45% Doctors In India Are Writing Incomplete Prescriptions: ICMR Survey Report

New Delhi: Around 10 percent of prescriptions from tertiary care and teaching hospitals analysed as part of a year-long government study had “unacceptable deviations” such as inappropriate prescription of of Medications or more than one diagnosis.The potential consequences of these deviations could have led to increased cost for patients and probability of increase in the number of adverse drug reactions or even treatment failure, according to the study.

‘Evaluation of prescriptions from tertiary care hospitals across India for deviations from treatment guidelines and their potential consequences’ analysed 4,838 prescriptions which was published in the Indian Journal of Medical Research (IJMR).

The multicentric study which was carried out from August 2019 to August 2020, was conducted by 13 ICMR Rational Use of Medicines Centres (RUMCs) located in tertiary care teaching hospitals and medical colleges across India including Delhi AIIMS and Safdarjung Hospital.

A deviation that could result in a drug interaction, lack of response, increased cost, preventable adverse drug reaction (ADR) and/or antimicrobial resistance was labelled as an ‘unacceptable deviation’.

“Against all the prescriptions assessed, about one tenth of them (9.8 per cent) had unacceptable deviations,” the study said.

All the prescribers were postgraduates in their respective disciplines and on average were in practice for four to 18 years.

Of the 475 prescriptions that had deviations, 102 had stated more than one diagnosis and in some of them drugs were prescribed inappropriately.

The drugs identified in prescriptions with unacceptable deviations were pantoprazole, rabeprazole and domperidone combination, trypsin/chymotrypsin, serratiopeptidase, ranitidine, azithromycin, cefixime, amoxicillin and clavulanic acid combination and aceclofenac.

“It appears that the above drugs were prescribed to not only treat the symptoms but also to treat potential side effects of the drugs prescribed.

“For patients with pain as a presenting symptom, analgesics were co prescribed with pantoprazole. Gastroprotective drugs are to be prescribed if the patient has a risk for developing peptic ulcer.

“Unnecessary prescribing of pantoprazole may lead to potential side effects such as abdominal bloating, oedema and rash,” the study stated.

Similarly, it was observed that a rabeprazole and domperidone combination along with antacids was prescribed for functional dyspepsia which is not recommended in national/international guidelines.

In this study, participants presenting with bilateral knee pain (osteoarthritis) were prescribed trypsin/chymotrypsin along with analgesics and/or serratiopeptidase with antibiotics. Existing scientific evidence for serratiopeptidase is not sufficient to support its use, it said.

Further, the study said the FDC (trypsin plus chymotrypsin) prescription is irrational and increases the cost of therapy. Azithromycin and the FDC (fixed dose combinations) amoxicillin plus clavulanic acid were co prescribed in upper respiratory tract infections (URTI), which was inappropriate and can contribute to antimicrobial resistance (AMR) in
the long run

Furthermore, cefixime was prescribed to patients suffering from acute otitis media (not the first choice as per STGs) along with an antihistamine, an analgesic and an anti-ulcer drug resulting in an unacceptable deviation, the study found.

Most of the physicians followed the disease-specific ICMR guidelines and the adherence to it was found to be around 55 per cent.

For those conditions where there were no Indian guidelines or recent updates in the guidelines, physicians used the international guidelines as these are not only updated regularly but also easily accessible in the public domain, the study stated.

In this study, outpatient prescriptions by physicians of various specialities in tertiary care, teaching government and private hospitals across India were analysed.

Prescriptions of eligible patients exiting from OPD or hospital pharmacy were captured and analysed their prescriptions.

To minimise the deviations, clinicians recommended online training on rational prescribing and administrative directives as potential interventions.

Inappropriate prescribing of medicines is a major clinical concern and can negatively impact upon efficacy, safety and economic issues for the patients. Hence, the treatment of patients in clinical practice should be individualised and based on principles of rational prescribing, the study asserted.

The present definition of rational use was drafted by the World Health Organisation (WHO) more than three decades ago at an international conference in Kenya in 1985.

However, inappropriate prescribing is still a problem and worldwide over 50 per cent of the medications may be prescribed or dispensed inappropriately and 50 per cent of the patients may be non-compliant to their medication.

Inappropriate prescriptions can lead to an increase in adverse drug reactions, hospitalisation and increase in cost of treatment.

Inappropriate use of medicines includes, but is not limited to, selecting injectable forms or expensive drugs when cheaper alternatives are available, polypharmacy, unwarranted antibiotic use, failure to adhere to clinical guidelines and non-compliance by patients to prescribed drug regimens.

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