Generic Prescribing Research Articles

The effect of prescription patterns on the performance of the pharmacy department of a Regional Referral Hospital, Uganda.

Poor drug prescription patterns (PP) result in irrational medicine use, avoidable stock outs and drug expiries. This study primarily assessed the effects of PP on the performance of the pharmacy department (PD) of Mbarara Regional Referral Hospital (MRRH) Uganda. This was a mixed method cross-sectional study conducted in the outpatient department (OPD) of MRRH, questionnaires were administered to 86 prescribers and 300 patient prescriptions were reviewed. Ethical clearance was granted and informed consent of patients. Data were analysed, presented in the form of graphs, tables. The overall prescription fill rate was 60.5%, being higher among dental officers and lower among those who did not adhere to generic prescribing and EML. Medical officers made most prescriptions at 69.3%. Prescriptions with four (47.1%) and six (17.5%) medicines respectively were made by clinical officers. Of the 300 prescriptions, 76% adhered to the Essential Medicines List (EML), 62% used generic name including 87.3% from dental officers and 52.9% by clinical officersThe overall prescription fill rate was 60.5%, being higher among dental officers and lower among those who did not adhere to generic prescribing and EML. Medical officers made most prescriptions at 69.3%. Prescriptions with four (47.1%) and six (17.5%) medicines respectively were made by clinical officers. Of the 300 prescriptions, 76% adhered to the Essential Medicines List (EML), 62% used generic name including 87.3% from dental officers and 52.9% by clinical officers. Prescription pattern affected the performance of the PD of MRRH, calling for its continued monitoring to ensure that guidelines are upheld, EML and UCG are availed and utilized.

Out-of-pocket prescription drug costs for adults with cardiovascular risk factors under Amazon's direct-to-consumer pharmacy service

US adults often overpay for generic prescription medications, which can lead to medication nonadherence that negatively impacts cardiovascular outcomes. As a result, new direct-to-consumer online medication services are growing in popularity nationwide. Amazon recently launched a $5/month direct-to-consumer medication subscription service (Amazon RxPass), but it is unclear how many US adults could save on out-of-pocket drug costs by using this new service. To estimate out-of-pocket savings on generic prescription medications achievable through Amazon's new direct-to-consumer subscription medication service for adults with cardiovascular risk factors and/or conditions. Cross-sectional study of adults 18-64 years in the 2019 Medical Expenditure Panel Survey. Of the 25,280,517 (SE ± 934,809) adults aged 18-64 years with cardiovascular risk factors or conditions who were prescribed at least 1 medication available in the Amazon RxPass formulary, only 6.4% (1,624,587 [SE ± 68,571]) would achieve savings. Among those achieving savings, the estimated average out-of-pocket savings would be $140 (SE ± $15.8) per person per year, amounting to a total savings of $228,093,570 (SE ± $26,117,241). In multivariable regression models, lack of insurance coverage (adjusted odds ratio [OR] 3.5, 95%CI 1.9-6.5) and being prescribed a greater number of RxPass-eligible medications (2-3 medications versus 1 medication: OR 5.6, 95%CI 3.0-10.3; 4+ medications: OR 21.8, 95%CI 10.7-44.3) were each associated with a higher likelihood of achieving out-of-pocket savings from RxPass. Changes to the pricing structure of Amazon's direct-to-consumer medication service are needed to expand out-of-pocket savings on generic medications to a larger segment of the working-age adults with cardiovascular risk factors and/or diseases.

PHARMACOECONOMIC STUDY OF VARIOUS BRANDS OF ANTI-EPILEPTIC DRUGS AVAILABLE CURRENTLY IN INDIA

Objectives: (a) Compiling a comprehensive list of the available dosage forms and strengths of various antiepileptic drugs marketed in India. (b) Calculating the percentage cost variation of individual drug formulations produced by different pharmaceutical companies. (c) Evaluating the percentage cost variation of these drugs. Methods: The cost of an exact drug (cost per 10 tablets) in the same strength and amount of forms being manufactured by different companies were got from the latest editions of “Current Index of Medical Specialties” and “Indian Drug Review.” The percentage price difference and cost ratio for each formulation were intended. Result: Among single drugs, the highest price variation was found in the drug pregabalin available in the form of capsules (75 mg and 150 mg), and a cost ratio of 6.64 and 5.87 was calculated which was significant. Among combination drugs, tablet Na valproate+valproic acid with the cost ratio of 1.91 was found to be the highest. Conclusion: Our study shows that there is very high price variation in some of the brands of anti-epileptic drugs. Generic prescribing should be promoted in the whole country by creating awareness and implementing proper regulatory guidelines.

