P-drug Concept Research Articles

A CROSS-SECTIONAL SURVEY OF KNOWLEDGE, ATTITUDE AND PRACTICE OF P-DRUG IN A TEACHING HOSPITAL.

Objective: Postgraduates represent the future generation of practitioners and there aren't many studies on the P-drug idea that specifically target them. Hence, we have taken up this study to assess the knowledge, attitude and practice of P-drug among the postgraduates. Methods: A prospective observational study with a cross-sectional design was conducted at a Tertiary Care Teaching Hospital. Participants' responses were gathered using a pre-validated questionnaire. It evaluated participants' understanding of the P-drug concept, attitudes about P-drugs as treatments for illnesses, and actual P-drug prescribing behaviours. Statistical Package for Social Sciences (SPSS) software version 26 was used to analyze data after compiling data in the Excel sheet. Results: Out of 230 participants, majority were the females (67.8%). 63% of participants were aware of the “rational use of medicines,” and around 57% of them knew about the P-drug concept. 44.8% were aware of STEP criteria which is applied to select P-drug. Only 66 were practising with the P-drug list and the majority of them opined that teaching programmes are necessary to create awareness about the practice of the P-drug. Conclusion: It is encouraging that the current study's findings point to reasonable drug usage rather than irrational use. The P-drug idea is a useful instrument for enhancing medical treatment and encouraging ethical drug usage. Furthermore, additional research has to be done to determine how P-drug use affects patient outcomes and healthcare expenditures over the long run.

Knowledge, attitude, and practice of ‘P-drug concept’ among postgraduate residents and interns in a tertiary care teaching hospital in Maharashtra

Background: A P-drug is a clinician’s personal or preferred or priority choice drug. The study aims to evaluate the knowledge, awareness, and practice of P-drug, which helps postgraduates to prescribe medicines rationally. The objective of this study is to assess the knowledge, attitude, and practice of the P-drug concept among postgraduate students at a tertiary care teaching hospital. Methods: The study is a prospective, cross-sectional pre-validated questionnaire-based study conducted in the tertiary care teaching hospital. A total of 300 postgraduates, interns and consultants from Tertiary care teaching hospital from Maharashtra were enrolled and instructed to fill the questionnaire. These filled forms were collected, and data was analyzed. Results: Out of 300 members, 233 filled the questionnaire, and these forms are evaluated. About 49.7% among them are aware of P-drug, 43.4% are aware of P-treatment, 28.4% are not including fixed-dose combinations in their P-drug list, 42% are aware of the advantages of prescribing P-drug, and 48.4% felt that teaching programs are needed for preparing P-drug list. Conclusions: The P-drug concept is requisite for improving the quality of health care and practicing rational use of medicine. As only a few studies have been conducted on the P-drug idea in this institute, the institutional teaching review board should run teaching programs regarding the P-drug concept.

Knowledge, awareness, and practice of “P-drug” concept among postgraduate students in a tertiary care hospital

Background: P-drug is a personal or preferred or priority choice drug of a clinician. The aim of the study is to evaluate the knowledge, awareness, and practice of P-drug which helps the postgraduates to prescribe drugs rationally. Aim and Objective: The objective of this study was to assess the knowledge, awareness, and practice of P-drug concept among postgraduate students at a tertiary care teaching hospital Vijayanagar Institute of Medical Sciences, Bellary. Materials and Methods: The study was a prospective cross-sectional pre-validated questionnaire-based study conducted in the Vijayanagar Institute of Medical Sciences, Bellary. A total of 300 postgraduates were enrolled and instructed to fill the questionnaire forms. These filled forms were collected, and data were analyzed. Results: Of 300 members, 285 filled the questionnaire, and these forms were evaluated. About 19.7% among them were aware of P-drug, 32.6% were aware of P-treatment, 38.5% were not including fixed-dose combinations in their P-drug list, 33.6% were aware of advantages of prescribing P-drug, and 97.3% felt that teaching programs were needed for preparing P-drug list. Conclusion: For improving the quality of health care and practicing rational use of medicine, the P-drug concept is very helpful. As only few studies have been conducted on the P-drug concept, the institutional teaching review board should conduct teaching programs regarding the P-drug concept.

