Irrational Drug Prescribing Research Articles

Effect of pharmaceutical promotion and incentives offered by pharmaceutical companies on the prescribing pattern of medical students: a cross-sectional study from a developing nation Pakistan

BackgroundPharmaceutical companies continuously pursue healthcare professionals, starting from the medical college level, which can ultimately lead to irrational prescribing of drugs and antibiotics. Therefore, our main aim was to evaluate the opinions and attitudes of medical students toward pharmaceutical promotion.MethodsThis study utilized a cross-sectional online survey that applied the snowball sampling technique. Data were collected from three public and three private sector medical colleges in Punjab, Pakistan using snowball sampling. A modified version of a pre-structured questionnaire was used to collect data between October 2020 and January 2021. Medical students from the third year onward were captivated. The tool was made available on Google Forms and students could access it by clicking the link shared. The effect of promotion on prescribing pattern and future prescribing of antibiotics were measured. Descriptive statistics, chi-square, and t-test were used to analyze the data.ResultsA total of 1,301 students filled out the survey, but only 1,227 responses were acceptable. The average age was found to be 23.4 ± 1.59 years. Slightly more than half of the respondents were male participants (57.7%), and a significant proportion (84.1%) reported being aware of pharmaceutical promotion. A smaller number (27.7%) felt that physicians who meet medical representatives more frequently tend to prescribe more antibiotics and 46.3% indicated they would be willing to prescribe antibiotics under the promotional influence. Medical students who were male, in senior college years, attended government institutions, and had lower parental income showed significantly higher perception and attitude scores (p < 0.05) which, in turn, may show their inclination to promotional activities. Many students agreed with the view that pharmaceutical promotion (PP) activities may alter prescribing practices and also believed that they contribute to the increased irrational prescribing of drugs and antibiotics.ConclusionThe study revealed that only a small number of students are willing to engage in promotional activities and accept rewards, which influences their choice toward selection of drugs and antibiotics. This study highlighted the necessity of giving proper educational instructions regarding the promotion of drugs to medical students. This study also focused on the educational prerequisites of the students.

Drug Prescribing Pattern among the Inpatients in the Surgery Department of Tertiary Hospital of Eastern Nepal

Background: Prescription is a written instruction by a health care personnel to pharmacist to dispense drug(s). Irrational drug prescribing is a global problem, particularly in developing and transitional countries. This study was conducted to see the status of World Health Organization (WHO) core prescription indicators, complementary indices and prescription errors. Methods: It was a quantitative cross-sectional descriptive study carried out among inpatients of general surgery of tertiary hospital in eastern Nepal. Ethical approval for the study was obtained from the Institutional Review Committee. It was a convenience sampling. Calculated Sample size was 224. Enrollment of patients started on 16 May 2018 with the last case being enrolled on 1 Oct 2019 after obtaining informed consent. Relevant data was entered in a semi-structured proforma. Microsoft excel 2016 and IBM Statistical Package for the Social Sciences (SPSS) v. 21 were used for descriptive statistics. Results: Median age of inpatients was 40 (24 - 54) years with male: female ratio being 1.05. Total 1492 drugs were prescribed in 224 prescriptions. Mean number of drugs prescribed was 6.66 ± 2.33. Percentage of drugs prescribed by generic name was 25.60%. Prescriptions with at least one antimicrobial agent was 89.3%. Prescriptions with at least one injection was 92.9%. Percentage of drugs prescribed from the WHO Essential Medicine List was 66.48%. Other complementary prescribing indicators and prescription errors were also calculated. Conclusions: Most prescription indicators were inadvertently deviated away from WHO standards. Prescription errors were comparable to other studies.

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.

