Jul-Sep, 2012 - Indian Journal of Pharmacy Practice
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Jul-Sep, 2012 - Indian Journal of Pharmacy Practice

Jul-Sep, 2012 - Indian Journal of Pharmacy Practice Jul-Sep, 2012 - Indian Journal of Pharmacy Practice

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Indian Journal of Pharmacy PracticeAssociation of Pharmaceutical Teachers of IndiaPrescription Monitoring Study of Antipsychotic Drugs in Geriatric Population atTertiary Level Referral Hospital in Rural India.Dilip. C*, Dinesh K. M. K, Divya R and Lisa M.MAl Shifa College of Pharmacy, Kizhattur, Perinthalmanna, Kerala-679325A B S T R A C TSubmitted: 02/06/2012Accepted: 12/08/2012An attempt was made to assess the prescription monitoring pattern of anti-Psychotic drugs in geriatric patients treated at tertiary level referralhospital and to rationalise the prescription habits of the clinicians. The study was conducted in tertiary level multispecialty referral hospital atPerinthalmanna. It was a prospective and observational study conducted among inpatients for four weeks by monitoring the case sheets andpatient interview in the hospital. The study was conducted to systematically assess the prescribing patterns of antipsychotic drugs amonggeriatric inpatients. A total of 65 geriatric patients were admitted to the hospital during the study period. . The indicator-driven analysis ofantipsychotic prescribing quality revealed a need for improvement, with the main prescribing problems relating to duration and combination oftherapies.INTRODUCTIONThe antipsychotics are indicated for treating psychoticdisorders, including schizophrenia, delusional disorder, andpsychotic symptoms in mood disorders and for a number oforganic psychoses. Antipsychotic drugs are among the mostwidely prescribed psychotropic medications for elderly1people. The rapidly expanding field of psychopharmacologyis challenging the traditional concepts of psychiatrictreatments, and research is constantly seeking new andimproved drugs to treat psychiatric disorders. In this way,psychiatrists are continuously exposed to newly introduceddrugs that are claimed to be safer and more efficacious. Drugprescribing forms an important part of medical treatment.There have been many overseas studies on prescribing pattern2of doctors. The number of persons above the age of 60 yearsis fast growing, especially in India. India as the second mostpopulous country in the world has 76.6 million people at orover the age of 60, constituting about 7.7% of totalpopulation. The problems faced by this segment of thepopulation are numerous owing to the social and culturalchanges that take place within the Indian society. Evaluationof the morbidity profile among elderly people, and the impactof chronic conditions on functional disability andpsychological well-being are an essential part ofcomprehensive assessment of the elderly. It will haveimplications for providing health care for the elderlypopulation and its costs. Increasingly, atypical antipsychoticAddress for Correspondence:Dilip. C, Asst professor, Al Shifa College of Pharmacy, Kizhattur,Perinthalmanna, KeralaE-mail: dillu7@rediffmail.comdrugs are prescribed for elderly patients with symptoms ofpsychosis and behavioural disturbances. Although nonpharmacologictreatments for behavioural disturbancesshould be tried first, medications often are needed to enablethe patient to be adequately cared for. Treatment withantipsychotics is very common in the elderly and oftenindispensable. However, for successful treatment, it isessential to have an adequate multidimensional assessment ofthe geriatric patient and of his or her polypathology andpolypharmacy, together with knowledge of age-dependentpharmacokinetics and pharmacodynamic changes and drug-3drug interactions.A Prescription Monitoring Program typically refers to a staterunprogram (in the United States) that serves as a registry totrack prescriptions for controlled substances. These servephysicians who want to know if his or her patient is receiving4similar medications from other physicians. Pharmacies thatdispense controlled substances are usually required to registerthe filling of such prescriptions with a state-run database Drugutilization audits are qualitative assurance programs to ensurethat drugs are used correctly and safely. The nature of suchaudits can be quantitative or qualitative or combination ofboth. Quantitative audits are concerned with quantifyingvarious facts of drug therapy use within a healthcare systemareas group whereas qualitative audits compare drug use orpractice with predetermined standards or criteria. The presentstudy was an attempt to asses drug utilization in psychotictherapy in patients above 60 years and also to know about thedaily activities of the patients by documenting in the standardscale of “Lawton Brody Instrumental Activity of Daily Living5Scale”. Here an attempt was made to assess the prescriptionmonitoring pattern of anti-Psychotic drugs in geriatricIndian Journal of Pharmacy Practice Volume 5 Issue 3 Jul - Sep, 2012 49

