Evaluation of prescriptions from tertiary care hospitals across India for deviations from treatment guidelines & their potential consequences.

Autor:	Shetty Y; Department of Pharmacology & Therapeutics, Seth GSMC & KEM Hospital, Mumbai, Maharashtra, India., Kamat S; Department of Pharmacology & Therapeutics, Seth GSMC & KEM Hospital, Mumbai, Maharashtra, India., Tripathi R; Department of Pharmacology & Therapeutics, Seth GSMC & KEM Hospital, Mumbai, Maharashtra, India., Parmar U; Department of Pharmacology & Therapeutics, Seth GSMC & KEM Hospital, Mumbai, Maharashtra, India., Jhaj R; Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India., Banerjee A; Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India., Balakrishnan S; All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India., Trivedi N; Department of Pharmacology, Medical College, Medical College, Baroda, Gujarat, India., Chauhan J; RUM Centre, Medical College, Medical College, Baroda, Gujarat, India., Chugh PK; Department of Pharmacology, VMMC & Safdarjung Hospital, New Delhi, India., Tripathi CD; Department of Pharamocology, The Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India., Badyal DK; Department of Pharmacology, Christian Medical College, Ludhiana, Punjab, India., Solomon L; Department of Pharmacology, Christian Medical College, Ludhiana, Punjab, India., Kaushal S; Department of General Medicine, Christian Medical College, Ludhiana, Punjab, India., Gupta K; Department of General Medicine, Christian Medical College, Ludhiana, Punjab, India., Jayanthi M; Department of Pharmacology, Post Graduate Institute of Medical Education & Research, Chandigarh, Punjab, India., Jeevitha G; Department of Pharmacology, Post Graduate Institute of Medical Education & Research, Chandigarh, Punjab, India., Chatterjee S; Department of Pharmacology, Institute of Post Graduate Medical Education & Research, Kolkata, West Bengal, India., Samanta K; Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India., Desai C; Department of Pharmacology, B. J. Medical College, Ahmedabad, Gujarat, India., Shah S; Department of Pharmacology, B. J. Medical College, Ahmedabad, Gujarat, India., Medhi B; Department of Pharmacology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India., Joshi R; Department of Pharmacology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India., Prakash A; Department of Pharmacology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India., Gupta P; Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India., Roy A; RUM Centre, All India Institute of Medical Sciences, New Delhi, India., Chandy S; Departments of Pharmacology & Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India., Ranjalkar J; Departments of Pharmacology & Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India., Bright HR; Departments of Pharmacy, Christian Medical College, Vellore, Tamil Nadu, India., Dikshit H; Department of Pharmacology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India., Mishra H; Department of Pharmacology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India., Roy SS; Department of Pharmacology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India., Kshirsagar N; Former National Chair Clinical Pharmacology ICMR, India.
Jazyk:	angličtina
Zdroj:	The Indian journal of medical research [Indian J Med Res] 2024 Feb 01; Vol. 159 (2), pp. 130-141. Date of Electronic Publication: 2024 Apr 04.
DOI:	10.4103/ijmr.ijmr_2309_22
Abstrakt:	Background Objectives: Irrational prescribing practices have major consequences on patient safety and also increase the economic burden. Real-life examples of impact of irrational prescription have potential to improve prescribing practices. In this context, the present study aimed to capture and evaluate the prevalence of deviations from treatment guidelines in the prescriptions, potential consequence/s of the deviations and corrective actions recommended by clinicians. Methods: It was a cross-sectional observational study conducted in the outpatient departments of tertiary care hospitals in India wherein the 13 Indian Council of Medical Research Rational Use of Medicines Centres are located. Prescriptions not compliant with the standard treatment guidelines and incomplete prescriptions with respect to formulation, dose, duration and frequency were labelled as 'prescriptions having deviations'. 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'. Results: Against all the prescriptions assessed, about one tenth of them (475/4838; 9.8%) had unacceptable deviations. However, in 2667/4838 (55.1%) prescriptions, the clinicians had adhered to the treatment guidelines. Two thousand one hundred and seventy-one prescriptions had deviations, of which 475 (21.9%) had unacceptable deviations with pantoprazole (n=54), rabeprazole+domperidone (n=35) and oral enzyme preparations (n=24) as the most frequently prescribed drugs and upper respiratory tract infection (URTI) and hypertension as most common diseases with unacceptable deviations. The potential consequences of deviations were increase in cost (n=301), ADRs (n=254), drug interactions (n=81), lack of therapeutic response (n=77) and antimicrobial resistance (n=72). Major corrective actions proposed for consideration were issuance of an administrative order (n=196) and conducting online training programme (n=108). Interpretation Conclusions: The overall prevalence of deviations found was 45 per cent of which unacceptable deviations was estimated to be 9.8 per cent. To minimize the deviations, clinicians recommended online training on rational prescribing and administrative directives as potential interventions. (Copyright © 2024 Copyright: © 2024 Indian Journal of Medical Research.)
Databáze:	MEDLINE
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