Drug utilization audit of antipsychotics using WHO methodology: recommendations for rational prescribing
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20183941Keywords:
Antipsychotics, Drug utilization, Olanzapine, WHO Prescribing indicatorsAbstract
Background: Utilization pattern of antipsychotics has undergone a major shift as the newly introduced atypical antipsychotics have heralded the market. Hence continuous studies on current prescribing trends are needed to provide most updated, effective and rational treatment of psychoses.
Methods: This cross-sectional prospective study was conducted at Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India. OPD tickets of the department of psychiatry for the year 2016-2017 were evaluated for a total of 310 cases. These prescriptions were used to determine the drug utilization of antipsychotics and for their appropriateness against the WHO recommended core prescribing indicators.
Results: A total of 310 patients satisfied the inclusion criteria and a male predominance was seen (male:female= 1.3:1). The most common psychotic disorder diagnosed was schizophrenia (44%). Majority of the patients (76%) received monotherapy and the prescribing trend showed a higher use of atypical antipsychotics (89%) over typical ones (11%). The most commonly prescribed anti-psychotic drugs were olanzapine (31%), followed by risperidone (26%). On analysing prescriptions according to the WHO core prescribing indicators it was observed that average number of antipsychotics prescribed per prescription was 1.32. 24% of drugs were prescribed by generic name and 5.2% were administered via injectable route. Drugs prescribed from National list of Essential Medicine, 2015 constituted 46%.
Conclusions: The high inclination towards the use of atypical antipsychotics observed in our study correlates with the global changing trends in the treatment of schizophrenia. WHO prescribing indicators should be adhered to, to impart rational prescribing.
References
Reus VI. Mental disorders. In: Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL and Loscalzo J, Eds. Harrison’s principles of internal medicine. 17th Edition. New York, NY: McGraw-Hill publication. 2008:2710-23.
World Health Organization: The World Health Report 2001: Mental health - new understanding, new hope Geneva: WHO; 2001. Available at: http://www.who.int/whr/2001/en/whr01_en.pdf
Jablensky A. Epidemiology of schizophrenia: the global burden of disease and disability. Eur Arch Psychiatry Clin Neurosci. 2000; 250(6):274-85.
Murthy RS. Mental health programme in the 11th five-year plan. Indian J Med Res. 2007;125(6):707-12.
Karak S, Hati S, Sil S, Dalui SK, Kumar S. Polypharmacy dominated prescribing pattern of antipsychotic drugs in a tertiary care hospital. World J Pharmacy Pharmaceut Sci. 2016;5(6):1045-55.
Ahuja N. Other psychotic disorders. A short textbook of Psychiatry. 7th Ed. Jaypee Brothers Medical Publishers (P) Ltd. 2011:83-8.
Insel TR. Rethinking schizophrenia. Nature. 2010;468(7321):187-93.
Purcell SM, Moran JL, Fromer M, Ruderfer D, Solovieff N, Roussos P et al. A polygenic burden of rare disruptive mutations in schizophrenia. Nature. 2014;506(7487):185-90.
Padmini Devi D, Amarjeeth R, Sushma M, Guido S. Prescription patterns of psychotropic drugs in hospitalized schizophrenic patients in a tertiary care hospital. Calicut Med J. 2007;5(4):e3.
Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med. 2005;2(5):e141.
Sridhar S, Ravi K, Raju M, Thomas L. A pilot study on utilization pattern of antipsychotic drugs in schizophrenic patients from southern India. World J Pharma Pharmaceut Sci. 2017;6(7):1301-08.
Ahuja N. Schizophrenia. A short textbook of Psychiatry. 7th Ed. Jaypee Brothers Medical Publishers (P) Ltd. 2011:54-68.
Jyothi NU, Pradeep P, Kumar MV, Sandeep K, Ramadasu P, Rao NR. Schizophrenia: psycho-social demographic profile and drug utilization study of anti-psychotics at a government medical teaching hospital. World J Pharma Pharmaceut Sci. 2015;4(9):1036-45.
ESEMeD/MHEDEA 2000 investigators, Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H et al. Sampling and methods of the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scand. 2004;109:8-20.
Faries D, Ascher-Svanum H, Zhu B, Correll C, Kane J. Antipsychotic monotherapy and polypharmacy in the naturalistic treatment of schizophrenia with atypical antipsychotics. BMC Psychiatry. 2005;5(1):26.
Šagud M, Vuksan-Ćusa B, Živković M, Vlatković S, Kramarić M, Bradaš Z et al. Antipsychotics: to combine or not to combine? Psychiatria Danubina. 2013;25(3):306-10.
Kreyenbuhl JA, Valenstein M, McCarthy JF, Ganoczy D, Blow FC. Long-term antipsychotic polypharmacy in the VA health system: patient characteristics and treatment patterns. Psychiatric Services. 2007;58(4):489-95.
Brüggemann BR, Elgeti H, Ziegenbein M. Patterns of drug prescription in a psychiatric outpatient care unit-the issue of polypharmacy. Ger J Psychiatry. 2008;11:1-6.
