Prescribing quality in patients with chronic diseases at primary and secondary health care facilities using prescription quality index tool

Background: Prescribing quality is a matter of major concern worldwide. This study was carried out to determine the quality of prescribing in chronic diseases at primary health care (PHC) and secondary health care (SHC) settings using the new prescription quality index (PQI) tool.Methods: A cross-sectional observational study was carried out at four PHC and two SHC facilities in Anand district of India. Patients attending these facilities for at least 3 months were included. Complete medical history and prescriptions received were noted. Total and criteria wise PQI scores were derived for each prescription. Prescriptions were categorized as poor (score of ≤31), medium (score 32-33), and high quality (score 34-43) based on PQI total score. The internal consistency of PQI was measured using item total correlation and Cronbach’s α so as to validate it in our settings. Data were analyzed using Statistical Package for Social Science 20.Results: A total of 134 prescriptions were collected and evaluated for quality of prescribing. Mean age of patients was 60.6 ± 13.5 years. Mean PQI score was 23.60 ± 9.3 with 71.6% prescriptions being of poor quality. Quality of prescribing did not differ at PHC and SHC (P>0.05). Of 22 criteria, PQI score was strongly correlated with drug indication, drug effectiveness, evidence-based prescribing, unnecessary duplication, duration of therapy, and cost (P<0.01). PQI total score was negatively correlated to the number of drugs per prescription. Cronbach’s α for the entire 22 criteria were 0.90.Conclusion: PQI was found to be a reliable tool for assessment of prescribing quality in chronic diseases

EVALUATION OF PRESCRIBING PATTERN OF FIXED DOSE COMBINATIONS OF ANTIHYPERTENSIVES AND ANTIDIABETIC AGENTS

  Objective: The objective of this research was to evaluate prescribing pattern of fixed dose combinations (FDCs) of antihypertensives and antidiabetic agents among patients of private hospitals.Methods: An observational study was carried out in the outpatient department of two hospitals. Data of patients being diagnosed with the symptoms of hypertension and diabetes were enrolled which mainly included information related to prescribe FDCs, i.e., antihypertensives and antidiabetics, respectively. Descriptive analysis of collected information was done which involved representation of demographical data, number of comorbidities, number of FDCs prescribed, and type of FDCs consequently.Results: Combination drug therapy was prescribed in maximum patients, which was enumerated as 93% among hypertensive patients and about 91% in diabetics. Average age of patients suffering more from hypertension was 64.5±18 years and that in case of diabetes sufferers was 54.5±18 years. The most frequent combination prescribed in hypertensive patients was of angiotensin receptor blocker (ARB) and calcium channel blocker (CCB) which were about 53%, and in diabetic patients, it was of biguanides and sulfonylureas about 63%. Comorbidity too was notified, and its estimation was 61% in hypertensive patients and 72% in diabetic patients, respectively.Conclusion: The study here demonstrates that the most often prescribed antihypertensive combination is of ARB and CCB, and subsequently for diabetes, the oral hypoglycemic combination is of biguanides and sulfonylureas. Most of FDCs contained medications of these two classes. Positive results were also observed in levels of blood pressure and glucose within the normal range