International Network For Rational Use Of Drugs Research Articles

Evaluation of Rational Medicines Use Based on World Health Organization Core Indicators: A Cross-Sectional Study in Five Health Districts in Mauritania.

The rational use of medicines is essential for preventing adverse medicine reactions, achieving therapeutic outcomes, and optimizing treatment costs. While the irrational use of medicines is frequently reported in sub-Saharan Africa, to the best of our knowledge no formal studies have taken place in Mauritania thus far. The main objective of this study was therefore to analyze the rational use of medicines in public and private not-for-profit health facilities, in five health districts in Mauritania. We conducted a cross-sectional study to assess the rational use of medicines. We used the standard indicators derived from the methodologies of the World Health Organization (WHO) and International Network for Rational Use of Drugs (INRUD). Data were prospectively collected from 1050 prescriptions/patients, in thirty-one public and private not-for-profit health posts/centers in 5 health districts. The data were analyzed using the Statistical Package for the Social Sciences. P value less than 0.05 at 95% confidence interval considered for significance of relationships for associations in statistical test. The average number of medicines per prescription was 2.21; 83.1% (1931/2325) of medicines were prescribed by generic name, but only 54% (1253/2325) were on the National Essential Medicine List (NEML). Antibiotics were prescribed in 62.4% (655/1050) of the consultations, and injectable medicines were prescribed in 15.6% (164/1050) of the consultations. The average consultation time was 16.32 minutes, and the average dispensing time was 97 seconds. Dispensed medicines were correctly labeled, and 83% (871/1050) of patients met the correct administration schedule. The NEML, and the "restricted NEML" for 76 commonly-used medicines, were available in all surveyed health facilities, but the National Therapeutic Guidelines were available in only 60.26% of them. Our findings indicate a possible excess of antibiotics prescriptions, and a likely lack of knowledge of the National Therapeutic Guidelines. There is a need to investigate in more detail the prescription patterns versus disease-specific therapeutic guidelines, and to qualitatively investigate the factors that contribute to the observed irrational prescribing. Moreover, training local staff in the rational use of medicines seems important.

Evaluation of Rational Drug Use Based on WHO/INRUD Core Drug Use Indicators in a Secondary Care Hospital: A Cross-Sectional Study in Western Uganda.

Rational drug use (RDU) promotes safe, efficient, and cost-effective utilization of medicines in hospital settings. The aim of this study was to assess rational drug use based on the World Health Organization (WHO) and the International Network for Rational Use of Drugs (INRUD) core drug use indicators. This prospective, descriptive, hospital-based cross-sectional study was conducted among patients attending the Outpatient Department of a secondary care hospital located in the Sheema District of Western Uganda. A total of 450 prescriptions were prospectively collected from eligible patients and subjected to evaluation by using the WHO/INRUD core drug use indicators (prescribing, patient care, and health-facility indicators). The average number of drugs prescribed per encounter was found to be 3.2 (optimal value=1.6-1.8). The percentages of drugs prescribed by their generic name (90.48%) and from the Essential Medicine List (96.23%) were close to the WHO reference (100%). The percentage of antibiotics (66.22%) and injections (25.22%) per encounter exceeded the WHO standards (antibiotics=20.0-26.8; injections=13.4-24.1). Among the patient-care indicators, the average consultation time (5.41 minutes), average dispensing time (131.03 seconds), percentage of medicines dispensed (76.11%), percentage of medicines adequately labeled (59.74%), and percentage of patients with dosage knowledge (49.50%) did not meet the WHO reference. Facility indicators such as the percentage of key medicines available in the stock (66.67%) did not conform to the WHO optimal value. The hospital made the EML hundred percent available to all practitioners. The study concludes that the prescribing, patient care, and health facility indicators at Sheema District Secondary Care Hospital deviate from the optimal values recommended by the WHO. Therefore, this study indicates a need for improvement on these indicators and a requirement for the ongoing educational initiatives focused on rational drug prescribing, dispensing, and patient use in order to comply with the standards set by the WHO.

