Assessment of awareness on generic drugs among health care professionals and laypersons

Background: In the present day world the expenditure on medicines is very high. Most of the people in developing countries find it difficult to afford expensive medicines. One of the measures to cut down the expenditure on medicines is to use generic drugs. Hence the study was taken up to know the awareness, attitude and preference for generic drugs among medical and non medical persons.Methods: The study was done on 290 participants. 60 medical interns, 30 doctors, 50 nurses, 50 non medical staff (clerks and attenders) and 100 patients were included. They were given a questionnaire to know the awareness and knowledge on generic drugs, willingness to prescribe (among doctors) and use it (non medical staff and patients).Results: This study showed that all medical persons- doctors, interns and nurses knew about generic drugs whereas 60% of non medical staff and 95% of the patients were not aware about it. All doctors had good knowledge about generic drugs and 80% prescribed it always. 70% of the patients depended on what doctors prescribed for them and never asked for generic/ branded drugs in particular. 70% non medical staff preferred it only sometimes.Conclusions: The awareness among non medical persons is poor than medical persons among the surveyed population. Hence adequate measures should be taken to increase awareness and knowledge among public so that they become imperative enough to ask their doctors to prescribe generic drugs

Prescribing pattern of antibiotics in pediatric department of a tertiary care teaching hospital

Background: Prescription is an order from doctor for medicine. Rational use of medicines requires that "patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community". Irrational use of medicines is a major problem worldwide. This leads to serious morbidity and mortality also leads to reduction in the quality of treatment due to antibiotic resistance. Evaluation of prescribing pattern will help in minimizing adverse drug reactions, resistance among children. Also help to know the attitude of the physicians towards prescribing. Aim of the present study was to evaluate the prescription pattern of antibiotics in paediatric inpatients of Hassan institute of Medical Sciences.Methods: A prospective study, conducted among 110 patients below the age of 18 years and being treated with antibiotics were included in our study. The results were analyzed using descriptive statistics.Results: Out of 110 patients, female (58) and male (52) are enrolled in the study from inpatient paediatrics department, majority of patients belonged to age group of 0-5 years (74%), respiratory tract infections 29 (35%) , gastrointestinal infections 26 (22%) and central nervous system in 9 (11%). Out of 227 antimicrobial agent, about 83.48% were cephalosporins, followed by ciprofloxicin (33.94%), amoxicillin (32.11%), and amikacin (6.42%).Conclusions: Cephalosporins (ceftriaxone) were most commonly used antibiotic, which covers gram positive, gram negative and anaerobic organism

A retrospective study of antimicrobial usage in wound healing

Background: Chronic wounds are responsible for increase in burden to healthcare systems. The evidence concerning effectiveness of antibiotic therapy or optimal regimens is insufficient. Patients with chronic wounds receive significantly more systemic and topical antibiotics. Current guidelines for antibiotic prescribing for such wounds are often based on expert opinion rather than scientific fact. As there is increasing prevalence of antibiotic resistance, the relationships between antibiotic resistance and rationales for antibiotic therapy have to be determined. Current practice of antibiotic usage for chronic wounds and postoperative wounds in a tertiary care setting should be studied.Methods: Retrospective study was conducted from February 2017 to February 2018 using medical records of patients with wound admitted in surgical departments in HIMS, Hassan, Karnataka. The inpatient records were analysed, which includes duration of stay in the hospital, number of drugs/products per person, percentage of antibiotics prescribed, percentage of antibiotic injection prescribed, and other modalities used to treat wounds.Results: In present study, amongst 100 antimicrobial prescriptions, 26 females and 74 males. The most commonly prescribed parenteral antibiotic was ceftriaxone (58%), followed by metronidazole (56%). The average number of antibiotics per prescription was 2.8. The mean duration parenteral antibiotics given was 4.26 days during their hospital stay oral antibiotics were 5.18 days after the discharge from the hospital.Conclusions: The information generated shall be used to decide the policies to govern the prescription of antibiotics in the management of chronic wounds and post-operative wounds

Comparison of safety and toxicity of liposomal versus conventional Doxorubicin: an updated review

