National List Of Essential Medicines Research Articles

PHP134 - Reimbursement Decision-Making in Ukraine: Current and Future Directions

Health technology assessment (HTA) introduction and development of the National List of Essential Medicines (NLEM) took place in Ukraine in 2016-2017. The study aimed to outline and analyze the launch of drug reimbursement programs in 2017 in line with the international requirements and future directions in Ukraine. . Literature review was conducted examining legislation database and scientific publications on the study issues in Ukraine. The state reimbursement program “Affordable Medicines” was launched in April 2017 for cardiovascular diseases, type 2 diabetes and asthma. According to Resolutions of the Cabinet of Ministers of Ukraine No.862 “On state regulation of prices on medicines” dated 09.11.2016 and No.863 “On implementation of reimbursement” dated 09.11.2016 was started implementation of the new state price regulation on the drugs. According to the bylaws such medicines have to be registered and included on the NLEM. The state budget funding was approved in the amount of 24,6 mln USD for this reimbursement program in 2017 and 35,1 mln USD for 2018 respectively. There is international reference pricing. Reference prices are calculated based on the prices in 5 countries: Poland, Latvia, Slovakia, Hungary and Czech Republic as a median reference prices for these medicines with terms DDD. The participation is voluntary both by the pharmaceutical companies and pharmacies. The reimbursement decisions are made by the MoH. Pharmaceutical company have to provide appropriate application form. The reimbursement list includes partially and fully reimbursed drugs (23 INN), approved by the Resolutions of the Cabinet of Ministers of Ukraine No. 1080 dated 27.12.2017. The quantity of consumed drugs by DDD increased by 85% in 2017. The program demonstrated the decrease in the average weighted price of drugs. The government is going to expand the list of diseases and chronic conditions by including new drugs in 2018.

Drug utilization study in diabetic patients seeking medical treatment in a north Indian rural medical college hospital

Background: Diabetes Mellitus is a chronic disease and its life-long management causes burden on lifestyle and financial condition of the patients. Drug utilization studies provide useful insights into the current prescribing practices.Methods: To evaluate the drug utilization pattern of anti-diabetic drugs in diabetic patients. A prospective observational study was carried out in adult diabetic patients visiting the Wards and Outpatient Department of General Medicine of a tertiary care hospital. The demographic data and utilization of different classes of anti-diabetic agents as well as individual drugs were analyzed.Results: In 125 patients (Male-65, Female-60), a total of 379 drugs (average 3.032±2.05) were used per day, out of which 76 (20.05%) were rational fixed dose combinations (FDCs) and 261 (68.86%) were prescribed from National List of Essential Medicines (NLEM) 2015. The number of drugs prescribed to be ingested was 326 (86.01%) and 63 (16.62%) were injectables.Conclusions: It was found that the prescription tendencies of the doctors were quite rational. More improvement can be done by sensitizing them to prescribe more drugs from NLEM. The limitations in the affordability of rural population should be taken care of while prescribing drugs for this chronic disease.

Pharmaceutical products as emerging contaminant in water: relevance for developing nations and identification of critical compounds for Indian environment.

Pharmaceuticals and personal care products (PPCPs) are contaminants of emerging concern and have been detected worldwide in water bodies in trace concentrations. Most of these emerging contaminants are not regulated in water quality standards except a few in the developed countries. In the case of developing countries, research in this direction is at a nascent stage. For the effective management of Pharmaceutical contaminants (PC) in developing countries, the relevance of PCs as an emerging contaminant has to be analyzed followed by regular monitoring of the environment. Considering the resource constraints, this could be accomplished by identifying the priority compounds which is again region specific and dependent on consumption behavior and pattern. In this work, relevance of pharmaceutical compound as emerging contaminant in water for a developing country like India is examined by considering the data pertaining to pharmaceutical consumption data. To identify the critical Pharmaceutical Contaminants to be monitored in the Indian environment, priority compounds from selected prioritization methods were screened with the compounds listed in National List of Essential Medicine (NLEM), India. Further, information on the number of publications on the compound as an emerging contaminant, data on monitoring studies in India and the number of brands marketing the compound in India were also analyzed. It is found that out of 195 compounds from different prioritization techniques, only 77 compounds were found relevant to India based on NLEM sorting.