Assessment of prescribing patterns and medication errors related to prescriptions in hospitalized diabetes mellitus type-2 patients in Khyber Pakhtunkhwa, Pakistan

AbstractObjectivesDiabetes mellitus (DM type-2) is a common, non-transmittable disease that affects people all over the world. Polypharmacy and inappropriate prescribing are more common in diabetic individuals. One of the most critical and fundamental abilities a doctor requires is the ability to write prescriptions. In emerging countries like Pakistan, irrational drug prescribing is a major healthcare issue. This study aims to investigate the prescriptions errors in patients with DM type-2 prescriptions admitted in medical wards and outpatients’ visits departments at Khyber teaching hospital.MethodsIn the Khyber Teaching Hospital in Peshawar, a prospective study was done to determine medicine prescribing patterns and identify prescription errors in hospitalized patients with DM type-2. Over the course of two months, 86 patients’ prescriptions were collected from the hospital’s medical ward. The pattern of prescriptions was investigated using WHO-recommended indicators, and prescription mistakes were identified. DM type-2 was shown to be substantially more common in females than in males in this clinical investigation. For the data analysis, various statistical methods were used and data were visualized.Key findingsDM type-2 was more common in adults above the age of 65, according to age groups (51–60). It was revealed that the average number of medications per prescription was 8.37%. In this study, we discovered that patients with DM type-2 had higher rates of hypertension than those with other disorders. The percentage of prescriptions with generic names was 3.61%, antibiotics were 15.69%, and injectables were 47.22% of the total 720 medications prescribed. The dose strength was absent in 18.75% of the 720 medications, and 6.25% of the pharmaceuticals had an incorrect dosage form.ConclusionTo promote reasonable drug therapy, the prescription pattern and prescription errors have highlighted the necessity to build an accurate system of documenting and analysing therapy before issuing a prescription.

ОЦЕНКА РИСКОВ ТЯЖЕЛОГО ТЕЧЕНИЯ COVID-19 И СЛУЧАИ НЕРАЦИОНАЛЬНОГО НАЗНАЧЕНИЯ ЛЕКАРСТВЕННЫХ ПРЕПАРАТОВ

Abstract. Introduction. The coronavirus infection pandemic has caused a significant increase in hospitalizations worldwide. Hospital mortality among patients aged 70 to 79 years was as high as 35%, and for patients older than 80 years more than 60%. The severity of COVID-19 is closely related to comorbidities. The COVID-19 outbreak necessitated the development of drugs to combat the pandemic, and known off-label drugs were used as an alternative treatment. The use of drugs with unproven efficacy is especially dangerous in individuals with serious heart disease and can be fatal. Aim. To reveal the dependence of severity of the disease on age and body weight on the analysis of COVID-19 patient charts, to compare the obtained results with the literature data and to identify cases of irrational prescribing of drugs. Material and methods. Case reports of 334 patients treated at a reassigned infectious disease hospital with COVID-19 were analyzed. Patients were divided into 2 groups: those aged 60 years and older (group 1) and those younger than 60 years (group 2). Statistics were calculated: for indicators having normal distribution the results were calculated as arithmetic mean, for the rest as median and interquartile range, categorical variables were presented as number or percentage. For nonparametric variables, we calculated the χ2 criterion for 2x2 tables (Pearson’s goodness-of-fit test). The maximum significance value was χ2 = 3.84 (with degree of freedom d.f.=1; p<0.05). Results and discussion. Analysis showed that individuals under 60 years of age were less likely to have a severe course of the disease (33.8%) than those aged 60 years or older 12312 345ВЕЕ С1Т2Н244СИЕЕВК545О2 ВСИЕЕН2Р5М54ЙЕЕЕЛЧЛДЕЕЕЕ3ЦЫЕД0оЕЕЕм,выЕЛ СпН24ЕС.Й3СНСТ5Б54ПКГ4Й2Е5 К2РС1П45АСТ5Б54ПКГ4Й2Е5 К2РС1П45А12 345ВЕЕ С1Т2Н244СИЕЕВК545О2 ВСИЕЕН2Р5М54ЙЕЕЕЛЧЛЛЕЕЕЕ3ЦЫЕД0оЕЕЕм,выЕ0 (45.6%). The duration of hospital stay in older patients was 10.7±2.58 bed/days, in younger patients 9.8±2.21. Statistically significant dependence of disease severity on body weight was not revealed. It was found that almost all patients were prescribed 5 drugs: omeprazole, paracetamol, ambroxol, heparin and acetylsalicylic acid. There were cases of irrational prescription of the following drugs: favipiravir, paracetamol, interferon-α, acetylsalicylic acid, baricitinib. Conclusion. COVID-19 management should be performed with careful evaluation of the prescribed medications for potential drug interactions and/or additional side effects.

