoj 2077. Patient related and drug related data and information were collected and analyzed. Results: The most frequent cases were Respiratory Tract Infections (22.22%), Dermatitis (11.55%) and Urinary Tract Infections (11.11%). Majority of cases were in between the age group of 21-30 years (25.11%).The average number of drugs per prescription was 2.37. The percentage of drugs prescribed by generic name and from an essential drug list of Nepal was (73.38%) and (97.46%) respectively. Out of 1067 drugs prescribed, antimicrobials (39.9%) were most commonly prescribed followed by NSAIDs (25.7%), and antihistamine (15.8%). Among antimicrobial, most commonly prescribed was amoxycillin ( 35.21%) which was followed by ciprofloxacin (16.43%) and azithromycin (14.08%). Conclusion: This study showed Respiratory Tract Infection was most common infectious disease and Amoxycillin was mostly prescribed drug.

Evaluation of prescribing patterns using WHO core drug use indicators in a pediatric hospital of Kabul Afghanistan: A prospective cross-sectional study

BackgroundThe global issue of irrational drug use, particularly concerning pediatric patients, is a significant concern. Notably, there has been a lack of studies assessing rational drug prescribing for pediatric patients within Afghanistan's healthcare system. This investigation aimed to address this gap by examining drug prescribing patterns at the Indira Gandhi Pediatric Health Institute (IPHI) in Kabul, Afghanistan. MethodsA prospective cross-sectional analysis was conducted to evaluate the prevailing drug prescribing practices at the outpatient department of IPHI in Kabul, Afghanistan. A systematic random sampling method was employed to select 600 outpatient prescriptions from the institute, following the World Health Organization (WHO) guidelines for investigating drug utilization in healthcare facilities. ResultsThe average age of patients was 4 years, and the average number of drugs per prescription was 2.9. Notably, 84% of prescriptions included one or more antibiotics, surpassing the WHO standard of <30%. Furthermore, 67% of the prescribed drugs were listed on Afghanistan's national essential drugs list (EDL), falling below the standard value of 100%. Only 35.1% of the prescribed drugs were in generic form, also lower than the recommended 100%. Moreover, 5.7% of all prescriptions included injections, the ideal value is <20%. The most frequently prescribed drug groups were anti-microbials (25.7%), followed by non-steroidal anti-inflammatory drugs (NSAIDs), (21.4%), gastrointestinal drugs (17.3%), and vitamins (7.8%). ConclusionThe study's findings indicate that, on average, a higher number of drugs were prescribed per patient visit at IPHI compared to recommended standards. Additionally, there was a lower utilization of generic drugs and drugs from Afghanistan's national essential drugs list (EDL), with an over-prescription of antibiotics.

Socioeconomic efficiency of neonatal screening for spinal muscular atrophy in the Russian Federation

Background. Spinal muscular atrophy (SMA) is a severe rare disease that has been widely discussed in recent years. Achievements in etiopathogenetic therapy and the social significance of the disease (child population, high mortality), the cost of treatment attracted the attention of the public and the goverment, which, among other things, led to the formation of a separate area with the creation of a fund to finance the treatment of patients with orphan diseases.Aim. To conduct an analysis of the socio-economic efficiency of mass neonatal screening for SMA in the Russian Federation.Materials and methods. A survey of patients (their parents) and doctors was conducted. The current clinical guidelines and the standard of medical care for children with SMA were studied. The cost of medicines is taken from the State Register of Maximum Selling Prices. If the drug is not included in the List of Vital Essential and Necessary Drugs, cost information from the procurement data is used.Results. The socioeconomic burden of SMA on identified patients was about 3,994,289,548 rubles per year prior to screening. The very introduction of mass neonatal screening will amount to about 679,224,000 rubles in year. At the same time, a disease detected in a timely manner due to neonatal screening and timely prescribed effective treatment can lead to a reduction in the cost of specialized and palliative care by 54,073,271 rubles, direct non-medical costs by 88,137,423 rubles, and indirect costs by 154,197,900 rubles per year, which together is more than 7 % of the calculated burden of SMA.Conclusion. The introduction of mass screening will lead to the fact that the number of annually detected patients will increase from current values to the actual value of the prevalence when registering patients with milder forms of SMA. The need for drug supply with drugs and medical care in general will increase. At the same time, children diagnosed with SMA will not die in the early years of life, their survival rate, life expectancy will increase, the quality of life will improve, infant mortality will decrease, which is the main task of neonatal screening and one of the goals of the National Healthcare Project.