Antimicrobial Utilization in Wound Infections in Tertiary Care Hospital

To identify the utilization pattern of antimicrobials in patients with suspected wound infections and skin and soft tissue infections (SSTI) according to WHO (World Health Organization) drug utilization indicators.This is a cross-sectional, record based study conducted in a tertiary care hospital after obtaining Institutional Ethical Committee approval. Patients of all ages admitted into N.R.I hospital between June to October 2017 suspected of wound and SSTIs were included in this study. Data of patients was collected from Medical records Department of the hospital. Analysis was done on 100 patients basing on inclusion criteria. Wound infections and SSTIs were found to be more common in males and in age group below 35 yrs. The major co-morbid conditions associated were diabetes and hypertension. Evaluation of prescriptions based on WHO drug utilization indicators showed that a total 201 antimicrobials were prescribed for 100 patients irrespective of positive or negative culture. Among antimicrobials, 31.8% were prescribed by their generic name.42.78 % were in the form of injections. 94.51 % of antimicrobials were in the National list of essential medicines 2015. Average duration of treatment given was for 7±3 days in the hospital. All the patients recovered well and got discharged. None of the patients died during the treatment among these 100 patients. The results obtained will be useful for implementing the modifications in the prescription for betterment of the patients and for the community.

Prescribing and dispensing practices for medicines used to treat non-communicable diseases in Uganda: a cross-sectional study

Abstract Background Non-communicable diseases (NCDs) are increasingly prevalent in low-income and middle-income countries (LMIC) and accessibility of medicines is essential for the management of these conditions. In Uganda, although many NCD medicines are now included in the national essential medicines list, sporadic evidence suggests that these medicines are widely unavailable to patients. The prescribing patterns of NCD medicines by providers and the dispensing patterns by dispensers represent important knowledge gaps in efforts to understand the care cascade for NCDs in Uganda. We aimed to describe the prescribing and dispensing practices for medicines used to treat NCDs, particularly hypertension, diabetes, and heart failure in Ugandan health-care facilities. Methods Based on WHO methodology, we did a cross-sectional study in which systematic sampling was used to collect data from patients attending outpatient NCD clinics at 15 higher-level public health-care facilities throughout Uganda. Demographic, prescribing, and dispensing information were collected using pre-tested structured questionnaires. Prescribing information was recorded from prescriptions, and dispensing information was obtained from medicine packets. Medicine tablets were counted by data collectors. Patients who reported not receiving all of their prescribed doses were contacted by phone to determine if they obtained the non-dispensed doses elsewhere. The primary outcome, which we term the Prescribing-Dispensing (P-D) Gap, was the percentage of prescribed doses that were not dispensed. Associations were tested using a linear mixed model. Findings We analysed data from 477 participants, of whom 454 (71%) were women. The average age was 51·4 years (SD 13·5). The mean number of drugs prescribed per encounter was 2·5 (SD 1·1), of which only 1·4 (0·9) drugs were dispensed. Overall, 82 591 total doses were prescribed, and 35 290·5 doses were dispensed, resulting in a P-D Gap of 57·3%. The P-D Gap was smaller for diabetes medicines than for medicines for cardiovascular diseases (46·2% vs 67·5%; p Interpretation A large P-D Gap exists for medicines used to treat NCDs in Ugandan public health-care facilities. The P-D Gap differs by medicine class and appears to be driven by medicine availability at public sector pharmacies. Most patients do not close this gap by purchasing medicines at private pharmacies, suggesting that under-treatment of these chronic conditions is widespread in patients who are already linked to care. Future work should explore feasible approaches to decrease this P-D Gap. Funding Doris Duke Clinical Research Fellowship.