Study of Drug Utilization Pattern during Second Wave of Covid-19 in a Tertiary Care Centre: A Retrospective Cross Sectional Study

Background: To study the drug utilization trends among patients with COVID-19 disease during the second wave in a tertiary care hospital. Methods: A retrospective cross-sectional study was conducted in patients admitted in COVID-19 wards during second wave of SARS – COVID-19 pandemic from 1st March 2021 to 30th June 2021. A total of 300 prescriptions were analysed. Assessment of prescription patterns were done as per the WHO-The International Network for Rational Use of Drugs (INRUD)drug use indicators. Results: A total of 3106 drugs were analysed.The average number of drugs prescribed was 11±5.1. The most frequent prescription was that of analgesic and antipyretic drug Paracetamol (95.26%) followed by vitamin C (94.74%) and multivitamins(87.89%) . Nearly all patients in this study received antibacterials, 68% received antivirals. Antibacterials commonly used were cephalosporins, amoxicillin- clavulanic acid combination and pipercillin –tazobactam combination. Antiviral drug Remdesivir was also used extensively in our study (54.21%). Other class of drugs which were commonly prescribed to more patients were Dalteparin (73.16%) and corticosteroids like methyl prednisolone (52.63%) and dexamethasone (51.05%). 35.68% of the drugs were prescribed with generic name .45.43% of the drugs were injectables . 2.96% of the drugs were prescribed as fixed dose combinations. Conclusion: In summary, the drug utilization for hospitalized patients with COVID-19 was diverse but generally complied with the ongoing guidelines. The drug were mostly prescribed from WHO essential drug list and percentage of fixed dose combination prescription was low. However not prescribing the drugs by generic name and large encounters of injectable was matter of concern. To get a better glimpse of drug utilization a more extensive study needs to be undertaken.

Drug use pattern using WHO core drug use indicators in public health centers of Dessie, North-East Ethiopia

BackgroundRational drug use requires that patients receive and take medication appropriately. Though the process of diagnosis and pharmaceutical care is complex, World Health Organization (WHO)/international network for rational use of drugs (INRUD) core drug use indicators investigate drug use to minimize the hazardous effect of the drug and enhance the wise use of scares resources. This study assessed drug use patterns in health centers of Dessie town using WHO/INRUD indicators.MethodsA cross-sectional study was conducted in public health centers of Dessie town. Data were retrospectively collected from 1500 prescriptions dispensed from January 1, 2018, to December 31, 2018 using WHO data collection tool to assess prescribing indicators. For patient care and health facility indicators, 600 patients and 3 health centers were prospectively reviewed. Systematic random sampling was used to select samples. Data were analyzed using the Statistical Package for the Social Sciences version 20.ResultsThe average number of drugs per encounter was 2.1. The percentage of encounters with antibiotics and injection was 44% and 13.9%, respectively. The percentage of drugs prescribed by generic name and from an essential drug list was 98% and 100%, respectively. On average, patients spent 4.7 min for consultation and 105 s for dispensing. From 1305 prescribed drugs, 92% were dispensed, while only 4% were labeled adequately. More than half (54.8%) of patients had adequate knowledge of their medication. None of the health centers had an essential drug list. The availability of key essential medicines was 64.10%.ConclusionThis study demonstrated irrational drug use practices in all healthcare facilities. Polypharmacy, antibiotics over-prescribing, short consultation and dispensing times, inadequate labeling of medicines, inadequate level of patients' knowledge about prescribed medicines, and unavailability of key drugs in stock were found to be the major problems. Continuous refreshment trainings on rational use of drugs and WHO recommendations should be given for prescribers and pharmacists. Further, we recommend studies involving large number of facilities to estimate overall prescribing practices.