Assessing the impact of COVID-19 on prescription patterns and antibiotic use: Insights from three military health facilities

BackgroundThe COVID-19 pandemic disrupted health systems globally and there are suggestions it impacted antibiotics prescribing patterns in clinical practice. ObjectivesThis study aimed to assess the effects of the COVID-19 pandemic on the prescribing patterns in three Nigerian military health facilities and investigate the factors associated with antibiotic prescriptions. MethodsThis was a two-year cross-sectional retrospective study. Three hospitals and a total of 11,590 prescriptions were purposively and conveniently sampled respectively. The World Health Organisation (WHO) and International Network of Rational Use of Drugs (INRUD) prescribing indicators were used to assess for polypharmacy, injection use, use of antibiotics, use of generic drugs and prescriptions from essential drug lists for the periods of the pandemic and before the pandemic. Indicators from both periods were compared for statistical significance using the independent t-test. Generalized linear modelling was applied to assess the factors associated with antibiotic prescriptions. The relationship between the receipt of antibiotics and independent variables was presented using incident risk ratios (IRR). ResultsOur findings showed that all five WHO/INRUD prescribing indicators were above the reference limit for the two-year study period. The study found there was a significant statistical difference between the COVID- and non-COVID-19 periods, with polypharmacy and antibiotic use indicators elevated during the pandemic compared to the latter. COVID-19 (IRR = 1.09), comorbidity (IRR = 1.74), pregnancy (IRR = 0.93), out-of-pocket payments (IRR = 1.10) and the inpatient department (IRR = 1.51) were associated with antibiotic prescriptions. ConclusionsThis provides insight on impact of the pandemic on prescription patterns and advocates for stewardship programs in clinical settings to ensure the rational use of drugs.

Prescription audit and drug interactions of anti-diabetic drugs at Outpatient Department at a tertiary care teaching hospital in Eastern Nepal

Type 2 diabetes mellitus (T2DM) is the third major non-communicable disease in Nepal. Drug utilization studies help in reducing the patient’s expenditure, adverse drug reactions and drug-drug interactions. It would help in understanding of consumption of drugs including newer ones. Objective was to analyze the prescribing pattern and drug interactions of anti-diabetic drugs. A prospective cross-sectional study was conducted among patients having T2DM at Birat Medical College and Teaching Hospital (BMCTH), Biratnagar, Nepal from May 2019- August 2019. WHO core drug use indicators were used to analyze the obtained data. Descriptive statistics like mean, standard deviation, frequency and percentage were calculated using Microsoft Excel 2013. Out of 200 patients, 104 (52.0%) were females and 49.5% were from the age group of 41-60 years. Average number of drugs per patient was 5.74. Biguanides (40.7%) were the most common prescribed oral antidiabetic drugs followed by Sulfonylureas (23.3%). The percentage of drugs prescribed by generic name and from WHO essential drug list was 0.6% and 15.4% respectively. A total of 95 (47.5%) patients has potential drug-drug interaction (DDI) and it was most common in the age group of 41-60 years (43.2%). Among 95 DDI, Metformin+Amlodipine ranked in 1st position (16 encounters). Polypharmacy was prevalent in the present study. Metformin was the most commonly prescribed anti-diabetic drug. The percentage of drugs from the WHO essential medicine list and prescribed by generic names was low. Prevalence of potential DDI was high.