NEED FOR DRUG PRICE CONTROL IN INDIA

India is one of the developing countries. A substantial proportion of population of this country is largely exposed to the drug market whose purchasing power is extremely low. Around 42% population of this country lives under the National poverty line ($1.25 per day). Vital issue concerning them is to access the health care facility at an affordable cost. Medicine is a part of health care cost and it costs to around 70% to 80% of total cost. Thus, cost of medicine is a governing factor of health care system especially when it comes to price control of health care facilities. To bring down the cost of health care facilities, government spends money for health care facilities. A comparative expenditure made by state government is depicted in this article. NPPA (National Pharmaceutical Pricing Authority) is the Indian pharmaceutical pricing regulating authority and it achieves its objectives by implementing the DPCO (Drug Pricing control order). In spite of existence of the DPCO, drastic price variation is observed between the products of same API (Active Pharmaceutical Ingredient) and several factors are responsible for the same. To overcome the stated problem and monopolistic trade practice by patent holder/brand manufacturer, TRIPS (Trade Related Intellectual Properties Rights) provides Compulsory Licenses which has its unique role to play in affordability of medicines. Essential medicine is a basic requirement of health care system to serve their customers and hence an effective and overt price control on drugs is the need of present. This study will thus try to justify the need to bring NLEM (National List of Essential Medicine) under DPCO.

Availability of WHO Essential Medicines for Cancer Treatment in Botswana.

PurposeStock outs of cancer drugs are potentially fatal but have not been systematically studied in low- and middle-income countries. The aim of this study was to determine the availability and alignment of the Botswana National Essential Medicines List (NEML) for cancer drugs with the WHO’s Essential Medicines List (EML).MethodsThe availability and cost of cancer drugs were analyzed using data from a weekly stock catalog sent by Botswana’s Central Medical Store to all pharmacy departments in government hospitals. Comparative data were extracted from the WHO EML and the “International Drug Price Indicator Guide-2014” from the Management Sciences for Health. Interviews with key informants were used to collect data on the Botswana NEML and the drug supply chain in the public sector.ResultsThe 2015 Botswana NEML for cancer had 80.5% alignment with the WHO EML. At least 40% of essential drugs were out of stock for a median duration of 30 days in 2015. Stock outs affected chemotherapy drugs included in first-line regimens for treating potentially curable diseases such as cervical, breast, and colorectal cancer and were not associated with buyer price of therapy. Analyses showed that the median price ratio for procured drugs was greater than 1 for 61% of the NEML drugs, which suggests inefficiency in procurement in the public sector.ConclusionsBotswana has one of the highest alignments of NEML to the WHO EML in the sub-Saharan African region, which is consistent with investment in the health care system evident in other clinical spheres. Better quantification of chemotherapy requirements using data from the National Cancer Registry and resource-sensitive treatment guidelines can help reduce stock outs and facilitate more effective and efficient procurement processes.

EVALUATION OF DRUG PRESCRIPTION PATTERN USING WORLD HEALTH ORGANIZATION PRESCRIBING INDICATORS IN TIKUR ANBESSA SPECIALIZED HOSPITAL: A CROSS–SECTIONAL STUDY

Background: Irrational use of antibiotics is a worldwide problem that contributes to dramatically increasing resistance and causes significant mortality, morbidity, and increased health care costs. In order to ensure the quality of health and medical care for patients and the community as a whole the proper use of medicines is an important element. Evaluation of drug use patterns with the WHO core drug use indicators is showing progressively more essential to promote rational drug use in developing countries. The main aim of this study was to assess the drug prescription pattern using WHO prescribing indicators at the Medical Outpatient Pharmacy in Tikur Ambessa Specialized Hospital (TASH). Methods: A retrospective cross-sectional survey was designed to the claim data .A sample of 2000 prescriptions was selected using systematic random sampling to determine the prescribing pattern from a total of 6,462 prescriptions written by medical interns, residents and senior physicians for a one -year period from February 2015 to January 2016. The raw data was cleaned, entered and analyzed using SPSS version 21.0 of the computer software. The results were summarized using texts and tables. Results: The average number of drugs per encounter was 2.84 +1.58 in the range of 1 to 9. The total number of the drugs which were prescribed by generic name was 97.9%. Of these, the total number of prescribed drugs which were included in the Ethiopian National Essential Medicine List was 99.3%. The present study highlighted the under use of antibiotics which accounts 6.6% (378), with majority being Crystalline Penicillin 27.1 % (94), followed by Amoxicillin 17.8%(62) and Ciprofloxacin 14.1% (49). A total of 8.4% (480) drugs were prescribed as injections. Conclusion: On the basis of the finding of this study, the drug prescription pattern did not meet the WHO core drug use indicators criteria.  It seems that there is a need for improvement of the prescribing patterns in the hospitals.  Therefore, the federal ministry of health and drug regulatory body's commitment will be required to bring about changes in drug use policies, organize health systems and legislative structures as required in order to foster rational drug use in the country. Keywords: Prescribing Indicators, Prescription, Rational Prescribing.  Â

