A study published in Indian Journal of Medical Research revealed significant deviations in prescriptions from standard treatment guidelines. It was conducted in tertiary care hospitals in India, where the 13 Indian Council of Medical Research (ICMR) Rational Use of Medicines Centres are located.
The study categorized prescriptions as having 'deviations' if they were incomplete regarding formulation, dose, duration, and frequency or if they did not comply with standard treatment guidelines. 'Unacceptable deviations' were identified when these deviations could result in drug interactions, lack of response, increased costs, preventable adverse drug reactions (ADR), or antimicrobial resistance.
Key Findings
- Prevalence of Deviations: Out of 4,838 prescriptions assessed, 45% exhibited deviations. Among these, 9.8% (475 prescriptions) had unacceptable deviations.
- Guideline Adherence: Clinicians adhered to treatment guidelines in 55.1% (2,667/4,838) of the prescriptions.
- Common Drugs and Conditions with Deviations: The most frequently prescribed drugs with unacceptable deviations were pantoprazole, rabeprazole+ domperidone, and oral enzyme preparations. Upper respiratory tract infection (URTI) and hypertension were the most common conditions with such deviations.
- Potential Consequences: Deviations led to increased costs (301 cases), ADRs (254 cases), drug interactions (81 cases), lack of therapeutic response (77 cases), and antimicrobial resistance (72 cases).
- Corrective Actions: The primary recommendations included issuing administrative orders and conducting online training programs on rational prescribing.
Inappropriate Prescribing: A Global and Local Concern
Inappropriate prescribing remains a significant clinical issue worldwide, impacting patient safety, treatment efficacy, and healthcare costs. The World Health Organization (WHO) has long advocated for rational use of medicines, yet over 50% of medications continue to be prescribed or dispensed inappropriately globally. In India, the study highlighted the absence of comprehensive data on the magnitude of irrational prescribing, thus underscoring the need for regular prescription audits and adherence to guidelines.
Analysis and Results
Out of 4,838 prescriptions, 2,968 (61.34%) were complete. Of these, 2,667 (55.12%) adhered to guidelines, while 301 (6.22%) had deviations. The study identified 1,870 incomplete prescriptions, with 1,558 (83%) deemed acceptable deviations due to minimal risk consequences. However, 312 incomplete prescriptions (17%) were considered unacceptable due to higher risk consequences, such as for chronic conditions like hypertension and diabetes. Overall, 475 prescriptions had unacceptable deviations, leading to a higher likelihood of increased costs (63%) and ADRs (53%).
Most Common Deviations
Unacceptable deviations were frequently associated with the prescription of pantoprazole, rabeprazole+ domperidone, and oral enzyme preparations. These deviations often occurred in prescriptions for conditions like URTI and hypertension, reflecting non-adherence to established guidelines and contributing to increased healthcare costs and patient risk.
Recommendations for Improvement
The study's findings emphasize the importance of improving prescribing practices through administrative orders and training programs. These measures aim to enforce adherence to rational prescribing principles and reduce the occurrence of unacceptable deviations. Additionally, the study advocates for incorporating rational prescribing education into the medical curriculum and ongoing professional development for clinicians.
(Input from various sources)
(Rehash/Pratiksha Jadhav/MSM)