Study of prescribing patterns of antihypertensives in South Indian population

Background: Objective of the study is to study the prescribing pattern of drugs used in the management of hypertension.Methods: A prospective study was conducted for the period of 6 months in an out-patient department. All patients of either gender with primary essential hypertensive patients who have been diagnosed with hypertension as per Joint National Committee-VII (JNC-VII) guidelines and patients receiving or prescribed with antihypertensive drugs were included. The collected was analyzed for the demographic profile of the patients and the prescribing pattern of antihypertensives drugs used in the treatment of hypertension.Results: A total of 360 prescriptions were analyzed during the study period, 59% were male and 41% were female. Maximum numbers of the patients were in the age group of 32.2% (50-59) years and 56.73% of the patients were in Stage-I hypertension. The results revealed that, the maximum number of patients underwent dual therapy, followed by 30.24% monotherapy, 13% of patients with triple drug therapy and 8.31% of the patients treated with more than 3 drugs. The results of pharmacotherapy revealed that dual therapy was the most preferred choice of treatment in reducing systolic blood pressure with (25.13%, p<0.0001) Angiotensin receptor-II blocker (ARBs) + β–Blockers than ARBs alone. Whereas in diastolic blood pressure there is a high percentage of reduction was found with (20.24%, p<0.0001) angiotensin converting enzyme inhibitors (ACEIs) + calcium channel blockers (CCBs) compare to ACEIs used alone.Conclusion: The most common drug classes involved in the study was ARBs 42.24% followed by CCBs 22%. The prescribing patterns of antihypertensive drugs follow the standard treatment as per the algorithm JNC-VII guidelines for hypertensio

Preparation, validation and user-testing of pictogram-based patient information leaflets for hemodialysis patients

AbstractBackground: Patient information leaflets are universally-accepted resources to educate the patients/users about their medications, disease and lifestyle modification. Objectives: The objective of the study was to prepare, validate and perform user-testing of pictogram-based patient information leaflets (P-PILs) among hemodialysis (HD) patients. Methods: The P-PILs are prepared by referring to the primary, secondary and tertiary resources. The content and pictograms of the leaflet have been validated by an expert committee consisting of three nephrologists and two academic pharmacists. The Baker Able Leaflet Design has been applied to develop the layout and design of the P-PILs. Results: Quasi-experimental pre- and post-test design without control group was conducted on 81 HD patients for user-testing of P-PILs. The mean Baker Able Leaflet Design assessment score for English version of the leaflet was 28, and 26 for Kannada version. The overall user-testing knowledge assessment mean scores were observed to have significantly improved from 44.25 to 69.62 with p value <0.001. Conclusion: The overall user opinion of content and legibility of the leaflets was good. Pictogram-based patient information leaflets can be considered an effective educational tool for HD patients

Prescription Pattern and Cost Analysis of Nutraceuticals among Type 2 Diabetes Mellitus Patients: A Cross-sectional Study

Introduction: Type 2 Diabetes Mellitus (T2DM) is a disorder related to the relative lack of insulin secretion leading to abnormal metabolism. In addition to insulin, various micronutrients takes part in the metabolic processes. The imbalance between these vital micronutrients might be one reason for the progression of chronic diseases. There is a need to understand the utilisation pattern of these nutraceuticals in treating chronic conditions like DM. Aim: To study the prescribing patterns of various types of nutraceuticals and the cost of nutraceuticals per prescription in T2DM patients. Materials and Methods: This cross-sectional study was conducted in a tertiary care teaching hospital of Dakshin Karnataka, India, from September 2021 to April 2022. Total 150 T2DM patients, who were prescribed atleast one nutraceutical, were included in the study. Collected data was assessed by descriptive analysis (quantitative data; age, height, weight, Body Mass Index (BMI), number of drug prescribed, number of prescriptions, cost of nutraceuticals) whereas qualitative data (gender, social classes, qualification, occupation, domiciliary status, marital status, duration of diseases, family history, social history, personal history) was documented using frequency/ percentage. Results: Out of total 150 subjects, 92 (61.33%) were males, and 58 (38.67%) were females. At the same time, the mean age of the patients was found to be 58.1 years. Among all the prescribed nutraceuticals, vitamins were found to be the most frequently prescribed 97 (64.66%), followed by proteins 45 (30%) and vitamins+minerals 42 (28%). The average number of nutraceuticals per prescription was 1.57±0.76. The average cost of nutraceuticals was 440.55 (Indian rupee) INR per prescription. Conclusion: The most commonly prescribed nutraceuticals were vitamins in 97 (64.66%) patients. The average additional cost for the nutraceuticals was found to be 440.55 INR

