Prescription Slip Research Articles

Assessment of Drug Usage Pattern among Bronchial Asthma Patients in a Tertiary Care Teaching Hospital, Tamilnadu: A Cross-sectional Study.

Asthma is a chronic inflammatory disease of the small airways. Chronic inflammation often causes hyper responsiveness of airways with wheezing, breathing difficulty, cough and chest tightness. The present study aimed to evaluate the drug usage pattern of anti-asthma drugs among asthma patients. The present study was a prospective, observational cross-sectional study carried out among 422 outpatients being treated at the respiratory medicine department, SRM Medical College Hospital and Research Centre. Data regarding the prescribing indicators and patient indicators were collected from the patients' prescription slips and entered in the preformed proforma. Prescribing indicators were taken into consideration in evaluating the rationality of prescriptions. In the present study, 49% of patients were between the age group of 20-40 years. Genderwise distribution showed 58.05% of males and 41.95% of females. A family history of asthma was seen in 68% of the study population. The present study reported smoking among 51% and tobacco chewing in 21% of the study population. Low economic strata were observed in 77.9% of the study population. According to asthma grading, 65.8% were in the mild intermittent, and 25% were in the mild persistent group. Patients were on β2 agonists (35.4%) and corticosteroids (32%). The most commonly used fixed drug combination was a short-acting β2 agonist with corticosteroid (40.5%). A total of 68% of drugs were used by the inhalational route and 29% by the oral route. The findings showed that, the most frequently prescribed drug was a short-acting β2 agonist with corticosteroid in a fixed-dose combination via inhalational route.

MANAGEMENT OF FACIAL FRACTURES, ITS DEMOGRAPHY AND CLINICAL OUTCOME

A retrospective study was performed on maxillofacial fractures among patients presented to our emergency department and treated at McGann Hospital, Shivamogga Institute of Medical Sciences, Shivamogga from May 2017 to June 2023. Aim:The aim of this study was to give an insight into the retrospective analysis of number of maxillofacial trauma cases reported to our institute and research centre and to understand the clinical aspects of facial fractures with treatment modality. Materials And Methods: The data for this study was obtained from the medical records and outpatient prescription slips of cases treated at McGann Hospital, Shimoga Institute of Medical Sciences, Shimoga from May 2017 to June 2023. The data included age, gender, etiology, pattern of fracture type of treatment modalities and the type of anaesthesia given were recorded. Results:The analysis involved a total of 158 patients treated at our institute from May2017 to June 2023. It was found that, the mandible was the most commonly fractured bone with parasymphysis as the most frequent site, followed by the zygomatic arch complex in the facial skeleton.Facial fractures were primarily among men in the age group of 21-30 years of age. Road traffic accidents were the main etiological factor associated. This study showed that patients were maximally treated by Open reduction and internal fixation [ORIF], some by intermaxillary fixation [IMF] and few by closed reduction. Conclusion:It was concluded that road traffic accidents were reported as the leading cause of maxillofacial fractures followed by assault, falls, and familial dispute. Open reduction and internal fixation remains the gold standard treatment modality.

PRESCRIBING PATTERN OF NUTRACEUTICALS IN ONCOLOGY: AN OBSERVATIONAL STUDY

Introduction: Nutraceuticals are products found in foods and fruits that are also used as medicines other than being used for nutrition. They provide physiological benefits and protection against chronic diseases. They include minerals, vitamins, amino acids, essential fatty acids, and medicinal herbs or other dietary substances used as supplements, for example, polyphenols, quercetin, co-enzyme Q, and genistein are in use due to their chemopreventive potential. Aim of Study: The aim of this study was to examine the prescribing pattern of nutraceuticals in cancer patients. Methods: The present cross-sectional and observational study was conducted in the outpatient department (OPD) of Oncology of GMC Jammu after getting approval from the Institutional Ethics Committee. Patients of either gender and diagnosed with carcinoma attending oncology OPD were included in the study. Fifty prescription slips were evaluated for the prescribing pattern of nutraceuticals. The data were analyzed in percentages. Results: Most of the patients were prescribed more than one nutraceutical. Most commonly prescribed nutraceuticals were vitamins (44%) which included vitamin A, B complex, C, and D followed by minerals (36%), essential amino acids (12%), beta-carotene (8%), coenzyme Q (6%), lycopene (6%), curcumin (4%), and wheatgrass (2%). Conclusion: Nutraceuticals are being increasingly prescribed to cancer patients. In our study, vitamins were the most commonly prescribed nutraceuticals. Most of them have antioxidant potential. Nutraceutical use may increase in the future due to their safety and therapeutic effects.