Similarities and Differences in Essential Medicines Lists of 137 Countries: A Quantitative Analysis

Background: Essential medicines lists (EMLs) are intended to include medicines that meet the priority needs of populations and they influence medication access for more than 5 billion people. The World Health Organization (WHO) maintains a Model EML that countries may adapt to their own circumstances. We compared the medicines included in national EMLs with the WHO Model EML, and assessed the extent to which countries' characteristics, such as region, size, and healthcare expenditure accounted for the differences. Methods: In this observational study, we searched the WHO EML repository for national EMLs. The medicines in each national EML were abstracted into an electronic database. We compared each national EML to the WHO Model EML and also to other national EMLs. We used a linear regression model to determine whether the differences were accounted for by geographic region, population size, life expectancy, infant mortality, gross domestic product per capita, and health expenditure per capita. Findings: We identified 137 country EMLs including 2182 medicines at least once. Each national EML contained 44 to 990 medicines (median 310, interquartile range, IQR, 271-426). The number of differences between each country's EML and the WHO Model EML ranged from 63 to 666 (289, 262-369). Linear regression showed that geographical region and health expenditure (140 more differences per $1000 in healthcare expenditure, 95 % CI 51-229) were associated with the number of differences and the adjusted R-squared was 0·33. Most medicines (1363, 62 %) were listed by less than 10 % of countries. Interpretation: The substantial differences between national EMLs are not easily explained by differences in country characteristics and thus may not be related to different priority needs. Most medicines are listed by a small number of countries. This information helps to identify specific opportunities to improve EMLs. Funding Statement: Canadian Institutes of Health Research and Ontario SPOR (Strategy for Patient Oriented Research) Support Unit. Declaration of Interests: NP reports grants from Canadian Institutes for Health Research, the Ontario SPOR Support Unit, and Physicians Services Incorporated during the conduct of the study. JKA has written reviews, commentaries, and medicolegal reports on various aspects of prescribing, and has sometimes received remuneration. AP reports grants from NIHR, grants from NIHR School of Primary Care Research, during the conduct of the study; and occasionally receives expenses for teaching Evidence-Based Medicine. CH has received expenses and fees for his media work. CH has received expenses from the WHO and holds grant funding from the NIHR, the NIHR School of Primary Care Research, The Wellcome Trust and is a NIHR Senior Investigator. CH has received financial remuneration from an asbestos case. CH has also received income from the publication of a series of toolkit books published by Blackwell’s. On occasion, CH receives expenses for teaching EBM and is also paid for his GP work in NHS out of hours. All other authors declare no competing interests. Ethics Approval Statement: No ethics approval was sought for this review of publicly available information.