АНАЛИЗ ЦЕНООБРАЗОВАНИЯ НА ЛЕКАРСТВЕННЫЕ ПРЕПАРАТЫ, ПРОИЗВЕДЕННЫЕ В УРАЛЬСКОМ ФЕДЕРАЛЬНОМ ОКРУГЕ

Introduction. Affordability of drugs is a determining factor of transiting to new price regulation mechanisms in the pharmaceutical market, such as reference pricing. Studying the social and economic determinants of wholesale and retail pricing in the pharmaceutical markets of various regions is of additional interest within the context of long- term transition to pharmaceutical insurance. Aim: To identify the signs of price discrimination, exemplified by some administrative-territorial entities of the Ural Federal District. Materials and Methods. A content analysis was performed regarding the aggregated offers available on the nation-wide pharmaceutical marketplace in the context of 10 drug manufacturers located in the Urals Federal District, and an assortment matrix was compiled (n=115). The assortment was analyzed using matrix-based and categorical methods of analysis, while pricing data were collected using the methods of descriptive statistics. Results and Discussion. Using the Sturges formula, interval series of prices were identified, and the variation coefficient was calculated for 115 trade names of drugs. The least variable were the lowest and highest price segments with high and low share of medicines included in the List of Vital and Essential Drugs, respectively. Two synthetic metrics were used to analyze the regional pricing features. Overall price variation was 14.6%, which suggests the presence of discriminatory pricing elements. The riskiest price segment is the range of RUB 100-200 per pack. Conclusions. Based on the findings of the pricing analysis for drugs manufactured in the regions of the Ural Federal District, the discriminatory pricing elements were found in the medium-low price segment.

Strategies for Removal of Barriers to Hepatitis C Elimination in Sub-Saharan Africa.

Hepatitis C virus (HCV) infection is a major global health threat, with serious consequences including liver cirrhosis and cancer. Despite efforts to combat HCV, an estimated 1.5 million new infections occur each year and HCV was the sixth leading cause of death in 2017. Nevertheless, political leaders are increasingly interested in the fight against HCV, and the achievements of countries such as Rwanda, Egypt, India, Mongolia, Pakistan, Georgia, and Ukraine have given hope that the elimination plan to reduce new infections to 90% and mortality to 65% by 2030 is possible. It is true that some African countries can attest to the difficulty of operationalizing the HCV program with expensive testing platforms and HCV drugs that few could afford in the past, let alone the logistics involved, given that active case detection is an asset for HCV elimination. The inability to add direct-acting antivirals (DAAs) to the national essential drug list and negotiate DAA cost subsidies remains a major challenge in Africa. The lessons learned from implementing and scaling up the human immunodeficiency virus program can provide a strong framework to deliver comprehensive HCV services. We present the strategies used by some African countries to move toward HCV elimination, describe the challenges they have faced, and suggest realistic solutions.

A Study of Drug Use in the Outpatient Pediatric Department of a Tertiary Care Hospital in Jammu and Kashmir

BACKGROUND&#x0D; The health care system around the world is concerned about rational drug use. To achieve this goal, the more vulnerable pediatric population necessitates additional attention. The study's objectives were to determine the most prevalent diseases and medications administered, as per WHO recommendations, by looking at prescription trends and the ailments for which they were prescribed.&#x0D; Objective&#x0D; The objective of this study was to find drug use in the outpatient pediatric department of a tertiary care hospital in Jammu and Kashmir.&#x0D; METHODS&#x0D; This four-month prospective study was undertaken in the paediatrics department of a tertiary care hospital in Jammu and Kashmir. The Institutional Ethical Committee gave its nod to the investigation, which was then carried out. The parent's or guardian's consent was obtained after discussion and explanation. The patient's and the prescriber's privacy were protected. Every pediatric prescription (from newborn to 12 years old) from the outpatient, inpatient, and critical care units was included in the research.&#x0D; RESULTS&#x0D; There were 498 prescriptions in total that were randomly collected and studied. There were a total of 1895 prescriptions, with an average of 4.01 per encounter. Prescriptions from the WHO's essential drug list (666) accounted for 35.14 percent of all prescriptions. There were 397 prescriptions written for antibiotics in total. A total of 79.72 percent of patient encounters involved an antibiotic prescription. The prescribed injections were used in 26.2% of the encounters.&#x0D; CONCLUSION&#x0D; With all the indicators, this study gives a positive outlook on drug use, especially for those on the EDL (Essential Drug List). It is possible to improve health care through regular auditing, continuous medical education, and evidence-based medicine (EBM). Drug prescribing patterns in a pediatric outpatient department have been analyzed in this research. To summarize, the role of the clinical pharmacist is critical in pediatrics, both as an integral part of the care team and in clearing up any confusion about the appropriate use of medications. As a pediatric patient, proper drug management is even more critical than for an adult. The prescribing patterns were improved, substantial issues with patients' or caretakers' grasp of consultant instructions were found, and even the financial burden on the patient was lessened with the aid of the WHO core indicators.

