Prescribing Patterns Research Articles

Assessing prescribing practices in a rural hospital: A cross-sectional study using WHO prescribing indicators

This cross-sectional study aims to assess the prescribing practices of physicians at a rural hospital in Western India, focusing on adherence to WHO prescribing indicators. The main research question addressed the extent of alignment with optimal prescribing standards. 1: Evaluate prescribing patterns in a rural hospital using WHO indicators. 2: Assess alignment with WHO standards and identify areas for improvement. 3: Understand demographic influences on prescribing. 4: Provide insights for optimizing rural healthcare delivery.A prospective, descriptive, cross-sectional approach was employed in the outpatient department of the rural hospital. A total of 604 prescriptions were sampled over two months, and data were collected using a random sampling method. The study followed ethical standards, and prescriptions were analyzed for demographic characteristics, prescribing patterns, and adherence to WHO indicators. The average number of drugs per prescription was 3.5, indicating a tendency towards polypharmacy. While 86% of drugs were prescribed generically, the study revealed areas of suboptimal adherence to WHO prescribing indicators, including antibiotic prescriptions (29%) and injectable use (50%). The analysis also highlighted disparities in prescribing patterns based on gender and age. The study provides valuable insights into prescribing practices in a rural healthcare setting, emphasizing the need for interventions to streamline prescriptions and enhance adherence to global standards. The identified areas for improvement include addressing polypharmacy, promoting generic prescribing, and optimizing antibiotic and injectable use.

A study on appropriate use and stewardship of proton pump inhibitors

Objective: To analyze the prescribing pattern of use of PPI with respect to “FDA-Approved Indications and Doses for PPI Therapy.” Materials and Methods: After obtaining approval from the Institutional Ethics Committee, a cross-sectional study was carried out among 400 inpatients in a tertiary care hospital in Bangalore. The data were collected from the patient case profile and prescriptions and noted in a self-designed data collection form. The statistical analysis of the collected data was performed using SPSS software and Excel. Results: The study, conducted on 400 patients, revealed a male majority (60%) and a female representation of 40%. Proton Pump Inhibitors (PPIs), mainly Pantoprazole (74.70%), were frequently prescribed, notably in General Medicine (220 patients). PPI use was generally appropriate: indication (99%), dose (97%), frequency (92.8%), and duration (91.8%). However, irrational prescriptions were noted: indication (1%), dose (3%), frequency (7.3%), and duration (8.3%). 139 drug interactions were identified, categorized into Major (39.6%), Moderate (46%), and Minor (14.4%). For example, Ondansetron and tramadol exhibited a major interaction. Among PPI combinations, 93.75% could affect CYP2C19 metabolism, and 6.3% had additive/synergistic toxicity potential.

A Study on Prescription Pattern of Drugs in Orthopaedics Inpatient Department of Navodaya Medical College Hospital and Research Centre in Raichur

A Study on Prescription Pattern of Drugs in Orthopaedics Inpatient Department of Navodaya Medical College Hospital and Research Centre in Raichur

SABINA + Hong Kong: a territory wide study of prescribing trends and outcomes associated with the use of short-acting β2 agonists in the Chinese population