Analysis of Stages of Implementation of International Concept of Essential Medicines in the System of Health of Ukraine

The article contains results of research of implementation of international concept of essential medicines in the system of health protection of Ukraine. The authors analyzed three National lists of essential medicines, which had been approved in 2001, 2006 and 2009, and their last editions. They used historical, comparative, logical, mathematical statistic and other methods of research. The authors determined that since the first National list of essential medicines in Ukraine had been approved in 2011, there hasn’t been a single approach (by methodology) to a selection and inclusion of medicines to the composition of the above-mentioned list. Moreover, there hasn’t been a single approach to the formation of National list of essential medicines as well. It was the third National list of essential medicines (2009) by the formation and order of medicines presentation, which followed international recommendations of World Health Organization. In different years, the number of medicines, which were showed in the lists, has fluctuated gisnificantly. Thus, a minimum number of medicines was in the third National list of essential medicines (251 medicines by ?NN, 2009) and a maximum number was in the second edition of the second National list of essential medicines (780 medicines, 2008). Specific weight of sales volume of medicines, which were included in the National list at pharmaceutical market, has been changing proportionally to the change of their number by years. The biggest volume of retail sale was in 2008 (42.43%), and the smallest?in 2009 (13.45%). A significant obstacle to the efficient implementation of international concept of essential medicines in Ukraine is absence of National list of ?ssential ?edicines for children.

Cost analysis study of neuropsychiatric drugs: Role of National List of Essential Medicines, India.

This study investigated the cost variation among neuropsychiatric drugs prevalent in the Indian market with reference to the National List of Essential Medicines (NLEM, 2015). To promote the rational use of medicines through cost variation analysis among drugs for neuropsychiatric disorders enlisted in NLEM and those not included in NLEM (NNLEM). This study included drugs used for epilepsy, migraine, psychosis, depression, generalized anxiety disorder (GAD), bipolar disorder, and obsessive-compulsive disorder (OCD). The unit drug cost for the selected strengths of different manufacturers mentioned in the Current Index of Medical Specialities 2016 was used for calculating cost/defined daily dose (DDD). Comparison was done among individual drugs and groups (NLEM and NNLEM) by cost/DDD in terms of interquartile range, percentage cost variation, and cost ratio. The cost variation is wide for neuropsychiatric drugs (maximum, 1724.3% for risperidone in NLEM, and 1780% for olanzapine in NNLEM). The drug-to-cost ratio is the highest (168.8 times) for bipolar disorder and the lowest (9.7 times) for GAD. The NLEM drugs were found to be more economical than the NNLEM drugs among antiepileptic drugs, antidepressants, and drugs for bipolar disorder; however, the reverse was noted for antimigraine drugs and drugs for GAD. Antipsychotic medications and drugs for OCD in the NLEM group have a wider range than in the NNLEM group. The NLEM group has economical drugs in some disease categories; there is a need to consider the cost effectiveness of all drug categories while revising the NLEM next time and attention should focus on drug price regulation policies to accomplish the goal of rational use of medicines.

An evaluation of rational prescribing in hospital outpatient practice in Sierra Leone and assessment of affordability of a prescription as an outcome.

IntroductionMedicines are the most frequently used intervention in healthcare. Rational and cost-effective prescribing is especially important in countries where access to effective medicines may be challenged by affordability issues. This study describes the prescribing patterns of doctors in government hospitals in Freetown, Sierra Leone, considering the scope for rationalising prescribing and reducing cost to the patient.MethodsA descriptive, retrospective, cross-sectional study was conducted at four hospitals, using selected World Health Organisation (WHO) indicators applied to 600 prescriptions, after systematic random sampling. The data was analysed using SPSS.16 and the Index of Rational Drug Prescrib-ing (IRDP) calculated. The Spearman's rank coefficient was used to examine possible associations between the number of medicines prescribed as generics and from the National Essential Medicines List (NEML) and cost of the prescription respectively. Affordability was determined from the average number of days of work required to purchase a prescription, based on the minimum wage of the lowest paid government worker in Sierra Leone.ResultsThe mean number of medicines per prescription from the four hospitals was 4.37(range 4.18-4.56) with 57% prescribed generically and 64% from the NEML. An antibiotic and injection were found on 72% and 26% of prescriptions respectively. The overall IRDP was 2.65/5. The aver-age cost per prescription was Le. 29,376.30 ($6.78), equivalent to 43 days of work of the lowest paid government worker.ConclusionIn this study, opportunities were identified for significant rationalisation and improvement in cost-effective prescribing.