Knowledge, Attitude and Practice of Rational Use of Medicine among Interns and Resident Doctors in Tertiary Care Teaching Hospital of Western City of Gujarat: A Cross-sectional Study

Introduction: According to the definition of Rational Use of Medicine (RUM), patients must receive pharmaceuticals that are “suitable to their clinical needs, in doses that fit their own specific requirements, for an adequate period of time, and at the lowest cost to them and their community”. By prescribing the proper medications in the proper dosages, doctors can influence the health and well-being of their patients. Aim: To evaluate the knowledge, attitudes, and practices of interns and resident doctors towards RUM in tertiary care center, Jamnagar, Gujarat. Materials and Methods: A cross-sectional, questionnaire-based study was conducted in August 2022 in Guru Gobind Singh Government Hospital, Jamnagar, Gujarat. Total 149 first year postgraduate students (residents doctors) from different specialties and 205 intern students of a tertiary care teaching hospital were included in the study. A questionnaire was administered, which included the questions regarding socio-demographic profile, use of Essential Medicines (EM), RUM, concept of Personal drugs (P-drug) and source of drug information. Data were statistically analysed using Chi-square test. Results: Mean age of Resident Doctors was 24.55±1.74 years while of interns was 22.86±1.27 years. Eighteen (12.08%) residents and 9 (4.39%) interns knew what the phrase RUM meant. At their place of employment, the National Model Essential Drug List was accessible to 12 (5.6%) interns and 16 (10.73%) residents. Out of total, 190 (92.68%) interns and 143 (95.97%) residents were able to identify the components of the prescription slip accurately. The word P-drug was known to roughly 74 (36.09%) interns and 34 (22.81%) residents, of which 45 (21.95%) interns and 27 (18.12%) residents were aware of the Safety, Tolerability, Efficacy, Price (STEP) criteria for P-drug selection. Conclusion: Majority of the responders seem to be aware of the concept of EM and RUM, while the word P-drug seems to be quite unknown to the responders. However, majority of responders prescribed EM which are old drugs. Since, the awareness of RUM among interns and residents was found to be inadequate it has critical importance to hold educational activities with the cooperation of physicians, health organisations, universities to avoid negative consequences of irrational drug use.

Client satisfaction with telemedicine services during COVID-19 pandemic: A cross-sectional survey from a teaching institute of North India.

Telemedicine has emerged as an essential interface between health care providers and patients during the pandemic. The present study was done to assess this technology's level of acceptance and satisfaction amongst the patients. We did a retrospective study amongst patients >18 years (n = 300) who had availed telemedicine services in different departments of a tertiary care hospital between May and August 2020. The patients were interviewed telephonically using a pre-tested semi-structured tool that collected information about the socio-demographic and clinical characteristics of the patients, and satisfaction was measured on a 5-point Likert Scale. Fifty-five percent patients received teleconsultation via a telephone call, while the others preferred video calling services on WhatsApp messenger. Overall, more than 97% of the clients depicted satisfaction with the telemedicine services in three major domains: registration/appointment services, consultation with the doctor and post-consultation services. Some of the common feedback included difficulty in getting medicine using the scanned copy of prescription slip generated by the hospital, problems faced in reimbursement of the bills, long waiting period, and poor quality of video calls due to slow internet. Telemedicine proved to be an efficient means of communication for many patients during the pandemic. Though patient satisfaction was high with the services received by them, timely assessment of the problems encountered in the implementation of telemedicine services will help evolve the services not just during the pandemic but even after that.