Cancer persists to be a major cause of hospitalization and death every year. With the passage of time, new formulations of anticancer drugs are being introduced to the market and are drawing the concern of healthcare professionals in terms of the superiority, toxicology, and cost-effectiveness of the new formulations in comparison to the conventional formulation of the same drugs. Doxorubicin, a highly potent chemotherapeutic agent, it comes with three formulations (pegylated liposomal, nonpegylated liposomal and non-liposomal conventional formulations). English-language literature of the three formulations of Doxorubicin has been reviewed to inform the healthcare professionals regarding the differences between these formulations. Liposomal Doxorubicin promotes better toxicology profile than non-liposomal conventional Doxorubicin with an increased cost. Due to very limited studies, the cost-effectiveness of liposomal Doxorubicin is not well defined. Apart from that, this review highlights the inter patient variability in regard to the clearance and volume of distribution following the administration of liposomal Doxorubicin. In conclusion, further studies regarding the superiority of liposomal formulation of Doxorubicin , efficacy and dose standardization of liposomal Doxorubicin should be sought in the near future in a more better way

Impact of educational intervention on pressurized metered dose inhaler technique among undergraduate medical students

Background: Inhaled medications form the cornerstone for the management of Asthma and related diseases. Proper technique of pressurized metered dose Inhalers (pMDIs) has proven to be associated with higher level of control of these conditions. Medical personnel who are responsible for training patients must themselves be proficient with usage of pMDI. This study evaluated the outcome of different educational interventions regarding the correct usage of pMDI.Methods: An interventional study was carried out with 60 second year medical students in department of pharmacology, HIMS, Hassan from June to August 2015. Pre and post intervention (after one week and one month) was evaluated based on National Asthma Education and Prevention Program (NAEPP) criteria for the use of pMDI by written and demonstration methods. The interventions included a video clip, an information leaflet and demonstration by a trained faculty.Results: Overall mean scores in pre-test for written knowledge and skill demonstration are 2.13±1.49 and 3.78±1.06 .There was substantial improvement in post intervention scores 7.15±1.41 and 7.37±1.67 (p<0.05) . Using one way ANOVA, demonstration group has shown statistically significant improvement in mean score compared to video and checklist groups in 1 week (8.8 versus 7.2 and 6.1, p<0.05) and 1 month (8.25 versus 7.1 and 5.7 (p<0.05) after the intervention.Conclusions: Correct usage of pMDI is a necessary skill for health care professionals and can be taught by various methods. The educational intervention by an interactive demonstration has proven to be effective in learning the inhaler technique

Assessment of depression among patients undergoing haemodialysis: a cross-sectional study

Background: Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. The beginning of dialysis treatment causes subtle changes in the life of CKD patients, mainly in the physical and social spheres. It affects the self-care of these patients which lead to poor adherence to dialysis. Hence, the present study was conducted to screen for depression.Methods: This was an observational study among 100 patients undergoing haemodialysis at HIMS, HASSAN. After taking informed consent, subjects were requested to complete Beck, depression Inventory, a 21-question multiple-choice self-report inventory for measuring the severity of depression. Descriptive statistics was applied to infer the findings.Results: The study population showed depression of mild (31%), borderline (10%), moderate (17%), severe (7%) and extreme (3%) grade and the remaining subjects did not show depressive symptoms (32%).Conclusions: Majority of patients undergoing hemodialysis were depressed. Major risk factors for depression were marital status of the patients, low literacy rate, gender and those started on dialysis recently

Adherence to treatment in patients undergoing dialysis

Background: Chronic Kidney Disease (CKD) is a silent disease that is frequently diagnosed in advanced stages. The prevalence and incidence of chronic kidney disease (end-stage renal disease) are continuously increasing, particularly in elderly patients. Poor adherence to complex multimodal therapies is a widely recognized problem in the daily care of dialysis patients, contributing to excess morbidity and mortality of this population. Aims and objectives was to assess the adherence to medications among patients undergoing haemodialysis and to explore the factors affecting non adherence.Methods: After obtaining approval from Institutional Ethics Committee, a prospective observational study was carried out among 150 patients, who were on dialysis in a tertiary care hospital, Hassan. An eight item Morisky Medication adherence questionnaire was used to assess medication adherence. Chi-square test applied to assess statistics.Results: Adherence levels were 28%, 42% and 30% for high, medium and poor adherence respectively. The overall prevalence of non-adherence among respondents was 30%. Among them 77.77% were males, 44.44% belonged to age group of 41-60 years, 40% illiterate, 60% employed, 51.11% of patients with smoking and alcoholic habits were not adherent to Dialysis. Other reasons contributing to non-adherence to treatment were forget fullness (86.66%), inadequate knowledge about side effects (80%), unhappy clinical visits (71.11%) and lack of assistance (48.88%).Conclusions: In this study patient showed moderate adherence. This emphasizes the need for constant motivation and education at frequent intervals to ensure better adherence