Gambaran Kerasionalan Resep Antibiotik Dengan Diagnosa ISPA Di Poli Anak Rumah Sakit Prikasih Jakarta Selatan Periode Januari – Maret 2020

Irrational drug use is a major problem in the world. Irrational prescribing of drugs can be described as medically inaccurate and ineffective in financing, treatment There are many studies that describe the treatment of ARD (Acute Respiratory Disease) patients who tend to use antibiotics which lead to overprescription and become irrational. This research was to descripte of a rational antibacterial prescription with a diagnosis of upper Acute Respiratory Tract Infection (ARI) at Prikasih Hospital Children's Clinic. Methods for this research is descriptive method using retrospective data. Samples in this study were 380 recipes. The results showed that there were 79.7% rational recipes and 20.3% irrational recipes. Based on the choice of drug type, cefixime is the most widely used antibiotic with a rule of 3 times a day.

EVALUATION OF PRESCRIBING INDICATORS AND PRESCRIPTION WRITING AT THE OUTPATIENT DEPARTMENT OF A PEDIATRIC TEACHING HOSPITAL IN LIBYA

Background:Irrational drug prescribing and inappropriate prescription writing have a serious medical and economicimpacton patients and society. Information on pediatric prescribing and quality of prescription writing in Libya are lacking. The aim of this study was to evaluate the extent of rational prescribing using the WHO indicatorsand to assessthe completeness of prescriptions recorded informationat the outpatient department of Benghazi Childrens Hospital. Results:A total of 603 prescriptions were sampled and analyzed. Concerning the prescribing indicators, the average number of medicines per encounter was 1.52, 5.47% of drugs were prescribed by generic name, 20.56% of encounters had at least one antibiotic prescribed, 25.87% of encounters were prescribed one injection or more and 61.27% of the prescribed drugs were from the Essential Drugs List. As regards the completeness of the recorded data on prescriptions, the patients name, gender, age and diagnosis were recorded in 99.34%, 10.78%, 85.74% and 29.85% of prescriptions, respectively. None of the prescriptions included the patients contact details and only 0.66% mentioned the patients weight. Prescribers information such as the name, signature and contact details were present in more than half of prescriptions while only 3.98% were stamped.Medication details like the dosage form, dose and frequency were written for more than 82% of the prescribed drugs whereas the strength and treatment duration were the least recorded drug information, 46.28% and 56.67%, respectively. Conclusion:Some forms of irrational drug prescribing as well as suboptimal recording of prescriptions information were observed at the outpatient department of Benghazi Childrens Hospital.

Critical analysis of drug promotional literature available to the medical practitioners

Background: To ascertain whether the pharmaceutical companies are following the WHO criteria for “Ethical medicinal drug promotion 1988” and “OPPI Code of pharmaceutical marketing practices, 2012” and to what extent. Also, to evaluate the therapeutic claims made by them in their drug promotional literature and other aspects.Methods: Drug Promotional Literature (DPL) from different pharmaceutical companies was collected from various Medical practitioners and analysed to see if they achieved objectives. Therapeutic claims made by them were classified as authentic, exaggerated, controversial, false, and misinterpreted.Results: Total 250 DPLs were collected and critically analysed for information content. Out of the 11 WHO criteria for ethical medicinal drug promotion (1988), Majority (30%) followed only 54.54% of the criteria while only 4% followed 100% of the criteria. The total number of claims in the 250 DPL were 354 of which 52.8% were authentic and 47.2% were misleading. From the misleading claims: 28.7% were exaggerated, 34.7% were controversial, 22.8% were false, 23% were ambiguous.Conclusions: This study enabled us to find out to what extent the pharmaceutical industries follow the standard criteria for DPL and evaluate the claims made by them. DPL is one of the important sources of drug information. Some of the pharmaceutical companies failed to follow the WHO criteria while advertising their products in order to make them look more lucrative having an underlying commercial motive. As they influence prescribing patterns of the clinicians, misleading promotional literature would result in irrational prescribing of drugs. To avoid this, DPL has to be critically evaluated.