Availability and Cost of Expensive and Common Generic Prescription Drugs: A Cross-sectional Analysis of Direct-to-Consumer Pharmacies.

Direct-to-consumer (DTC) pharmacies sell generic prescription drugs, often at lower prices than traditional retail pharmacies; however, not all drugs are available, and prices vary. To determine the availability and cost of generic drugs at DTC pharmacies. Cross-sectional study. Five national DTC pharmacies in April and May 2023. Each qualifying form of 100 generic drugs with the highest cost-per-patient (expensive) and the 50 generic drugs with the highest number of patients (common) in Medicare Part D in 2020 MAIN MEASURES: Availability of these drugs and the lowest DTC pharmacy price for a standardized drug strength and supply (e.g., 30 pills), compared to GoodRx retail pharmacy prices. Of the 118 expensive generic dosage forms, 94 (80%) were available at 1 or more DTC pharmacies; out of 52 common generic dosage forms, 51 (98%) were available (p < 0.001). Of the 88 expensive generics available in comparable quantities and strengths across pharmacies, 42 (47%) had the lowest cost at Amazon, 23 (26%) at Mark Cuban Cost Plus Drug Company, 13 (14%) at Health Warehouse, and 12 (13%) at Costco; for 51 common generic formulations, 16 (31%) had the lowest cost at Costco, 14 (27%) at Amazon, 10 (20%) at Walmart, 6 (12%) at Health Warehouse, and 5 (10%) at Mark Cuban Cost Plus Drug Company. For the 77 expensive generics with available GoodRx retail pharmacy prices, the median cost savings at DTC pharmacies were $231 (95% CI, $129-$792) or 76% (IQR, 53-91%); for 51 common generics, savings were $19 (95% CI, $10-$34) or 75% (IQR, 67-83%). Many of the most expensive generic drugs are unavailable at direct-to-consumer pharmacies. Meanwhile, less expensive, commonly used generics are widely available, but drug prices vary by pharmacy and savings are modest, requiring patients to shop around for the lowest cost.

(317) Significant Cost Savings for Erectile Dysfunction Medications are Available Using Discount Online Pharmacies Compared to Medicare

Abstract Introduction The Mark Cuban Cost Plus Drug Company (CPD) is an online retailer launched in January 2022 that sells generic prescription medications directly to consumers at cost of ingredients and manufacturing plus a fixed 15% margin in addition to a small pharmacy dispensing fee and shipping fee. GoodRx is an online tool which offers coupons redeemable at pharmacies for discounts on prescription medications. The combination of these two tools offers physicians a way to provide prescription medications to patients at lower costs, which may lead to improved medication adherence and lower medication expenditures nationally. Objective To compare the cost of various erectile dysfunction medications when purchased through retail pharmacies, reimbursed through Medicare, or obtained utilizing CPD and GoodRx. Methods A review of publicly available data from CPD and GoodRx was performed to obtain average retail and discounted prices for generic sildenafil, tadalafil, and vardenafil. GoodRx prices were obtained using prices from Costco, CVS, Walgreens, and Walmart pharmacies in the most from populous zip code from each of the 3 most populous U.S. states: California, New York, and Texas. Prices were adjusted to account for dosage and prescribed quantity to estimate an average cost per dosage unit ($/adu). The Medicare Part D Drug Spending and Utilization data from 2021 were used to report the average spending per dosage unit and total expenditure for each of the listed medications. These data were compared to create an estimate of average national savings after use of CPD or GoodRx. Results Average spending per dosage unit for sildenafil, tadalafil, and vardenafil was less when GoodRx or CPD were used (0.28 $/adu, 0.31 $/adu, and 6.17 $/adu respectively), compared to Medicare pricing (2.14 $/adu, 8.08 $/adu, and 27.84 $/adu respectively) or retail pricing (0.52 $/adu, 2.82 $/adu, and 8.35 $/adu respectively). When adjusted for total dosage units, use of CPD over Medicare pricing for the three medications would result in a combined annual national saving of $149M. Use of either CPD or GoodRx compared to retail pricing would similarly result in a combined annual nation saving of $40M. Conclusions The utilization of CPD and GoodRx in the prescription of common erectile dysfunction medications may lead to significant reductions in pricing compared to retail and Medicare estimates. Knowledge of these prescription tools may lead to significant reductions in national expenditures on medications and decreased cost burden for patients seeking treatment. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