THE RATIONALITY OF DRUG PRESCRIPTIONS AT THE GYNAECOLOGY DEPARTMENT IN A TERTIARY CARE TEACHING HOSPITAL IN KELANTAN

The aim of this study is to assess the rational prescribing pattern of drugs for pregnant women using World Health Organization (WHO)/International Network for Rational Use of Drugs (INRUD) core drug prescribing indicators. A one-year retrospective research design from (October 2016–September 2017) was used to review pregnant women prescriptions from their medical records at Hospital Universiti Sains Malaysia (HUSM). A structured data collection form using WHO/INRUD document on prescribing indicators was used. Data was sorted and categorised according to the US Food and Drug Administration (USFDA) pregnancy classification systems and Anatomical Therapeutic Classification (ATC). Then, data was compared with the references values of WHO/INRUD. Descriptive analysis were performed using SPSS version 20. A total of 741 medical files met the study inclusion criteria. The average number of prescribed drugs per prescription and the percentage of prescribed drugs from hospital formulary list and health ministry list were within the acceptable range listed by WHO. Whereas, the percentage of pregnant women with antibiotics and injection drugs were lower than normal values 17.67% and 8.23%, respectively. Percentage of prescribed drugs from categories C and D were 13.8% and 2.8%, respectively. Whereas 24.8% of prescribed drugs were from unclassified risk category. On the other hand, multivitamins preparations were the highest category of prescriptions 17.7%. Injections and number of antibiotics per encounter were lower than the recommended range listed by WHO. However, a great caution and careful prescribing behaviour of physicians were noticed at gynaecology/obstetric departments and most of the prescribed medications were rational and safe during pregnancy.

Study of the effect of pharmacotherapeutic audit meetings on prescription writing in a tertiary care center-an interventional study

Background: Rational drug prescription is a practice when an appropriate drug with correct dosage, formulation, frequency and duration is prescribed. Prescription audit with the help of regular Pharmaco-therapeutic audit meetings (PTAM) is a continuous cycle, involving observing practice, setting standards, comparing practice with standards, implementing changes and observing new practice. World health organization (WHO) and international network for rational use of drugs (INRUD) jointly provided a few prescription and drug use indicators to guide rational prescription writing practice. Aim of the study was to assess the effect of pharmaco-therapeutic audit meetings on prescription writing and its rationality.Methods: This was a single center cross-sectional, prospective study conducted over a period of 14 months (December 2018-February 2020). Prescriptions from outpatient departments of general medicine, pulmonary medicine, physical medicine and rehabilitation (PMR), community and family medicine (CFM), pediatrics and psychiatry were collected. All the collected prescriptions were screened for rationality using WHO/INRUD core indicators and the index of rational drug prescribing was calculated. Prescriptions beyond acceptable limit were discussed in PTAM and same process was repeated over next 2 months to assess change in prescribing patterns after PTAM. Chi-square and student’s t-test was used for statistical analysis.Results: Statistically significant change in proportions for antibiotic prescribing was 3.4% [95% CI (-1.7%-9.4%), p=0.20] and prescriptions with generic name drugs was 10.5% [95% CI (6.1-14.6%) p<0.0001 was seen while no significant change was seen in injectable preparation use 0.6% [95% CI (-0.6%-1.5%); p=0.26)] and prescriptions from essential drug list (EDL) 0.5% [95% CI (-4.2%-5.4%) p=0.83].Conclusions: Our study showed that PTAM is an effective way to improve rationality of prescriptions and must be done regularly for improving prescribing practices.

Pharmacotherapeutic audit meetings as a tool of improving prescribing practices

Background: Pharmacotherapeutic audit meeting (PTAM) is a good tool to review prescriptions for rationality and suggest measures for improving quality of prescriptions. To promote this, World Health Organization (WHO) and International Network for Rational Use of Drugs (INRUD) provided drug prescribing and drug use indicators. To assess the impact of PTAMs as an intervention for improving quality and rationality of prescriptions.Methods: This was a single centre, prospective study conducted from December 2018-February 2020. Prescriptions from outpatient surgical departments were collected, screened using WHO/INRUD core indicators and discussed in PTAMs. The same process was repeated over next 2 months to assess change in prescribing patterns after PTAM. Chi-square and Student’s t-test was used for statistical analysis.Results: The difference in proportions for antibiotic prescribing was 8.7% [95% CI (1.0%-16.7%), p=0.02]; injectable preparation use was 0.7% [95% CI (-0.4%-2.3%) p=0.23]; prescriptions with generic name drugs was 10.9% [95% CI (5.6-16.2%) p<0.0001] and prescriptions from Essential drug list (EDL) was 8.1% [95% CI (2.5%-13.5%) p=0.0046].Conclusions: Our research showed PTAM could be an effective tool to implement WHO/INRUD drug prescribing indicators robustly. Hence, it could be included in WHO/INRUD policies as an intricate part of institutional healthcare delivery system.