PRESCRIBING TRENDS IN ASTHMA IN PEDIATRICS: A LONGITUDINAL, OBSERVATIONAL STUDY

Objectives: In recent years, the prevalence of asthma has globally increased. Despite intensive treatment, many children with asthma are not achieving good symptom control. The present study aims to analyze the prescribing trends in pediatric asthma according to the World Health Organization (WHO) prescribing indicators.
 Methods: This was an observational, longitudinal study conducted for the duration of 6 months with a sample size of 62. Children with age 1–14 years with asthma, who fulfilled the inclusion criteria, were enrolled after obtaining the written informed consent. Data were collected from outpatient department prescription slips for 2 times, one at 1st enrollment and the next after 1 month and changes in the prescription were noted. Peak expiratory flow rate (PEFR) was measured on both visits and the change in PEFR was noted.
 Results: Male predominance was seen (67.74%) with age of 5–9 years (40.32%). Average number of drugs per prescription was 1.96. The most commonly prescribed anti-asthmatic drug was inhaled corticosteroids (ICS) (78.22%). Only 1.5% drugs were prescribed by generic names and 22.22% drugs from the essential drug list. Inhalational route (38.71%) was preferred over the oral route (20.97%). After 1 month of treatment, change in PEFR was found to be statistically significant.
 Conclusion: The study concluded that average number of drugs per prescription and use of antibiotics was conforming to the WHO prescribing standards but prescribing from essential medicines list and by generic name need to be encouraged.

Pattern of adverse drug reactions occurring at department of neurology of a tertiary care hospital in India

Background: The objective of the study was to study the pattern and trends of adverse effects of drugs used in department of neurology in a tertiary care hospital.Methods: A prospective, observational study was carried out for a duration of 12 months from November 2018 to October 2019 at Department of Neurology and Department of Pharmacology and Therapeutics, G.S.V.M. Medical College, Kanpur after getting an approval from institutional ethical committee. Data was collected by analyzing OPD prescription slip, treatment charts and investigation reports. All relevant information regarding adverse drug reactions (ADRs) were collected as per norms of Indian Pharmacopoeia commission (IPC).Results: During the study period, a total of 130 ADRs reported. Most of the ADRs were reported due to antiepileptic drugs followed by antiparkinsonian drugs. Dizziness was the most frequent ADR reported. Most of the ADRs were reported due to phenytoin. Other ADRs observed were drowsiness, nausea/vomiting, weakness, joint pain, dyskinesia.Conclusions: Most of the ADRs were due to anti-epileptic drugs. Most of the reactions were of mild severity.

Prescription pattern, safety and prevalence of resistance of antimicrobial drugs in MICU of IGIMS, Patna: An observational and prospective study

Objective: Due to limited availability of newer antibiotics to treat emerging multidrug-resistant species of pathogen, there is an urgent need for highlighting the misuse of antibiotics and taking appropriate measures to promote rational antibiotic prescription. This study was designed to know the antibiotic prescription patterns in MICU, the prevalence of antibiotic resistance, the effectiveness of empirical antibiotic therapy and safety and tolerability of the antibiotics prescribed. Materials and Methods: This study was an observational and prospective study. 100 consecutive prescriptions were collected from MICU, IGIMS, Patna from January 2019 to June 2019. All antibiotics listed on first prescription slip was noted and their dosage schedule, route of administration, date of discontinuation, generic name and related laboratory investigations were also recorded. Result: 723 drugs were prescribed out of which 244 were antibiotics. 3rd generation cephalosporins (118 prescription/48.36 %) were most frequently prescribed followed by Amoxicillin + Clavulanate (40 prescriptions/16.39%). Prevalence of resistance was most in cephalosporins (6%) followed by Amoxicillin + Clavulanate (5%). Approx. 27.5% failure of treatment was found in patients receiving empirical antibiotic therapy. Percentage of suspected ADRs was mostly found in linezolid (33.33%) followed by Ceftriaxone (16.66%). Conclusion: Antibiotics are overprescribed in our ICUs and this is increasing the burden of unnecessary adverse effect, resistance and treatment costs. At the time of admission, patients with poor prognosis and older age are prescribed more antibiotics. Antibiotics stewardship programs should be promoted and regulation of antibiotic utilization, proper use of guidelines and proper surveillance should be ensured by responsible authorities. Keywords: Antibiotics, ICU, Prescriptions, Resistance, Safety & tolerability.

Antimicrobial prescribing patterns in surgical inpatient of tertiary care hospital in Eastern India

Background: Antimicrobials form the cornerstone of prescriptions for treating infection. Surgical management cannot be possible without the use of antibiotics. Severity of infection, suspected spectrum of organisms and their sensitivity, co-morbidities of the patient, route of antibiotic administration are the important parameter to consider before selecting antibiotic.Methods: Cross-sectional, hospital based, descriptive study was conducted in the ward of Surgery Department of IQ City Medical college, Durgapur over a period of 1 year. The relevant information was entered into the pretested preformats (containing name, age, sex, diagnosis, ongoing treatment as recorded from patients’ prescription slips or CRFs) and analyzed. Necessary permission was granted by the Institutional Ethical Committee and written informed consent was obtained from the patients prior to collecting their prescription slips/CRF.Results: Commonest cause of hospitalization was cholelithiasis (318 (32.7%)). Antimicrobials were the most commonly prescribed drugs (1626 (31.6%)). Single antibiotic prescribing frequency are similar to two antibiotic prescribing (both 44%). Piperacillin+Tazobactum combination most commonly prescribe antibiotic.Conclusions: Beta lactam antibiotic specifically Piperacillin (ATC class: J01D) were the most commonly prescribed antibiotic agents both before and after surgical procedures.