(164) Potential Savings with Use of Cost Plus Pharmacy for Medical Treatment of Erectile Dysfunction

Abstract Introduction With its stated goal “to end ridiculous drug prices,” the Mark Cuban Cost Plus Drug Company (MCCPDC) launched in January 2022 with over 100 generic prescription drugs available to be mailed directly to patients without the involvement of health insurance. To promote drug cost transparency, all drugs are priced at the cost to manufacture the drug with a 15% administrative markup, a $3 pharmacist fee, and a $5 shipping fee. Prior research has focused on the theoretical savings MCCPDC could offer if Medicare purchased drugs at MCCPDC prices with studies reporting a potential $3.3 billion in savings for Medicare. Prescription drug spending is continuing to rise in the United States and providers are increasingly considering patient’s out-of-pocket costs. MCCPDC touts a transparent, consistent pricing model, but it is unclear if this pricing model will actually translate to cost savings for patients. Objective We sought to analyze if Mark Cuban Cost Plus Drug Company (MCCPDC) can offer savings directly to patients compared with other mail-order pharmacies, local pharmacies (based on zip code of our urology clinic) and with patients using health insurance to fill prescriptions for their sildenafil, vardenafil and tadalafil. Methods Out of the approximately 100 generic drugs available on MCCPDC website, we analyzed the 3 drugs that are prescribed to treat erectile dysfunction. We analyzed drug prices of 30 and 90-day prescriptions at the same dose of each medication. Using Good Rx prescription drug search engine, we compared the drug prices of the cheapest mail order and local in person pharmacies near our zip code. We also included prices for the recently started telemedicine company Roman. To compare if MCCPDC could offer savings to patients using health insurance to fill their prescriptions, we extracted the out-of-pocket drug costs for patients from the 2020 Medical Expenditure Panel Survey (MEPS; a national survey that compiles data from both the pharmacy and the survey respondent to determine the exact cost of each prescription filled during that year) and the 2020 Medicare Part D spending data. Medicare Part D spending data was used to estimate the out-of-pocket cost for each medication, which is approximately a 25% copayment for Medicare prescriptions. Results MCCPDC offered the lowest direct-to-consumer price on sildenafil and tadalafil 90-day prescriptions (Table 1). MCCPDC saved patients approximately $10 per sildenafil and tadalafil prescription compared with the next cheapest option. We found additional, although smaller, savings at 30-day prescriptions for sildenafil and tadalafil. MCCPDC was not the cheapest option for vardenafil. Compared with Roman, MCCPDC offered cheaper prescriptions for sildenafil and tadalafil by over $300 and $900, respectively. Conclusions MCCPDC can offer significant cost savings to patients, especially considering the high number of sildenafil and tadalafil prescriptions each year. The transparency and consistency in pricing with MCCPDC can be utilized by providers when counseling patients on medical therapy options for erectile dysfunction. Disclosure No.

Influence of Medical Practitioners’ Attitude on the Prescription Behaviour for Generic Medicines

The study is an attempt to find out vital areas related to doctors’ attitude towards generic medicines limiting its mass use. Attitude of medical practitioners, one factor amongst several, was chosen to evaluate doctors’ behaviour towards generic medicines. Most of the countries in the world, rich or poor, are taking more interest in generic medicines due to rising healthcare costs. In India, out of pocket expenses towards healthcare costs are one of the highest in the world besides affordability issue due to its demographics. Generic medicines offer as an alternative to expensive medicines. Government is promoting use of generic medicines; doctors are being advised to write prescription in generic names; however, there are several challenges in its mass use. The study is of national importance as it addresses the issue of low generic prescriptions despite unaffordable access to expensive branded medicines. A questionnaire constructed descriptive, cross-sectional study was conducted in North India in 2020 amongst 228 medical practitioners at primary, secondary and tertiary healthcare centres. Spearman’s rank correlation computed to assess the association between attitude and prescription of generic medicines was found to be positively correlated between the two variables indicating a significant moderate association between them. Attitude of doctors towards generic medicines has been found to be playing a significant role in influencing doctors in prescribing generic medicines which explains limited use of generic drugs.