English

Misuse of antibiotics is the main cause for resistance development. The objective of this study is to assess patterns of antibiotics use and associated problems at Jimma Health Center. The study was conducted from February 25, 2016 to March 25, 2016. For the analysis of prescribing indicators retrospectively 295 patient charts that fulfills inclusion criteria were systematically selected from a total of 9800 charts from the health center registry department (from March 8, 2015 to March 25, 2016). Prospectively 120 patients were interviewed. The average number of drugs per encounter was 2.2 and percentage of encounter with antibiotics was 32%. 98.9% of medication was prescribed by their generic name and injection encounter was 9%. Amoxicillin was a commonly prescribed antibiotic during the study period (26%). The average consultation and dispensing time were 5.1 and 1.3 min, respectively and 73% of drugs dispensed were adequately labeled. There was a copy of Ethiopian essential drug list and standard treatment guidelines (STG - 2014). There was no drug formulary during the study period and some antibiotics were not available. Result of this study revealed prescribing practices and average number of drugs per prescription slightly deviate from World Health Organization standard. But generic and injection prescribing as well as use of Ethiopian essential drug list was not a problem. Key words: WHO guideline, antibiotics, prescribing indicators, Jimma Health Center.

Sensible Factors that Need Strategic Change to Improve the Medical Drug Availability across Healthcare Institutions in Sri Lanka

Abstract : Access to medicines remains a major obstacle for people across the world to maintain their health at a desired level. Ensuring an adequate supply of safe and effective drugs of acceptable quality is an integral part of the health policy of Sri Lanka. The medical supplies division is the sole organization responsible for providing all pharmaceuticals, surgical items, laboratory items, radioactive items, and printed materials for government sector healthcare institutions. The establishment of an independent drug regulation authority, the Declaration of a national essential drug list, the establishment of a separate drug procurement entity, Pooled procurement, digitalization of drug management, and expansion of drug storage capacity are key strategies that have been implemented by the Ministry of Health to minimize the drug shortages across the healthcare institutions of Sri Lanka. Despite the implemented strategies drug shortage continue to evolve from time to time as a public outcry in the media. This case study describes the critical issues that need to look at more strategically to improve drug availability.

Drug Utilization Pattern in Pneumonia among Pediatric Patients at a Tertiary Care Hospital

INTRODUCTION: Pneumonia remains the leading cause of hospitalization and mortality in young children in low and middle-income countries like Nepal. Antibiotics are commonly prescribed for pediatric pneumonia patients. To prevent antimicrobial resistance, antibiotics must be prescribed rationally. Therefore, the purpose of this study was to evaluate the drug utilization pattern in pediatric pneumonia patients at a tertiary care hospital by using World Health Organization (WHO) prescribing indicators. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted among pediatric pneumonia patients at Universal College of Medical Sciences, Bhairahawa, Nepal from December 2022 to May 2023. Ethical approval was taken from the Institutional Review Committee (UCMS/IRC/191/22) and the purposive sampling method was used. Data were collected from pro-forma to assess WHO prescribing indicators and analyzed in Statistical Package for Social Sciences (SPSS) version 20 program and expressed as frequency and percentage for all variables. RESULTS: A total of 1408 drugs were prescribed to 196 prescriptions or patients. The average number of drugs per prescription was 7.18. The most common 51.5% of prescriptions contain 4-5 drugs per prescription. The percentage of prescriptions with antibiotics and injections was 100% respectively. Drugs prescribed by generic name were 44.24% and those matched to the national Essential Drugs List of Nepal were 53.19%. Cephalosporins (86.7%) were the most frequently prescribed antibiotics followed by aminoglycosides (79.1%). All the antibiotics were given parenterally (100%). CONCLUSIONS: The study reported inadequate compliance with WHO prescribing indicators and recommended policy formulation and application by regulatory agencies to promote the drug utilization study.

