A Comparative drug utilization study of depression patients between tertiary care teaching hospital and private practitioners of Dehradun city, Uttarakhand

Abstract Background: Drug utilization studies are beneficial in clinical practice for rational prescribing, as there is continuous proliferation of new drugs and the increasing recognition of their delayed adverse effects. Depression is an important global public health problem thus making such studies a must for minimizing the medication errors. Aim and objectives: Present study audits the prescribing pattern of psychiatric private practitioners (PPs) vs psychiatric practitioners of tertiary care teaching hospital (TCTH) at Dehradun, Uttarakhand. Materials and methods: A total of 371 prescriptions were analysed, 196 were from collected from PPs and 175 from TCTH at Dehradun. They were analysed using WHO drug use indicators and National List of Essential Medicines (NLEM-2013). Results: Anxiolytics 150(25.25%) were most commonly prescribed by the PPs followed by antidepressants 120(20.20%) and antipsychotics 111(18.48%), whereas antidepressants 105 (27.78%) was the major drug group prescribed by TCTH followed by anxiolytics 102(26.98%) and antipsychotics 37(9.79%). Tricyclic antidepressants(TCAs) were most frequently prescribed antidepressants followed by selective serotonin reuptake inhibitors(SSRIs) at TCTH whereas SSRIs were the major antidepressants prescribed by PPs. Anxiolytics and anticholinergics co-prescription with antidepressants and antipsychotics respectively, was a common observation among PPs and TCTH. Analysis of prescription revealed average number of drugs prescribed per prescription in teaching hospital is 2.16 vs 3.03 among the private practitioners. 18.25% Fixed drug combinations(FDCs) were prescribed by TCTH while 0% were prescribed by PPs. 55.39% and 55.56% drugs were prescribed from the NLEM-2013 by the PPs and the TCTH respectively. Conclusion: There were lesser number of drugs prescribed per prescription and more frequent use of drug combinations at TCTH while no drug combinations and greater number of drugs per prescription were prescribed by PPs. Newer class of drugs were more frequently prescribed by PPs. Key words: Drug utilization studies, antidepressants, antipsychotics, anxiolytics, Fixed drug combinations

Study on Drug Prescribing Pattern in Dengue Patients in a Tertiary Care Hospital – A tool to teach Clinical Pharmacology

Abstract Introduction and Aim: Dengue fever (DF) is the most common arboviral infection of mankind gaining global attention. Data about drug usage patterns in DF in India are lacking.The present study was undertaken to analyze drug utilization pattern of dengue infections to teach certain basic skills to MBBS students which will form an integral component of practising rational therapeutics. Methods: A total no of 122 cases were followed up by the 5th semester 2nd Professional undergraduate students in the department of pharmacology at hospital wards of SGRRIM &HS, Dehradun from June 2012 to July 2014. Patients were analysed on various parameters using WHO drug use indicators and National List of Essential Medicines. Results: A total of 122 prescriptions were analyzed. Male:Female ratio was (72.95%, 27.05%) Age wise distribution of patients was done: 0-15 years were 9 (7.34%), 16-30 years were 45(36.88%), 31-45 years were 46(37.70%), 46-60 years were 18 (14.75%) and >60 years were 4 (3.28%). A total of 614 drugs were prescribed. 169(27.52%) antimicrobials, 99(16.12%) antipyretics, 91(14.82%) antacids, 65(10.59%) multivitamins, 55(8.96%) antiemetics and 135(21.99%) in miscellaneous category were prescribed. 243(40.23%) oral drugs and 361(59.77%) injectable drugs were prescribed. 5.03 drugs per prescription were prescribed. 377(62.42%) drugs were prescribed from National Essential Medicine List.100% drugs were prescribed by brand names. Conclusion: Majority of the drugs were prescribed from national essential medicine list. As the incidence of DF is increasing with epidemics, the demand for specific treatment guidelines is in great need. Key words: Dengue fever, drug utilisation pattern, rational prescribing