DRUG UTILIZATION PATTERN IN PAEDIATRIC PATIENTS IN A SECONDARY CARE HOSPITAL

Objective: The study was carried out to generate research on drug utilization pattern in paediatric patients in government headquarters hospital, Tiruppur, Tamilnadu, India using world health organization (WHO) and international network for rational use of drugs (INRUD) core indicator.
 Methods: The core prescribing indicators of the world health organization was used to assess the appropriate use of drugs. Index of rational drug prescribing (IRDP) developed by Zhang and Zhi was also used to find out the performance of a health care system in terms of drug utilization.
 Results: Out of 859 drugs in 200 cases the highest prescribed drug class is antibiotics 304(35.39%) and the majority of drugs were administered in injectable form 412(47.94%). It was analysed that a majority of prescriptions 117(58.5%) were discharged in between 4-7 d. 161(80.5%) patients were dismissed after completion of treatment. On analysing world health organization (WHO) prescribing core indicators, the average number of drugs per prescription was 4.29 which is higher than double the average number (i.e., 2). This indicates poly-pharmacy practice. 97.78% of drugs were prescribed were the generic name and percentage of encounters with antibiotic prescribed was 90.5% which is thrice greater than world health organization (WHO) standard<30%. Prescribing of injections is not within the world health organization (WHO) recommended range<20% and it was far higher showing 97.5% which is essential for paediatric inpatients. The prescribing practice in paediatric ward is in complete adherence to national essential drug list (EDL) or formulary. The mean value of the index of rational drug prescribing (IRDP) obtained was 3.09 which is very similar to that of optimal value world health organization (WHO).
 Conclusion: Prescription by generic name, prescribing drugs from essential drug list (EDL) and free government supply are encouraging findings in this hospital. The result shows poly-pharmacy and overuse of antibiotics are the areas to be concerned. The better clinical outcome shows rational prescribing is practised well.

Prescribing indicators at primary health care centers within the WHO African region: a systematic analysis (1995-2015).

BackgroundRational medicine use is essential to optimize quality of healthcare delivery and resource utilization. We aim to conduct a systematic review of changes in prescribing patterns in the WHO African region and comparison with WHO indicators in two time periods 1995–2005 and 2006–2015.MethodsSystematic searches were conducted in PubMed, Scopus, Web of science, Africa-Wide Nipad, Africa Journals Online (AJOL), Google scholar and International Network for Rational Use of Drugs (INRUD) Bibliography databases to identify primary studies reporting prescribing indicators at primary healthcare centres (PHCs) in Africa. This was supplemented by a manual search of retrieved references. We assessed the quality of studies using a 14-point scoring system modified from the Downs and Black checklist with inclusions of recommendations in the WHO guidelines.ResultsForty-three studies conducted in 11 African countries were included in the overall analysis. These studies presented prescribing indicators based on a total 141,323 patient encounters across 572 primary care facilities. The results of prescribing indicators were determined as follows; average number of medicines prescribed per patient encounter = 3.1 (IQR 2.3–4.8), percentage of medicines prescribed by generic name =68.0 % (IQR 55.4–80.3), Percentage of encounters with antibiotic prescribed =46.8 % (IQR 33.7–62.8), percentage of encounters with injection prescribed =25.0 % (IQR 18.7–39.5) and the percentage of medicines prescribed from essential medicines list =88.0 % (IQR 76.3–94.1). Prescribing indicators were generally worse in private compared with public facilities. Analysis of prescribing across two time points 1995–2005 and 2006–2015 showed no consistent trends.ConclusionsPrescribing indicators for the African region deviate significantly from the WHO reference targets. Increased collaborative efforts are urgently needed to improve medicine prescribing practices in Africa with the aim of enhancing the optimal utilization of scarce resources and averting negative health consequences.

