APTI ijopp - Indian Journal of Pharmacy Practice

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Indian J. Pharm. Pract. 1(2), Jan-Mar, 2009APTIijoppEvaluation of Drug Information Service provided by ClinicalPharmacy Department based on Provider and Enquirers' Perspective1 2 34 5Kuchake V.G , Maheshwari O.D , Surana S.J , Patil P.H , Dighore P.N .1,2,3,4. Department of Clinical Pharmacy, R.C.Patel Institute of Pharmaceutical Education & Research, Shirpur,Dist: Dhule (M.S.), India – 4254055. M.D.(Medicine), Department of Clinical pharmacy, Indira Gandhi Memorial Hospital, Shirpur, Dhule,Maharashra-425405*Address for correspondence: msvragavrajan@yahoo.comAbstractHypertension is not a disease but an important risk factor for cardiovascular complication. This type of medicalaudit and appropriate feedback on usage of antihypertensive medications may greatly assist the health careproviders in rational use of medications.The objective of this study was to evaluate the prescribing pattern and drugutilisation of antihypertensive medications in uncomplicated hypertension. Observational and Prospective studywas performed at Indira Gandhi Memorial Hospital, Shirpur, Maharashtra in India. Total 5025 patients visited themedicine ward of Indira Gandhi Memorial Hospital. Among them 244 patients had uncomplicated hypertension.ststFrom 1 July, 2008 to 31 December, 2008 Hypertensive medications were divided into 2 main categories;Monotherapy and Combination therapy was defined and discussed separately. During 6 months study period, 510prescriptions were collected, among them 244 including (132) female & (112) male patients were as per inclusioncriteria. Among them, 150 patients were on mono therapy which included 78 female & 72 male patients, comprising54%(81) on Calcium Channel Blockers, 24.67%(37) on â-Blockers, 11.33%(17) on Angiotensin ReceptorBlockers, 6%(9) on Angiotensin Converting Enzyme Inhibitors, 4%(6) on Diuretics respectively, and 38.52% (94)patients on combination therapy. In the view of drug utilisation, it was observed that, the diuretics are lessprescribed and calcium channel blockers are frequently prescribed medications in management of hypertension.So, it requires further improvement of prescription pattern of antihypertensive medication for better patient healthcare.Key Words: Anti-hypertensive drugs, drug utilisation, hypertension, prescribing patternINTRODUCTIONHypertension, a major risk factor for cardiovascular Socio-economic, behavioral, nutritional and public(CV) disease and stroke and one-quarter of the adult health issues can lead to increase in CV diseasepopulation of Western societies suffer from throughout the world. A plethora of new drugs are now(1)hypertension. Increasing awareness and diagnosis of available, and the quality of life of such people can behypertension, and improving control of blood pressure improved considerably. A number of drugs in variouswith appropriate treatment, are considered critical public(4-5)combinations are generally used for effective long-health initiatives to reduce cardiovascular morbidity and term management. Therefore, drug utilisation studies,(2)mortality. The Seventh Report of the Joint Nationalwhich evaluate, analyze the medical, social andCommittee on the Detection, Evaluation, and Treatmenteconomic outcomes of the drug therapy, are moremeaningful and observe the prescribing attitude ofof High Blood Pressure (JNC VII) is the most prominent(6,7)physicians with the aim to provide drugs rationally .evidence-based clinical guideline for the management of(3)The present prescribing study for antihypertensive drugshypertension. Poor control on hypertension can lead towas undertaken in the outpatient department (OPD) atthe development of ischemic heart disease, heart failure,Indira Gandhi Memorial (IGM) hospital, Shirpur (ruralstroke & chronic renal insufficiency.area) Maharashtra for the purpose of assessing thecurrent trend of prescribing pattern of anti-hypertensiveIndian Journal of Pharmacy PracticeReceived on 06/01/2009 Modified on 13/02//2009drugs. This kind of medical audit can help to make theAccepted on 17/02/2009 © APTI All rights reservedprescribing practice of physicians more rational and62