Assessment of drug attitude, medication adherence and quality of life among psychiatric patients in South Indian population: a cross sectional study

Background: In spite of many progresses in treatment of psychiatric disorders, medication nonadherence plays an important role in worsening of clinical condition and affects quality of life among psychiatric patients. There are numerous factors contributing for medication nonadherence among patients with mental illness. So, this study was conducted to assess psychiatric patients’ adherence of medication and to improve their quality of life with psychiatric disorder. The objectives of the study were to analyze impact of pharmacophilia and pharmacophobia on medication adherence among patients with psychiatric disorders at a tertiary care hospital and to assess quality of life among pharmacophilic and pharmacophobic patients.Methods: A cross-sectional study was conducted in outpatient psychiatric department for a period of two months. After obtaining informed voluntary consent, patient’s socio-demographic details, diagnosis, and treatment were recorded from prescription slip. Patients above 18yr age with psychiatric diagnosis as per International Classification of Diseases 10 (ICD-10) and receiving at least one psychotropic medication for >1 month were enrolled in study and assessed using: Drug attitude inventory classification (DAI-10); Medication Rating Scale (MARS); Quality of life enjoyment and satisfaction Questionnaire-Short Form (Q-LES-Q-SF).Results: Among 130 patients, 116 were pharmacophilic and 14 were pharmacophobic as per DAI-10 scale. 81.9% of pharmacophilic were adherent to prescribed medication assessed using MARS scale only 14.3% were pharmacophobic. The quality of life was better in pharmacophilic compared to pharmacophobic group (p=0.002) using Q-LES-Q-SF.Conclusions: This study concluded that pharmacophilic patients have higher adherence and good quality of life index compared to pharmacophobic. Proper counselling of pharmacophobic patients by psychiatrists could improve adherence and QOL.

Drug utilization pattern in pregnancy at a tertiary care hospital in Puducherry: a cross sectional observational study

Background: Drug utilization pattern in pregnancy population provide insights regarding drug profile and interventional measures and also minimizes the inherent risk occurring due to unethical prescription.Methods: It was a prospective cross sectional study where prescription slips were collected. Further drugs were categorized according to the classification defined by US Food and drug Administration for pregnancy. Using Pre validated questionnaire the pregnant women were interviewed and parameters regarding knowledge about antenatal visit and contraception, self-medication practices were noted.Results: Among the total 365 participants, 81.4% had finish their high schooling and were in reproductive age group of 22-25. Study revealed predominant usage category- A drugs in I (95.5%), II (97.8%), III (96.4%) trimester. None of them received Category D or X drugs. Almost 100% and 98.6% in III and II trimester respectively received iron. Other drugs prescribed were calcium, anti-emetics, anti-ulcer, NSAIDS and antimicrobial. The awareness about Intra Uterine Contraceptive Devices and Oral Contraceptive Pills were 48.2% and 31.5% respectively. Unfortunately only 4.9% felt that drug use could be dangerous to foetus. 58.9% were aware about antenatal examination during pregnancy.Conclusions: Evaluation of drug utilization pattern periodically will minimize incidence of risk to foetus and mother during pregnancy.

Drug prescription behavior: A cross-sectional study in public health facilities in two states of North India.