A questionnaire-based survey among clinicians and postgraduates regarding knowledge, awareness and practice of p-drug in Government General Hospital, Rangaraya Medical College, Kakinada

Background: P-drug is a personal or preferred or priority choice drug of a clinician. The aim of the study is to evaluate knowledge, awareness, practice of p-drug which helps the clinician to prescribe drugs rationally.Methods: The study was a prospective cross-sectional pre-validated questionnaire-based study conducted in Government General Hospital, Rangaraya Medical College, Kakinada. During the study period a total of 300 members were enrolled and instructed to fill the questionnaire forms. These filled forms were collected and data were analyzed.Results: Out of 300 members, 240 filled the questionnaire, and these forms were evaluated. Among them 16.6% were aware of p-drug, 27.5% were aware of P treatment, 32.5% were not including FDC’s in their p drug list, 28.33% were aware of advantages of prescribing P drug and 82% felt that teaching programs were needed for preparing p drug list.Conclusions: For promoting and achieving rational use of medicine, P drug concept is one of the milestones. As few were aware of p-drug concept, institutional teaching review board should conduct teaching programs regarding p drug concept.

Personal formulary for gonorrhea developed by residents of pharmacology

Introduction: Incorporating P-drug concept in pharmacology curriculum can assist the students to learn principles of rational evaluation of available therapeutic options and form a well informed and rational decision concerning drug treatment for an individual patient. This study was designed to develop a personal formulary by senior residents and postgraduate students for the treatment of gonorrhea according to P-drug concept of Joshi and Jayawickramarajah. Materials and Methods: Senior residents and junior residents (post graduate students) were taught about how to analyze and give score (?) to drugs used for gonorrhea available in market with the help of various standard text books & journals available in the library, by internet and Current Index of Medical Specialties (CIMS). Scores were given to each four parameters (efficacy, safety, cost and convenience) from 1 to 10 for each drug. Each parameter had given a fractional numerical rating (β) according to the importance i.e. 0.4 for efficacy, 0.3 for safety, 0.2 for cost and 0.1 for convenience. Score (?) was multiplied by fractional numerical rating (β) to get total score (?=? x β). The drug with the highest score became the personal drug. Results: Cephalosporin group had highest score (8.4). Treatment cost of Cefixime was lowest (? 24.9) with respect to Ceftriaxone (? 30.55) and Cefotaxime (? 30.62) but the overall score was better for Ceftriaxone (score 7.2) so it was chosen as Personal drug for gonorrhea. Further personal formulary was developed for the P-drug ceftriaxone as a practical elaboration of the P-drug concept. Conclusions: Teaching of P-drug concept to residents will be helpful in acquiring proper skills in the development of personal formulary and also helpful in promoting rational use of medicines. Keywords: P-drug, Personal formulary, Rational uses of drugs, Prescription writing.

Problem-Based Question Oriented Learning in Understanding the P-drug Concept among Medical Undergraduates

Objective: To make a better understanding of P-drug concept among undergraduates to bring out a better physician in a society is the main objective behind to include P-drug in the curriculum which can only be made by including problem-based question learning among them. Materials and methods: An observational study was done by including case studies in their practical class of Pdrug. Results: There was a better understanding of the selection of P-drug among undergraduates; it was more convenient for them to understand how to select P-drug on the basis of clinical cases. Conclusion: More and more of the clinical case-based study should be included in the curriculum for better understanding and to bring the future physician with a good concept of rational use of medicine.

Effectiveness of case-based learning, task-based learning, and didactic lectures on teaching personal drug concept among medical undergraduates