BackgroundExcessive use of short-acting β2 agonists (SABA) in patients with asthma continues to be a notable concern due to its link to higher mortality rates. Global relevance of SABA overuse in asthma management cannot be understated, it poses significant health risk to patients with asthma and imposes burden on healthcare systems. This study, as part of global SABINA progamme, aimed to describe the prescribing patterns and clinical outcomes associated with SABA use in the Chinese population.MethodsRetrospective cohort study was conducted using anonymized electronic healthcare records of Clinical Data Analysis and Reporting System (CDARS) from Hong Kong Hospital Authority (HA). Patients newly diagnosed with asthma between 2011 and 2018 and aged ≥12 years were included, stratified by SABA use (≤2, 3–6, 7–10, or ≥11 canisters/year) during one-year baseline period since asthma diagnosis date. Patients were followed up from one-year post-index until earliest censoring of events: outcome occurrence and end of study period (31 December 2020). Cox proportional regression and negative binomial regression were used to estimate the mortality risk and frequency of hospital admissions associated with SABA use respectively, after adjusting for age, sex, Charlson Comorbidity Index (CCI), and inhaled corticosteroid (ICS) dose. Outcomes include all-cause, asthma-related, and respiratory-related mortality, frequency of hospital admissions for any cause, and frequency of hospital admissions due to asthma.Results17,782 patients with asthma (mean age 46.7 years, 40.8% male) were included and 59.1% of patients were overusing SABA (≥ 3 canisters per year). Each patient was prescribed a median of 5.61 SABA canisters/year. SABA overuse during baseline period was associated with higher all-cause mortality risk compared to patients with ≤2 canisters/year. Association was dose-dependent, highest risk in those used ≥11 canisters/year (adjusted hazard ratio: 1.42, 95% CI: 1.13, 1.79) and 3–6 canisters/year (adjusted hazard ratio: 1.22, 95% CI: 1.00, 1.50). Higher SABA prescription volume associated with increased frequency of hospital admissions with greatest risk observed in 7–10 canisters/year subgroup (adjusted rate ratio: 4.81, 95% CI: 3.66, 6.37).ConclusionsSABA overuse is prevalent and is associated with increased all-cause mortality risk and frequency of hospital admissions among the patients with asthma in Hong Kong.

Antibiotic appropriateness at outpatient settings in Ethiopia: the need for an antibiotic stewardship programme.

Antibiotics are drugs of natural or synthetic origin used to treat various infections. The practice of excessive and inappropriate antibiotics use is the main global cause of bacterial resistance, which is one of the most serious global public health threats. It is estimated that about 50% of global antibiotic prescriptions are inappropriate. This study assesses the prevalence and pattern of inappropriate prescriptions of antibiotics amongst ambulatory care visits in Ethiopia. A facility-based, cross-sectional study with a quantitative approach was conducted amongst randomly selected prescriptions issued for outpatients from May to June 2022 at Debre Markos Specialized Comprehensive Hospital, Northwest Ethiopia. Descriptive statistics, such as frequencies and percentages, were computed. For group comparisons, χ2 and independent sample t-tests were computed. The statistical significance of the association was considered at p<0.05. A total of 2640 antibiotics were prescribed for patients in the outpatient setting with various bacterial infections via 911 prescriptions, of which 49.5% were non-compliant with the national treatment guideline. Guideline non-compliant prescriptions increased remarkably amongst patients in the outpatient setting diagnosed with community-acquired pneumonia (38.8% versus 30.1%; p=0.006) and peptic ulcer disease (14.9% versus 9%; p=0.006). Moreover, inappropriate prescription was significantly higher amongst patients taking amoxicillin/clavulanic acid (33.2% versus 48.2%; p<0.001) and cephalexin (17.8% versus 24.3%; p=0.016). Large proportions of antibiotic prescriptions for outpatients were non-compliant with the national treatment guideline, suggesting that prescribers need to give special attention to outpatients whilst ordering antibiotics such as amoxicillin/clavulanic acid and cephalexin. Antibiotic stewardship efforts to optimize outpatient antibiotic prescriptions and reduce the use of potentially inappropriate antibiotics are needed in Ethiopia.