Background:Poor prescription practices result in increased side effects, adverse drug reactions, and high cost of treatment. The present study was undertaken to describe the drug-prescribing patterns in two North Indian states through prescription auditing.Materials and Methods:The study was carried out in 80 public health facilities across 12 districts in two states of Haryana and Punjab (6 in each) covering all levels of care. The information from prescription slips was abstracted on a structured pro forma for all patients who visited the pharmacy of the health facility.Results:A total of 1609 prescriptions were analyzed. On an average, 2.2 drugs were prescribed per patient. Nearly 84% of the drugs were prescribed from the essential drug list (EDL). Antibiotics were prescribed in 45.3% of prescriptions, followed by vitamins (34.8%) and nonsteroidal anti-inflammatory drugs (33.9%). Drugs were prescribed in their generic names in 70% of cases. Diseases of the ear, nose, and throat (18%) were most common followed by the diseases of the gastrointestinal and renal (17%) and musculoskeletal system (16%). Only 40% of children suffering from diarrhea received oral rehydration salts while 80% of them received antibiotics. Among cases of upper respiratory tract infection, nearly 75% received antibiotics.Conclusion:The results of this study raise concerns about the overuse of antibiotics although most of the drugs (84%) were from the EDL and in generic names (70%). There is lack of data regarding prescription practices which necessitates real-time prescription monitoring through online data entry and transmission.

Retrospective Study of Facial Fractures.

Aim:The aim of this study was to give an insight into the retrospective analysis of a number of maxillofacial trauma cases reported to our institute and research center.Materials and Methods:The data for this study was obtained from the medical records and outpatient prescription slips of cases treated at the Oral and Maxillofacial Surgery Department from 2010 to 2016. Etiology, age, gender, pattern of fracture, and surgical treatment modalities undertaken in these patients were recorded.Results:A total of 353 maxillofacial trauma patients with mean age of 40 years, treated at our institute were evaluated from 2010 to 2016. Mandible was the most commonly fractured bone with parasymphysis as the most frequent site. Majority of victims were males (male:female ratio of 4:1) and also in the third decade of life. This study showed that 73% patients were treated by open reduction and internal fixation (ORIF), 25.8% by intermaxillary fixation (IMF) and Stabilization of fracture mandible with acrylic splint and circummandibular wiring was done in 0.8% pediatric patients.Conclusion:It was concluded that road traffic accidents were reported as the leading cause of maxillofacial fractures followed by assault, falls, and familial dispute. Maxillofacial surgeons as health care providers must continue their ‘face it’ campaign to decrease the incidence of road traffic accidents. Open reduction and internal fixation remains the gold standard treatment modality.

Assessment of drug use pattern for lower respiratory tract infection in outpatient department of paediatric at central referral hospital: a cross-sectional study

Background: Prescription audit is an important tool to analyse rational use of drug at different health sectors. The aim of the study was to evaluate the prescribing pattern using World Health Organization prescribing indicators for lower respiratory tract infection in children below five years of age.Methods: A cross-sectional study was conducted in the outpatient department of Paediatrics at Central Referral Hospital, Gangtok, Sikkim, India for a period of 18 months. Study involved children between 1-5 years of age with fever/cough with or without respiratory distress. The data were collected from the out patient department prescription slips as well as interviewing the parents/guardians after finishing the physician consultation. The data were processed using statistical software SPSS 20.Results: The study was conducted with 57 prescriptions comprising 210 drugs from both male (54.38%) and female (45.61%) patients. The average number of drugs per prescription was found to be 3.68. negligible (0.013%) prescription containing generic name of drug was found, 96.66% of medicines were prescribed from National Essential List of Medicine (NELM). No prescriptions were found to have injectables, 8.57% of the prescriptions were found to contain fixed dose combination. Amongst the drug categories, salbutamol accounted for 23.33% in total prescription followed by paracetamol (22.85%) and amoxicillin (7.14%). While accounting for the formulations used, the maximum prescriptions were containing syrup followed by nebulization.Conclusions: The use of generic names was minimal, only few of the prescriptions had vitamins and tonics with no use of injectable preparations. Maximum numbers of drugs were prescribed from NELM.

Evaluation of Knowledge, Attitude and Practice of Rational use of Medicine Among Interns and Resident Doctors in a Tertiary Care Teaching Hospital

: Objective: To evaluate and compare knowledge, attitude and practice of rational use of medicine among post graduate students and interns in a tertiary care teaching hospital. Material and Method: This was a questionnaire based study which included 100 post graduate students from different specialties and 100 intern students of a tertiary-care teaching hospital. Results: Ninety six percent respondents were aware about the term RUM and 95% practiced it, only 10.5% had NLEMI available at their work place and 48% clinicians were able to correctly name the parts of the prescription slip. 87.5% respondents were aware about EM and 85% prescribed them. Percentage of respondents prescribing EM and practicing RUM was significantly higher in male than in females. (p<0.0001). Though 32% respondents practiced ‘p’ drug concept only 15.5% were aware about STEP criteria. Conclusion: In the present study majority of respondents were aware about most of the issues concerned with RUM addressed in the questionnaire which seems to be a positive finding. But being future prescribers all of them need to have correct knowledge about all the issues addressed.Key words: Essential medicine, P-drug, KAP study.