A Retrospective Study on prescribing pattern of drugs among pregnant inpatients in Tertiary Care Hospital

Aim and Objective: The aim of the present study was to evaluate the prescribing pattern of drugs among pregnant women in antenatal ward of Employee’s State Insurance Corporation (ESIC) hospital, Ayanavaram, Chennai. Methods and Materials: A retrospective study was conducted in 100 pregnant women for a period of 6-months. Each prescription was analyzed for demographic variables, various categories of drugs prescribed and individual drugs prescribed in that category. Results: In the present study, vitamin and mineral supplements (67%) were the most commonly prescribed category followed by Intravenous fluids (12%) and anti-emetics (7%). Among vitamin and mineral supplements, folic acid (31%) was the most commonly prescribed drugs. Ringer lactate (58%) was the most commonly prescribed IVF. Ondansetron (57%) was the most commonly prescribed anti-emetic. Most commonly prescribed anti-microbial agents were Metronidazole and Mebendazole (22% each). According to teratogenic risk, Category-B (45%) was highest. The percentage of injections prescribed was 22%. Conclusion: The present study showed that vitamin and mineral supplements were the most commonly prescribed drugs, anti-biotics were less used. Prescription by generic name was high and most of the drugs prescribed were from the National List of Essential Medicines (NLEM) which represents rational prescription. Utilization of category B drugs must be decreased and avoidance of category D drugs is recommended.

COST-UTILITY ANALYSIS OF MULTIPLE SCLEROSIS TREATMENT IN THAILAND.

Although interferon beta-1a (IFNß-1a), 1b (IFNß-1b), and fingolimod have been approved as multiple sclerosis (MS) treatments, they have not yet been included on the National List of Essential Medicines (NLEM) formulary in Thailand. This study aimed to evaluate the cost-utility of MS treatments compared with best supportive care (BSC) based on a societal perspective in Thailand. A Markov model with cost and health outcomes over a lifetime horizon with a 1-month cycle length was conducted for relapsing-remitting MS (RRMS) patients. Cost and outcome data were obtained from published studies, collected from major MS clinics in Thailand and a discount rate of 3 percent was applied. The incremental cost-effectiveness ratio (ICER) was calculated and univariate and probabilistic sensitivity analyses were performed. When compared with BSC, the ICERs for patients with RRMS aged 35 years receiving fingolimod, IFNβ-1b, and IFNβ-1a were 33,000, 12,000, and 42,000 US dollars (USD) per quality-adjusted life-year (QALY) gained, respectively. At the Thai societal willingness to pay (WTP) threshold of USD 4,500 per QALY gained, BSC had the highest probability of being cost-effective (49 percent), whereas IFNβ-1b and fingolimod treatments showed lower chance being cost-effective at 25 percent and 18 percent, respectively. Compared with fingolimod and interferon treatments, BSC remains to be the most cost-effective treatment for RRMS in Thailand based on a WTP threshold of USD 4,500 per QALY gained. The results do not support the inclusion of fingolimod or interferon in the NLEM for the treatment of RRMS unless their prices are decreased or special schema arranged.

OP108 From Essential Medicines List To Health Technology Assessment, And From Reimbursement To Pricing Decision-Making