Prescription of lipid-lowering therapy, LDLc control, and risk of MACE in patients after ST-elevation myocardial infarction in Mexico

Abstract Funding Acknowledgements None. Background/Introduction Optimal control of low-density lipoprotein cholesterol (LDLc) has been demonstrated to reduce cardiovascular event rates after ST-elevation myocardial infarction (STEMI). However, real-world data shows that a low proportion of patients achieve LDLc targets. Furthermore, the association of LDLc levels and major cardiovascular adverse events (MACE) in post-STEMI patients is limited in developing countries. Purpose In this study, we aimed to assess the prescription patterns of lipid-lowering therapies, LDLc control, and their impact on the risk of MACE after STEMI in Mexico. Methods We conducted a prospective observational study of patients with STEMI. LDLc levels and prescriptions of lipid-lowering therapy were assessed during the first scheduled visit following STEMI hospital discharge. LDLc control was determined in accordance with the 2023 European Society of Cardiology Acute Coronary Syndrome Guidelines, which recommend achieving LDLc levels below 55 mg/dL for secondary prevention. Patients were categorized as controlled (if LDLc &amp;lt;55 mg/dL) and not controlled (if LDLc &amp;gt;55 mg/dL) and were followed for a median of 4.5 years to evaluate the rate of MACE, including cardiovascular death, cardiogenic shock, recurrent MI, and heart failure. Results We included 447 patients with a mean age of 57.87 (± 10.5 years), predominantly male (84.5%). Hypertension (43.8%), smoking (41.1%), type 2 diabetes mellitus (33.5%), obesity (26.6%), and dyslipidemia (21.4%) were highly prevalent. The median LDLc level in the total population was 65.4 mg/dL (IQR 49.2- 87.7). Among these, 34% (152) were considered controlled, while 66% (295) were not. Baseline clinical characteristics did not significantly differ among the groups. Prescription of high-intensity statins reached 94.7%, and ezetimibe and PCSK-9i were used in 1.8% and 0.4% of cases, respectively. We observed no statistically significant difference (Hazard ratio: 1.03, 95% confidence interval 0.74-1.73) in the rate of MACE based on LDLc control (Fig.1). The risk of MACE was also not different based on the use of high-intensity statins. Conclusions In this real-world study of patients post-STEMI, LDLc control was achieved in just one-third of the population. While the prescription of high-intensity statins was high, combination therapy was low. We did not observe a statistically significant association with an increased long-term risk of MACE; however, we noted a higher rate of events compared with other series.

Antithrombotic therapy after heart valve surgery, contemporary practice in the United Kingdom.

There is a lack of high-quality data informing the optimal antithrombotic drug strategy following bioprosthetic heart valve replacement or valve repair. Disparity in recommendations from international guidelines reflects this. This study aimed to document current patterns of antithrombotic prescribing after heart valve surgery in the UK. All UK consultant cardiac surgeons were e-mailed a custom-designed survey. The use of oral anticoagulant (OAC) and/or antiplatelet drugs following bioprosthetic aortic (AVR) or mitral valve replacement (MVR), or mitral valve repair (MVrep), for patients in sinus rhythm, without additional indications for antithrombotic medication, was assessed. Additionally, we evaluated anticoagulant choice following MVrep in patients with atrial fibrillation (AF). We identified 260 UK consultant cardiac surgeons from 36 units, of whom 103 (40%) responded, with 33 units (92%) having at least one respondent. The greatest consensus was for patients undergoing bioprosthetic AVR, in which 76% of surgeons favour initial antiplatelet therapy and 53% prescribe lifelong treatment. Only 8% recommend initial OAC. After bioprosthetic MVR, 48% of surgeons use an initial OAC strategy (versus 42% antiplatelet), with 66% subsequently prescribing lifelong antiplatelet therapy. After MVrep, recommendations were lifelong antiplatelet agent alone (34%) or following 3 months OAC (20%), no antithrombotic agent (20%), or 3 months OAC (16%). After MVrep for patients with established AF, surgeons recommend warfarin (38%), a direct oral anticoagulant (37%) or have no preference between the two (25%). There is considerable variation in the use of antithrombotic drugs after heart valve surgery in the UK and a lack of high-quality evidence to guide practice, underscoring the need for randomized studies.

Assessment of antibiotic prescribing pattern and cost for hospitalized patients: A study from Palestine.