Drug prescribing pattern in surgical wards of a tertiary care hospital in Western part of India

Background: In surgical wards, drugs are required to manage pain, nausea, vomiting, infections, etc. A growing number of pharmaceutical products are available in present era. Irrational prescribing of drugs is prevalent worldwide. Drug utilization study can be used to assess prescribing patterns. Authors undertook this study to determine current practice of prescribing in surgical wards of the hospital.Methods: Authors conducted observational, noninterventional, descriptive study among patients admitted in surgical wards for one year. Authors have analysed collected data of 604 patients using descriptive statistics to determine utilization pattern of drugs and drug use indicators.Results: Appendicitis (14.9%) followed by hernia (10.6%) were leading diseases for admission. Mean duration of stay was 7.44. Average number of drugs in a prescription was 8.94. Antibiotics (32.07 %), analgesics (17.11 %) and antacids (16.09 %) were leading drug groups prescribed. Amikacin (5.81 %) followed by metronidazole (5.30 %) and ciprofloxacin (5.19 %) were commonly prescribed antimicrobial drugs. Tramadol (5.31 %) and pantoprazole (7.17 %) were leading drugs prescribed from analgesics and antacids respectively. All prescriptions had at least one injectable drug. At least one antibiotic was present in 92.05 % prescriptions. Majority of drugs (87.27 %) were prescribed by generic names. Proportion of drugs prescribed from essential medicine list was 84.22 %.Conclusions: Polypharmacy and injectable drug prescribing were common in practice. There is a scope for improving such prescribing practices among practitioners. Use of multiple antibiotics should be avoided whenever possible and usage should be evidence based.

Prescription Pattern In Hypertensive Patients In A Tertiary Care Teaching Hospital, Dhaka, Bangladesh

Background: Irrational drug prescribing is a common practice globally; it results in increased morbidity, mortality & economic burden on society. Drug utilization studies are an important tool to promote rational prescribing.Aims & Objective: To study on drug prescribing pattern in hypertensive patients.Materials and Methods: A drug utilization study was conducted in hypertensive patients by the department of cardiology in OPD at Shaheed Suhrawardy Medical college hospital for 6 months. 645 prescriptions were evaluated for prescribing pattern by using WHO drug use indicators.Results: 645 prescriptions were analyzed. A total of 1828 drugs were prescribed. 697 (38.13%) antihypertensive, 243 (13.30%) anti diabetics, 174 (9.52%) non-steroidal anti-inflammatory drugs (NSAIDs), 154 (8.44%) statins, 114 (6.24%) thyroid hormone, 54 (2.95%) anti-anxiety/ antidepressants and 392(21.44%) miscellaneous drugs were prescribed. 697 antihypertensive drugs were prescribed. 234 (33.57%) angiotensin receptor blockers (ARBs), 117 (16.79%) angiotensin converting enzyme (ACE) inhibitors, 95 (13.63%) Beta blockers, 83 (11.91%) Calcium channel blockers 168 (24.10%) Fixed dose combinations (FDCs) of antihypertensive were included. 2.83 drugs were prescribed per prescription. 225 (32.28%) antihypertensive were prescribed from essential medicine list.Conclusion: Most commonly prescribed drugs were ARBs and ACE inhibitors. Rational prescribing requires consideration to dose and duration and interaction with other medications.J Shaheed Suhrawardy Med Coll, December 2016, Vol.8(2); 39-43