Prescribing pattern in ophthalmological outpatient department of a tertiary care teaching hospital in Dehradun, Uttarakhand: a pharmaco-epidemiological study

Background: Irrational prescribing is a common phenomenon, seen among medical practitioners. Knowledge, awareness, and attitude denote the practicing trends among the practitioners. The objective of this study was to describe the prescribing practices in Ophthalmology outpatient department (OPD) to promote rational prescribing.Methods: This study was conducted between January 2011 to June 2011, in Department of Pharmacology and Ophthalmology, SGRRIM and HS, Dehradun, Uttarakhand. A total number of 255 prescriptions were randomly collected from the Ophthalmology OPD and were analyzed for various parameters using national essential medicine list 2011 and World Health Organization drug use indicators.Results: A total number of255 prescriptions were evaluated for prescribing pattern, 153 (60%) patients were between 16 and 45 years of age, the male: female ratio was 1.13:1. 237 (93%) patients from middle socioeconomic status. Diseases pattern observed were conjunctivitis 102 (40%), refractive error 45 (17.64%), stye 12 (4.7%), cataract 9 (3.52%), and miscellaneous 87 (34.12%). One hundred and thirty-eight (54.11%) patients received antimicrobial agents, fluoroquinolone (ofloxacin, moxifloxacin, gatifloxacin, etc.) were the most frequently prescribed antimicrobial drugs, analgesics (diclofenac and ketorolac) were prescribed to 45 (17.64%) patients, 54 (21.17%) received steroids (dexamethasone and prednisolone), 96 (37.64%) patients received other drugs (carboxymethylcellulose [CMC], multi-vitamins, zinc preparations, acyclovir, and anti-allergics). Fixed dose combinations (FDCs) were used in 90 (35.29%) patients, the most common combination was antimicrobials with steroids. All the drugs were prescribed by brand names and 1.9 drug/prescription was used.Conclusion: Topical antimicrobial agents are the most commonly used drugs in ophthalmic OPD in our setup; the most common FDCs prescribed were antimicrobials with steroids, the other commonly used drugs were analgesics, CMC and anti-allergic drugs

Role of pharmaco-epidemiology in psychopharmacology: a study in psychiatric out-patient department of a tertiary care teaching hospital at Dehradun, Uttarakhand

Background: Prescription auditing studies are a part of drug utilization studies, are beneficial in clinical practice for rational prescribing of drugs and helpful for minimizing the medication errors. They are important tool to promote rational prescribing.Methods: This wasa prospective drug utilization study conducted by the Department of Pharmacology in Psychiatry out-patient department at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun for a period of 6 months. A total of 311 prescriptions were evaluated for prescribing pattern using World Health Organization drug indicators and National Essential Medicine List (NEML) 2011.Results: A total of 311 prescriptions were evaluated, 157 (50.48%) were females, and 154 (49.52%) were males, mean age was 37.14±0.8 years. Majority of patients were married 207 (66.56%), housewife 116 (37.30%) and belong to middle socioeconomic group 205 (65.92%). A total of 1250 drugs were prescribed, anti-anxiety (anti-A) 379 (30.32%), anti-depressants (anti-Ds) 348 (27.84%), anti-psychotics (anti-Ps) 118 (9.44%), anti-epileptics (anti-Es) 64 (5.12%), mood stabilizer 20 (1.6%), anti-cholinergics 28 (2.24%) and others 293 (23.44%). Oral formulations 1247 (99.76%), 4.02 drugs/prescription, 100% drugs were prescribed by brand names. 220 (17.6%) fixed dose combinations were prescribed. Most frequently prescribed among anti-A drugs were propranolol 160 (42.22%) and diazepam 105 (27.70%), among anti-Ds drugs were amitriptyline 65 (18.68%) and escitalopram 59 (16.95%) and among anti-Ps risperidone 49 (41.53%) and olanzapine 38 (32.20%), respectively. About 51.36% drugs were prescribed from the NEML 2011. Result has revealed polypharmacy in the practice.Conclusions: Anti-A drugs were the most commonly prescribed drugs followed by anti-Ds, anti-Ps and anti-Es respectively. Rational prescribing requires further consideration with special reference to polypharmacy and providing feedback to the physicians