One of the largest problems facing the world today is the morbidity and mortality caused by antibiotic resistance in bacterial infections. A major factor in antimicrobial resistance (AMR) is the irrational use of antibiotics. The objective of this study was to assess the prescribing pattern and cost of antibiotics in two major governmental hospitals in the West Bank of Palestine. A retrospective cohort study was conducted on 428 inpatient prescriptions containing antibiotics from two major governmental hospitals, they were evaluated by some drug use indicators. The cost of antibiotics in these prescriptions was calculated based on the local cost. Descriptive statistics were performed using IBM-SPSS version 21. The mean ± SD number of drugs per prescription (NDPP) was 6.72 ± 4.37. Of these medicines, 38.9% were antibiotics. The mean ± SD number of antibiotics per prescription (NAPP) was 2.61 ± 1.54. The average ± SD cost per prescription (CPP) was 392 ± 744 USD. The average ± SD antibiotic cost per prescription (ACPP) was 276 ± 553 USD. The most commonly prescribed antibiotics were ceftriaxone (52.8%), metronidazole (24.8%), and vancomycin (21.0%). About 19% of the antibiotics were prescribed for intra-abdominal infections; followed by 16% used as prophylactics to prevent infections. Almost all antibiotics prescribed were administered intravenously (IV) 94.63%. In general, the average duration of antibiotic therapy was 7.33 ± 8.19 days. The study indicated that the number of antibiotics per prescription was statistically different between the hospitals (p = 0.022), and it was also affected by other variables like the diagnosis (p = 0.006), the duration of hospitalization (p < 0.001), and the NDPP (p < 0.001). The most commonly prescribed antibiotics and the cost of antibiotics per prescription were significantly different between the two hospitals (p < 0.001); The cost was much higher in the Palestinian Medical Complex. The practice of prescribing antibiotics in Palestine's public hospitals may be unnecessary and expensive. This has to be improved through education, adherence to recommendations, yearly immunization, and stewardship programs; intra-abdominal infections were the most commonly seen infection in inpatients and ceftriaxone was the most frequently administered antibiotic.

Abstract PO4-17-07: RELATE 2: A real-world observational study assessing feasibility, acceptability, perceived impacts of digital apps for patients receiving olaparib or trastuzumab deruxtecan (T-DXd) as part of routine clinical practice

Abstract Background: Safe and effective use of two new treatments, T-DXd or olaparib, in breast cancer (BC) requires awareness, education and co-ownership by patients and care teams. It is hypothesized that a patient-centered digital app that provides disease and treatment-specific guidance and symptom reporting functionality while collecting specific data could positively impact patients’ confidence, self-monitoring of symptoms and experience of care. This study will develop and assess two new treatment-specific versions of the accredited OWise app to evaluate how BC patients accept and use the app and how use in routine care appears to impact patients and their experience of care in relation to monitoring symptoms. As a novel element, this study will explore the feasibility of combining treatment-specific real-world data collection with digital health support to understand how treatment patterns and characteristics in the real-world setting. OWise is a specific BC app that has been endorsed by NHS digital and is widely available through NHS app library in UK and in Netherlands. It currently has over 18K registered users. Trial Design: The study involves two workstreams which include several sources for data collection. Workstream 1 involves collection of participants OWise data (including patient entered data as well as usage statistics) and a brief survey for participants to provide feedback on their experience using OWise every three months for up to 18 months. Survey questions are focused on their perceptions of the usefulness of the app for monitoring their health changes and communicating with their care team. Workstream 2, will launch approximately three months after the launch of Workstream 1 and will include qualitative interviews with two groups of people: 1) a small number of participants who are already enrolled in Workstream 1 and 2) clinicians (and multidisciplinary team/nurses) to further understand the perceived benefits of the app. The study’s duration will be 21 months Eligibility Criteria: The patients must be prescribed either T-DXd or Olaparib and be at least 18 years of age, be able to create an OWise account (e.g., mobile or web application) and have activated the unique study code for the treatment specific version of OWise and be able to provide online consent for study participation Aims: Primary objectives are to evaluate the feasibility, acceptability, and perceived impacts on patient experience, treatment use, and quality of care of two treatment specific OWise apps in routine BC care. Secondary objectives will focus on prescribing patterns, concomitant medicine use in UK practice, understanding strategies used in the real-world setting to manage AE and demographic and clinical characteristics of patients treated in the UK Statistical methods: Aggregated Participant-level quantitative data and usage data will be analyzed for response frequencies, means, standard deviations (SD), medians, ranges, and confidence intervals (CI). Descriptive statistics and advanced statistics will be used to identify core variables and trends, investigate data distribution links between data, test significant differences between datasets according to profile/status. Target Accrual: 300 patients T-DXd and 150 olaparib using the OWise app and being part of the real-world study. The prescription decision is independent of the study enrolment. Contact: Dr Sophie McGrath. sophie.mcgrath@rmh.nhs.uk Citation Format: Sophie McGrath, Peter Hall, Michael Acquadro, Soren Skovlund, Parveen Jayia, Stuart McIntosh, David Cameron. RELATE 2: A real-world observational study assessing feasibility, acceptability, perceived impacts of digital apps for patients receiving olaparib or trastuzumab deruxtecan (T-DXd) as part of routine clinical practice [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-17-07.

