Drug utilization study of anti-hypertensive drugs and prescription pattern adherence with joint national committee-8 guideline

Background: Hypertension is a major and serious non-communicable disease. It is also a major risk factor for cerebrovascular strokes, coronary artery thrombosis, and renal failure. The overall prevalence of hypertension in India is 29.8%. Joint national committee-8 guidelines on prevention, detection, evaluation, and treatment of high blood pressure highlight that aggressive blood pressure control is essential for the reduction of hypertension-associated morbidity and mortality.Methods: It was a cross-sectional, observational study. Prescriptions were collected from four pharmacy stores located in four different areas of Ahmedabad over a period of 2 months. These were analysed along with relevant co-morbidities and, the level of prescription pattern adherence was assessed as per JNC 8 guidelines. Appropriate statistical tests were applied for analyses of collected data.Results: A total of 321 prescriptions were collected. Out of them, 186(57.9%) were prescribed to male patients while 135 (42.1%) were for female patients. Mean systolic and diastolic blood pressure was found to be 152 mmHg and 91 mmHg respectively. The mean age of the patients was found to be 44.63 years. A total of 209 (65.1%), 91 (28.34%), 21 (6.54%) prescriptions had monotherapy, dual therapy, and polytherapy for treating hypertension respectively. Amlodipine (CCBs) was found to be the most commonly prescribed medicine as a monotherapy. The overall adherence rate was found to be 77.88%.Conclusions: The present study demonstrated that medical professionals are not completely adhering to standard guidelines while prescribing antihypertensive drugs. There is substantial scope for improvement, particularly the utilization of antihypertensive agents in patients of the pre-hypertension category, where non-pharmacological measures play an important role to treat the condition.

Assessment of parents induced self-medication in paediatric population in rural and urban areas of Ahmedabad, Gujarat

Background: Self-medication is termed as administration of medications by care-givers without medical consultation. It includes several forms through which the individual themselves or the ones responsible for them decide, without medical evaluation, which drug they will use and in which way for the symptomatic relief and cure of a condition. Objectives of the study was to estimate the overall prevalence of parents induced self-medication, to identify the most commonly used drugs and the reasons of self-medications in rural and urban areas of Ahmedabad, Gujarat.Methods: This is community based observational cross sectional study was conducted over a period of four months in urban and rural areas of district Ahmedabad under the field practice area of AMC MET Medical College and Sheth LG General Hospital, district Ahmedabad, Gujarat. The study population included children from 5-15 years. The data was collected from the care giver/parents of the children through a pre-validated questionnaire.Results: Prevalence of self-medication was 86.14%. Most common illness for which self- medication was done was fever in 84 children (22.16%) followed by acidity in 72 children (18.99%). Commonly used drugs were antipyretics, antibiotics and oral rehydration therapy. Previous prescription was used by most of them to procure the drugs and previous experience on efficacy was the most common reason cited.Conclusions: In this study, the prevalence of parents induced self-medication is quite high. There is a need to strengthen public education regarding self- medication, by mass media and local government authorities

A cross sectional observational study to evaluate utilization of antimicrobials in paediatric department of a tertiary care teaching hospital

Background: Antimicrobials play cardinal role in management of infectious disease. Paediatric age group forms significant part of developing countries and have high chances of acquiring infectious. Misuse and overuse of these antimicrobials are leading culprits in causing antimicrobials resistance. The purpose of this study was to analyse utilization of antimicrobials among paediatric department of a tertiary care teaching hospital. Methods: A cross sectional observation study was conducted for three months in paediatric department of a tertiary care teaching hospital. The demographics and antimicrobials use details were observed daily from patients admitted to paediatric outpatient department, wards and intensive care unit to assess according to The World Health Organization-International Network of Rational Use of Drugs drug prescribing indicators and WHO antibiotics AWaRe (Access, Watch, Reserve) classification. Results: In our study we found that mean antimicrobial use in OPD, wards and ICU was1.15±0.35, 1.12±0.33 and 2.25±1.01 respectively. Cephalosporins were most commonly prescribed in OPD (34.62%) and wards (65.26%) while piperacillin-tazobactam (29.93%) in ICU. Percent encounter with an antibiotic in OPD, Wards and ICU was 8.41%, 30.71% and 33.58% respectively. 56.69%, 81.35% and 55.80% antibiotics prescribed in OPD, Wards and ICU respectively were of Watch group. 5.66% Reserve group antibiotics were prescribed in the ICU. Conclusions: Prescribing trends of antimicrobials is near to WHO standard but according to AWaRe classification, watch group antibiotics were prescribed more than Access group

Drug utilization pattern evaluation and cost variation analysis of anti-fungal agents in tinea infected patients in dermatology department of a tertiary care teaching hospital