Evaluation of Drug Prescription Pattern Using WHO Prescribing Indicators in Libya: A Cross-Sectional Study

Background and aims. The improper use of drugs due to irrational prescriptions is a common problem in Libya. This study aimed to investigate the prescribing pattern and predictors of antibiotic prescription in primary health care facilities in three districts (east, west, and south) in Libya. Methods. In this retrospective study, 484 prescriptions were examined. World Health Organization-recommended indicators for rational use were examined (WHO): e.g., the percentage of prescriptions covering antibiotics, prescription of injections, and prescription of drugs by a generic name and from a national essential drug list, as well as the average number of drugs per prescription, were all considered. Results. The average number of drugs per prescription was 4.72, with a maximum of 7 drugs in a prescription, and the percentage of prescriptions involving antibiotics and injections was 30.4% and 10.5%, respectively. There were 28.6% drugs prescribed by their generic name and 82.8% were retrieved from the essential drugs list. The most common category of medicines were 18.9% antibiotics, 18.3% antihypertensives, and 15.7% multivitamins and minerals. While the lowest consumed drugs were steroids 2.5%. Conclusion. There was some irrational drug prescribing, particularly with regard to injections and antibiotics. It is suggested that physicians participate in continuing education programs on rational prescribing for various medical indications.

P-373 Low-Dose Vaginal Misoprostol Application Before Office Hysteroscopy

Abstract Study question In gynecological interventional procedures what should be the minimum misoprostol dose for achieving cervical maturation? Summary answer 50mcgr vaginal misoprostol before office hysteroscopy; decreases the VAS score, bleeding and the total procedure time. What is known already Misoprostol has been on the World Health Organization (WHO) essential drugs list since 2005 due to its uterotonic effect.FIGO (The International Federation of Gynecology and Obstetrics) published a posology table in 2017 that does not cause side effects in off-label use of misoprostol in the obstetric field.There are many publications that misoprostol facilitates interventional gynecologic procedures by allowing cervical maturation . However, no guidelines have yet been published on the dose and route of administration Study design, size, duration This Prospective Randomized Clinical Research was approved by Ankara City Hospital Clinical Research Ethics and Academic committee . Then, 100 women who underwent office hysteroscopy in Ankara City Hospital Gynecology and Obstetrics Clinic gynecology-infertility outpatient clinic between 01/12/2021-01/05/2022 were included in the study after their informed consent was obtained. Participants/materials, setting, methods 50 women who self-administered 50 mcg vaginal misoprostol the night before the office hysteroscopy procedure and 50 women who did not administer the drug were compared. The primary outcome of the study was the duration of the procedure, with the pain score during the procedure used being the (VAS) score system. The secondary outcome was procedure and drug-related side effects Statistical evaluation of the data was performed using the SPSS for Windows version 20.0 Main results and the role of chance In the medicated group the mean of VAS scores during and after the procedure, and the transition and the total time of the procedure were significantly lower than non-medicated group. Limitations, reasons for caution In Turkey, there is only one misoprostol product (CYTOTEC Ali Raif İlaç Sanayi A.Ş) with the 200 mcg posology Off label use of misoporostol in obstetrics is legal since 2021 but not for gynecological practice. We do not have country guidelines on misoprostol posology in obstetrics and gynecology usage also Wider implications of the findings In gynecological interventional procedures especially before office hysteroscopy, it is important to apply a minimum dose of misoprostol for cervical maturation due to its bleeding-increasing effect in patients whith endometrial polyps or hyperplasia .Because bleeding is the most important factor affecting image quality and procedure efficacy during hysteroscopy. Trial registration number E2-21-1068 dated 24.11.2021

Monoclonal antibody usage pattern in a tertiary care center: A retrospective study

Abstract Background: Monoclonal antibodies (mAbs) are agents that are clones of homogenous parent B cells used in managing and diagnosing multiple conditions. They are used for individualized therapy for patients due to their high specificity for an antigen/epitope. Much needs to be understood about their utilization patterns in a developing country like India, where accessibility and cost play a major role in patient care. Objectives: The objectives of this study were to evaluate the drug prescribing patterns and indications for use of mAbs and compare their availability, with the essential drug list of the World Health Organization (WHO) and the National list of essential medicines in India (NLEM). Materials and Methods: This is a retrospective cross-sectional study conducted from July to December 2021. Data were collected from 237 patients who have visited the tertiary care center or been admitted and have received mAbs. Demographic data, department of admission, diagnosis on admission, and mAbs used during treatment were recorded and analyzed. Results: Out of the 237 patients, who were eligible for this study, 61.6% of them were males and 38.4% were females. The department of ophthalmology used mAbs most commonly (65.8%). Ranibizumab was the most used mAb in this department and overall. Conclusion: Out of the mAbs being used in the tertiary care center, only rituximab was part of the NLEM (India) essential drug list, and six more drugs were present in the WHO essential drug list. The advent of biosimilars is expected to bring costs down significantly for the patient and have better treatment outcomes.