Development of antibiotic metrics for hospitalists via multi-institutional modified Delphi survey.

Closing the gap between evidence-supported antibiotic use and real-world prescribing among clinicians is vital for curbing excessive antibiotic use, which fosters antimicrobial resistance and exposes patients to antimicrobial side effects. Providing prescribing information via scorecard improves clinician adherence to quality metrics. We aimed to delineate actionable, relevant antimicrobial prescribing metrics extractable from the electronic health record in an automated way. We used a modified Delphi consensus-building approach. Our study entailed two iterations of an electronic surveydisseminated to hospital medicine physicians at 10 academic medical centers nationwide. Main outcomes comprised consensus metrics describing the quality of antibiotic prescribing to hospital medicine physicians. Twenty-eight participants from 10 United States institutions completed the first survey version containing 38 measures. Sixteen respondents completed the second survey, which contained 37 metrics. Sixteen metrics, which were modified based on qualitative survey feedback, met criteria for inclusion in the final scorecard. Metrics considered most relevant by hospitalists focused on the appropriate de-escalation of antimicrobial therapy, selection of guideline-concordant antibiotics, and appropriate duration of treatment for common infectious syndromes. Next steps involve prioritization and implementation of these metrics based on quality gaps at our institution, focus groups exploring impressions of clinicians who receive a scorecard,and analysis of antibiotic prescribing patterns before and after metric implementation. Other institutions may be able to implement metrics from this scorecard based on their own quality gaps to provide hospitalists with automated feedback related to antibiotic prescribing.

Retrospective study investigating naloxone prescribing and cost in US Medicaid and Medicare patients

BackgroundOpioid overdoses in the USA have increased to unprecedented levels. Administration of the opioid antagonist naloxone can prevent overdoses.ObjectiveThis study was conducted to reveal the pharmacoepidemiologic patterns in naloxone prescribing...

Evaluation of antipsychotic side effects on schizophrenia patients at Dr Radjiman Wediodiningrat Hospital, Indonesia

Background: Schizophrenia is the most common mental illness with a poor prognosis. Antipsychotics are the major treatment for Schizophrenia. Objective: This study examines schizophrenia patients' side effects and antipsychotic medication. Method: A retrospective study with cross-sectional observational analysis was conducted in June 2023, with only the data from schizophrenia patients in Dr. Radjiman Wediodiningrat Hospital, Indonesia. Data were collected from the prescription records of schizophrenia inpatients from January to June 2023. The Chi-square test was used to analyse and measure the relationship between the incidence of adverse events with antipsychotics in schizophrenia patients. Result: Schizophrenia inpatients were majority male (74.7%) and the age 18-35 years was 41%. This study showed that the pattern of prescription of antipsychotics is atypical monotherapy (37.6%) and combinations (24.9%) were the most antipsychotics prescribed. Most of the schizophrenia outpatients have extrapyramidal syndrome side effects (31.9%), such as rigidity (12.2%), tremor (3.5%), dystonia (6.6%), and other side effects (11.8%). Conclusion: This study highlighted that atypical antipsychotics were the most common choice for treatment in the inpatient setting. Atypical have a lower risk of extrapyramidal side effects than typical. The negative effects of atypical antipsychotics, including metabolic syndrome, have not been identified. Thus, more research is required.