Introduction:All health systems are challenged by finite resources to address unlimited demand for services. In many countries priority-setting and resource-allocation decision-making has been inconsistent and unstructured. In these cases, the lack of coherence between limitless promise and limited resources leads to implicit and covert rationing through waiting lines, low quality, inequities, and other mechanisms. Over the past decades, different countries have established specialized health technology assessment (HTA) organizations aimed at better informing health care policies and clinical practice. Although the first technology assessment institution, although not exclusively health related, was the Office for Technology Assessment (OTA) in the U.S. in the 1970s, HTA is not yet current nationwide practice. Nevertheless, there are more than fifty agencies in operation in over thirty countries to assist systematic priority setting, especially in high income countries. The cases of Ukraine, Colombia and U.S. represent different features of the need for systematic priority setting. Ukraine is moving from National essential medicines lists (EML) to more dynamic HTA use to update its publicly funded benefits package; Colombia established a few years ago nationwide HTA, but is currently attempting to use HTA for Pricing and Reimbursement since healthcare coverage is so heavily contested by judicialization. Nevertheless, even in countries where formal HTA activities are ongoing, and in most low and middle income countries, rationing still occurs as an ad hoc, haphazard series of non-transparent choices that reflect the competing interests of governments, payers and other stakeholders. Henceforth, there is the opportunity to closely review why the state of development for HTA varies so much according to setting.Methods:Retrospective policy analysis considering common motivators for the implementation of HTA; the agenda setting model of the three streams (problems, policy and politics) for policy action ; and qualitative approaches for the inception of HTA are being used in these three cases.Results:Through a qualitative approach, ten “drivers” previously emerged with the ability to help or hinder HTA development in Colombia were used to assess the difference of HTA development in the USA and Ukraine (i.e. availability and quality of data, implementation strategy, cultural aspects, local capacity, financial support, policy/political support, globalization, stakeholder pressure, health system context, and usefulness perception). Policy/political and financial support, stakeholder pressure, cultural aspects and health system context were the most prominent drivers to induce or prevent institutional development of HTA in different countries.Conclusions:Common motivators, similar drivers and context specific characteristics are all influential for the implementation of HTA at the national level. Policy/political and financial support, stakeholder pressure, cultural aspects and health system context preliminarily seemed the most prominent drivers to induce or prevent institutional development of HTA in different countries. Henceforth, methods and processes matter, as well as the political economy for HTA. Further research is needed to test these preliminary findings.

Essential cancer medicines in the national lists of countries of the WHO South-East Asia Region: a descriptive assessment.

In 2015, the need for equitable access to cancer treatments in low- and middle income countries was underscored by the addition of 16 essential cancer medicines to the 19th World Health Organization (WHO) model list of essential medicines (WHO EML). This study assessed the degree to which this expanded WHO EML from 2015 has influenced inclusion of cancer medicines in the most recent national essential medicines lists of the countries of the WHO South-East Asia Region. The inclusion of a selected list of 38 essential cancer medicines in the 2015 WHO EML was assessed in the most recent national lists of essential medicines from the 11 countries of the WHO South-East Asia Region. Additionally, the availability of six essential cancer medicines common to the national lists of essential medicines from six countries of the WHO South-East Asia Region was explored. Of the 38 selected essential cancer medicines included in the 19th WHO EML, a mean of 18.0 (range 2-33) were included in the national lists of countries of the WHO South-East Asia Region. Of the 25 essential cancer medicines included in the WHO EML prior to the 19th revision, a mean of 14.6 (range 2-21) were included in national lists; notably fewer of the 13 cancer medicines added in the 2015 revision were included: mean 3.4 (range 0-12). Compared with the WHO EML, there is a lag in the inclusion of essential cancer medicines in national lists of essential medicines in the WHO South-East Asia Region. Alignment of essential cancer medicines in national lists of essential medicines among the 11 countries in the region varies significantly. These differences may hinder regional strategies to improve access to essential cancer medicines, such as pooled procurement of selected high-cost medicines. The link between the availability and affordability of essential cancer medicines warrants further investigation, in the context of access to medicines for universal health coverage.

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.

Study of utilisation trends of drugs in patients admitted with cardiovascular diseases at a tertiary care hospital in Goa