Rationale Treatment of GERD During Pregnancy: A Prescription Audit Using who Core Drug use Indicators

Background: GERD is a common condition worldwide. It is also frequently seen during pregnancy due to hormonal changes and increasing intra-abdominal pressure. Treatment is usually focused on resolving symptoms. In this regard life style modification and pharmacological interventions are done. But prescribing during pregnancy is a risk benefit condition. Irrational prescribing is a routine practice nowadays. Prescribing during pregnancy needs more care. To avoid hazards associated with irrational prescribing WHO has developed five indicators. Aim and objective: This study was designed to find out prescription mistakes during pregnancy using WHO core drug use indicators. To provide clinicians with prescribing guidlines in order to avoid future discrepancies while prescribing. Method: It was a cross sectional study. Data was obtained from outpatient obstetric departments and analyzed. Result: Antacids, PPIs, Ranitidine and metoclopramide were frequently used drugs. All drug classes are present in essential drug list of Pakistan 2021.Only 8% of the total drugs were prescribed by generic name. Number of drugs per encounter was minimum 5%.Number of injections per encounter was also within standard range 23%. About 20% of prescription were expensive which is a high cost for an under developing country like Pakistan. Practical implication: Good prescribing puts positive impact on patient’s physical and mental health. Conclusion: There should be a shift of prescription from brand name to generic name. Control of prescription cost is another issue highlighted. WHO core drug use indicators are only limited to outpatient Departments. These are of limited value for in doors patients where drug prescriptions are more complex. Keywords: Drug use WHO Drug use, GRED, Pregnancy, Pakistani Women

Prescription Audit for WHO Prescribing Indicators and Prescription Errors in a Tertiary Care Teaching Hospital

ABSTRACT Aim: Our study aimed to audit prescriptions for the prescription indicators given by WHO and to analyze prescription errors, evaluating the frequency and types of prescription errors. Methodology: Prospective study was done in Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, under Pharmacology Department in October 2020. The prescriptions from all the OPD (outpatient departments) were collected from the pharmacy store. Prescriptions for the follow-up medication and devoid of medicine were excluded from the study. Results: Total of 1451 errors were found from 400 collected prescriptions, out of which 324 (22.3%) were errors of omission and 145 (10.0%) were errors of commission related to drugs whereas 982 (67.7%) were the error of omission other than drug details. A total of 1257 drugs were prescribed making an average of 3.14 drugs per prescription, out of which 28.72% drugs were prescribed by generic name. About 34.0% of patients were prescribed antibiotics and 2.25% of patients were prescribed injectable drugs. All the drugs were prescribed from the National Essential Drug List (NEDL). Conclusion: The prescription audit showed that there is a need to train prescribing doctors as per the standard MMC and NMC guidelines for rational prescription writing to minimize the chance of major errors like not writing the dose of the drug, not writing it in capital letters, drug-related instructions, diagnosis and so on. The prescription audit should be carried out at regular intervals to improve prescription writing skills to establish a better healthcare system.

Prevalence of cardiovascular diseases and drug utilization review at secondary care hospital in South India

Background: To study prevalence of cardiovascular diseases and drug utilization review in patients with cardiovascular diseases. Methods: This was a cross-sectional study conducted for about 6 months from December 2021 to February 2021 in a Secondary care hospital. Prescriptions of 167 patients with cardiovascular diseases were analysed. Patient Case files were used for extracting necessary data. Results: The collected data was analyzed by MS-Excel (Counts and Percentages).Cardiovascular diseases were most common in the age group of 31-40 years (27.55%) followed by 51-60 years (24.49%) among male patients and in female patients, it was more common in the age group of 41-50 years (23.19%) followed by 51-60 years (21.74%). Most prevalent cardiovascular disease was found to be Hypertension (31%), followed by coronary artery disease (21%) and acute coronary syndrome (19%). Diabetes Mellitus (39%) and Hematological disorders (20%) are the most found co-morbidities along with cardiovascular diseases. Antiplatelet and antihypertensive were the most prescribed category of drugs. Of all Cardiovascular drugs, Aspirin (115 prescriptions) followed by Clopidogrel (100 prescriptions), Atorvastatin (73 prescriptions), Olmesartan (54 prescriptions) and Metoprolol (49 cases) were mostly prescribed. Common combinations of drugs prescribed are Aspirin + Clopidogrel + Atorvastatin (25%) followed by Aspirin + Clopidogrel (24%). Out of the total 658 drugs prescribed, 15.95% (105) were from Essential Drug List of India (2011). Of the total drugs prescribed, 15.95% (105) were from Essential Drug List of India. Conclusions: The present study concluded that most of the drugs were prescribed rationally according to current guidelines. Combination therapy found to have an implication for the good cardiovascular outcome on long term follow-up.