A Scoping Review of Studies Using Artificial Intelligence Identifying Optimal Practice Patterns for Inpatients With Type 2 Diabetes That Lead to Positive Healthcare Outcomes

The objective of this scoping review was to survey the literature on the use of AI/ML applications in analyzing inpatient EHR data to identify bundles of care (groupings of interventions). If evidence suggested AI/ML models could determine bundles, the review aimed to explore whether implementing these interventions as bundles reduced practice pattern variance and positively impacted patient care outcomes for inpatients with T2DM. Six databases were searched for articles published from January 1, 2000, to January 1, 2024. Nine studies met criteria and were summarized by aims, outcome measures, clinical or practice implications, AI/ML model types, study variables, and AI/ML model outcomes. A variety of AI/ML models were used. Multiple data sources were leveraged to train the models, resulting in varying impacts on practice patterns and outcomes. Studies included aims across 4 thematic areas to address: therapeutic patterns of care, analysis of treatment pathways and their constraints, dashboard development for clinical decision support, and medication optimization and prescription pattern mining. Multiple disparate data sources (i.e., prescription payment data) were leveraged outside of those traditionally available within EHR databases. Notably missing was the use of holistic multidisciplinary data (i.e., nursing and ancillary) to train AI/ML models. AI/ML can assist in identifying the appropriateness of specific interventions to manage diabetic care and support adherence to efficacious treatment pathways if the appropriate data are incorporated into AI/ML design. Additional data sources beyond the EHR are needed to provide more complete data to develop AI/ML models that effectively discern meaningful clinical patterns. Further study is needed to better address nursing care using AI/ML to support effective inpatient diabetes management.

71. Psychiatric Prescription Patterns and Treatment Outcomes in 3q29 Deletion Syndrome

71. Psychiatric Prescription Patterns and Treatment Outcomes in 3q29 Deletion Syndrome

PRESCRIPTION PATTERN OF NUTRACEUTICALS IN PATIENTS VISITING A TERTIARY CARE HOSPITAL, KATHMANDU, NEPAL

Objectives: This study aims to provide a comprehensive analysis of the prescription pattern of nutraceuticals in patients visiting a tertiary care hospital in Kathmandu which includes identification of commonly prescribed nutraceuticals, analysis of co-prescribed drug classes, identification of major nutraceutical compositions, analysis of patient expenditure on nutraceuticals, and quantification of nutraceutical availability. Methods: A purposive sampling method was used to conduct a descriptive cross-sectional study involving 304 patients from the outpatient departments of a tertiary care hospital, Nepal. Data on patients’ sociodemographic characteristics, co-prescribed drugs, nutraceutical details, and supplement expenses were collected using a structured questionnaire and form. Patient cards provided the necessary information, which was then analyzed with SPSS-16 and Microsoft Excel. Results: Out of 304 prescriptions analyzed, 64% were prescribed to females and 26% to patients aged 31–45 years. The general medicine department accounted for 44% of nutraceutical prescriptions, with multivitamins being the most common (91%). Tablets were the preferred dosage form 56%, and gastrointestinal disorder medicine was commonly co-prescribed with nutraceuticals. Nutraceuticals alone accounted for approximately 52% of the total medicine cost. Conclusion: Nutraceuticals are being continuously used in the treatment of various diseases. The future of nutraceuticals is bright and can transform health care. More studies need to be taken up on the prescription of nutraceuticals in health care.