Study of antimicrobial prescribing pattern in a tertiary care teaching hospital at Dehradun, Uttarakhand, India - A tool to teach clinical pharmacology to MBBS students

Background: Due to increasing resistance to a majority of antimicrobials, it becomes very necessary to teach undergraduate students, the future prescribers, about the judicious and rational use of antimicrobial drugs. The objective of this study was to impart the basic clinical skills to undergraduate MBBS students which will form an integral component of practising rational therapeutics.Methods: A total no of 737 cases were followed up by the 5th semester 2nd Professional MBBS students in the Department of Pharmacology at Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIM and HS), Dehradun from June 2013 to July 2015. Patients were analysed on various WHO drug use indicators like drug formulations, drugs prescribed per prescription, Fixed dose Combinations (FDCs), drugs prescribed from National List of Essential Medicines (NLEM) and drugs prescribed by generic names.Results: A total of 737 prescriptions were analysed. Male: Female ratio was 1.74:1 (63.50%:36.50%). Majority of the patients 218 (29.58%) were in 16-30 years age group. A total of 1205 antimicrobials were prescribed. 304 (25.23%) cephalosporins were most frequent followed by 184(15.27%) penicillins, 176(14.61%) antitubercular drugs, 163(13.53%) nitroimidazoles, 143 (11.87%) fluoroquinolones, 102 (8.46%) aminoglycosides, 29 (2.41%) macrolides, 19 (1.58%) tetracyclines, 12 (1%) carbapenems, 11 (0.91%) antimalarials, 11 (0.91%) antihelminthics, 6 (0.50%) glycopeptides, 4 (0.33%) lincosamides and 41 (3.41%) miscellaneous antimicrobials. Most frequently prescribed antimicrobial was Ceftriaxone which was given in 97 (8.05 %) patients. A total of 424 (35.19%) oral antimicrobials, 777 (64.48%) injectable antimicrobials and 04 (0.33%) local/topical antimicrobial drugs were prescribed. 5.13 drugs per prescription and 1.64 antimicrobials per prescription were prescribed. 2100 (55.56%) drugs were prescribed from National List of Essential Medicine 2015 (NLEM 2015). 1177 (97.68%) antimicrobials were prescribed from NLEM. 1110 (92.12%) antimicrobials were prescribed by brand names. A total of 342 (28.38%); fixed dose combinations of antimicrobials were prescribed.Conclusions: Majority of the prescriptions revealed poly-pharmacy and a very high percentage of drugs were prescribed by their respective brand names. It is only by observing drug utilization patterns, current trends and common errors in prescriptions can be highlighted and rational prescription of antimicrobials can be taught to MBBS students

Comparative evaluation of various analgesic drugs in Wistar rats used as a teaching tool to teach animal experiments to post graduate MD Pharmacology students

 Background: Postgraduates when join Pharmacology department, they don’t have much idea about guidelines and methods to do animal experiments. This study was designed to sensitize postgraduate students to animal experiments by evaluating the anti-inflammatory effects and the efficacy of diclofenac, tramadol and etoricoxib in reducing paw edema in wistar rats.Methods: The wistar rats of 225-250gram were divided into four groups (n=10 each). In all the groups the paw edema on right paw was created using 0.1ml of 1% formalin subcutaneously. Group 1 rats (control), group 2 were given diclofenac, group 3 were given tramadol and group 4 were given etoricoxib orally. The parameters assessed were water displacement in plethysmography after 2, 4, 24, 48 hours of giving the drug. The circumference of edematous paws after 4 hours, licking of paw was observed over 30minutes of giving the drug and was compared. Pre and post study feedback were obtained from the students by using a preformed questionnaire to assess the knowledge gained by the students.Results: The test showed that all the drugs were effective in reducing inflammation, circumference of edema and the licking duration significantly (p<0.05). The post study answering of questions by postgraduate was 100% in comparison to pre-study answering which was 33%.Conclusions: A short animal study conducted as a teaching tool to postgraduate students was able to teach the guidelines of animal experiments and handling of animals effectively