Drug Utilization Pattern and Cost Analysis of Drugs used at Dermatology Out Patient Department in a Tertiary Care Hospital

INTRODUCTION&#x0D; The irrational prescription of drugs is highly prevalent among patients suffering from skin diseases. Since it has a serious impact on health and economy, there is an urgent need to study drug utilization pattern in hospital settings. Therefore, this study aims to investigate drug utilization pattern and its cost analysis in Dermatology Out Patient Department in a tertiary care teaching hospital.&#x0D; MATERIAL AND METHODS&#x0D; A four-month, prospective, cross-sectional descriptive study was conducted from 10th February 2022 to 10th June 2022 in newly diagnosed cases attending Out Patient Department of dermatology at Universal College of Medical Sciences, Bhairahawa, Nepal. Ethical approval was obtained from the Institutional Review Committee (UCMS/IRC/037/22). Purposive consecutive sampling technique was used. The data were collected from patient cards and details were filled in predesigned proforma. The collected data were analyzed in Statistical Package for Social Sciences version 20.&#x0D; RESULTS&#x0D; A total of 601 prescriptions were scrutinized. The common skin condition found was eczema (9.98%) while the common classes of drugs prescribed were antifungals (31.94%). The number of drugs per prescription varied from one to five with an average of 3.11. It was observed that 3.95% of prescription was by generic names. The maximum of drugs (36.06%) was prescribed in tablet form. The percentage of antibiotics prescribed and drugs prescribed from the WHO Essential Drugs List were 12.31% and 27.88% respectively. The average cost per prescription calculated was 739.39 Nepali Rupees.&#x0D; CONCLUSION&#x0D; A drug utilization study can help to rationalize prescriptions, reduce errors, and improve cost-effective treatment.

Assessment of Prescribing Practices and Factors Related to Antibiotic Prescribing in Community Pharmacies.

Background and Objectives: Overprescribing of antibiotics is one of the important contributors of antimicrobial resistance globally. A high proportion of antibiotics prescribed in community settings are unnecessary or inappropriate. This study assesses the prescribing practices and factors related to antibiotic prescribing in community pharmacies in United Arab Emirates (UAE). Materials and Methods: A cross-sectional study utilizing a quantitative approach was carried out in the community pharmacies of Ras Al Khaimah (RAK), UAE. Six hundred and thirty prescription encounters from 21 randomly selected community pharmacies were investigated using World Health Organization (WHO) core prescribing indicators. Factors related to antibiotic prescribing were identified using logistic regression analyses. Results: In 630 prescription encounters, a total of 1814 drugs were prescribed. Out of these, the most commonly prescribed drug class was antibiotics (43.8% prescriptions) and the antibiotic was amoxicillin/clavulanic-acid (22.4%). The average number of drugs per prescription was 2.88, which was higher than the WHO recommended value of 1.6-1.8. In addition, more than half of the prescriptions (58.6%) had drugs by generic names and the majority of the drugs prescribed (83.8%) were from the essential drug list, which were lower than the optimal values of 100%. The majority of the antibiotics prescribed in the study were from the WHO's Access group antibiotics. Multivariable logistic regression analysis identified patient age (children-OR: 7.40, 95% CI: 2.32-23.62, p = 0.001 and adolescent-OR: 5.86, 95% CI: 1.57-21.86, p = 0.008), prescriber qualification as general practitioner (OR: 1.84, 95% CI:1.30-2.60, p = 0.001), and number of drugs per prescription (OR: 3.51, 95% CI: 1.98-6.21, p < 0.001) as independent factors associated with antibiotic prescribing. Conclusions: This study reveals considerable variations from the WHO recommendations for the different prescribing indicators in the community pharmacies of RAK, UAE. In addition, the study reports overprescribing of antibiotics in the community setting, indicating the need for interventions to promote rational use of antibiotics in a community setting.