Prescription and Dispensation of QT-Prolonging Medications in Individuals Receiving Hemodialysis

Individuals with dialysis-dependent kidney failure have numerous risk factors for medication-related adverse events, including receipt of care by multiple clinicians and initiation of some QT-prolonging medications with known risk of torsades de pointes (TdP), which is associated with higher risk of sudden cardiac death. Little is known about the prescription and dispensation patterns of QT-prolonging medications among people receiving dialysis, hindering efforts to reduce drug-related harm from these and other medications in this high-risk population. To examine prescription and dispensation patterns of QT-prolonging medications with known TdP risk and selected interacting medications prescribed to individuals receiving hemodialysis. This cross-sectional study included patients 60 years or older who were enrolled in Medicare Parts A, B, and D receiving in-center hemodialysis from January 1 to December 31, 2019. Analyses were conducted from October 20, 2022, to June 16, 2023. New-user prescriptions for the 7 most frequently filled QT-prolonging medications characterized by the timing of the new prescription relative to acute care encounters, the type of prescribing clinician and pharmacy that dispensed the medication, and concomitant use of selected medications known to interact with the 7 most frequently filled QT-prolonging medications with known TdP risk. The main outcomes were the frequencies of the most commonly filled and new-use episodes of QT-prolonging medications; the timing of medication fills relative to acute care events; prescribers and dispensing pharmacy characteristics for new use of medications; and the frequency and types of new-use episodes with concurrent use of potentially interacting medications. Of 20 761 individuals receiving hemodialysis in 2019 (mean [SD] age, 74 [7] years; 51.1% male), 10 992 (52.9%) filled a study drug prescription. Approximately 80% (from 78.6% for odansetron to 93.9% for escitalopram) of study drug new-use prescriptions occurred outside of an acute care event. Between 36.8% and 61.0% of individual prescriptions originated from general medicine clinicians. Between 16.4% and 26.2% of these prescriptions occurred with the use of another QT-prolonging medication. Most potentially interacting drugs were prescribed by different clinicians (46.3%-65.5%). In this cross-sectional study, QT-prolonging medications for individuals with dialysis-dependent kidney failure were commonly prescribed by nonnephrology clinicians and from nonacute settings. Prescriptions for potentially interacting medications often originated from different prescribers. Strategies aimed at minimizing high-risk medication-prescribing practices in the population undergoing dialysis are needed.

A situational analysis of antibiotic prescription, dispensing practices and resistance pattern in Nepal: Are we losing the battle?

Background: Antibiotics are widely utilized to treat infections and provide preventative and therapeutic benefits in animal and human healthcare. However, because of the emergence and spread of resistance mechanisms, which cause bacteria to become less susceptible to antibiotics and other treatments and less effective, antimicrobial resistance (AMR) has grown to be one of the most significant worldwide public health concerns. Low- and middle-income countries (LMICs) such as Nepal have a high rate of infectious illnesses and antibiotic resistance, which can lead to both human and financial losses. Methods: The information for the scenario analysis was acquired through a review of published and grey literature, as well as interviews with important stakeholders from all sectors. Conclusion: Besides knowing all the challenges of antibiotic resistance, the programs assuring towards AMR is conducted in Nepal in very infrequent way. The antibiotic use should be optimize by giving various personalized treatment approaches and accurate diagnosis which plays vital roles in minimizing unnecessary antibiotic prescriptions. We can organize different awareness programs to reduce antibiotic resistance that may enhance the proper use of antibiotic with proper dose and prescription in accordance health care professionals. Interpreting all the problems, government should give more priority to antibiotic resistance and should be able to minimize the problems. If antibiotic resistance is not taken in a very serious way by all the healthcare workers like doctors, nurses, pharmacists, lab technicians, etc. then the battle we are fighting leads to be defeated and problem will never end.