Drug utilization pattern of analgesics as a teaching tool for rational therapy to MBBS students in a medical college at Dehradun, Uttarakhand, India

Background: As a need to introduce Clinical Pharmacology at the undergraduate level the drug utilization studies (DUS) offer useful methods for teaching and training in drug therapy. The indiscriminate use of medicines results in unwanted side effects, drug interactions. Thus keeping this view in mind, this drug utilization research was set to evaluate the prescribing pattern of analgesics to impart certain basic skills to MBBS students which will form an integral component of practicing rational therapeutics.Methods: The retrospective study was conducted by Pharmacology department in SGRRIM and HS. A total of 726 prescriptions were collected by 2nd professional MBBS students entering 5th semester and randomly evaluated for prescribing pattern using WHO drug use indicators.Results: A total of 726 prescriptions were analyzed. Male:Female ratio was 470:256(1.8:1). Age wise distribution of patients 0-15years 122(16.80%), 16-30 years 139(19.41%), 31-45years 242 (33.33%), 46-60 years 113(15.56%) and >60years 110 (15.15%). A total of 4663 drugs were prescribed. 435(9.32%) were analgesics. 208 (47.81%) Paracetamol, 66 (15.17%) Tramadol, 62(14.25%) Aceclofenac, 51 (11.72%) Diclofenac, 46 (10.57%) Ibuprofen and 2(0.45%) Buprenorphine were prescribed. 301 (69.20%) Oral drugs and 134 (30.80%) Injectable were prescribed. 108 (24.83%) Numbers of Fixed dose combinations. 0.60 of analgesics were prescribed per prescription. 381 (87.59%) analgesics were prescribed from National Essential Medicine list 2015. 369 (84.83%) drugs were prescribed by brand names.Conclusions: The main purpose of undergraduate medical curriculum is to develop the requisite diagnostic and therapeutic skills of a basic doctor. Such type of drug utilization studies is set with the objective to encourage rational prescribing, and to identify good and bad prescribing practices

Comparative evaluation of beta-blockers with or without statins in the treatment of essential hypertension at a tertiary health care setup

Background: The effects of statins apart from their role as cholesterol lowering agents have prompted this study to evaluate their antihypertensive role. Beta-blockers (BB) are one of the most effective drugs in hypertension. The present study was designed for comparative evaluation of BB with or without statins in the treatment of essential hypertension in a tertiary health care setup.Methods: This study was conducted in 20 hypertensive patients by Pharmacology Department in Medicine outpatient department at SGRRIM and HS Dehradun for 1 year. Initially, patients were stabilized for 4 weeks by BB and then subdivided into 2 groups. Group I: BB (n=10) and Group II: BB+statins (n=10). Patients were followed up every 4 weeks for 16 weeks. Systolic blood pressure (SBP) and diastolic blood pressure (DBP), waist hip ratio (WHR), body mass index (BMI) were done every visit. Lipid profile was done at 4 and 16 weeks. Analysis was performed using t test. p≤0.05 was significant.Results: At 4 and 16 weeks, SBP in Group I was 133.6±3.7 and 127±1.61 mmHg (p>0.05) and in Group II was 141.2±2.97 and 130.6±0.71 mmHg (p0.05) and in Group II was 84.6±1.39 and 83.8±1.45 mmHg (p>0.05), respectively. At 16 weeks intergroup SBP and DBP comparison was done, which was not significant (p>0.05). At 4 and 16 weeks improvement in lipid profile in Group I (p>0.05) was not significant, but a significant improvement in Group II (p0.05), respectively.Conclusions: Both groups showed significant improvement in BP. However, no significant difference was seen on intergroup comparison. Larger studies with more patients are needed to establish the role of statins in hypertension