<p class="abstract"><strong>Background:</strong> CVDs have emerged as a leading cause of mortality and morbidity in the world as well as in India. Drug usage is life saving and at times many drugs may be needed. Drug utilization studies aid to find the appropriateness of treatment, identify shortcomings if any, and provide a feedback to the healthcare providers to improve their management with drugs. So such types of studies are of vital importance in every hospital.</p><p class="abstract"><strong>Methods:</strong> This was a prospective, observational study of 180 patients with CVDs admitted in medicine and cardiology wards of a tertiary care hospital, conducted through case records and patients’ interviews. Data was represented as mean±SD, number and frequency. </p><p class="abstract"><strong>Results:</strong> Incidence of cardiovascular diseases was more in males (56.67%) than the females (43.33%). Average number of drugs prescribed per patient was 9.16 and that of cardiovascular drugs was 5.08 ± 2.15. Antiplatelets (88.88%) were the most commonly prescribed cardiovascular drugs followed by hypolipidemics (82.22%). About 15.06% of injectables and 1.2% of fixed dose combinations (FDCs) were prescribed. Drugs prescribed by generic names were 1.6% and those from the National List of Essential Medicines were 92.79%.</p><p><strong>Conclusions:</strong> The results of this study suggested: polypharmacy, overuse of injections and low prescribing habits from essential drug list. Though antiplatelet, hypolipidemic use was higher, these are an essential part of treatment of certain CVDs. </p>

Drug utilization pattern in out-patients with respiratory tract infections in a rural teaching hospital: a prospective observational study

Background: Respiratory tract infections are common clinical problems in the general population. Antimicrobials are the mainstay in the management and irrational use of them may increase resistance to bacteria and the total cost of treatment. Objectives: To evaluate the pattern of drug prescriptions for respiratory tract infections in Medicine and Pediatric outpatient departments of a rural teaching hospital.Methods: Over a period of 18 months, 391 prescriptions of outpatients with respiratory tract infection were collected. The drugs prescribed, their dose and duration of treatment were recorded. DU 90% was calculated.Results: The mean (±SEM) age of the patients was38.55±0.9 years and there were 204 (52.1%) men and 187 (42.1%) women. The most common disorder among the patients was acute rhinitis (61.1%) while the least common was acute bronchitis (1.3%). Microbial culture and sensitivity was done in 23 patients and Klebsiella pneumonia (8.2%) and enterococcus (0.07%) was the most common and least common organism respectively. Penicillins (50.9%), cephalosporins (26.7%), antitubercular drugs (8.5%), macrolides (4.8) constituted DU 90%. Monotherapy was advocated in 91.7% and multidrug therapy in 8.3% of patients. The average number of antimicrobials prescribed per prescription was 0.52. Two thirds (67.6%) of the prescribed drugs were from the national list of essential medicines 2011 (NLEM).Conclusions: Penicillins and cephalosporins were the commonly used antibiotics for respiratory tract infection in outpatients of a rural teaching hospital and two thirds of the prescribed drugs were essential medicines.

Antihypertensive Prescription Pattern and Compliance to JNC 7 and JNC 8 at Tertiary Care Government Hospital, Hyderabad, India: A Cross-sectional Retrospective Study

Background: The monitoring of hypertension treatment can provide insight into the rational drug use pattern. The objective of this study was to examine the antihypertensive medication use among South Indian adults with hypertension in compliance with the hypertension treatment guidelines (Seventh Joint National Committee [JNC 7] and JNC 8). Methods and Results: A total of 550 hypertensive people aged >25 years were included in this retrospective cross-sectional study. The order of drugs prescribed in the year 2012 was beta blockers (BB) > calcium channel blockers (CCB) > CCB + BB > angiotensin receptor blockers (ARB) > angiotensin-converting enzyme inhibitors (ACEI) > thiazide diuretics, whereas in the year 2014, the order has changed drastically, namely, ACEI > CCB > ARB > BB > thiazide diuretics (P < .001). Most notably, there was a large increase in the use of monotherapy (from 56.9% to 82.5%, P < .001). The usage of BB has simply moved from the first position to the last position in concordance with JNC 8 guidelines, whereas use of thiazide diuretics was found to be the least preferred drug in the 2012 prescriptions, thus deviating from JNC 7 guidelines. The use of generic names (28.3% vs 11.3%) and National List of Essential Medicines (NLEM) compliance (79.3% vs 60.9%) were significantly more in the calendar year 2012 than in the calendar year 2014 (P < .001). Conclusions: Antihypertensive medication use has gone through wide variations among south Indian adults with hypertension. Combination therapy regimens must be adopted as per the guidelines for achievement of blood pressure goals.