Analysis of cost between branded medicines and generic medicines in a tertiary care hospital

Background: There is much debate regarding the importance of promoting the use of cheaper generic alternatives over brand-name drugs. While generic drugs have been noted to be comparable to brand-name drugs in their ability to treat conditions, significant debate surrounding their bioavailability or the concentration of the drug that reaches its site of action has arisen. Many experts continue to believe that generic and brand-name drugs are bioequivalent and equally viable options for effective drug treatment, as assumed in this review.Methods: Prices of commonly used branded and generic medicines in same concentration, dosage form and combination were compared with the help of Indian Drug Review, brochures of pharmaceuticals and pharmacies and Jan Aushadhi price list 2017. Mean of all the prices available of branded and generic medicine were calculated and the percentage difference in the mean costs of generic and branded medicines were calculated.Results: The mean cost of 47 branded medicines out of the selected 50 medicines was higher than their generic versions. Mean cost of 3 generic medicines was higher than branded ones. Percentage difference in the mean costs of branded and generic medicines varied from 70%.Conclusions: This study has shown a very noteworthy difference of prices between branded and generic drugs. Efforts should be taken to promote the generic medication. Misconception about low efficacy with generic drugs should be erased

Treatment adherence and factors contributing to non adherence among type 2 diabetes mellitus patients in a tertiary care hospital: a cross sectional study

Background: Diabetes mellitus (DM) is the most common endocrine disorder and major global public health problem. Lack of adherence to antidiabetic medication has lead to suboptimal blood sugar control, treatment failure, accelerated development of complications and increased mortality, thus medication adherence plays an important role in disease control. Hence present study was taken to evaluate the treatment adherence and factors affecting non adherence among Type 2 diabetes mellitus patients.Methods: A cross sectional study carried out by Department of Pharmacology and Medicine, Hassan Institute of Medical Sciences, Hassan. Total 150 patients of type 2 diabetes were recruited after taking their informed consent. Adherence to treatment and factors associated with non adherence has been assessed during a personal interview with each patient using standardized questionnaire.Results: Adherence levels were 28%, 42% and 30% for high, medium and poor adherence respectively. The overall prevalence of non adherence among respondents was 30%. Among them 77.77% were males, 44.44% belonged to age group of 41-60 years, 40% illiterate, 60% employed, 51.11% of patients with smoking and alcoholic habits were not adherent to anti diabetic treatment. Other reasons contributing to non-adherence to treatment were forget fullness (86.66 %), inadequate knowledge about side effects (80%), unhappy clinical visits (71.11 %) and lack of assistance (48.88 %).Conclusions: Results showed that patients in the area of study were moderately adherent to anti-diabetic medications. This emphasizes the need for constant motivation and education at frequent intervals to ensure better adherence

A prospective evaluation of efficacy and safety of topical bromfenac 0.09% over topical flurbiprofen 0.03% after cataract surgery

Background: Different medications are used to reduce pain and inflammation after cataract surgery. Hence this study was taken up to compare the efficacy and safety of topical bromfenac 0.09% over topical flurbiprofen 0.03% in reducing anterior chamber inflammation and pain after cataract surgery.Methods: Total of 100 patients who underwent uneventful cataract surgery with posterior chamber intra ocular lens (IOL) implantation were randomly allocated to receive bromfenac 0.09% and flurbiprofen 0.03% topically from first post-operative day onwards for 6 weeks. Assessment of anterior chamber inflammation and pain was done by slit lamp and visual analogue scale respectively on each follow up days. Analysis was done by unpaired t test and Fischer’s exact test.Results: The response to treatment was earlier in bromfenac group for all the inflammatory changes (significant difference was found on day 7, p<0.05) except for corneal edema where both the groups showed similar response. On 7th day after surgery, 72% patients in flurbiprofen group and 12% in bromfenac group had pain (score1), while on the 14th day none in the bromfenac group complained of pain whereas 4% in flurbiprofen group still had pain. Both the drugs were safe and no clinically serious adverse effects were observed in either of the groups.Conclusions: This study showed both the medications, topical bromfenac 0.09% and topical flurbiprofen 0.03% effective and safe in reducing pain and anterior chamber inflammation after cataract surgery but the response was earlier with bromfenac 0.09%