To study the preferred antihypertensive drugs in patients suffering from diabetes mellitus at a tertiary care hospital of Uttarakhand with an emphasis on compelling indications

Background: People with diabetes are more likely to also have high blood pressure. Hypertension can increase the risk of diabetes complications and is a powerful risk factor for development of a wide variety of cardiovascular, cerebrovascular and renal diseases. The treatment of hypertension in patients with diabetes thus becomes all the more important and may effectively prevent cardiovascular events. This study was thus planned with the aim to study the preferred antihypertensive drugs in patients suffering from diabetes mellitus and to teach UG students about the clinical importance of compelling indications in the treatment of hypertension.Methods: A total of 100 prescriptions of patients suffering from hypertension and diabetes mellitus were collected from diabetic hypertensive visiting the department of Medicine. Data was analysed in terms of percentage to find out the most and least preferred antihypertensive drugs in diabetes mellitus.Results: ACE inhibitors (30.95%) and ARBs (30.16%) were the most preferred, diuretics (19.84%), and CCBs (11.9%), and beta blockers (7.14%) were the least preferred antihypertensive drugs in diabetes patients. Three patients were on non-pharmacological treatment and among the remaining 97 prescriptions, monotherapy was the most common mode (70.1%) of therapy for hypertension, and drugs in combination were prescribed to 29.89% patients.Conclusions: ACE-I and ARBs were the preferred antihypertensive drugs prescribed in diabetic hypertensive. Treatment of hypertension should be individualized depending upon the compelling indications. This should be taught to undergraduate students in a practical way in collaboration with Medicine department

A drug utilization and pharmacoeconomic study of anti-diabetic drugs prescribed to type 2 diabetes mellitus patients visiting the medicine out-patient department of a tertiary care hospital of north India

Background: Type 2 diabetes mellitus (T2DM) patients require anti-diabetic drugs on chronic basis, frequent monitoring of blood glucose levels and a number of laboratory investigations, all of which result in significant economic burden on the diabetes patients and the world economies. The purpose of this study was to analyse the prescribing pattern to highlight the current approaches to the rational use of anti-diabetic drugs in T2DM patients visiting the medicine out-patient department, and to calculate the economic burden of different anti-diabetic therapies prescribed to patients with T2DM in a tertiary care hospital of north India.Methods: This prospective study included T2DM patients visiting the out-patient department of medicine of a tertiary care hospital of Uttarakhand, India. Prescriptions of patients diagnosed as cases of T2DM were analysed as per the WHO drug use indicators. For pharmacoeconomic evaluation, the cost variation of different anti-diabetic therapies was compared using the cost-effectiveness analysis method.Results: 273 prescriptions from 148 men and 125 women were analysed. 805 drugs were prescribed to the patients with an average of 2.95 per encounter: 494 anti-diabetic drugs with an average of 1.81 drugs per patient, and 311 for co-morbid conditions. Of the 494 anti-diabetic drugs, 75.1% were oral anti-diabetic (OAD) agents and 24.9% were insulin’s. Metformin (209) and insulin aspart (42) were the most prescribed OAD and insulin, respectively. The pharmacoeconomic analysis included 138 patients. The cost per unit (1 mg/dl) reduction in fasting blood glucose was lowest with glipizide and metformin combination (INR 10.46) and highest with insulin degludec and insulin aspart combination (INR 217.38). The average total direct cost of therapy for two months was INR 2244.39 ± 2745.05 (INR 362.88 to INR 10806). 86.63% of the average total direct cost of therapy was attributed to anti-diabetic agents.Conclusions: Metformin was the most common OAD agent and insulin aspart was the most common injectable anti-diabetic drug prescribed in patients with T2DM. The newer anti-diabetic drugs sitagliptin and newer insulin analogues were also prescribed to a great extent. Overall, the prescribing trend was rational to a great extent and had improved since the earlier study in the same institute. The most cost-effective anti-diabetic therapy was combination therapy of glipizide and metformin. The cost of diabetes management is high, especially for insulin therapy