Prescription Pattern of Cholelithiasis at Surgery Ward in Tertiary Care Hospital

Background: Cholelithiasis is a chronic recurrent disease of the hepatobiliary system. The impaired metabolism of cholesterol, bile acids and bilirubin are characterized by gallstone formation.The number of surgical procedures for cholelithiasis has risen markedly in developed countries since 1950. An estimated 90% of cholecystectomies are now performed by the laparoscopic approach worldwide. Objectives: The aim of the study was to study prescription pattern of Cholelithiasis at surgery ward in B&amp;C medical college teaching hospital and research Centre Pvt. Ltd. Materials and Methods: A Retrospective study was conducted and data of Cholelithiasis cases admitted at Surgery ward from 2077/01/01 BS to 2077/12/31 BS were collected. Coding of data , result and interpretation of data were drawn using SPSS version 16 and MS Excel 2016 . Result: The present study included 137 patients.Among them,80.3% were females and 19.7% were males. The high incidence of cholelithiasis was found in the age group 30-39 years (27%). 98.5% of total hospitalized patient were prescribed with antibiotics followed by Proton Pump inhibitors (93.4%) and NSAIDS(92%) .Among antibiotics, Ceftriaxone (65.7%) were the most prescribed one. During discharge , antibiotics (98.5%) were the most prescribed group of medicine followed by Proton Pump Inhibitors (88.3%) and NSAIDS(67.9%). And among antibiotics, Cefixime (52.6%) were mostly prescribed. While analyzing prescription pattern of discharge medication it was found that percentage of drugs prescribed by generic name was 13.86% and percentage of drugs prescribed from essential drug list was 43.36%. Conclusion: The present study revealed that there was greater incidence of Cholelithiasis in females (80.3%) than in males and in the age group 30-39 years (27%) .The results obtained from this study showed that most commonly prescribed medicines were antibiotics. Prescription through generic name and essential drug list was low. Therefore, prioritization on prescribing drugs by generic name and from essential drug list needs to be encouraged.

A cross sectional study on prescription patterns of antipsychotic drugs among adults with psychiatric illness in a tertiary care hospital

Importance: Antipsychotic drugs are typically used to treat schizophrenia but they are also helpful for other psychotic symptoms, including manic states with psychotic symptoms including hallucinations, delusions. Objective: To study the prescribing patterns of antipsychotic drugs among people with psychiatric illness &amp; to study the prescribing factors comparison between elderly and Adolescent’s patients. Design and Settings: This is a prospective, comparative, cross sectional and observational study conducted on 100 patients in IP and OP psychiatry Department at Prathima Institute of Medical Sciences. In this study, we compared 1st generation antipsychotics with 2nd in prospective of their safety and effectiveness. Study Period: 6 months (Sep 2022- Feb 2023). Participants: Study population: 100.Study Criteria; Inclusion criteria includes: Adults of age 18-55 years, Geriatrics above 60years. Exclusion criteria includes: Paediatrics, Pregnant women. Main outcome and measure: 2nd generations antipsychotics are more commonly prescribed as it has more effectiveness and less side effects. Results: In our study population out of 100 patients, majority of the patients were from the age group of 30-35 years (20%), 25-30 years (17%). Among 100 patients, the most common symptoms were anger (30%), fearfulness (31%), decreased sleep (57%). Majority of the patients have been diagnosed with schizophrenia (26%), mixed anxiety and depressive disorder (26%). Atypical drugs were more commonly prescribed (risperidone 64%, olanzapine 14% and quetiapine 14%) than typical drugs (haloperidol 25%, chlorpromazine 2%). Conclusion and Relevance: we have observed that there is a greater need for patient education regarding psychiatric illness in order to have better patient outcomes, and providing knowledge regarding medication adherence. In this study, among typical and atypical antipsychotics the later are more commonly prescribed compared to former as it has more effectiveness and less side effects.

Prescription pattern of antibiotics and infection control among outpatients presented at the different community pharmacies in Lahore, Pakistan

Prescription pattern of antibiotics and infection control among outpatients presented at the different community pharmacies in Lahore, Pakistan