Prescription audit study in a tertiary care hospital using the anatomical therapeutic chemical and defined daily dose classification concept
Keywords:Defined daily dose use, Drug utilization, Pharmacovigilance, Prescription audit
Background: In 1996, WHO recognized the need to develop and use the anatomical therapeutic chemical (ATC) and defined daily dose (DDD) as an international standard for utilization studies wherein it appointed experts in clinical pharmacology, drug utilization, drug regulation, drug evaluation, statistics, and medicine to monitor drug utilization on a standard and uniform pattern around the world.
Methods: All the prescriptions presented to main dispensary of the hospital from January-December 2013 in mid-month period of 10 days were taken for the analysis in terms of pharmacovigilance, polypharmacy, drug usage group wise, pharmacoeconomics, and drug utilization in DDD/1000/day along with ATC classification using customized software.
Results: 35,808 prescription forms containing 121, 303 drugs were presented to main dispensary of the hospital across which medicines were dispensed. Polypharmacy was calculated to be 3.27±0.44 standard deviation. Approximately, 60% of total prescription forms analyzed were lacking essential and basic such information as age, gender, or diagnosis. Pharmacoeconomics of this study indicates that a major budget was mainly spent on drug groups belonging to - metabolic, antibiotics, hormones, and related drugs. A voluminous consumption of drugs belonged to drug groups - metabolic drugs like statins, hormones, and related drugs such as various oral hypoglycemics, anti-hypertensives, psychotropics, and proton pump inhibitors or H2 blockers, all indicative toward stressful and sedentary lifestyle of modern era and unhealthy lifestyles, a trend of increasing morbidity and mortality, reducing significantly the productive man-hours.
Conclusions: This study was undertaken in a government tertiary care hospital which gives insight into the day to day functioning status of our health care delivery system. It is an opportunity on self-assessment in further improving the health care delivery by implementing measures which economizes on scarce health care budget as well as minimizing the common prescription errors.
Millard A. Perceptions of clinical audit: A preliminary evaluation. J Clin Eff. 1996;1(3):96-9.
Hopkins A. Clinical audit: time for a reappraisal? J R Coll Physicians Lond. 1996;30(5):415-25.
Robinson S. Evaluating the progress of clinical audit. Int J Theory Res Pract. 1996;2:373-92.
Duke MNG. Drug Utilization Studies-Method and Uses. European Series No. 45. Copenhagen, Denmark: WHO Regional Publications; 1993. p. 1-4.
Rønning M. Coding and classification in drug statistics - From national to global application. Nor J Epidemiol. 2001;11(1):37-40.
Ramsay LE. Bridging the gap between clinical pharmacology and rational drug prescribing. Br J Clin Pharmacol. 1993;35(6):575-6.
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):411-15.
Lord J, Johns LP. Development of an instrument to assess staff perceptions of the impact of trust-based clinical audit programmes. J Clin Eff. 1996;1(3):83-9.
Robinson S. Audit in the therapy professions: Some constraints on progress. Qual Health Care. 1996;5(4):206-14.
Curtis P. Medical audit in general practice. J R Coll Gen Pract. 1974;24(146):607-11.
Gaud RS, Jain DK, Kaskhedikar SG, Chaturvedi SC. Critical evaluation of present prescribing pattern. Indian J Hosp Pharm. 1989:26:70-72.
Benet LZ. Principles of prescription order writing and patients compliance instructions. In: Goodman AG, Rail TW, Nies AS, Taylor P, editors. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 8th edition. New York: Pegamon Press Inc.; 1991. p. 1640.
Shrishlya MV, Mahesh K, Nagarani MA, Sr Mary C, Andrade C, Venkataraman BV. Prescription audit study in an Indian hospital setting using the DDD (defined daily dose) concept. Indian J Pharmacol. 1994;26(1):23-8.
Patterson HR. The problems of audit and research. J R Coll Gen Pract. 1986;36(286):196.
Ross-Degnan D, Laing R, Santoso B, Ofori-Adjei D, Lamoureux C, Hogerzeil H. Improving pharmaceutical use in primary care in developing countries: a critical review of experience and lack of experience. Paper Presented at the 1st International Conference on Improving the Use of Medicines, Chiang Mai, Thailand, 1-4 April, 1997.
Hogerzeil HV, Bimo, Ross-Degnan D, Laing RO, Ofori-Adjei D, Santoso B, et al. Field tests for rational drug use in twelve developing countries. Lancet. 1993;342(8884):1408-10.
Laing R, Hogerzeil H, Ross-Degnan D. Ten recommendations to improve use of medicines in developing countries. Health Policy Plan. 2001;16(1):13-20.
Reizenstein P. Quality and health care in Sweden. BMJ. 1991;303(6807):900-2.
Kapoor B, Raina RK, Kapoor S. Drug prescribing pattern in teaching hospital unit. Indian J Pharmacol. 1985;17 Suppl 1:168.
Kumar H, Gupta U, Grag KC, Agarwal KK. A Study of trend of drug usage in hospital unit. Indian J Pharmacol. 1986:18:50.
Sood B, Verma RK, Gulati PV. Diagnosis and treatment in general hospital. Clinician 1984;48:263-70.
Jaju BP. Practicability of Alma Ata declarations: some observations in drug profile of prescriptions. Indian J Pharmacol. 1985;17(4):229-32.
Hede SS, Diniz RS, Agshikar NV, Dhume VG. Pattern of prescribed and OTC drugs in North Goa. Indian J Pharmacol. 1987;19:145-8.
Krishnaswamy K, Kumar BD, Radhaiah G. A drug survey - Precepts and practices. Eur J Clin Pharmacol. 1985;29(3):363-70.
Uppal R. Utilization of antimicrobials for caesarean section in a district hospital in India. Apua Newsl. 1990;8:2.
Uppal R. Antimicrobial drug usage in urology. Int J Clin Pharmacol Ther Toxiocol. 1991;29(a):336-8.
Uppal R. Drug utilization of antimicrobials in caesarean section. J Obstet Gynecol India. 1991;41:346-9.
Jaju BP. Practicality of Alma Alta declaration: some observations in drug profile of prescriptions. Indian J Pharmacol. 1985;17:229-32.
Guidelines for ATC Classification and DDD Assignment. Oslo, Norway: WHO Collaborating Centre for Drug Statistics Methodology; 2012.
ATC Index with DDDs. Oslo, Norway: WHO Collaborating Centre for Drug Statistics Methodology; 2013.