Introduction to drug utilization research by World Health Organization. Geneva. 2003. Available at: http://apps.who.int/medicinedocs/pdf/s4876e/s4876e.pdf.
The ICD-10 Classification of Mental and Behavioural Disorders. Clinical descriptions and diagnostic guidelines. World Health Organization. Available at: http://www.who.int/classifications/icd/en/bluebook.pdf.
WHO. How to investigate drug use in health facilities: selected drug use indicators - EDM research series No. 007. 1993. Available at: http://apps.who.int/medicinedocs/en/d/Js2289e.
Atif M, Sarwar MR, Azeem M, Umer D, Rauf A, Rasool A et al. Assessment of WHO/INRUD core drug use indicators in two tertiary care hospitals of Bahawalpur, Punjab, Pakistan. J Pharmaceut Policy Practice. 2016;9(1):27.
National list of Essential Medicine. 2015. Available at: http://cdsco.nic.in/WriteReadData/NLEM-2015/NLEM,%202015.pdf. Accessed on 01/07/2018.
Rational use of medicines. The Lancet. 2010; 375(9731): p 2052. Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60944-0/fulltext Accessed on 01/07/2018.
Gupta N, Sharma D, Garg SK, Bhargava VK. Auditing of prescriptions to study utilization of antimicrobials in a tertiary hospital. Indian J Pharmacol. 1997;29(6):411-5.
Chakravarty P, Neog P, Dewan B. Prescribing pattern of antipsychotic drugs in the outpatient department of psychiatry in Silchar Medical College and Hospital, Assam. Open J Psychiatry Allied Sci. 2016;7(1):11-4.
Sushma HK, Jyothi CH, Somashekar HS, Avanthi E, Imran M, Raja B. Prescribing pattern of antipsychotic medications in patients with schizophrenia in a tertiary care hospital. Int J Basic Clin Pharmacol. 2017;4(1):134-8.
Thakare. V, Yadav. P. Observational study to evaluate prescription patterns in schizophrenia inpatient department of psychiatry unit. World J Pharmaceut Res. 2015;4(1):721-8.
Atal S, Atal S. Drug prescribing pattern and cost analysis of antipsychotics at a tertiary care hospital. Int J Pharmaceut Sci Res. 2016;7(6):2611-14.
Galani JV, Patel J, Patel K, Patel D. An epidemiological survey of patients suffering from schizophrenia in Gujarat. Mintage J Pharmaceut Med Sci. 2013:2(1);15-7.
Rode SB, Salankar HV, Verma PR, Sinha U, Ajagallay RK. Pharmacoepidemiological survey of schizophrenia in Central India. Int J Res Med Sci. 2017;2(3):1058-62.
Ali A. Disability in schizophrenia and its relationship with duration of illness and age of onset. International J Psychosocial Rehabilitation. 2009;14(2):37-41.
George A, Chaithra S, Thomas JE, James A, Siva Kumar T. Study on prescribing pattern in psychiatric disorders in a tertiary care hospital. Int J Innovative Pharmaceut Sci Res. 2016;4(6):641-7.
Banerjee I, Roy B, Sathian B, Banerjee I, Chakraborty PK, Saha A. Socio demographic profile and utilization pattern of antipsychotic drugs among schizophrenic inpatients: a cross sectional study from western region of Nepal. BMC Psychiatry. 2013;13(1):96.
Piparva KG, Parmar DM, Singh AP, Gajera MV, Trivedi HR. Drug utilization study of psychotropic drugs in outdoor patients in a teaching hospital. Indian J Psychol Med. 2011;33(1):54.
Siddiqui RA, Shende TR, Mahajan HM, Borkar A. Antipsychotic medication prescribing trends in a tertiary care hospital. Int J Basic Clin Pharmacol. 2017;5(4):1417-20.
Ross S, Bond C, Rothnie H, Thomas S, Macleod MJ. What is the scale of prescribing errors committed by junior doctors? a systematic review. Br J Clin Pharmacol. 2009;67(6):629-40.
National Institute for Clinical Excellence (Great Britain). Principles for best practice in clinical audit. Radcliffe publishing;2002.
Balaji R, Sekkizhar M, Asok Kumar M, Nirmala P. An observational study of drug utilisation pattern and pharmacovigilance of antipsychotics. Int J Curr Pharmaceut Res. 2017;9(6):56-62.
Kumar S, Chawla S, Bimba HV, Rana P, Dutta S, Kumar S. Analysis of Prescribing Pattern and Techniques of Switching Over of Antipsychotics in Outpatients of a Tertiary Care Hospital in Delhi: A Prospective, Observational Study. J Basic Clin Pharmacy. 2017;8(3):178-84.
Mathew P. Generic drugs: Review and experiences from South India. J Fam Med Primary Care. 2015;4(3):319-23.
Patted UH, Hema NG, Nagaraj AKM. Antipsychotics in schizophrenia: a retrospective study of drug utilization pattern in outpatient department of psychiatry at a tertiary care hospital. Int J Basic Clin Pharmacol. 2018;7(1):167-72.
