DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20190138

Prescription audit and drug utilization pattern in outpatients of psychiatry department of tertiary care teaching hospital: an observational study

Angelika Batta, Pushpawati Jain, Bhupinder Kalra

Abstract


Background: The domain of psychiatric illnesses is grossly underrepresented in the current health care scenario especially due to overreliance on mortality rather than the morbidity or dysfunction. The field of psycho-pharmacology is witnessing constant development and introduction of new drugs for which holistic utilization, effectiveness, and side effects studies are the need of the hour. In addition, inappropriate use of drugs poses a potential hazard to patients. Our current study aims at studying the morbidity pattern of various psychiatric ailments and focuses on the prescribing trends of psychotropic drugs.

Methods: A prospective observational study was conducted in psychiatry out-patient department of a tertiary care hospital for a period of 12 months. Prescription pattern of psychotropic drugs was analyzed using predesigned format. Prescriptions were collected from OPD and hospital pharmacy. Prescriptions were analysed as per WHO indicators for prescriptions. Descriptive statistics were used for analysis.

Results: Depression was found to be the most common psychiatric disorder encountered (32.6%). Average number of psychotropic drugs prescribed per patient 2.45±1.013. Antidepressants along with BZD were the most frequently prescribed psychotropic drugs in various psychiatric disorders. Among the total of 2445 psychotropic drugs prescribed, 99.98% were oral formulations. Psychotropic fixed dose combinations were present in 1.68% of the prescriptions. Only 28% of medicines were prescribed by generic names. Utilization of drugs from the WHO’s 18th list of essential medicines of India was 29%. PDD of risperidone was 1.57mg in schizophrenia. Escitalopram, resperidone and propranolol were the most commonly prescribed drugs for mood disorders, schizophrenia and anxiety respectively.

Conclusions: The concomitant use of two psychotropic drugs was the preferred therapy. FDC of anti-cholinergics with both typical and atypical antipsychotics were used. Benzodiazepins were significant part of therapy.


Keywords


Prescription Pattern, Polypharmacy, Psychotropic drugs

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References


Einarson T. Pharmcoepidemiology. A Text book of Clinical Pharmacy Practice essential concepts and skills. 1st ed., Hyderabad: Universities Press (India) Limited; 2008:405-423.

Laporte JR, Porta M, Capella DO. Drug utilization studies: a tool for determining the effectiveness of drug use. Brit J Clin Pharmacol. 1983 Sep 1;16(3):301-4.

Pradhan SC, Shewade DG, Tekur U, Zutshi S, Pachiappan D, Dey AK, et al. Changing pattern of antimicrobial utilization in an Indian teaching hospital. Int J Clin Pharmacol Thera Toxicol. 1990 Aug;28(8):339-43.

World Health Organization. The World Health Report 2001: Mental health: new understanding, new hope. World Health Organization; 2001.

Thakkar KB, Jain MM, Billa G, Joshi A, Khobragade AA. A drug utilization study of psychotropic drugs prescribed in the psychiatry outpatient department of a tertiary care hospital. J Clin Diag Res. JCDR. 2013 Dec;7(12):2759.

Sharma P, Das SK, Deshpande SN. An estimate of the monthly cost of two major mental disorders in an Indian metropolis. Ind J Psychi. 2006 Jul;48(3):143.

Baldessarini RJ. Drug therapy of depression and anxiety disorders. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. Edited by Brunton LL, Lazo JS, Parker KL. New York, McGraw-Hill; 2006:429-460.

Piparva KG, Parmar DM, Singh AP, Gajera MV, Trivedi HR. Drug utilization study of psychotropic drugs in outdoor patients in a teaching hospital. Ind J Psychol Med. 2011 Jan;33(1):54.

Stratton CW, Ratner H, Johnston PE, Schaffner W. Focused microbiological surveillance by specific hospital unit as a sensitive means of defining antimicrobial resistance problems. Diagnostic Microbiology and Infectious Disease. 1992 Feb 1;15(2):2-3.

Tabish A. Drug utilization pattern in psychiatry outdoor patients at tertiary care teaching hospital of Bastar region. IJPR. 2015;5(4):98.

Jorm AF, Christensen H, Griffiths KM. Changes in depression awareness and attitudes in Australia: the impact of beyondblue: the national depression initiative. Aust New Zeal J Psych. 2006 Jan;40(1):42-6.

Shaktibala D, Atif BM, Vijay K, Srihari D. Psychotropic drug utilization study in psychiatric OPD of a tertiary care teaching hospital in Dehradun, Uttarakhand. J Adv Rese Biologi Scie. 2013;5(4):386-91.

Kukreja S, Kalra G, Shah N, Shrivastava A. Polypharmacy in psychiatry: a review. Mens Sana Monographs. 2013 Jan;11(1):82.

Gopalakrishnan S, Ganeshkumar P, Katta A. Assessment of prescribing practices among urban and rural general practitioners in Tamil Nadu. Indian J Pharmacol. 2013 May;45(3):252.

Moore S, Jaime LK, Maharajh H, Ramtahal I, Reid S, Ramsewak FS, et al. The prescribing of psychotropic drugs in mental health services in Trinidad. Revista Panamericana de Salud Pública. 2002;12:207-14.

Grover S, Kumar V, Avasthi A, Kulhara P. An audit of first prescription of new patients attending a psychiatry walk-in-clinic in north India. Ind J Pharmacol. 2012 May;44(3):319.

Trivedi J, Dhyani M, Yadav V, Rai S. Anti-psychotic drug prescription pattern for schizophrenia: Observation from a general hospital psychiatry unit. Ind J Psychia. 2010 Jul 1;52(3):279.

Lader MH, Bond AJ, James DC. Clinical comparison of anxiolytic drug therapy. Psychological medicine. 1974 Nov;4(4):381-7.

Ashton H. Guidelines for the rational use of benzodiazepines. Drugs. 1994 Jul 1;48(1):25-40.

Kamath A, Bheemesh V, Reddy S, Thunga R. Psychotropic drug utilization in psychiatry inpatients in a tertiary healthcare setting. Int J Med Pharmac Scien. 2012;3(4):16-22.

Dhasmana DC, Rawat Y, Mishra KC. What is so atypical about atypical antipsychotics!. Ind J Pharmacol. 2003 Sep 1;35(5):322.

Broekema WJ, de Groot IW, van Harten PN. Simultaneous prescribing of atypical antipsychotics, conventional antipsychotics and anticholinergics-a European study. Pharm World Sci. 2007;29(3):126-30.