Background: Tinea infections are chronic superficial fungal infections, highly prevalent in tropical countries like India. Therefore, long-term therapy is needed and this can inflict a financial burden on the patients. Aim of the study was to assess drug utilization patterns in patients diagnosed with tinea infection and to evaluate the cost variability of anti-fungal agents. Methods: A cross-sectional observational study was conducted in patients for 3 months after taking permission from IEC. All adult patients already diagnosed with tinea infection were enrolled. Evaluation of drug utilization pattern was carried out using WHO core drug prescribing indicators and percentage of cost variability was calculated between different brands of anti-fungal agents. Results: A total of 252 patients were enrolled. Tinea corporis and cruris were the most commonly diagnosed tinea infection. Pruritus was the most common presenting symptom. Past history of similar illness was seen in 74 (29.4%) patients mean of 3.83±0.87 drugs were prescribed per patient. Drugs prescribed from NLEM was only 42.1%. Most commonly prescribed drugs were oral itraconazole and topical miconazole. Percentage of cost variability was seen maximum with capsule itraconazole 200 mg (237.5%) by oral route and luliconazole 30 gm (175.6%) by topical route. Conclusions: Prescribing practices of drugs can be improved by promoting generic drug and prescribing drugs from NLEM. Wide range of cost variation can lead to high economic burden in tinea infected patients

A cross-sectional study to assess the drug utilization pattern and pharmacotherapeutic adherence among patients with schizophrenia and quality of life of patient’s caregiver in a tertiary care teaching hospital

Background: Schizophrenia is a chronic severe psychiatric illness affecting nearly 0.4 to 1.4% of people in India. Many newer anti-psychotic drugs are used now-a-days in schizophrenia. Poor adherence to the treatment given to patients of schizophrenia is observed very often. Although, the quality of life of schizophrenia patients is very much compromised; at the same time, quality of life of the caregiver is also compromised. Methods: A cross-sectional Observational study was conducted among patients already diagnosed with Schizophrenia and on treatment, after ethical approval. Data relevant to study variables was collected in a pre-designed case record form. Evaluation of drug utilization pattern was done by WHO core drug prescribing indicators. Medication adherence was assessed through modified Morisky scale. Quality of life of relative or caregiver was assessed through WHO-QOL BREF questionnaire scale. Results: Patients of 18 years and above were enrolled. Among them, average age was 35.8±5.5 years. In my study, female patients were 64.7% and male patients were 35.3%. Average number of drugs per prescription was 3.8. Drugs prescribed by generic name were around 86.2%. Around 56.9% of drugs were prescribed from national list of essential medicines. Atypical antipsychotics were prescribed in 32% of all prescriptions for Schizophrenia; Whereas Benzodiazepines were prescribed in 19% of all prescriptions. Average Medication adherence score using MMS scale was 3.7±2.2. Patients with high adherence to the medications prescribed were nearly 71% and patients with low adherence to the medications prescribed were 29%. Mean total WHOQOL-BREF score was 75.2±6.5 out of 120. Conclusions: Most prescribed class of drugs was atypical anti-psychotics. Pharmacotherapeutic adherence among patients with schizophrenia was relatively high. Quality of life of patients’ relative or caregiver was impaired to some extent, more impaired in physical health and social relationships domain

Drug utilization study in patients of COPD in TB and Chest department in a tertiary care teaching hospital

Background: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. It is the fourth leading cause of death in the world, and further increase in its prevalence and mortality can be predicted in the coming decades. Many people die prematurely from it or its complications. Total deaths from COPD are projected to increase by more than 30% in the next 10 years unless urgent action is taken to reduce the underlying risk factors, especially tobacco use. Estimates show that in 2020 COPD will become the third leading cause of death worldwide. A wide range of drugs are prescribed for COPD but not strictly according to established guidelines.Methods: A prospective observational study of drugs prescribed in COPD was conducted in outdoor patients at TB and Chest department at Sheth L. G. General Hospital.Results: Total 90 prescriptions of COPD patient were collected and studied for drug utilization. The results revealed that the ratio of prevalence in males was higher than females, which was 73% and 27% respectively. Theophylline (93.3%) and chlorpheniramine (71.1%) were most prescribed drugs.Conclusions: According to the results, prevalence was higher in males than females and was higher in smokers than nonsmokers and most common prescribed class of drug was methylxanthine

Occurrence of depression, anxiety and stress among medical students working during COVID Pandemic