Rational Drug use in Pakistan: A systematic review

<p style="text-align: justify;"><strong>Background:</strong> This article provides a review of different studies about rational use of drugs in Pakistan and different interventions to improve drug use in the country. The analysis of these studies focused on the quality of services offered by these pharmacies, knowledge of drug sellers and dispensing practices. <strong>Material and methods</strong>: The summary of rational drug use and their possible health consequences is based on reviews of drug use in Pakistan. A systematic inventory of published research work since 1990 to 2015 was undertaken to identify studies which focused on different aspects of rational drug use. Annals and computerized databases of International Network for Rational Use of Drugs (INRUD), WHO, PubMed, Science Direct were screened for relevant journal articles, research reports and newsletters. To expand and fortify the search process, the general search engine Google was utilize. <strong>Results:</strong> Initially, a total of 60 articles were retrieved for electronic databases by the authors. These articles were then again matched with the objectives of this study and those articles which did not qualify, were excluded. After further screening, 20 articles were selected and 15 appropriate studies were finally included in the review. <strong>Conclusion:</strong> In this study, we find out that large number of drugs is being used in wrong way. The current paper highlighted that quality of services provided at community pharmacies in Pakistan is not satisfactory. The situation of rational drug use indicators in the hospitals where the study was conducted is alarming. There is an urgent need for intervention to improve the situation. <strong>Key words: </strong>Rational drug use, Irrational drug use, Pakistan.

Analysis on the data of antibiotic prescriptions comment in China, 2014-2015

To evaluate the rationality of antibiotic use in the outpatient and emergency departments in some class 3A hospitals in China through International Network for Rational Use of Drugs(INRUD). The antibiotic prescriptions were collected from the outpatient and emergency departments in 78 class 3A hospitals of 25 provinces through INRUD during 2014-2015. The basic information of the antibiotic prescriptions and the prescriptions rationality were evaluated. A total of 447 894 prescriptions of antibiotics were analyzed. From 2014 to 2015, the qualified rate the prescriptions increased from 91.52% to 93.08%, and the antibiotic use rate was similar(11.72% and 12.04%). The major irrational prescription type was inappropriate prescription, including inappropriate indication(32.42%, 34.02%)and inappropriate usage and dosage(24.22%, 18.56%). Totally, the antibiotic use in the outpatient and emergency department reached the standard in China. However, the use of antibiotics didn't meet the national requirements in some area. It is necessary to promote the rational use of antibiotics.

Pharmaceutical policies: effects of financial incentives for prescribers.

The proportion of total healthcare expenditures spent on drugs has continued to grow in countries of all income categories. Policy-makers are under pressure to control pharmaceutical expenditures without adversely affecting quality of care. Financial incentives seeking to influence prescribers' behaviour include budgetary arrangements at primary care and hospital settings (pharmaceutical budget caps or targets), financial rewards for target behaviours or outcomes (pay for performance interventions) and reduced benefit margin for prescribers based on medicine sales and prescriptions (pharmaceutical reimbursement rate reduction policies). This is the first update of the original version of this review. To determine the effects of pharmaceutical policies using financial incentives to influence prescribers' practices on drug use, healthcare utilisation, health outcomes and costs (expenditures). We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (searched 29/01/2015); MEDLINE, Ovid SP (searched 29/01/2015); EMBASE, Ovid SP (searched 29/01/2015); International Network for Rational Use of Drugs (INRUD) Bibliography (searched 29/01/2015); National Health Service (NHS) Economic Evaluation Database (searched 29/01/2015); EconLit - ProQuest (searched 02/02/2015); and Science Citation Index and Social Sciences Citation Index, Institute for Scientific Information (ISI) Web of Knowledge (citation search for included studies searched 10/02/2015). We screened the reference lists of relevant reports and contacted study authors and organisations to identify additional studies. We included policies that intend to affect prescribing by means of financial incentives for prescribers. Included in this category are pharmaceutical budget caps or targets, pay for performance and drug reimbursement rate reductions and other financial policies, if they were specifically targeted at prescribing or drug utilisation. Policies in this review were defined as laws, rules, regulations and financial and administrative orders made or implemented by payers such as national or local governments, non-government organisations, private or social insurers and insurance-like organisations. One of the following outcomes had to be reported: drug use, healthcare utilisation, health outcomes or costs. The study had to be a randomised or non-randomised trial, an interrupted time series (ITS) analysis, a repeated measures study or a controlled before-after (CBA) study. At least two review authors independently assessed eligibility for inclusion of studies and risks of bias using Cochrane Effective Practice and Organisation of Care (EPOC) criteria and extracted data from the included studies. For CBA studies, we reported relative effects (e.g. adjusted relative change). The review team re-analysed all ITS results. When possible, the review team also re-analysed CBA data as ITS data. Eighteen evaluations (six new studies) of pharmaceutical policies from six high-income countries met our inclusion criteria. Fourteen studies evaluated pharmaceutical budget policies in the UK (nine studies), two in Germany and Ireland and one each in Sweden and Taiwan. Three studies assessed pay for performance policies in the UK (two) and the Netherlands (one). One study from Taiwan assessed a reimbursement rate reduction policy. ITS analyses had some limitations. All CBA studies had serious limitations. No study from low-income or middle-income countries met the inclusion criteria.Pharmaceutical budgets may lead to a modest reduction in drug use (median relative change -2.8%; low-certainty evidence). We are uncertain of the effects of the policy on drug costs or healthcare utilisation, as the certainty of such evidence has been assessed as very low. Effects of this policy on health outcomes were not reported. Effects of pay for performance policies on drug use and health outcomes are uncertain, as the certainty of such evidence has been assessed as very low. Effects of this policy on drug costs and healthcare utilisation have not been measured. Effects of the reimbursement rate reduction policy on drug use and drug costs are uncertain, as the certainty of such evidence has been assessed as very low. No included study assessed the effects of this policy on healthcare utilisation or health outcomes. Administration costs of the policies were not reported in any of the included studies. Although financial incentives are considered an important element in strategies to change prescribing patterns, limited evidence of their effects can be found. Effects of policies, including pay for performance policies, in improving quality of care and health outcomes remain uncertain. Because pharmaceutical policies have uncertain effects, and because they might cause harm as well as benefit, proper evaluation of these policies is needed. Future studies should consider the impact of these policies on health outcomes, drug use and overall healthcare expenditures, as well as on drug expenditures.