Perception of Availability, Accessibility, and Affordability of COVID-19 Vaccines and Hesitancy: A Cross-Sectional Study in India

Background: The current study aimed to identify the perceptions and issues regarding the affordability, availability, and accessibility of COVID-19 vaccination and determine the extent of vaccine hesitancy among non-vaccinated individuals. Methods: A Prospective cross-sectional study was conducted among 575 individuals for a period of six months. All the relevant information was collected using the peer-validated survey questionnaire. An independent t-test was applied to check the association between variables. Result: Among 575 participants, 80.8% were vaccinated, and 19.2% were non-vaccinated. Among the vaccinated, 35.1% were vaccinated in private centres and 64.9% in public health centres (PHC). In total, 32% had accessibility issues and 24.5% had availability issues. However, responders vaccinated at PHC were having more issues in comparison to other groups which was statistically significant (p &lt; 0.05). Among the 163 privately vaccinated participants, 69.9% found it completely affordable. Another 26.9% and 3.1% found vaccines partly affordable and a little unaffordable. Among the 110 non-vaccinated, 38.1% were found to be vaccine-hesitant. Conclusions: Individuals vaccinated at PHC experienced issues such as long waiting times, unavailability of doses, and registration. Further, a significant level of hesitancy towards COVID-19 vaccines was observed. The safety and efficacy of COVID-19 vaccines contributed to negative attitudes

Emerging doctor of pharmacy program in India: A survey on general opinion of selected educated Indians

Objective: The aim of this study was to evaluate the awareness and perception of general educated Indian individuals about Doctor of Pharmacy course. Methods: A cross-sectional structured Pharm.D questionnaire survey was conducted at educational institutions of India mainly through e-mails. Pharm.D questionnaire survey was conducted over a period of six months. The questionnaire was classified into four major categories, including course-related questions, roles-related questions, critical comparative questions, and opinion-based questions. The responses were collected and analyzed to assess the opinions and attitudes of the study population regarding the course Pharm.D. Findings: Out of 2819 responses, 66.01% agreed that Indian syllabus, teaching procedure, and hospital training in institutions are enough to prepare an ideally graduated Pharm.D. Respondents of about 70.59% agreed that Pharm.Ds should take care of complete responsibility of drug therapy rather than physicians prescribing the medications and Pharm.Ds fixing the dose. The statement "Pharm.Ds play a vital role in improving medication adherence through patient counseling" was accepted by 47.80%, whereas 41.40% did not accept it as they felt that the Pharm.D′s role in this regard is not more than the physician′s role, and 10.80% suggested that other healthcare professionals would play a better role. Among all the respondents, 73.64% of the study population was found to be ready for giving equal credit and respect to Pharm.Ds as physicians. Conclusion: Our survey emphasizes on the opinion of educated people of having Pharm.Ds in both government and private hospitals to take care of complete therapy and for improving medication adherence

Health-care cost of diabetes in South India: A cost of illness study

Objective: The objective of this study is to analyze the health-care cost by calculating the direct and indirect costs of diabetes with co-morbidities in south India. Methods: A prospective observational study was conducted at Rohini super specialty hospital (India). Patient data as well as cost details were collected from the patients for a period of 6 months. The study was approved by the hospital committee prior to the study. The diabetic patients of age >18 years, either gender were included in the study. The collected data was analyzed for the average cost incurred in treating the diabetic patients and was calculated based on the total amount spent by the patients to that of total number of patients. Findings: A total of 150 patients were enrolled during the study period. The average costs per diabetic patient with and without co-morbidities were found to be United States dollar (USD) 314.15 and USD 29.91, respectively. The average cost for those with diabetic complications was USD 125.01 for macrovascular complications, USD 90.43 for microvascular complications and USD 142.01 for other infections. Out of USD 314.15, the average total direct medical cost was USD 290.04, the average direct non-medical cost was USD 3.75 and the average total indirect cost was USD 20.34. Conclusion: Our study results revealed that more economic burden was found in male patients (USD 332.06), age group of 51-60 years (USD 353.55) and the patients bearing macrovascular complications (USD 142.01). This information can be a model for future studies of economic evaluations and outcomes research

Assessment of medication errors and adherence to WHO prescription writing guidelines in a tertiary care hospital