Prescription pattern among patients having mild to moderate bronchial asthma using metered dose inhaler and dry powder inhaler in tertiary hospital in western india

Background: Bronchial asthma is a syndrome characterized by airflow obstruction that manifests as shortness of breath, wheezing and cough. The treatment is tailored according to the severity of the disease. The drugs used for treatment of bronchial asthma include inhaled corticosteroids, beta-2 agonists, methylxanthines, leukotriene antagonists and mast cell stabilizers. Despite the availability of all these drugs, which are recommended for the treatment, not every patient achieves complete control of the disease. The reason behind this could be irrational prescribing of drugs for the treatment and errors in the technique of using inhaler devices. Though rational prescribing of drugs and correct technique for the use of inhaler can be improved by proper training of target population, but there is paucity of such data in our country.Methods: This study was planned to monitor prescription pattern and errors in use of inhalation devices, in patients diagnosed as cases of mild to moderate bronchial asthma, attending Out Patient Department (OPD) of respiratory medicine of a tertiary hospital. A total of 207 patients were recruited and their prescription pattern and inhalation technique were assessed.Results: The study showed that inhaled short acting β2-agonists and inhaled corticosteroids were the most commonly used drug groups, which were prescribed to all the patients in the study, followed by long acting β2-agonists, leukotriene antagonists and methylxanthines in decreasing order.Conclusions: As a conclusion, the treating physicians were prescribing according to the laid down guidelines. It is concluded that such studies should be periodically done to ensure the adherence to the treatment guidelines.

Prescribing patterns of rural family physicians: a study in Kermanshah Province, Iran

BackgroundThe inappropriate use of drugs due to irrational prescriptions is a common problem in Iran, but there is little evidence of prescription patterns in rural family physicians. This study aimed to explore the prescribing pattern and rational drug use indicators for family physicians using Index of Rational Drug Prescribing (IRDP) in Kermanshah Province, Iran.MethodsIn this retrospective study, 352,399 prescriptions from 184 family physicians in 103 primary health care (PHC) centers were examined. As stated, an analysis was done for rational use indicators suggested by World Health Organization (WHO): e.g., the percentage of prescriptions containing antibiotics, injections, and those prescribed by a generic name and from a national essential medicine list, plus the average number of drugs per prescription; these factors were all taken into account. Rational drug use was studied with the IRDP.ResultsThe average number of drugs per prescription was 3.14 (± 1.2) and the average cost per prescription was 116,740 IRR (USD 3.6). Around 19% of prescriptions had more than four drugs, while the percentage of prescriptions involving antibiotics and injections was 52.1% and 24.4%, respectively. There was 95.1% drugs prescribed by their generic name and 95.9% were retrieved from the essential drugs list. The value of the IRDP was 3.70 out of 5.ConclusionThe findings of this study showed that some degree of irrational drug prescribing exists among family physicians, especially in terms of injections, antibiotics, and polypharmacy. It is recommended that there be continuing education programs for physicians regarding rational prescribing for different kinds of medical indications. Clinical practice guidelines should also assist with the rational use of medicine.

Prescribing pattern and prescription errors: a study at a tertiary care hospital of Bangladesh

Irrational prescribing of drugs is a major health concern in developing countries like Bangladesh. A study was therefore undertaken in a hospital, situated in Rajshahi region of Bangladesh, to find the prescribing pattern and to detect the prescription errors to the admitted patients. Prescriptions of 200 patients were collected from various departments of the hospital over a period of three months. Prescription pattern was analyzed using general indicators suggested by WHO and prescribing errors were determined by comparing the prescribed drugs with national standard treatment guidelines, textbooks and authentic online resources. The average number of drugs per prescription was found to be 4.89 and 76.5% prescriptions contained complex regimen. In this study, we found no prescription with generic name. The percentage of prescription with antibiotics was 78% that was 15.95% of total drugs. The injectable preparations used were 17.18% of total 978 drugs. About 769 (3.85 per prescription) prescription errors were identified from 978 prescribed drugs. The name of 35 prescribed drugs was not clear due to illegible hand writing. The dose strength was missing for 279 drugs and 31 drugs had improper abbreviation. The study also identified 409 drug interactions. About 6.5% prescription orders were identified for the patients with kidney and urinary problems and there was no dose adjustment. Frequency of occurrence of prescription errors found during the study can be rated high. The prescription pattern and the prescription errors have indicated the need to establish proper system of recording and analyzing therapy before writing a prescription in order to promote rational drug therapy.Bangladesh Pharmaceutical Journal 18(1): 20-24, 2015