Indicators of quality use of medicines in South‐East Asian countries: a systematic review

To identify indicators of quality use of medicines used in South-East Asian region. A systematic review was conducted searching MEDLINE, Embase and The International Network for Rational Use of Drugs (INRUD) and The World Health Organization (WHO) website. Original studies or reports carried out in the South-East Asian region, explicitly using indicators to measure quality use of medicines, and published between January 2000 and July 2011 were included. A total of 17 studies conducted in 7 of 11 countries in South-East Asia were included. WHO indicators focusing on general medication use in health facilities were most widely used (10 studies). Twelve studies used non-WHO indicators for measuring quality use of medicines in clinical areas (geriatrics and obstetrics) or specific diseases, such as diarrhoea and pneumonia. In five studies, WHO indicators were used along with non-WHO indicators. There was little information available about validity, reliability and feasibility of the non-WHO indicators. The majority of indicators measured process rather than structure or outcome. There were very few indicators addressing non-communicable diseases. A limited number of studies have been published explicitly using indicators of quality use of medicines across South-East Asia. Importantly, existing indicators need to be complemented with valid, reliable and feasible indicators related to non-communicable diseases, particularly those with a high financial burden to meet the current medical challenges in the region.

A review of the assessment tools used to evaluate whether medicines are prescribed rationally or not

ObjectiveThe rational use of medicines is recognised as important by the WHO.1 It is important that medicines are used in children safely, effectively and in the most economic way. The...

Médicaments essentiels génériques et accès aux soins de santé primaires aux populations dans la préfecture sanitaire de Mambéré-Kadéï

To assess whether people in Mambéré-Kadéï have access to essential medicines for primary health care. The study was conducted in 14 public health care centres of the medical district of Mambéré-Kadéi (Central African Republic). This cross-sectional study assessed the drugs prescribed for 40 randomly selected outpatients consulting in each of 14 randomly selected public health centres from June 1, 2000, through March 30, 2001. The methodology used was adapted from the World Health Organization study protocol (WHO indicators) and the International Network for Rational Use of Drugs (INRUD). Accessibility and affordability of key medicines. Complete data were available for 512 study consultations. A mean of 79.3%( 95% Confidence Interval (CI): 77.5-81.7%) of the 14 essential generic drugs monitored were available in the health centre pharmacies. A median prescription cost 2800 Francs FCA ($4.5), a cost within the ability to pay of 73.2% (CI: 72.8-76.2). These results suggest that the population in Mambéré-Kadéï had access to affordable essential medicines. Although availability and accessibility of the generic essential drugs are good in this medical district, the study also showed the need for action to improve access to primary health care for the patients too poor to pay: 26.8% (95% CI: 23.8-28.2).