The objective of the study is to assess the medication errors and adherence to WHO prescription writing guidelines in a tertiary care hospital. A prospective observational study was carried out for a period of 8 months from June 2015 to February 2016 at tertiary care hospital. At inpatient department regular chart review of patient case records was carried out to assess the medication errors. The observed medication errors were assessed for level of harm by using NCCMERP index. The outpatient prescriptions were screened for adherence to WHO prescription writing guidelines. Out of 200 patients, 40 patients developed medication errors. Most of the medication errors were observed in the age group above 61 years (40%). Majority of the medication errors were observed with drug class of antibiotics 9 (22.5%) and bronchodilators 9 (22.5%). Most of the errors were under the NCCMERP index category C. Out of 545 outpatient prescriptions, 51 (9.37%) prescriptions did not have prescriber’s name and all of the prescriptions lack prescriber’s personal contact number. Eighteen prescriptions did not have patient’s name and 426 (78.2%) prescriptions did not have patient’s age. The prevalence of medication errors in this study was relatively low (20%) without any fatal outcome. Omission error was the most frequently observed medication errors 31 (77.5%). In the present study, the patient’s age was missing in 78.2% of the prescriptions and none of the prescriptions had patient’s address and the drug names were not mentioned by their generic names

Assessment of pain and maternal complications after normal vaginal delivery

Management of postpartum perineal pain is essential because untreated pain can interfere with the motherhood experience and might result in various complications. The study aimed to assess postpartum perineal and postpartum pain intensity, pharmacological management and maternal complications after normal vaginal delivery. A prospective observational study was conducted in Obstetrics and Gynaecology among 300 women who underwent normal vaginal delivery. The severity and intensity of the perineal pain in subjects were relatively high, i.e. severe on Day 1, moderate to mild pain on Day 2 and mild pain on Day 3. The overall postpartum pain was mild on all 3 d. Non-steroidal anti-inflammatory drugs (NSAIDs) and analgesic combination drugs were prescribed the most for pain management, which significantly impacted pain reduction. All participants involved in the study had a postpartum haemorrhage and was the most common complication. The study concludes that there was a significant reduction in the overall intensity of pain from Day 1 to Day 3.IMPACT STATEMENT What is already known on this subject? Vaginal delivery is a multidimensional process that causes inflammation of cervical tissue and tears in the birth canal, leading to pain perception. Previous studies reported increased pain intensity on the first day after childbirth and a gradual decrease as the days pass. What do the results of this study add? The well-accepted pain scales, such as faces rating scale (FRS) and verbal numeric scale (VNS) were appropriate for assessing the intensity of perineal pain. Self-developed and validated postpartum pain assessment questionnaire (PPAQ) was beneficial for the assessment of postpartum pain. NSAIDs and analgesics combination was effective in managing the pain. What are the implications of these findings for clinical practice and/future research? Accurate pain assessment is essential for humanising patient care since it helps make a correct plan for required intervention, and its evaluation can help provide appropriate medications and reduce complications. Self-developed and validated PPAQ is easy to use and can be used in clinical studies to assess postpartum pain

Drug utilization pattern in South Indian pediatric population: A prospective study

Background: Studies on the process of drug utilization focus on factors related to prescribing, dispensing, administering and taking of medication and its associated events. Aims: The aim of this study is to assess the prescribing patterns of medicines, apply the World Health Organization (WHO) core indicators and to assess the appropriateness of prescribed medicines in a pediatric unit. Materials and Methods: A prospective observational drug utilization study was carried out in a pediatric unit of a super specialty hospital in South India for a period of 9 months. Patients who attended the pediatric unit with the age newborn to 18 years were included in the study and patients who were not willing to participate in the study were excluded and the data collected from the pediatric unit were analyzed. Results: Out of 209 patients, the average number of drugs per patient was 4.56. The percentage of drugs prescribed with the generic name was found to be 19.16%. Among 209 prescriptions 49.78% of the drugs were essential drugs. Among the antibiotics 33.33% prescribed, cephalosporin group were the most commonly prescribed followed by amino glycoside and penicillin. Nearly, 21.80% of the medicines were given as intravenous and the prescriptions without drugs were 1.43%. Only 75.6% of patients have knowledge about their dosage schedule and almost all the prescriptions were appropriate. Conclusion: The assessment of WHO core indicators helped to improvise the prescribing pattern, identify significant problems involved in the knowledge gap of patients or caretakers understanding of instructions provided by consultants and even to minimize the cost burden on patient