A STUDY OF DRUG PRESCRIBING PATTERN AND COST ANALYSIS AMONG DIABETIC PATIENTS IN A TERTIARY CARE TEACHING INSTITUTE IN NORTH INDIA’

Diabetes mellitus is a chronic metabolic disorder associated with significant morbidity and mortality due to diabetic complications and other co-morbid conditions. Therefore, other drugs are also used commonly with antidiabetic drugs for the treatment of diabetic patients. A prescription is a written advice, mentioning the drugs and other instructions to a pharmacist to dispense the drugs properly to treat the disease. It becomes necessary to write the drugs and other parameters in a candid, concrete and clear manner on the prescription slip. It has been observed that prescriptions are generally vague which lead to misinterpretations and thereby resulting in failure of drug therapy, drug-drug interactions, overuse or underuse of drug and adverse drug reactions. WHO has set quality and quantity indicators to evaluate the use of drugs to be used in the hospitals/dispensaries. Prescription slips were randomly collected from the diabetic patients visiting the OPDs of the Guru Gobind Singh Hospital attached to Medical College, Faridkot, for analysis and evaluation. Prescriptions slips were taken from the patients after taking written consent and analyzed for quality and quantity prescriber indicators recommended by WHO. A total of 366 prescriptions were collected and analyzed for drugs used in diabetic patients. Average number of drugs prescribed is 4.98. The most commonly prescribed drugs were Oral antidiabetic agents, CVS related (antihypertensive, nitrate, antiplatelet, etc.), vitamins and minerals, insulin, GIT related drugs, lipid lowering drugs, antimicrobial, CNS related and NSAIDs and their percentages were 20.55%, 26.97%, 22.20%, 7.8%, 6.57%, 5.86%, 5.75%, 2.63% and 1.48% respectively. All the drugs were prescribed by non-generic (Trade) names, which included 31.36% drugs from the Essential Drugs List. Oral forms prescribed were 85.85% and injectable were 14.15% (insulin 7.8% and other injectable 6.35%).The average cost of the oral antidiabetic agent per day per prescription was ₹7.95/- and this cost increased to ₹10.15/- with addition of CVS related drugs, ₹17.23/- with vitamins&amp; minerals and ₹10.57/- with lipid lowering agents and it was seen that if a patient was prescribed all these drugs then the average cost of the treatment got raised to ₹45/- (approx.) or $ 0.82 USD per day per prescription. There is a high tendency and frequency to prescribe more than two drugs but less used from the essential drugs list for the treatment of the diabetesand other co-morbid conditions. Most of the drugs prescribed were cardiovascular related drugs and multivitamins along with oral antidiabetic drugs. There is an urgent need to develop the prescription writing skills for budding doctors regarding the use of Essential Drugs List to reduce the cost of treatment. Key words: Prescription audit, prescribing indicators, Essential Medicine List (EML), Co-morbid conditions

Hospital waiting time: the forgotten premise of healthcare service delivery?

This is a national study which aims to determine the average waiting time in Malaysian public hospitals and to gauge the level of patient satisfaction with the waiting time. It also aims to identify factors perceived by healthcare providers which contribute to the waiting time problem. Self-administered questionnaires were the main method of data collection. Two sets of questionnaires were used. The first set solicited information from patients on their waiting time expereince. The second set elucidated information from hospital employees on the possible causes of lengthy waiting time. The questionnaires were administered in 21 public hospitals throughout all 13 states in Malaysia. A total of 13,000 responses were analysed for the patient survey and almost 3,000 were analysed for the employee survey. The findings indicate that on average, patients wait for more than two hours from registration to getting the prescription slip, while the contact time with medical personnel is only on average 15 minutes. Employee surveys on factors contributing to the lengthy waiting time indicate employee attitude and work process, heavy workload, management and supervision problems, and inadequate facilities to be among the contributory factors to the waiting time problem. Public healthcare in Malaysia is in a state of "excess demand", where demand for subsidised healthcare far outstrips supply, due to the large fee differential between public and private healthcare services. There is a need for hospital managers to reduce the boredom faced by patients while waiting, and to address the waiting time problem in a more scientific manner, as has been carried out in other countries through simulation and modelling techniques. Healthcare organisations are keen to address their waiting time problem. However, not much research has been carried out in this area. The study thus fills the lacuna in waiting time studies in healthcare organisations.

