Oct-Dec, 2011 - Indian Journal of Pharmacy Practice

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Mihir Y.P - Study of Prescribing Pattern for Evaluation of Rational Drug Therapy in Warangal(g) Date of issuing the prescription, whether mentioned ornot.(II) Rationality of prescription(a) Number of drugs prescribed.(b) Number prescribed in generics.c) Number of fixed dose combinations used.(d) Dose strength and dosage of drug whether written or not.(e)(f)Duration of therapy – short, long, or not mentioned.Banned drug formulations.All the drugs used were assigned different categories using[6]criteria suggested by Kunin et.al .RESULTSPatient's Identity: Name, age, address were mentioned in100 %, 15 % and 0 % of the prescriptions respectively. Date ofwriting prescription was mentioned in 100% of prescriptions.Superscription: Traditionally denoted by letter 'Rx' wasmentioned in 35 % of prescriptions. 65% of prescriptionswere without superscription.Inscription & Subscription: It consists of four componentsi.e. base, adjuvant, corrective and vehicle. Since only alreadycompounded drugs were studied, these components ofinscription were not analyzed separately. Route of drugadministration was mentioned in 24 % of drugs only, rest ofthe drugs were in oral dosage forms (76%). However, dosageforms were mentioned in 74.8 % of the drugs. In 57.7 % ofprescriptions, duration of therapy was mentioned.Instructions to the patient: Instructions to the patient wereinadequate in 32 % of the prescriptions. Instructions weregiven in simple English in 20% and using local language in 80% of the prescriptions. Instructions regarding refilling ofprescription and substitution of products were not given in allthe cases.Prescriber's Identity: Name and qualification of theprescriber were known in 100 % of the prescriptions.Registration number was also known in 100 % of theprescriptions.For rationality of prescription: Average number of drugsper prescription was 3.41. Drugs were not prescribed undergeneric name in any of the cases. Fixed drug combinationswere used in 7.9 % of prescriptions.Dose strength & dosage: Dose and dosage were notmentioned in 25.2 % of the prescriptions. Dose and dosagewere found incorrect in 8% of the prescriptions in which theyare mentioned.Duration of therapy: Duration of therapy was not mentionedin 42.3 % of prescriptions. In majority of the cases,instructions' regarding duration of drug therapy was verbal. Inthose cases where the duration had been mentioned, it wasfound to be correct in 52 %, short in 38 % and prolonged in 10% of prescriptions.Overprescribing: Over prescribing was encountered in 25 %of the prescriptions e.g. paracetamol was prescribed inaddition to various anticold preparations which alreadycontain paracetamol, more than one NSAIDS was prescribedto same patients.Banned drug formulations: None of the drugs banned bydrug controller of India were used in the present study.On analysis of various drugs based on the criteria suggested[6]by Kunin et al, 1973 , it has been found that use of drug wasinappropriate in 20% of the cases.Table 1: Analysis of PrescriptionsParticularNumberTotal number of prescriptions 250Total number of drugs used 854Average number of drugs per prescription 3.41Drugs prescribed under generic names 0.0 (0%)Drugs prescribed under brand names 854 (100%)Fixed dose combinations used 68 (7.9%)Dose and dosage not mentioned 216 (25.2%)Duration of therapy not mentioned 362 (42.3%)DISCUSSIONTwo parameters were assessed in the present study i.e.adherence to prescription format and rationality ofprescription. Results obtained after auditing prescriptions forprescription format indicate that majority of prescriptions donot adhere to the ideal pattern of prescription writing.Important demographic parameters like age and gender werenot written in majority of the cases. Directions regarding totalamount of drug to be dispensed and instructions regarding useof drug were inadequate in 45 % & 28 % of the prescriptionsrespectively.Second component of the present study was auditingprescriptions for rationality. Though quality of prescribing isassociated with use of relatively limited number of7pharmaceutical products. It is preferable to keep the numberof drugs prescribing as low as possible since higher figuresalways lead to increased risk of drug interactions and8,9increased treatment cost. Average number of drugs perprescription (3.41) in the present study was less than that10,11,12reported by various Indians and international workers.Indian Journal of Pharmacy Practice Volume 4 Issue 4 Oct - Dec, 2011 78
Mihir Y.P - Study of Prescribing Pattern for Evaluation of Rational Drug Therapy in WarangalPrescribing under generic name is considered economical andrational but none of the prescriptions were written under ageneric name. Though this figure is higher than reported bysome Indian researcher yet it is too little to be considered11rational.Over prescribing was found only in 25% of the prescriptions,a figure far less than that reported by other Indian11researchers. It was also found that drug use was found to beinappropriate in one-third of the cases. Antibiotics were themost inappropriately used drugs. This not only exposespatients to avoidable adverse drug reactions but also totheproblems of drug resistance.From the results of the present study, we conclude thatAuthorities should arrange periodic refresher courses inrational drug therapy and in latest management of diseases forthe doctors.More emphasis needs to be laid on teaching the art of writinga prescription to undergraduate and postgraduate medicalstudents. A week's posting in clinical pharmacology andtherapeutics if possible, should be taught over duringinternship and this period should be utilized in teachingprescription writing and rational drug therapy.This study has a limitation that the total number ofprescriptions were only two hundred and fifty and morestudies are needed to be carried out in order to confirm thesefindings.REFERENCES1. Country Assistance Plan – Nepal. Asia Development Bank, Mar30 1999.2. M de Vries, TPG, Heluling RH, Hogerzeil HV, Freste DA. Guideto Good prescribing. A practical guide W.H.O. 1994.35:575-6.4. Pradhan SC, Shewade DG, Shashindren CH, Bapna .IS. Drugutilization studies. National Med Jour India 1988; 1:185-89.5. Molstad S, Hovelius B, Kroon L, Melender. A prescription ofantibiotics to outpatients in hospital clinics, Community healthcentre & private practice. Eur Jour clin Pharmacol 1990; 39:9-12.6. Kunin CM, Tupasi T, Craig WA. Use of antibiotics: a briefexposition of problem and some tentative solutions. Ann InterMed 1973; 79:555-560.7. Bergman U, Popa C. Tomson Y. Drug utilization 90 % a simplemethod for assessing the quality of drug prescribing. Eur JourClin Pharmacol 1998; 54:113-18.8. Nies SA. Principles of therapeutics. Gilman GA, Rall WT. NiesSA, Taylor P, (Eds). The pharmacological basis of therapeutics8th Eels New York Pergamon Press 1990; 62-83.9. Atanasova I, Terzivaov D. Investigations on antibiotics in ahospital for a one year period. Int Jour clin Pharm Ther 1995;33:32-33.10. Minocha KB, Bajal S, Gupta K. A clinic pharmacological studyof out-patient prescribing patterns of dermatological drugs in anIndian tertiary hospital. Ind Jour Pharmacol 2000; 32:384-85.11. Ansari KU, Singh S, Pandey RC. Evaluation of prescribingpatterns of doctors for rational drug therapy. Ind Jour ClinPharmacol 1998; 30:43-46.12. Rehana HS, Nagarani MA, Rehana Moushullli . A study on thedrug prescribing pattern and use of antimicrobial agents at atertiary care teaching hospital in eastern Nepal. Ind JourPharmacol 1998; 30:175-80.3. Ramsay L E. Blidging the gap between clinical pharmacologyand rational drug prescribing. Br J Clin Pharmacol 1993;Indian Journal of Pharmacy Practice Volume 4 Issue 4 Oct - Dec, 2011 79
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