ANALISIS PELAYANAN BIDANG FARMASI MENGGUNAKAN INDIKATOR LAYANAN BERBASIS WHO: TINJAUAN SISTEMATIS

Pharmaceutical services in hospitals are an inseparable part of the hospital's health service system that is oriented towards patient service, the provision of quality and affordable pharmaceutical preparations, medical devices, and consumables for all levels of society including clinical pharmacy services. The purpose of this study is to systematically review the implementation of pharmaceutical services based on WHO indicators. The articles used were selected from the Google Scholar journal database published from January 2013 to December 2023. Keywords for the study included "service" or "pharmaceutical" or "pharmacy" or "indicator" or "hospital" or "WHO". A total of 476 articles were generated from the initial search, the author identified 8 articles on pharmaceutical services based on WHO indicators. Based on a systematic review, most hospitals have implemented pharmaceutical services based on WHO indicators. Based on a systematic review, the implementation of pharmaceutical services in accordance with WHO standards is the selection stage: conformity with the hospital formulary; procurement: frequency of procurement of each drug item annually and on an EOQ basis; distribution: the degree of availability of the drug; Usage: percentage of generic prescriptions, percentage of drugs delivered, percentage of drugs labeled complete and average time spent serving prescriptions.

A cross-sectional study on drug utilization and it’s cost analysis in the urological disorders and other health issues in patients of a tertiary care hospital

To evaluate drug utilization patterns in terms of WHO indicators, urological disorders, and other health issues in patients of a tertiary care hospital.After obtaining approval from the Institutional Ethics Committee, a cross-sectional study was carried out among 200 inpatients in a tertiary care hospital in Bangalore. The data were collected from the patient case profile and prescriptions and noted in a self-designed data collection form. The statistical analysis of the collected data was performed using SPSS software and Excel. In a study of 200 patients with urological disorders (129 males and 67 females), common co-morbidities included diabetes, hypertension, and hypothyroidism. Benign Prostate Hyperplasia (BPH) and Urinary Tract Infections (UTI) were the prevalent diagnoses. Prescribed drugs included analgesics, antipyretics (26.7%), antibiotics (18.1%), proton pump inhibitors (18.0%), anti-hypertensives (8.7%), anti-emetics (7.9%), anti-hyperlipidemic (7.6%), vaccines (7.5%), and loop diuretics (5.5%). Average drugs per prescription were 6.94, with 23.79% prescribed generically. Antibiotics accounted for 48% of encounters, and injectables were used in 52% of cases. All the drugs came from the essential list. Polypharmacy affected 58% of patients over 50 years, with 32 major interactions and observed adverse drug reactions. The current research provides valuable insights into the overall pattern of drugs used in urological disorders. Physicians should be encouraged to increase generic prescribing to reduce medication cost burdens as well as to avoid unessential drugs, which may lead to polypharmacy and may result in other medication-related problems.

Strategies to reduce out-of-pocket medication costs for Canadians with peripheral arterial disease.

Given that peripheral arterial disease (PAD) disproportionately affects people of lower socioeconomic status, out-of-pocket expenses for preventive medications are a major barrier to their use. We carried out a cost comparison of drug therapies for PAD to identify prescribing strategies that minimize out-of-pocket expenses for these medications. Between March and June 2019, we contacted outpatient pharmacies in Hamilton, Ontario, Canada, to assess pricing of pharmacologic therapies at dosages included in the 2016 American College of Cardiology/American Heart Association guideline for management of lower extremity PAD. We also gathered pricing information for supplementary charges, including delivery, pill splitting and blister packaging. We calculated prescription prices with and without dispensing fees for 30-day brand-name and generic prescriptions, and 90-day generic prescriptions. Twenty-four pharmacies, including hospital-based, independent and chain, were included in our sample. In the most extreme scenario, total 90-day medication costs could differ by up to $1377.26. Costs were affected by choice of agent within a drug class, generic versus brand-name drug, quantity dispensed, dispensing fee and delivery cost, if any. By opting for prescriptions for 90 days or as long as possible, selecting the lowest-cost generic drugs available in each drug class, and identifying dispensing locations with lower fees, prescribers can minimize out-of-pocket patient medication expenses. This may help improve adherence to guideline-recommended therapies for the secondary prevention of vascular events in patients with PAD.