Background: P (personal) drug selection is an important competency. The knowledge of how and why a drug is selected for a condition is a gap which can lead to incompetence. Aims and Objectives: This study was conducted to compare the effectiveness of teaching P-drug concept using case-based learning (CBL), task-based learning (TBL), and didactic lectures (DL) among 4th semester medical undergraduates. Materials and Methods: This was a quasi-experimental study conducted in the Department of Pharmacology, Government Medical College, Kottayam, for 2 months. After obtaining ethical clearance and informed consent, the participants (n = 145) were divided into three groups – TBL, CBL, and DL and each received 6 sessions on P-drug concept at the end of which a feedback was collected and an examination was conducted. The data were analyzed with SPSS 16 using ANOVA and Kruskal–Wallis test. Results: The participants of CBL compared to TBL and DL (P < 0.001) agreed that the sessions were interesting, beneficial, and would be a welcome change in curriculum and they would prepare a P list for future use. The TBL participants compared to CBL and DL agreed (P < 0.01) that these sessions imparted skills to select P-drug, gave an idea of the cost of different drugs and different sources of information, and promoted interaction with facilitators. The TBL and DL participants had a greater mean score in post-session assessment compared to those of CBL (P < 0.001). Conclusion: TBL and CBL are innovative methods, well accepted by the participants. A combination of DL, TBL, and CBL will reduce misconception and confusion, curbing future irrational prescriptions.

Problem-Based Question Oriented Learning in Understanding the P-drug Concept among Medical Undergraduates

Problem-Based Question Oriented Learning in Understanding the P-drug Concept among Medical Undergraduates

Assignment-based learning of essential medicine list concepts among undergraduate medical students

Background: The concepts of essential medicines and rational drug therapy are necessary to be understood undergraduate students. Aims and Objectives: (i) To make the second MBBS students aware regarding essential medicine lists (EMLs) through “student assignment.” (ii) To find out differences between 18th and 19th World Health Organization EMLs. Materials and Methods: The assignment-based activity was conducted in pharmacology theory lectures of the fifth semester MBBS batch at Pramukhswami Medical College, Gujarat. A total of 98 undergraduate and four postgraduate students participated in the activity. Students were divided into 19 groups and assigned different categories of EMLs. All the groups were asked to study the assigned categories and prepare the information regarding the 18th and 19th EMLs for presentation in the next session. Descriptive statistics were used to analyze the data. Results: Of 19 groups, four groups submitted the answers through WhatsApp on the same day of assignment. However, only one among the four groups submitted complete and correct answers. Among all groups, presentation of five groups was either incomplete or incorrect. There are total 30 categories in both 18th and 19th EMLs. There are total 409 drugs including 27 fixed-dose combinations (FDCs) in the 19th EML as compared to 377 drugs including 24 FDCs in the 18th EML. However, three new subcategories were added in the 19th EML. Conclusion: This EML-based activity needs to be implemented and repeatedly practiced for the undergraduate MBBS students to make them understand P-drug concept, rational use of medicines now during the student life and also in future during their professional life.

Study on assessment of awareness about concepts in undergraduate pharmacology curriculum among clinicians in a tertiary care teaching hospital

Background: Rational prescribing forms the corner stone of successful implementation of rational drug use. To boost the cause of rational use of Medicine, the P-drug concept was given in late nineties. The idea was to make Physicians familiar with few personal drugs chosen from National Essential drug list based on efficacy, safety, suitability and cost. The present study was conducted to assess the awareness of clinicians about basic pharmacological concepts.Methods: It is a cross sectional study with a study population of 100, conducted in RRMCH for a period of one month. It is a questionnaire based study involving clinicians and post graduates working in this hospital. Descriptive statistical analysis has been carried out in the present study.Results: In our study, 38% of physicians were aware of the term Essential drugs and 26% of doctors prescribed drugs from National Essential drug list. 56% of respondents were aware of term rational drug use but only 1/3 of them were aware of adverse effects, drug interactions of the drugs they prescribed. Majority of physicians (85%) used standard text book as the source of drug information.Conclusions: Lack of knowledge among physicians about new concepts like p-drug, rational drug use and essential drugs points towards need for having more CMEs on basic pharmacological concepts.