Study on drug prescribing pattern in diabetes mellitus patients in a tertiary care teaching hospital at Dehradun, Uttarakhand

Background: Irrational drug prescribing is associated with increased morbidity, mortality and economic burden on the society. Study of prescribing pattern is a component of medical audit that does monitoring and evaluation of the prescribing practice of the prescribers and recommends necessary modifications to achieve rational medical care. Aims & Objectives: This study was designed to analyze the current prescription patterns of drugs used in the treatment of type 2 diabetes mellitus patients. Materials and Methods: Present study has been conducted in diabetes mellitus patients by the department of pharmacology in medicine outpatient department at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun for 6 months. 312 prescriptions were randomly evaluated for prescribing pattern using WHO drug indicators. Results: A total of 312 prescriptions were analyzed. Mean age was 54.96 ± 0.57 years. Male: Female ratio was 1.04:1. Socio-economic status (SES): Upper 24 (7.69%), Upper Middle 75 (24.04%), Lower Middle 93 (29.81%), Upper Lower 69 (22.11%) and Lower 51 (16.35%). Family history of diabetes mellitus seen in 129 (41.35%) patients and average duration was 7.92±0.37 years. A total of 1242 drugs were prescribed. 666 (53.62%) antidiabetics, 216 (17.39%) antihypertensives, 159 (12.8%) multivitamins, 90 (7.25%) antiplatelets, 42 (3.38%) statins and 360 (5.56%) in miscellaneous category were prescribed. Amongst antidiabetics, the most frequently prescribed drugs were metformin 273 (40.99%), glimepiride 228 (34.23%) followed by pioglitazone 45 (6.76%), acarbose 33 (4.95%), gliclazide 30 (4.5%), sitagliptin 30 (4.5%), glibenclamide 15 (2.25%) and insulin 12 (1.8%). 99.03% oral drugs were prescribed. Numbers of Fixed dose combinations of antidiabetic drugs were 246 (36.93%). 3.98 drugs per prescription were prescribed. 288 (43.24%) antidiabetics were prescribed from National List of Essential Medicines (NLEM), 2011. 100% drugs were prescribed by brand names. Conclusion: The most commonly prescribed drugs were Metformin and Glimepiride. Rational prescribing can be improved by sensitizing our physicians and providing them with the feedback of the study.

Study on drug prescribing pattern in hypertensive patients in a tertiary care teaching hospital at Dehradun, Uttarakhand

Background: Irrational drug prescribing is a common practice globally; it results in increased morbidity, mortality & economic burden on society. Drug utilisation studies are an important tool to promote rational prescribing. Aims & Objective: To study on drug prescribing pattern in hypertensive patients. Materials and Methods: A drug utilisation study was conducted in hypertensive patients by the department of pharmacology in medicine OPD at SGRRIM & HS, Dehradun for 6 months. 645 prescriptions were evaluated for prescribing pattern by using WHO drug use indicators. Results: 645 prescriptions were analysed. A total of 1828 drugs were prescribed. 697 (38.13%) antihypertensives, 243 (13.30%) antidiabetics, 174 (9.52%) non-steroidal anti-inflammatory drugs (NSAIDs), 154 (8.44%) statins, 114 (6.24%) thyroid hormone, 54 (2.95%) anti-anxiety/antidepressants and 392(21.44%) miscellaneous drugs were prescribed. 697 antihypertensive drugs were prescribed. 234 (33.57%) angiotensin receptor blockers (ARBs), 117 (16.79%) angiotensin converting enzyme (ACE) inhibitors, 95 (13.63%) Beta blockers, 83 (11.91%) Calcium channel blockers 168 (24.10%) Fixed dose combinations (FDCs) of antihypertensives were included. 2.83 drugs were prescribed per prescription. 225 (32.28%) antihypertensives were prescribed from essential medicine list. Conclusion: Most commonly prescribed drugs were ARBs and ACE inhibitors. Rational prescribing requires consideration to dose and duration and interaction with other medications.