Prescribers’ Perception Towards Generic and Branded Medicines

Background: Patients may not adhere to treatment plans due to cost of medicines. Generic prescribing is a mechanism for reducing cost of drugs thereby improving access to healthcare. It is therefore of value to understand Nigerian physicians’ perception towards generic prescribing. Objectives: To determine the perception of a sample of physicians towards prescribing generic and branded medicines. Methods: A descriptive multi-centered cross-sectional study in two teaching hospitals was carried out with pre- tested, self-administered, structured questionnaires. Data collected were sorted and entered into SPSS version 23 for descriptive statistics and Instat GraphPad for inferential statistics. P-value ≤ 0.05 was considered significant. Ethical considerations were observed. Results: Response rate was 71%, majority of the respondents (59.9%) were males. Registrar, junior registrar and consultant constituted 36%, 23% and 9% respectively. Four components were extracted and identified as efficacy and packaging, availability of prescribing information, bioavailability and cost as factors influencing physician prescription of either generic or branded medicine. Cost had the highest mean score of 3.70 ± 1.26, indicating most influential factor. Majority of the physicians considered severity of illness (40.34%) a decision influencer. There was a significant association between facilities and demographics which showed a significant difference in the domains of efficacy (and packaging) and cost. Conclusion: Physician generic medicine prescribing appears to be influenced by their perception of the efficacy, cost, bioequivalence, marketing activities of pharmaceutical companies and their own current location of practice.

Prescribing patterns of antidiabetic drugs in elderly patients attending a tertiary care hospital

Background: Type 2 diabetes mellitus is one of the most known chronic diseases in almost all countries and continues to rise in numbers and significance. Prescription pattern studies are drug utilization studies with the main focus on prescribing, dispensing, and administration of drugs and are mainly undertaken to promote rational use of medicines. Aims and Objectives: To study the prescribing patterns of antidiabetic drugs in elderly patients attending tertiary care hospitals. Materials and Methods: It was a cross-sectional study. After obtaining Institutional Ethics Committee clearance, written informed consent was obtained from all patients in the study. After consultation, prescriptions issued to the patients were copied into pro forma and case record forms. All participants with a disease duration &gt;1 year and an age above 65 years were included in the study. Details like the number of drugs, dosage forms, frequencies, and number of comorbidities were entered into the pro forma. Results: The total number of drugs prescribed was 654. The average number of drugs per prescription was 2.18. The most commonly prescribed class of drugs were biguanides (93.4%), followed by sulfonylureas (81%), and alpha-glucosidase inhibitors (42.3%). Generic drugs were seen in 97.4% of prescriptions, and insulins were seen in 22% of prescriptions. The percentage of prescriptions with drugs from the Essential Drug List (EDL) was 98%. Conclusion: Prescription pattern monitoring studies would thus help in the understanding of the extent of quality prescribing and rationality. In this study, the prescribing of injections, generic prescribing, and prescribing from EDL were adequate.

Drug Utilization Research and Predictors of Outcomes in the Intensive Care Unit of a Tertiary Care Hospital: A Prospective Observational Study.

Multiple drugs are commonly prescribed to intensive care unit (ICU) patients owing to the disease profile, multiple organ dysfunction, prophylaxis, management of stress ulcers, nosocomial infections, etc. This study aimed to evaluate the drug utilization patterns and factors influencing mortality and duration of stay in ICU patients. Methodology: A prospective observational study was conducted in the ICUof our tertiary care hospital, Postgraduate Institute of Medical Sciences, Rohtak. Data was collected from treatment charts of patients using a structured pretested proforma. World Health Organization Anatomical Therapeutic Chemical/Defined Daily Dose (WHO ATC/DDD) methodology and core prescribing indicators were used to assess drug utilization data. The effect of different variables on mortality and duration of stay in the ICU was evaluated using regression analysis. An average of 8.78 drugs were prescribed per patient. Among the 922 prescriptions, anti-infectives, anti-inflammatory drugs, and drugs acting on the gastrointestinal tract were the most frequent medication classes prescribed. Polypharmacy and trade name prescribing were common. For most of the drugs, the prescribed daily dose corresponded to the WHO-DDD except ceftriaxone and levofloxacin. Age, presence of cardiac disorders, and Glasgow Coma Scale (GCS) score at admission directly correlated with mortality while the use of diuretics had a negative correlation with the duration of ICU stay. Conclusions: There is a need to rationalize drug therapy in the ICUwith regard to limiting polypharmacyand emphasizing generic drug name prescribing and adherence to the essential drug list. Antibiotic prescription patterns, in particular, deserve a special focus keeping in mind the multitude of factors demanding aggressive antibiotic use in critically ill intensive care patients.