Rational drug prescribing and dispensing in tertiary care teaching hospital of Western Nepal

Background: Previous studies have acknowledged that irrational use of medicines is a problem in Nepal. Studies from the Manipal Teaching Hospital have identified lacunae in prescribing and recommended interventions to improve the drug use pattern in the hospital. Educational and managerial interventions have been carried out to improve the use of medicines. Objectives: The study was conducted with the objectives of analyzing the prescriptions for rational prescribing and dispensing, and to evaluate the patient’s knowledge regarding use of drugs as per the International Network for Rational Use of Drugs (INRUD)/WHO indicators. Methods: The prescription and labeling of the dispensed drugs were checked for their accuracy and necessary details were entered in the encounter form developed as per the INRUD/WHO indicators. Patients were interviewed for their knowledge regarding dose, duration, and frequency of the drug prescribed. The filled encounter forms were analyzed for the results. Results: The average drugs per prescription were 2.53. Only 16.38% of drugs were prescribed by generic name and 18.08% of the total drugs were fixed-dose combinations. It was found that only 37.09% and 31.06% of the drugs prescribed were from the Essential drug list of Nepal and WHO Essential drug list respectively. A very high percentage (97.92%) of the drugs was prescribed from the hospital drug list and 47.75% of the drugs were from the Nepalese National Formulary. The average cost per prescription was found to be NRs. 224.83 (USD 3.10). It was found that all of the medication envelopes were labeled with name of the drug and time of administration. All the patients knew the duration of the therapy and time of administration time of drugs. Conclusion: The study reported an improvement in the drug use at Manipal Teaching Hospital. There was also a reduction in the prescription cost and improvement in patient knowledge regarding the medications. However, larger studies covering more patients are needed.

Medical speciality and pattern of medicines prescription

To describe the prescribing patterns and their quality in relation to the prescriber's medical specialty in a defined population. The study was done on a random sample of all primary care medical prescriptions made through the social security system during 1 year in Andorra, a small European country. Number and type of prescribed medicines, prescribers' medical speciality and patients' age and gender were recorded. Medical specialties considered were General Practice, Paediatrics, Cardiology, Pneumology, Gynaecology, Ophthalmology and Other. A set of various quality indicators [World Health Organisation (WHO)/International Network for Rational Use of Drugs (INRUD) indicators and others] was used. The number of medicines prescribed per encounter varied depending on the prescriber's medical specialty and patient's age. Cardiologists and pneumologists tended to prescribe more medicines than other medical specialties. Patients older than 65 years received more prescriptions than younger adults, mostly at the expense of cardiovascular drugs. The contribution of the various groups and subgroups of medicines and the scores of various prescribing indicators showed wide variability across the medical specialties. Prescribing patterns and indicators of prescription quality show wide variability depending on the prescriber's medical specialty. This has important implications for priority setting in information, continuous education and research.

Intervention research to promote clinically effective and economically efficient use of pharmaceuticals: The international network for rational use of drugs

Despite acceptance of the essential drug concept by over 100 countries, current drug use patterns frequently result in unsafe use, waste of scarce resources, non-compliance, excess adverse drug reactions and disease resistance. Even in countries where resources for research are available, most efforts to improve drug prescribing have never been properly evaluated. Proposed interventions should reflect the behavioral basis for current drug use, target priority public health areas, and be feasible in developing country contexts. Most importantly, they must be critically assessed for cost and effectiveness in well-controlled field trials. The International Network for Rational Use of Drugs (INRUD) is a cooperative organization of health professionals and researchers in developing countries whose aim is to promote improved quality of care through more clinically effective and economically efficient use of pharmaceuticals. To accomplish this, INRUD will strengthen regional and national capacities to develop and scientifically evaluate programs to improve drug use and disseminate information on practical strategies shown to be cost-effective.