DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20174793

Practices regarding prescription and dispensing of drugs in a tertiary care hospital in rural West Bengal, India

Alapan Bandyopadhyay, Debdut Dhar, Abhijit Mukherjee, Sharmistha Bhattacherjee, Samir Dasgupta

Abstract


Background: Irrational prescription practices are a distressing global problem, especially in the developing countries. A study was conducted to assess the patterns of prescribing and dispensing drugs in a tertiary healthcare centre serving a large rural population in the eastern India.

Methods: A cross-sectional observational study was conducted from July-September 2016 in the general out-patient department and the institution pharmacy of a tertiary care hospital of West Bengal, India. Data were congregated by collection and review of individual prescriptions, measuring the time of interaction between patients and prescribers/dispensers, and conducting patient interviews at exit.

Results: Analysis of the collected and tabulated data revealed that after average, 2.5 medicines were prescribed per prescription, with 95.26% being under their generic name. Of the drugs prescribed, 95.79% were from the essential drug list. The average consultation time was 150.0s (SD 62.3s) and average dispensing time was 81.5s (SD 51.2s). Of the drugs prescribed, 86.12% of drugs were actually dispensed from the institution pharmacy but none of the drugs were labeled. The percentage of prescriptions with an antibiotic was 47.83%, while injections were recorded on in 2.83% of the prescriptions. Percentage of patients who had knowledge of the dosage of the drugs prescribed to them was 91.67%.

Conclusions: While the study found high percentages of drugs prescribed under generic names high percentage of drugs actually prescribed from the Institution Pharmacy, prescription of drugs from the Essential Drugs List, and a low number of injections per prescription conforming to WHO set standards, it also found a lack of drug labelling, high percentage of prescription of antibiotics to be indicators that do not conform with the WHO set international standards.


Keywords


Drug use indicators, Rational drug use, West Bengal

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References


The rational use of drugs. Report of the Conference of Experts. Geneva, World Health Organization, 1985. Available at http://apps.who.int/medicinedocs/en/d/Js17054e/.

Promoting rational use of medicines: Core components. WHO Policy Perspectives on Medicines, No.5. Geneva, World Health Organization, 2002. Available at http://apps.who.int/medicinedocs/pdf/h3011e/h3011e.pdf. Retrieved on September 15, 2017.

Medicines use in primary care in developing and transitional countries: Fact book summarizing results from studies reported between 1990 and 2006. Geneva, World Health Organization, 2009. Available AT http://www.who.int/medicines/publications/primary_care_ 8April09.pdf. Retrieved on September 15, 2017.

Sabaté E. Adherence to long-term therapies. Evidence for action. Geneva, World Health Organization, 2003. Available at http://apps.who.int/medicinedocs/en/d/Js4883e/.

White TJ, Araekelian A, Rho JP. Counting the costs of drug related adverse events. Pharmacoeconomics. 1999;15(5):445-58.

Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: A meta-analysis of prospective studies. Journal of the American Medical Association. 1998;279(15):120-5.

Hitchen L. Adverse drug reactions result in 250 000 UK admissions a year. British Medical Journal. 2006;332:1109.

Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ. 2004 Jul 1;329(7456):15-9.

Reducing and preventing adverse drug events to decrease hospital costs. Research in Action, Issue 1, March 2001. Agency for Healthcare Research and Quality. Available at: http://www. ahrq.gov/qual/aderia/aderia.htm. Retrieved on September 15, 2017.

Simonsen L, Kane A, Lloyd J, Zaffran M, Kane M. Unsafe injections in the developing world and transmission of bloodborne pathogens: a review. Bulletin of the World Health Organization. 1999;77(10):789-800.

Holloway K, Dijk LV. The World Medicines Situation 2011, Rational use of Medicines. 2011. 24 p. Report No.: WHO/EMP/MIE/2011.2.2 Available at: http://apps.who.int/medicine docs/documents/s18064en/s18064en.pdf. Retrieved on September 15, 2017.

How to Investigate Drug Use in Health Facilities: Selected Drug Use Indicators - EDM Research Series No. 007 (1993) by WHO. Available at http://apps.who.int/medicinedocs/en/d/-Js2289e/ 3.1.html. Retrieved on September 15, 2017.

Guyon AB, Barman A, Ahrned JU, Ahmed AU, Alam MS. A baseline survey on use of drugs at the primary health care level in Bangladesh. Bull WHO. 1994;72:265-71.

Krause G, Borchert M, Benzler J, Heinmüller R, Kaba I, Savadogo M. Rationality of drug prescriptions in rural health centres in Burkina Faso. Health Policy Plan. 1999;14:291-8.

Chareonkul C, Khun VL, Boonshuyar C. Rational drug use in Cambodia: study of three pilot health centers in Kampong Thorn Province. Southeast Asian J Trop Med Public Health. 2002;33:418-24.

Desta Z, Abula T, Beyene L, Fantahun M, Yohannes AG, Ayalew S. Assessment of rational drug use and prescribing in primary health care facilities in north-west Ethiopia. East Afr Med J. 1997;74:758-63.

Bosu WK, Ofori-Adjei D. An audit of prescribing practices in health care facilities of the Wassa West district of Ghana. West Afr J Med. 2000;19:298-303.

Hamadeh GN, Dickerson LM, Saab BR, Major SC. Common prescriptions in ambulatory care in Lebanon. Ann Pharmacother. 2001;35:636-40.

Simon N, Hakkou F, Minani M, Jasson M, Diquet B. Drug prescription and utilization in Morocco. Therapie. 1998;53:113-20.