Dilip .C - Prescription Monitoring Study of Antipsychotic Drugs in Geriatric Population at Tertiary Level Referral Hospital in Rural India.patients treated at tertiary level referral hospital, to rationalisethe prescription habits of the clinicians and to assess aperson's ability to perform tasks such as using a telephone,doing laundry and handling finances, using the “LawtonInstrumental Activity of Daily Living Scale”.OBJECTIVE:To assess the prescription monitoring pattern of anti-Psychotic drugs in geriatric patients treated at tertiary levelreferral hospital and to rationalise the prescription habits ofthe clinicians. To assess a person's ability to perform taskssuch as using a telephone, doing laundry and handlingfinances, using the “Lawton Instrumental Activity of DailyLiving Scale”.METHODOLOGYA prospective study done in the psychiatric department of thetertiary level multi-speciality hospital situated in Malabarregion of Kerala, which covers a period of three weeks in themonth of December. We have included the followinginclusion and exclusion criteria for the study.Inclusion criteria:Ÿ Patients who were diagnosed as psychiatric patients.Ÿ All the patients who were admitted in the psychiatricdepartmentŸ Persons who were taking antipsychotic drugs for > 2yearsŸ All the inpatients of age ≥ 55 yearsExclusion criteria:Ÿ Patients below 50yrsŸ Out patientsŸ Patients who were taking antipsychotic drugs prescribedfrom outside the hospitalŸ Discharged prescriptionŸ Prescription containing incomplete informationIt was a prospective and observational study conductedamong inpatients for three weeks by monitoring the casesheets and patient interview in the hospital. The dailyactivities of the patients were documented in the standardscale of “Lawton Brody Instrumental Activity of Daily LivingScale”. All the enrolled patients who met the criteria werefollowed on the daily basis from the date of admission to tillthe day of discharge to note the antipsychotic medicinesprescribed. Prescriptions were collected from the case sheetcontaining at least one antipsychotic drug, multiple drugs etc.The drug usage pattern was analysed in terms of individualdrug, its class and dosing regimen such as route, frequencyand duration of therapy was calculated. Patients admitted tothe hospital were reviewed on the daily basis. Any change inthe dose of drug, addition of drug or changes in theprescription were noted during the study. The addition ofanother antipsychotic drug to or any change to theantipsychotic drug was considered as separate prescription.All the prescriptions were throughly checked with standardprescribing guidelines for the antipsychotic drugs for theirrational use of drugs. Patient demographic details such asage, sex, occupation, educational status, height and bodyweight, clinical status such as comorbidities, reason foradmission, provisional diagnosis were collected. Thepatient's interview was done on the daily basis and the detailswere collected regarding the changes or difficulties that theyface in daily life, because of taking antipsychotic drugs. Foreg: difficulty in remembering the names of the relatives,patients feeling loneliness , difficulty in doing the usual dailyworks, fear to travel alone etc. The necessary and relevantdata collected were documented in a suitably designed datacollection form. The daily activities of the patients weredocumented in the standard scale of “Lawton BrodyInstrumental Activity of Daily Living Scale”. By using thisscale we assessed whether antipsychotic medications affectedthe normal activity of the patients. Values were expressed asmean (± standard deviation or as percentage).RESULTS AND DISCUSSIONA prospective observational study was conducted in a tertiarylevel referral hospital with more than 60 consultants ofnational reputation. During the study 65 elderly patients wereselected which who met the inclusion criteria. The study wasconducted to systematically assess the prescribing patterns ofantipsychotic drugs among geriatric inpatients. A total of 65geriatric patients were admitted to the hospital during thestudy period. Of the total admission 27(41.53%) were femaleand 38(58.46%) patients were male. Out of 65 patients41.53% had high school education and about 47.6% ofpatients had education below high school. 10.76% of patientswere uneducated. Majority of the patients (63.07%) werefound to be from middle class followed by (29.23%) fromhigh class and (7.69%) were from low class. Out of 65patients, 17(26.15%) patients were from orthopaedicdepartment, 15(23.076%) patients each from generalmedicine and neurology. Patients from cardiology,pulmonology and gastroenterology were 8(12.3%), 1 (1.5%)and 2(3.1%) respectively followed by general surgery,nephrology, and urology 2(3.1%), 4(6.15%), and1(1.53846%) respectively. Patient's ability assessment (usingLawton Brody Instrumental Activities of daily living scale):In this study, it was found out that, around 29% of patientswere taking antipsychotic drugs and most of these patientswere 60-65years age. Assessment of person's ability toperform daily activities was done using 'Lawton BrodyIndian Journal of Pharmacy Practice Volume 5 Issue 3 Jul - Sep, 2012 50