Assessment of Awareness among Clinicians about Concepts in Undergraduate Pharmacology Curriculum: A Novel Crosssectional Study

Objective:In the last 30 years, concepts in pharmacology have moved from Essential Medicines (EM) to P-drugs via the Rational Use of Medicines (RUM), but no structured study has evaluated the level of understanding among working clinicians about these concepts. The present study is designed to fulfill that lacuna.Materials and Methods:A cross-sectional study was carried out in and around the teaching hospitals attached to Medical Colleges, enrolling 504 clinicians from six centers across North India to fill-up a questionnaire containing 25 questions. The results were compiled using percentages and averages.Results:Only one-fourth of the participants claimed that they always prescribed Essential Medicines; no one could accurately count the number of drugs / drug combinations in the Indian Essential Drug list; only 15.1% of the clinicians used to write the generic names of drugs on a prescription slip; about one-third of the clinicians were not fully aware about the adverse effects, drug interactions, and contraindications of the drugs they prescribed; about 83% of the physicians admitted to rely on information from Medical Representatives (MRs) and the interest in research activities seemed to be lost.Conclusion:Results show a sorry state of affairs among clinicians, as far as the level of understanding about EM, P-drugs, and RUM is concerned, and points toward arranging more continuing medical education (CME) for clinicians regarding these concepts.

Current scenario of attitude and knowledge of physicians about rational prescription: A novel cross-sectional study

Background:In the last 30 years concepts in pharmacology have moved from Essential Medicines (EM) to P-drugs via the Rational Use of Medicines (RUM), but no structured study has evaluated the level of understanding among the working clinicians about these concepts.Aim:The present study was designed to assess the attitude and knowledge of clinical practitioners about the concepts of RUM, EM, P-drugs, and sources of drug-information, across North India.Materials and Methods:A cross-sectional study was carried out in and around the teaching hospitals attached to Medical Colleges, enrolling 504 clinicians from six centers across North India to fill-up a questionnaire containing 25 questions.Statistical Analysis:The results were compiled using percentages and averages. Univariate analysis, which explores each variable in a data set separately, was carried out by using the Fisher's exact test.Results:Only one-fourth of the participants claimed that they always prescribed Essential Medicine; no one could correctly count the number of drugs / drug combinations in the Indian Essential Drug list; only 15.1% of the clinicians wrote the generic names of drugs on the prescription slip; about one-third of clinicians were not fully aware about the adverse effects, drug interactions, and contraindications of the drugs they prescribed; about 83% of physicians admitted to relying on information from Medical Representatives and an interest in research activities seemed to be lost.Conclusion:Results show a sorry state of affairs among clinicians, as far as the level of understanding about EM, P-drugs, and RUM is concerned, and it points toward arranging more continuing medical education (CME) for clinicians with regard to these concepts.

Two for One: A Self-Management Plan Coupled with a Prescription Sheet for Children with Asthma

Despite strong recommendations in the asthma guidelines, the use of written self-management plans remains low among asthmatic patients. To develop a written self-management plan, based on scientific evidence and expert opinions, in a format intended to facilitate its dispensing by health care professionals, and to test the perception of its relevance and clarity by asthmatic children, adolescents and adults. Inspired by previously tested self-management plans, surveys of asthma educators, expert opinions and the 2004 Canadian Asthma Guidelines, the authors simultaneously developed French and English versions of a written self-management plan that coupled with a prescription. The self-management plan was tested in parents and their asthmatic children (aged one to 17 years), and it was revised until 85% clarity and perceived relevance was achieved. Ninety-seven children and their parents were interviewed. Twenty per cent had a self-management plan. On the final revision, nearly all items were clear and perceived relevant by 85% or more of the interviewees. Two self-management plans were designed for clinics and acute care settings, respectively. The plans are divided into three control zones identified by symptoms with optional peak flow values and symbolized by traffic light colours. They are designed in triplicate format with a prescription slip, a medical chart copy and a patient copy. The written self-management plans, based on available scientific evidence and expert opinions, are clear and perceived to be relevant by children, adolescents and their parents. By incorporating the prescription and chart copies, they were designed to facilitate dispensing by physicians in both clinics and acute care settings.