Shakespeare’s reflective genre. On reflection involved in the staging of culture

The opposition of two terms, tradition vs reflection, is laid at the foundation of the construct which is often accepted now as a representation of world culture in the process of its staging. ‘Tradition’ stands for the collective mind and the ritual/norm, while ‘reflection’ covers the growth of the individual talent liberating itself from the normative authority of generic and other prescriptions. The borderline — beyond which the power of genre with its rules, rigidly established in the classical poetics, visibly loses its prescriptive power and individual talent takes over — is usually located somewhere between the late Renaissance and the early romantic era. Among the generic forms thatrepresent a new reflective genre, S. Averintsev reckons the novel by Cervantes, Shakespeare’s tragedies, Montaigne’s essays, Pascal’s intellectual prose... In the present article, the renaissance sonnet is added to this list due to the role it played in ‘the origin of the modern mind’ (P. Oppenheimer) and its three hundred years of domination in European lyric poetry. The sonnet, with special attention given to Shakespeare’s sequence, is analyzed after a model elaborated by M. Bakhtin for the novel and by Y. Tynyanov for the Russian ode.

Interruptions in Insurance Coverage and Prescription Drug Utilization: Evidence from Kentucky.

This study examined how interruptions in insurance coverage affect purchases of prescription drugs for young adults. It used data spanning 2014 to 2018 from Kentucky's prescription drug monitoring program, which tracked the universe of federally-regulated (Schedule II-V) prescription drugs dispensed in the state. The study employed a regression discontinuity design based on the age limit at 26 for dependent insurance coverage for children. At age 26, the probability of purchasing a prescription decreased by 5%, with all subcategories of prescriptions affected. The share of generic prescriptions increased for stimulants (the only category observed with substantial branded prescriptions). By age 27, prescription purchases returned to levels observed at 25, but the share purchased with public insurance and the generic share for stimulants remained higher. The findings suggest that interruptions in insurance coverage decrease prescription drug utilization by young adults and that public insurance programs such as Medicaid are important for resuming treatment.

Assessing prescribing practices in Indian health facilities: a comprehensive review

Prescription patterns play a critical role in healthcare delivery, affecting the efficacy of medication therapy and resource utilization. Rational prescribing practices are essential for safe and effective healthcare, necessitating comprehensive prescriptions containing medication details, prescriber information, and patient instructions. This review explores prescription completeness and rationality, utilizing WHO prescribing indicators and other completeness metrics, across Indian healthcare facilities. A systematic search was conducted in PubMed and Google Scholar for original research articles published between 2013 and 2023, focusing on WHO-recommended prescribing indicators and completeness criteria. Inclusion criteria covered articles in English, spanning primary, secondary, or tertiary care settings. Data from selected articles were extracted and analysed. Data were synthesized from sixty-seven studies, depicting various prescribing practices. The assessment encompassed prescribing, patient care, and facility indicators. Findings highlighted challenges such as illegible prescriptions, incomplete details, polypharmacy, brand name dominance, and inappropriate antibiotic use. Despite WHO recommendations, generic prescribing was limited. This review reiterates the need for interventions to enhance prescription quality, patient safety, and cost-effectiveness. Recommendations include adopting electronic prescribing systems, standardizing prescription formats, conducting regular prescription audits, implementing educational programs, promoting generic drug use, and adhering to essential medicines lists. These multifaceted strategies can improve prescribing practices and ultimately contribute to enhanced healthcare outcomes in India.