Medical students' task based learning of P-drug concept - A study to know its effectiveness and participant feedback

Objectives: To study the effectiveness of task based learning of P-drug concept among 2 nd year medical students in India. Methods: This was an interventional study carried out among two groups of 41medical students each. P-drug concept was introduced to both the groups as a power point aided lecture class. Later, students from group B were assigned a task of preparing a list of P drugs for commonly diagnosed illness in our hospital. Six months after the intervention, knowledge and skills regarding P drug selection was assessed. The results were expressed as counts and percentages. Statistical analysis was done using chi-square test. Student feedback was also taken. Results : Group B showed statistically significant better understanding of P drug concept when compared to group A(p< 0.05). Among group B students 59% were able to rearrange the steps for selecting P drugs in correct order which was significant (p< 0.05), compared to 37% from group A. For determining suitability of drug, 75.6% students from group A and 49% from group B gave importance to patient related factors. Drug related factors were considered important by 19% students from group A and 37% from group B. Group B students (29%) showed statistically significant (p <0.05) better understanding of the concept of essential medicines when compared to 10% students from group A. Conclusion: Feedback from interventional group was positive and encouraging. Performing a task provided them to learn better about P drug concept.

Evaluation of knowledge, attitude and practice of rational use of medicines among clinicians in a tertiary care teaching hospital

Context: Prescribing is a challenging task requiring knowledge of essential medicine (EM), rational use of medicines (RUM) and personal drugs (P-drug). Though the majority of clinicians recognize the importance of RUM, most of them have not been able to apply this knowledge in their medical practice. Aims: The aim of the following study is to assess knowledge, attitude and practice of clinicians about RUM, EM, P-drugs, and sources of drug information. Settings and Design: A cross-sectional, questionnaire based study . Subjects and Methods: Study was carried out in 100 respondents including faculty members and junior residents (JRs) in a tertiary-care teaching hospital. Statistical Analysis: Univariate analysis was carried out using fisher's exact test. Results: Nearly 93% respondents were aware about EM, but only 79% prescribe them. Percentage is significantly higher in respondents of age more than 30, having clinical experience <5 years and in faculty members as compared to residents. Nearly 87% respondents were aware about RUM, but only 83% practice it. Though 30% respondents practiced P-drug concept only 1% were aware about STEP criteria. Practicing P-drug concept was significantly more in JRs compared to faculty members (P < 0.0001). None of the respondents were aware about the number of drugs in National List of EMs of India . Conclusions: It is an encouraging finding that higher percentages of clinicians were aware about EM and also prescribed it. However, level of understanding related to P-drug concept and existence of essential medicines list are much below par. Also prescribing by trade name and heavy dependency on medical representatives for drug information is the matter of concern.

The concept of personal drugs in the undergraduate pharmacology practical curriculum.

I have read the thought provoking research letter by Dr Parmar and Jadav on The concept of personal drugs in the undergraduate pharmacology practical curriculum.[1] I have the following comments to share with the readership of the IJP. The concept of P-drug for the undergraduate practical curriculum is a good instrument to promote the practice of rational therapeutics with the objective to promote use of cost effective, safe and suitable medicines. However, the concept needs to be utilized in its right perspective so that it does not leave enough to question its utility. In selecting a P-drug for acute amoebic dysentery so far as the drug group is concerned, nitroimidazoles may be the choice. However, choosing a drug among this group will require utilization of certain criteria. Therefore, using the criteria of efficacy, safety, suitability and affordability [Table 1], one may conclude that tinidazole is a better choice to be a P-drug (along with a luminal amoebicide-vide infra). This is because of its suitability i.e., once or twice daily intake) and comparable cost of a course of treatment (3 days for tinidazole v/s 7-10 days of metronidazole). The authors have ignored the suitability factor. It is one of the important criteria for selecting a P-drug. It not only includes patient-related conditions, which preclude the use of selected drug, but also the convenience of dosage form and dosage schedule.[2] Adherence to treatment is improved by creating a good doctor-patient relationship, giving necessary drug related information to the patient and most importantly, prescribing a few drugs with a simple dosage schedule (one or two times a day).[2] Table 1 Comparison of nitroimidazoles in acute amoebic dysentery[4] It is difficult to agree with the authors' proposition of ignoring the advice of clinical teachers in selecting P-drug. Medical teachers have gained expertise from long standing practice and medical students learn greatly from these experts. In fact they may provide vital information to the students about the use of existing drugs and this will help them a lot in selecting their own P-drugs. Furthermore, authors' recommendation of use of a luminal amoebicide AFTER a course of nitroimidazole is contrary to the text book recommendation of its concurrent use.[4,5] Is a P-drug concept different from the principle of choosing a ‘drug’ of choice? The drug of choice for roundworm infestation is selected by using same criteria [Table 2]. Table 2 Criteria of selection of a suitable antihelminthic agent[3–4] It is clear that albendazole is a drug of choice because of convenience of single dose, comparable efficacy, safety and cost. It can also be considered to be a P-drug for roundworm infestation.