Indian J. Pharm. Pract. 1(2), Jan-Mar, 2009prudent and thereby help in improving the patient healthcare.characteristic of all 244 uncomplicated hypertensivepatients is seen in Table No. 1.MATERIALS AND METHODFigure No. 1 and 2 shows the social history of patientsThe observational and prospective study was carried out like their occupation and education. The data suggestedat IGM hospital to collect the information of the patients.The Protocol was prepared as per World Healththat elderly patients having more hypertension amongmore patients were rest. Illiterates are more prevalence(8)Organization (WHO) guidelines and study was than literates.approved by Institutional Human Ethical Committee Overall, 150 (61.48%) patients were treated with a single(IHEC) of R.C.Patel Institute of Pharmaceutical anti-hypertensive drug and 94 (38.52%) patients wereEducation & Research, Shirpur.treated with anti-hypertensive drug combinationsStudy design: This study was observational and suggesting that mono-therapies to be dominant in thisprospective conducted over the 6 months periods from type of rural area.st st1 July 2008 to 31 December 2008 for assessing Table No 2 shows the details of patients, who wereprescribing pattern and drug utilisation ofantihypertensive drugs in the management oftreated with monotherapy. Among them, 81 (54.0%)patients were treated with Calcium Channel Blockersuncomplicated hypertension(CCBs), 37 (24.67%) were treated with â-blockers,Study site: The study was carried out at the Medicine 17 (11.33%) with Angiotensin receptor blockers(ARBs),ward of IGM hospital of Shirpur for collection of data. 9(6.0%) were treated with Angiotensin ConvertingStudy setting: The study was carried out on out patients Enzyme Inhibitors(ACEIs), and 6(4.0.%) treated withof medicine ward, who were currently following the diuretic. Calcium channel blockers were the mosttreatment of uncomplicated hypertension in IGM frequently prescribed antihypertensive drugs ashospital, Shirpur.monotherapy.Source of data: All necccesary & relevant information Figure No.3 show details of patients treated withwere collected from out patient department cards, combination therapy. Among them 59, (62.78%) werelaboratory data report, treatment chart and verbal treated with two drugs, 31(32.98%) with three drugs andcommunication with patients.4 (4.25%) were treated with 4 drugs.Collection of data: The format for the collection of the It was observed that eight different two-drug antithedata is prepared as per WHO based guidelines andhypertensive combinations, were prescribed to hyp-Institutional Human Ethical Committee of R.C.Patel ertensive patients (Table no.3), namely: , â –blocker withInstitute of Pharmaceutical Education & Research, CCB 23 (32.98%), ARB with diuretic 18(30.51%), CCBShirpur which involved patient as well as medication with diuretic 6(10.17%), â-blocker with diureticinformation.4(6.78%), ARB with CCB 4(6.78%), ACEI with CCBInclusion criteria: Patients either male or female with2(3.38%), ACEI with diuretics 1 (1.69%) and ARB withage more than 18 years, with History of hypertension orâ-blocker1 (1.69%).currently diagnosed with hypertension and prescribed The CCB with â-blocker was the most frequentlyprescribedtwo-drug combination in overall populationwith antihypertensive medication.Exclusion criteria: Patients with other comorbiditiesfollowed by ARB with Diuretic. The CCB with â-blockerlike diabetes, other cardiovascular disorders, stroke,were less prescribed in male than female patients due toasthma, Chronic Obstructive Pulmonary Disease(9)side effect of â-blockers in male patients.(COPD), arthritis, and other infectious disease.DISCUSSIONStatatical Data AnalysisA Prescription-based survey is considered to be one ofThe t- tests (Unpaired, Two tailed) were used forthe most effective methods to assess and evaluate drugevaluation of mean S.E.M. (Standard Error Mean) of ageutilization of medication. It is also important to considerand blood pressure of patients. A value of P0.05 (twotherecommendations of international bodies ontailed test) was declared as statistically significant.hypertension that help to improve prescribing practice ofRESULTSst stDuring 6 months study from 1 July 2008 to 31 the physicians and ultimately, the clinical standards. ADecember 2008, total 5025 out patients visited the continuous supervision is therefore required throughmedicine ward of hospital, among them, 510 patients such kinds of systematic audit that provide feedbackwere diagnosed with hypertension of which 244 had from the physician and help to promote rational use ofuncomplicated hypertension. The demographic drugs.63
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