Ravi Shankar P, Partha P, Nagesh S. Prescribing patterns in medical outpatients. Int J Clin Pract. 2002;56:549-51.

Chukwuani CM, Onifade M, Sumonu K. Survey of drug use practices and antibiotic prescribing pattern at a general hospital in Nigeria. Pharm World Sci. 2002;24:188-95.

Najmi MH, Hafiz RA, Khan I, Fazli FR. Prescribing practices: an overview of three teaching hospitals in Pakistan. J Pak Med Assoc. 1998;48:73-7.

Massele AY, Nsimba SE, Rimoy G. Prescribing habits in church-owned primary health care facilities in Dar Es Salaam and other Tanzanian coast regions. East Afr Med J. 2001;78:510-4.

Trap B, Hansen EH, Hogerzeil HV. Prescription habits of dispensing and non-dispensing doctors in Zimbabwe. Health Policy Plan. 2002;17:288-95.

The World Bank. Rural Population of India (% of total population) (2015) [Data File] Available at http://data.worldbank.org/indicator/SP.RUR.TOTL.ZS?locations=IN. Retrieved on September 15, 2017.

Isah AO, Ross-Degnan D, Quick J, Laing R, Mabadeje AF. The Development of Standard Values for the WHO Drug Use Prescribing Indicators. Nigeria: ICUM/EDM; 2004. Available at http://archives.who.int/icium/icium1997/posters/1a2_txt.html.

Abdulahi M, Shifera WT. Pattern of prescription in Jimma Hospital. Ethiop J Health Dev. 1997;11:263-7.

Bannenberg WJ, Forshaw CJ, Fresle D, Salami AO, Wahab HA. Evaluation of Nile Province Essential Drug Project. Geneva: WHO, WHO/91.10; 1991. Available at https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2097-3.

Ministry of Health/Zimbabwe Essential Drug Action Programme. Essential drug survey. Geneva: WHO, 74(WHO/93.1). 1993.

Karimi A, Haerizadeh M, Soleymani F, Haerizadeh M, Taheri F. Evaluation of medicine prescription pattern using World Health Organization prescribing indicators in Iran: A cross-sectional study. J Res Pharm Pract. 2014;3:39-45.

Hogazeil HV, Bimo, D- Ross Degnan, Laing RO, Adjei DO, Santaso B, et al. Field test for rational drug use in twelve developing countries. Lancet. 1993;342:1408-10.

Sarkar AP, Biswas S, Tripathi SK. A study on drug use in a district hospital of West Bengal. Indian J Public Health. 2007;51(1):75-6.

Dutta A, Chakraborty S. Practice of rational drug uses in a rural area of 24 pgs (s) in West Bengal. J Adv Pharm Technol Res. 2010;1:358-64.

Gangopadhyay T, Mandal A, Mandal S, Basu B, Maiti T, Das A, et al. Drug utilization study from a government sponsored pharmacy in a tertiary care teaching hospital of rural West Bengal: a cross-sectional study. Int J Health Allied Sci. 2016;5:138-42.

Vijaykumar TM, Sathyavati D, Subhashini T, Grandhi S, Dhanaraju MD. Assessment of prescribing trends and rationality of drugs prescriing. Int J Pharmacol. 2011;7:140-3.

Prasad PS, Rudra JT, Vasanthi P, Sushitha U, Sadiq M J, Narayana G. Assessment of drug use pattern using World Health Organization core drug use indicators at Secondary Care Referral Hospital of South India. CHRISMED J Health Res. 2015;2:223-8.

Patrick OE, Olumide GO, Okhamafe AO. Prescribing practices in two health care facilities in Warri, Southern Nigeria: a comparative study. Trop J Pharmacol Res. 2003;2:175-82.

Kumari R, Idris MZ, Bhushan V, Khanna A, Agarwal M, et al. Assessment of prescription pattern at the public health facilities of Lucknow district. Indian J Pharmacol. 2008;40:243-7.

Haas JS, Phillips KA, Gerstenberger EP, Seger AC. Potential savings from substituting generic drugs for brand-name drugs: medical expenditure panel survey, 1997-2000. Ann Intern Med. 2005;142:891-7.

Kumar K, Singh A, Kumar S, Ram F, Singh A, Ram U, et al. Socio-Economic differentials in impoverishment effects of out-of-pocket health expenditure in China and India: evidence from WHO SAGE. PLoS ONE. 2015;10(8):e0135051. doi:10.1371/journal.pone.0135051.

Ghimire S, Nepal S, Bhandari S, Nepal P, Palaian S. A prospective surveillance of drug prescribing and dispensing in a teaching hospital in Western Nepal. J Pak Med Assoc. 2009;59:726-31.

Medical Council of India, Circular to the dean/principals of medical colleges regarding the prescribing drugs under their generic names, MCI-211(2) (Gen.)/2012-Ethics, (2013) Available at http://www.mciindia.org/tools/announcement/CircularEthics 21.01.2013.pdf. Retrieved on September 15, 2017.

Centers for Disease Control and Prevention. India-Chapter 4-2016 Yellow Book, Traveler’s Health 2016. Available at http://wwwnc.cdc.gov/travel/yellowbook/2016/select-destinations/india Retrieved on September 15, 2017.

Mathew B, Gadde R, Nutakki P, Doddayya H. Assessment of drug dispensing practices using who patient care and health facility indicators in a private tertiary care teaching hospital. Int J Pharm Pharm Sci. 2013;5:368-71.