ADDRESSING RATIONAL PRESCRIBERS THROUGH THE PHARMACOLOGY AND THERAPEUTICS COURSE WORK OF MBBS SYLLABUS IN BANGLADESH

Pharmacology is most rapidly expanding science in medical discipline which leads to the development of many important drugs to treat many medical conditions that was previously untreat able . This paper focuses on the necessity of integration of pharmacology in the medical curriculum in all clinical phases and ethical aspect s of medicine in terms of irrational prescribing. Irrational prescribing of drugs is a major global health problem i n medical practice. Currently Pharmacology is taught at phase - II, a 2 year period in a 5 years undergraduate medical Programme in Bangladesh under the name ‘Pharmacology and Therapeutics’. Indiscriminate use of clinically inappropriate and ineffective medi cines are a serious problem. Medicines in Bangladesh are inappropriately prescribed, again all kinds of drugs including controlled product s are dispensed and sold out frequently without prescription. Henceforth there are regular violation of medical ethics and professionalism. As only pharmacology and therapeutics deals with the correct selection of drugs, the subject should be continued to teach up to phase - III. In addition , therapeutic discussion should be incorporated with proper logbook during internshi p in order to make safe and efficient prescribers. Supreme priority should be given to legal and ethical aspects of medicine. Medical professionals must uphold social order by ensuring

Current scenario of rational usage of various drugs in indoor patients

Background: Irrational prescribing of drugs is of common occurrence in clinical practice. Rational drug prescribing is defined as “the use of the least number of drugs to obtain the best possible effects in the shortest period and at a reasonable cost”. The present study was designed to evaluate the practice of rational prescription in patients (cases) admitted in various wards ofG.S.V.M.MedicalCollege and associated hospitals atKanpur. Methods: This study was carried out on patients admitted in different wards. For the study of drug prescribing patterns, each prescribed drug was counted only once for a patient, irrespective of change in dose and route of administration. WHO guidelines were taken into consideration. Both distribution of type of drug as well as drug category were evaluated in different departments thereafter. The characteristics chosen on each prescription provided the incidence of poly pharmacy and frequencies of prescribing of individual drug were analyzed. The data obtained were subsequently categorized systematically and analyzed by taking WHO guidelines into consideration. Results: The most commonly prescribed drugs were vitamins and tonics (57.5%) followed by anti-microbial agents (12.7%), non-steroidal anti-inflammatory drugs (10.5%), anti-hypertensive (5.2%), anti cough remedies and acid peptic disease drugs. Generic drug prescription was very low as most of drugs prescribed were proprietary. A low number of Fixed Dose Combinations (FDCs) were prescribed, this finding was in accordance with the WHO recommended list of FDCs. Items on the WHO model list of essential drugs were prescribed frequently. The use of drugs has been found to be in accordance with the disease, the patient had. Conclusions: Present study highlighted that there was a high incidence of irrational prescribing practice that increased with the total number of drugs per prescription.