Background: Since the COVID-19 pandemic began, medical students have been allotted various duties like rapid antigen testing, Sanjivani corona ghar seva (service provided by the government for home quarantine people), RTPCR swab collection, and posting in wards and intensive care units (ICUs). While executing the COVID-19 duties, students had a significant degree of a significant degree of ambiguity and apprehension. The purpose of this study was to determine the psychological impact of COVID-19 on medical students performing COVID-19 duties.Methods: A questionnaire-based, cross-sectional observational study was conducted among undergraduate and postgraduate students of a tertiary care teaching hospital, who were deployed on COVID-19 duty during pandemic. A google form-based questionnaire was structured, encompassing demographic details, Depression, Anxiety and Stress Scale-21 (DASS-21) questionnaire and other (additional) COVID-19 duty related questions. The analysis of data was done by using unpaired t-test and chi-square test in Statistical package for social sciences (SPSS) version 20.0Results: In our research study, we found that occurrence of depression, anxiety, and stress was 40.46%, 48.37%, and 30.69% among the medical students during COVID -19 duty, respectively. Higher occurrence and more severity (p<0.01) of depression, anxiety and stress was seen in female medical students during COVID-19 duty in pandemic.Conclusions: We observed a higher occurrence of depression, anxiety, and stress among medical students while performing their COVID-19 duty in a pandemic. Medical students played a significant role in the COVID-19 pandemic. Therefore, measures should be taken to ensure the psychological wellbeing of medical students.

Cross sectional observational study to assess the knowledge of drugs utilized in emergency medical conditions amongst medical interns and residents in tertiary care teaching hospital

Background: Medical interns and residents are future medical professionals and as first-line responders, they may confront any type of emergency. Knowledge of pharmacotherapeutics (PTs) is the backbone of emergency care. Therefore, this study is designed to assess PTs’ knowledge and identify the lacunae in handling various medical emergencies among medical interns and residents.Methods: This was a cross-sectional, observational, questionnaire-based study. A self-structured questionnaire containing 30 close-ended questions, assessing the knowledge of drugs utilized in various medical emergency conditions was prepared and circulated in the form of a Google form. A credit score of “1” was given for each correct response. Grading of knowledge was done as “poor” (≤50%), “average” (>50-70%), and “adequate” (>70%-100%) The student’s unpaired t-test was used to analyse the data.Results: A total of 282 candidates responded, with 148 (52.48 %) interns and 134 (47.52%) residents. Participants had the least knowledge of PTs for anaphylactic shock. Participants’ knowledge of PTs was found to be adequate regarding the central nervous system and electrolyte disorders while average regarding toxicology, immunization, and endocrine system. Results suggested that residents (mean score: 21.42±5.06) were significantly (p=0.0165) more knowledgeable than interns (mean score: 19.96±5.08). Among respondents, 17.6% of interns and 13.4% of residents had poor performance while 45.9% of interns and 53.7% of residents had adequate performance.Conclusions: The current study provides valuable information regarding the state of PTs’ knowledge in medical emergencies among interns and residents, which can be used to improve undergraduate as well as postgraduate training. 

A drug utilization study in glaucoma patients in ophthalmology out patient department in a tertiary care hospital

Background: According to World Health Organization (WHO) studies Glaucoma is a chronic progressive symptomatic disease that damages retinal cells and is one of the leading cause of preventable blindness worldwide. Availability of newer topical agents has modernized the management of glaucoma.Methods: A prospective observational study was carried out from August 2016 to December 2016 at ophthalmology Out Patient Department of L.G General Hospital, Ahmedabad by authours after the approval of the Institutional Ethics Committee.Results: Out of total 101 patients, 71 were males and 30 were females. Average age of patient is 54 years. Common variant of Glaucoma was Primary Open Angle Glaucoma in 57.4% of patients. Average number of drugs per prescription was 2 (45%). Most commonly used Fixed Dose Combination was Brimonidine +Timolol Drops which was used in 87 (86.1%) patients. Most commonly used adjuvant drug was Tab. Acetazolamide (60% of patients).Conclusions: Common variant of Glaucoma was Primary Open Angle Glaucoma in 57.4% of patients. Most commonly used Fixed Dose Combination was Brimonidine+Timolol Drops which was used in 87 (86.1%) patients and commonly used Single drug therapy is Tab. Acetazolamide in (60% of patients)

Self-medication amongst pregnant women in a tertiary care teaching hospital in India

Background: Self-medication is a popular practice in developing countries where there is no strict regulation of drugs sold in local pharmacies. General public is usually unaware of the adverse effects of drugs used for common illness and continue using them without prescription during pregnancy. This study was carried out to know the extent of self-medication practised by pregnant women and various factors associated with it.Methods: A questionnaire based, cross-sectional study of pregnant women visiting the OB GYN-OPD of a tertiary care teaching hospital was conducted. 303 eligible subjects were questioned and statistical analysis was carried out.Results: Total 16.5% women were found to be self-medicating during pregnancy for common conditions like headache (26%), fever (23%) and common cold (19%). Odds Ratio between the self-medicating and non-self-medicating groups for variables like age (<25 years; ≥25 years), education (illiterate; literate) and gestational age (<20 weeks; ≥20 weeks) are 1.6, 2 and 1.73 respectively. Women with a history of self-medicating before pregnancy were significantly more likely to continue doing so during pregnancy (p value <0.00001).Conclusions: A significant proportion of pregnant women have been found to self-medicate without knowing the adverse effects of the drug used. Thus, spreading awareness against this health-predicament is necessary