<strong>Indian</strong> <strong>Journal</strong> <strong>of</strong> <strong>Pharmacy</strong> <strong>Practice</strong>Association <strong>of</strong> Pharmaceutical Teachers <strong>of</strong> IndiaPrescription Monitoring Study <strong>of</strong> Antipsychotic Drugs in Geriatric Population atTertiary Level Referral Hospital in Rural India.Dilip. C*, Dinesh K. M. K, Divya R and Lisa M.MAl Shifa College <strong>of</strong> <strong>Pharmacy</strong>, Kizhattur, Perinthalmanna, Kerala-679325A B S T R A C TSubmitted: 02/06/<strong>2012</strong>Accepted: 12/08/<strong>2012</strong>An attempt was made to assess the prescription monitoring pattern <strong>of</strong> anti-Psychotic drugs in geriatric patients treated at tertiary level referralhospital and to rationalise the prescription habits <strong>of</strong> the clinicians. The study was conducted in tertiary level multispecialty referral hospital atPerinthalmanna. It was a prospective and observational study conducted among inpatients for four weeks by monitoring the case sheets andpatient interview in the hospital. The study was conducted to systematically assess the prescribing patterns <strong>of</strong> antipsychotic drugs amonggeriatric inpatients. A total <strong>of</strong> 65 geriatric patients were admitted to the hospital during the study period. . The indicator-driven analysis <strong>of</strong>antipsychotic prescribing quality revealed a need for improvement, with the main prescribing problems relating to duration and combination <strong>of</strong>therapies.INTRODUCTIONThe antipsychotics are indicated for treating psychoticdisorders, including schizophrenia, delusional disorder, andpsychotic symptoms in mood disorders and for a number <strong>of</strong>organic psychoses. Antipsychotic drugs are among the mostwidely prescribed psychotropic medications for elderly1people. The rapidly expanding field <strong>of</strong> psychopharmacologyis challenging the traditional concepts <strong>of</strong> psychiatrictreatments, and research is constantly seeking new andimproved drugs to treat psychiatric disorders. In this way,psychiatrists are continuously exposed to newly introduceddrugs that are claimed to be safer and more efficacious. Drugprescribing forms an important part <strong>of</strong> medical treatment.There have been many overseas studies on prescribing pattern2<strong>of</strong> doctors. The number <strong>of</strong> persons above the age <strong>of</strong> 60 yearsis fast growing, especially in India. India as the second mostpopulous country in the world has 76.6 million people at orover the age <strong>of</strong> 60, constituting about 7.7% <strong>of</strong> totalpopulation. The problems faced by this segment <strong>of</strong> thepopulation are numerous owing to the social and culturalchanges that take place within the <strong>Indian</strong> society. Evaluation<strong>of</strong> the morbidity pr<strong>of</strong>ile among elderly people, and the impact<strong>of</strong> chronic conditions on functional disability andpsychological well-being are an essential part <strong>of</strong>comprehensive assessment <strong>of</strong> the elderly. It will haveimplications for providing health care for the elderlypopulation and its costs. Increasingly, atypical antipsychoticAddress for Correspondence:Dilip. C, Asst pr<strong>of</strong>essor, Al Shifa College <strong>of</strong> <strong>Pharmacy</strong>, Kizhattur,Perinthalmanna, KeralaE-mail: dillu7@rediffmail.comdrugs are prescribed for elderly patients with symptoms <strong>of</strong>psychosis and behavioural disturbances. Although nonpharmacologictreatments for behavioural disturbancesshould be tried first, medications <strong>of</strong>ten are needed to enablethe patient to be adequately cared for. Treatment withantipsychotics is very common in the elderly and <strong>of</strong>tenindispensable. However, for successful treatment, it isessential to have an adequate multidimensional assessment <strong>of</strong>the geriatric patient and <strong>of</strong> his or her polypathology andpolypharmacy, together with knowledge <strong>of</strong> age-dependentpharmacokinetics and pharmacodynamic changes and drug-3drug interactions.A Prescription Monitoring Program typically refers to a staterunprogram (in the United States) that serves as a registry totrack prescriptions for controlled substances. These servephysicians who want to know if his or her patient is receiving4similar medications from other physicians. Pharmacies thatdispense controlled substances are usually required to registerthe filling <strong>of</strong> such prescriptions with a state-run database Drugutilization audits are qualitative assurance programs to ensurethat drugs are used correctly and safely. The nature <strong>of</strong> suchaudits can be quantitative or qualitative or combination <strong>of</strong>both. Quantitative audits are concerned with quantifyingvarious facts <strong>of</strong> drug therapy use within a healthcare systemareas group whereas qualitative audits compare drug use orpractice with predetermined standards or criteria. The presentstudy was an attempt to asses drug utilization in psychotictherapy in patients above 60 years and also to know about thedaily activities <strong>of</strong> the patients by documenting in the standardscale <strong>of</strong> “Lawton Brody Instrumental Activity <strong>of</strong> Daily Living5Scale”. Here an attempt was made to assess the prescriptionmonitoring pattern <strong>of</strong> anti-Psychotic drugs in geriatric<strong>Indian</strong> <strong>Journal</strong> <strong>of</strong> <strong>Pharmacy</strong> <strong>Practice</strong> Volume 5 Issue 3 <strong>Jul</strong> - <strong>Sep</strong>, <strong>2012</strong> 49

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