Drug prescribing indicators in village health clinics across 10 provinces of Western China

The irrational use of drugs was a global problem, especially in developing countries. However, there are no studies available on irrational use of drugs in rural Western China. To assess the drug prescribing patterns using World Health Organization Drug Use Indicators at village health clinics in rural areas of Western China. A total of 20 125 prescriptions were collected from 680 primary health clinics in villages from 40 counties in 10 provinces of Western China. Five measurements were used to assess the irrational drug use: percentage of encounters with an antibiotic prescribed, average number of drugs per encounter, percentage of encounters with an injection prescribed, percentage of drugs prescribed by generic name and percentage of drugs prescribed from National Essential Medicines List or Formulary. Index of Rational Drug Prescribing (IRDP) was used as an indicator of rational drug use. The percentage of prescriptions containing antibiotics was 48.43%, while the average number of drugs per prescription was 2.36, and the percentage of injection prescriptions was 22.93%. The percentage of drugs prescribed by generic name was 64.12%, and the percentage of drugs prescribed from the National Essential Drug List was 67.70%. The IRDP of the present study was 3.32 with the optimal level of 5. There are also some regional variations in these measurements. The study provides some evidence of irrational use of drugs to a great extent in rural areas of Western China. Overuse of injection and overuse of antibiotics were the most prominent manifestations of such irrational drug prescribing.

Prescription analysis of pediatric outpatient practice in Nagpur city

Background:Medication errors are probably one of the most common types of medical errors, as medication is the most common health-care intervention. Knowing where and when errors are most likely to occur is generally felt to be the first step in trying to prevent these errors.Objective:To study prescribing patterns and errors in pediatric OPD prescriptions presenting to four community pharmacies across Nagpur city and to compare the prescription error rates across prescriber profiles.Materials and Methods:The study sample included 1376 valid pediatric OPD prescriptions presenting to four randomly selected community pharmacies in Nagpur, collected over a period of 2 months. Confirmed errors in the prescriptions were reviewed and analyzed. The core indicators for drug utilization studies, mentioned by WHO, were used to define errors.Results:The 1376 prescriptions included in the study were for a total of 3435 drugs, prescribed by 41 doctors. Fixed dose formulations dominated the prescribing pattern, many of which were irrational. Prescribing by market name was almost universal and generic prescriptions were for merely 254 (7.4%) drugs. The prescribing pattern also indicated polypharmacy with the average number of drugs per encounter of 2.5. Antibiotics were included in 1087 (79%) prescriptions, while injectable drugs were prescribed in 22 (1.6%) prescriptions. The prescription error score varied significantly across prescriber profiles.Conclusion:The findings of our study highlight the continuing crisis of the irrational drug prescribing in the country.

Identifying outcome-based indicators and developing a curriculum for a continuing medical education programme on rational prescribing using a modified Delphi process

BackgroundContinuing medical education (CME) is compulsory for physicians in Iran. Recent studies in Iran show that modifications of CME elements are necessary to improve the effectiveness of the educational programmes. Other studies point to an inappropriate, even irrational drug prescribing. Based on a needs assessment study regarding CME for general physicians in the East Azerbaijan province in Iran, rational prescribing practice was recognized as a high priority issue. Considering different educational methods, outcome-based education has been proposed as a suitable approach for CME. The purpose of the study was to obtain experts' consensus about appropriate educational outcomes of rational prescribing for general physicians in CME and developing curricular contents for this education.MethodsThe study consisted of two phases: The first phase was conducted using a two-round Delphi consensus process to identify the outcome-based educational indicators regarding rational prescribing for general physicians in primary care (GPs). In the second phase the agreed indicators were submitted to panels of experts for assessment and determination of content for a CME program in the field.ResultsTwenty one learning outcomes were identified through a modified Delphi process. The indicators were used by the panels of experts and six educational topics were determined for the CME programme and the curricular content of each was defined. The topics were 1) Principles of prescription writing, 2) Adverse drug reactions, 3) Drug interactions, 4) Injections, 5) Antibiotic therapy, and 6) Anti-inflammatory agents therapy. One of the topics was not directly related to any outcome, raising a question about the need for a discussion on constructive alignment.ConclusionsConsensus on learning outcomes was achieved and an educational guideline was designed. Before suggesting widespread use in the country the educational package should be tested in the CME context.