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 pattern of antibiotics in various clinical departments of a tertiary care health institution: a retrospective observational study

Background: Antimicrobial resistance has been considered as one of the greatest challenges to the general public health today. The Antibiotic Stewardship Program has emphasized on prevention of drug resistant bacterial infection, targeted therapy against susceptible or resistant microorganism and to curtail unnecessary and irrational use of antibiotics. Present study aimed to evaluate the pattern of antibiotic prescription amongst the hospitalized patients of IGMC Shimla in Himachal Pradesh. Methods: It was a retrospective observational study. Data was collected from hospital records of admitted patients in medicine and Surgical wards. Patient data like demographic profile, average hospital stay and number of antibiotics prescribed were extracted from their hospital records. Also, the data about oral/parenteral, generic/branded empirical/definitive and therapeutic/prophylaxis prescription in each patient were collected. Results: In medicine ward, the number of generic prescriptions 78 (71.5%) were more as compared to branded 31 (28.5%) and majority were given the parenteral 61 (55.9%) than the oral 48 (44.1%) dosage form. In surgery ward, the branded prescriptions 61 (91%) out-numbered the generic prescription 6 (9%). The route of administration was mostly oral; 56 (83.5%), while only few had parenteral prescription; 11 (16.5%) in this ward. Conclusions: It was found that majority of patients in medicine ward received generic named antibiotics for definitive management, while in surgical ward branded named antibiotics were prescribed for surgical prophylaxis. The cephalosporin was the most commonly prescribed antibiotic group. Majority of antibiotics belonged to “watch” category as far as WHO’s AWaRe classification is concerned.

Detecting entanglement harnessing Lindblad structure

The problem of entanglement detection is a long standing problem in quantum information theory. One of the primary procedures of detecting entanglement is to find the suitable positive but non-completely positive maps. Here we try to give a generic prescription to construct a positive map that can be useful for such scenarios. We study a class of positive maps arising from Lindblad structures. We show that two famous positive maps viz. transposition, reduction map and Choi map can be obtained as a special case of a class of positive maps having Lindblad structure. Generalizing the transposition map to a one parameter family we have used it to detect genuine multipartite entanglement. Finally being motivated by the negativity of entanglement, we have defined a similar measure for genuine multipartite entanglement.

Implications of the South African National Drug Policy on prescribing patterns: a case study of the Limpopo province

BackgroundThe South African National Drug Policy (SA-NDP) was introduced to promote rational medicine use (RMU). This study evaluates the quality of prescribing in the public healthcare sector in South Africa's Limpopo province following the World Health Organization's (WHO) rational prescribing standards. In addition, the prescribing practices in South Africa were compared to other African countries.MethodsA prospective cross-sectional survey of patients' prescriptions was conducted in Limpopo, South Africa, from October to December 2018. Findings were compared with the WHO reference values (WHO-RV), and the International Network of Rational Use of Drugs (IRDP) tool was used to measure the degree of rational prescribing. The optimal IRDP value was defined as 1. Study findings were compared with results from a previous study conducted in Limpopo and studies from Ethiopia and Eritrea.ResultsSix hundred prescriptions were reviewed. The mean (SD) age was 43.9 ± 24.4 years (females = 56.5%). The average number of drugs prescribed (4.3, IRDP = 0.47) was higher than the WHO-RV (< 2). Generic prescribing (43%, IRDP = 0.43) and medicines prescribed from the essential medicines list (EML) (90%, IRDP = 0.90) were less than the WHO-RV (100%, respectively). Antibiotics (28%, IRDP = 1) and the number of injections prescribed (8%, IRDP = 1) were below the WHO-RV (< 30% and < 20%, respectively). The number of medicines prescribed was higher compared to previous years (4.3 vs. 3.4). Antibiotic prescribing declined (28% vs. 63.4%). Generic prescribing (43% vs. 41.7%) and medicines prescribed from the EML (90% vs. 93.1%) did not improve. A higher number of medicines were prescribed in this study compared to Ethiopia (1.7) and Eritrea (1.8), and a lower number of antibiotics were prescribed compared to Ethiopia (58.2%) and Eritrea (54.5%). Generic prescribing was low compared to Ethiopia (95.6%) and Eritrea (94.9%). All studies showed reduced injection prescribing (6.6–15.9%) and similar prescribing from the EML (90–95%).ConclusionsThere is an increased potential for drug-drug and adverse reactions with the increased number of prescribed medicines; however, the patient's clinical needs may warrant using multiple medicines. There is a need for generic prescribing to reduce medicine expenditure.