P-drug concept and the undergraduate teaching

P-drug concept and the undergraduate teaching

The concept of personal drugs in the undergraduate pharmacology practical curriculum

I have read the thought provoking research letter by Dr Parmar and Jadav on The concept of personal drugs in the undergraduate pharmacology practical curriculum.[1] I have the following comments to share with the readership of the IJP. The concept of P-drug for the undergraduate practical curriculum is a good instrument to promote the practice of rational therapeutics with the objective to promote use of cost effective, safe and suitable medicines. However, the concept needs to be utilized in its right perspective so that it does not leave enough to question its utility. In selecting a P-drug for acute amoebic dysentery so far as the drug group is concerned, nitroimidazoles may be the choice. However, choosing a drug among this group will require utilization of certain criteria. Therefore, using the criteria of efficacy, safety, suitability and affordability [Table 1], one may conclude that tinidazole is a better choice to be a P-drug (along with a luminal amoebicide-vide infra). This is because of its suitability i.e., once or twice daily intake) and comparable cost of a course of treatment (3 days for tinidazole v/s 7-10 days of metronidazole). The authors have ignored the suitability factor. It is one of the important criteria for selecting a P-drug. It not only includes patient-related conditions, which preclude the use of selected drug, but also the convenience of dosage form and dosage schedule.[2] Adherence to treatment is improved by creating a good doctor-patient relationship, giving necessary drug related information to the patient and most importantly, prescribing a few drugs with a simple dosage schedule (one or two times a day).[2] Table 1 Comparison of nitroimidazoles in acute amoebic dysentery[4] It is difficult to agree with the authors' proposition of ignoring the advice of clinical teachers in selecting P-drug. Medical teachers have gained expertise from long standing practice and medical students learn greatly from these experts. In fact they may provide vital information to the students about the use of existing drugs and this will help them a lot in selecting their own P-drugs. Furthermore, authors' recommendation of use of a luminal amoebicide AFTER a course of nitroimidazole is contrary to the text book recommendation of its concurrent use.[4,5] Is a P-drug concept different from the principle of choosing a ‘drug’ of choice? The drug of choice for roundworm infestation is selected by using same criteria [Table 2]. Table 2 Criteria of selection of a suitable antihelminthic agent[3–4] It is clear that albendazole is a drug of choice because of convenience of single dose, comparable efficacy, safety and cost. It can also be considered to be a P-drug for roundworm infestation.

Application of personal drug (P-drug) seminar to clinical pharmacy education in the graduate school of pharmaceutical sciences

The P-drug seminar, a novel method of teaching the process of rational pharmacotherapy, was introduced in 2000 into the practice program of the clinical pharmacy course in the Graduate School of Pharmaceutical Sciences, Toyama Medical and Pharmaceutical University (TMPU). The P-drug concept is evidence-based drug selection according to criteria (i.e., efficacy, safety, suitability and cost) deter mined in advance and rational prescribing by each physician. The P-drug seminar originated from educational courses for medical students at the University of Groningen and has been propagated by the WHO Action Programme on Essential Drugs world wide. In the TMPU, the seminar consists of 5 half-days before the start of bedside teaching during clinical pharmacy practice. Each term, 8 graduate students licensed as pharmacists form one seminar group, and 32 students have completed it successfully in the past 2 years. Problem-based learning and self-awareness methods are applied through discussion among students. The same teaching materials as those used in the WHO P-drug workshop and the English textbook Guide to Good Prescribing were adopted. A short lecture on the pharmacist's role in the rational use of drugs was added to modify the original P-drug workshop for medical students since this was considered suitable for graduate students in clinical pharmacy. Our graduate students were able to learn the process of pharmacotherapy by following the steps of P-drug selection and rational treatment under the P-drug concept and also understand the viewpoint of prescribers and pharmacists' roles as medical staff. In conclusion, this is the first report on application of the P-drug method to clinical pharmacy education.