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34525-Article Text-162102-1-6-20190720 International Journal of Pharmacy and Pharmaceutical Sciences Print ISSN: 2656-0097 | Online ISSN: 0975-1491 Vol 11, Issue 9, 2019 Original Article PRESCRIPTION PATTERN OF CARDIOVASCULAR AND/OR ANTIDIABETIC DRUGS IN ABUJA DISTRICT HOSPITALS NKEIRUKA GRACE OSUAFOR *, CHINWE VICTORIA UKWE, MATTEW JEGBEFUME OKONTA Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, PMB 410001 Enugu State, Nigeria Email: [email protected] Received: 10 Jun 2019 Revised and Accepted: 25 Jul 2019 ABSTRACT Objective: The study aimed to describe the prescription pattern of cardiovascular and/or anti-diabetic drugs and adherence to the World Health Organization (WHO) prescribing indicators in Abuja District Hospitals. Methods: This descriptive retrospective study was carried out in Asokoro and Maitama District Hospitals Abuja. One thousand and nine prescriptions that contained a cardiovascular drug (CVD) and/or anti-diabetic drug issued between June 2017 and May 2018 from the Medical Outpatient Department were analyzed. Data were collected from the pharmacy electronic database, prescription pattern and adherence to WHO prescribing indicators were assessed. The analysis was done using descriptive statistics. Results were presented as percentages, means, and standard deviations. Results: The frequency of treatment was higher among women (58.8%) and the age group of 41–60 (54.8%). The average number of drugs prescribed was 3.3±1.6: the percentage of drugs prescribed in generic was (64%) and (78.8%) were from the Essential Drug List (EDL). Calcium Channel Blockers (CCB, 71.7%) and Biguanides (B, 92.4%) were the most prescribed CVD and anti-diabetic drug. The majority of the CVD (74.5%) and diabetes (63.6%) patients were on combination therapy. The most frequent CVD combination was CCB plus Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers (29.7%). Compared to men, the proportion of females taking one or more CVD (61.3%) or antidiabetic (56.4%) was higher. Conclusion: The prescribing indicators are not optimal in Abuja district hospitals. Women received more treatment for cardiovascular and diabetes diseases than men while the age range of 41-60 was more treated than other age groups. Keywords: Cardiovascular, Anti-diabetic, Prescription pattern, Prescribing indicators, District hospitals © 2019 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open-access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) DOI: http://dx.doi.org/10.22159/ijpps.2019v11i9.34525 INTRODUCTION The district hospitals in FCT are at the center of the provision of care for CVD and diabetes, and make a good site for an investigation into Non-Communicable Diseases (NCDs) is a global health threat the prescription pattern. affecting men and women in their most productive years. In 2016, NCDs were responsible for more than 70% of the global deaths [1]. There are variations in the reports of prescription patterns for CVDs Presently an epidemiological transition has taken place in lower- and diabetes drugs, studies have reported Calcium Channel Blockers middle-income countries [2] where NCDs constitute more than 60% (CCB) [11–13] or Angiotensin-Converting Enzyme Inhibitor (ACEI) of deaths in the region [1]. Cardiovascular diseases (CVDs) and [14, 15] as the most utilized class of antihypertensive drugs. Other diabetes were responsible for more than 50% of mortality due to studies have documented diuretics [16, 17] as the most utilized CVD. NCDs in lower-middle-income countries [1]. Global Health Estimates Reports on the prescription pattern of anti-diabetics documented in 2016 showed that CVDs and diabetes accounted for 29% of Years sulphonylureas [14,18] or metformin [19] as the most utilized class of Life Lost and 40.7% of deaths due to NCDs among Nigerian men of diabetes drug. However, inherent differences exist in prescription and women [1, 3]. In Nigeria, the prevalence of CVDs has not been patterns across countries and even among similar health institutions established but existing evidence shows an increase in the of the same country, which necessitates more information on the prevalence of risk factors like hypertension and obesity [4, 5]. The pattern of use of drugs for these diseases. With more drugs being prevalence of diabetes in Nigeria ranges between 4.04% [6] to registered in Nigeria, there is always a gap in the knowledge of the 5.77% [7]. With these increases, hospital consultations and use of drugs. Also, the guidelines on the management of CVDs and attendant drug prescription which is an integral part of the diabetes are not gender or age-specific on classes of a drug to use and it is not clear whether the prescription is the same for different management of CVDs and diabetes are likely to assume an upward gender and age group. This study was undertaken to assess and different trend. Consequently, there is a need to evaluate the prescription patterns for CVD and diabetes and adherence to WHO quality of care received by the patients in terms of prescription. prescribing indicators in two secondary health institutions. Existing evidence suggests that Cardiovascular (CV) drugs and anti- diabetic drugs are among the highest therapeutic drug class MATERIALS AND METHODS prescribed in the outpatient [8, 9]. The WHO recognizes the investigation of prescription as an objective method to describe drug Methods use in health facilities [10]. Evaluation of prescription pattern and Study design and setting prescribing indicators can describe the prevailing prescription trend and assess the extent of rational drug use. Drug use study can be This retrospective study was conducted in Abuja District Hospitals used to evaluate the healthcare needs of people according to age and in Nigeria from June to August 2018. Abuja is the Federal Capital sex at various levels of the health care system and this may Territory (FCT). FCT has thirteen district hospitals that are contribute to adjustments in the drug policy of a country's health established and managed by the FCT Hospital Management Board. care system. This is particularly important in Nigeria where drug The operations of clinical services in these hospitals differ to some products exist both as a single agent and fixed-dose combinations. extent as they do not all have the same type of specialists. Two Osuafor et al. Int J Pharm Pharm Sci, Vol 11, Issue 9, 21-27 district hospitals were purposively selected out of the thirteen Analysis of data district hospitals. Asokoro and Maitama District Hospitals were chosen because they maintain an accessible electronic medical The data were coded into Statistical Package for the Social Sciences database that covers the period of the study and runs a Medical for Window (IBM SPSS version 21) and subsequently analyzed using Outpatient Department (MOPD). Information in the database of descriptive statistics. Association between prescriptions, gender, pharmacy department include patient identification number, date of and age were tested with chi-square. P-value<or = to 0.05 was birth, date of prescription, sex, occupation, drugs prescribed, clinic considered statistically significant. Results were expressed in where the prescription is being generated from, source of funding frequencies, percentages, numbers, means and standard deviations. for the treatment, The Medical Outpatient Department (MOPD) To evaluate the prescription pattern, the number of cardiovascular holds a CV and diabetes clinic on two separate days of the week. and antidiabetic drugs was determined for each prescription. The drugs were classified according to the Anatomical Therapeutic A sampling of the prescriptions Chemical (ATC) code. The cardiovascular drugs include calcium Using the information provided from the pharmacy records on the channel blockers-C08, agents acting on the rennin angiotensin number of cardiovascular (CV) drugs and anti-diabetics dispensed system-C09, diuretics-C03, beta-blocking agents-C07, centrally for the period, the total prescriptions containing a cardiovascular acting drugs-C02A, and cardiac therapy-C01. The anti-diabetic was drug and/or anti-diabetic were estimated to be 7279. The classified into biguanides-A10BA, sulfonylureas-A10BB, dipeptidyl consultation days and prescriptions containing cardiovascular (CV) peptidase (DPP-4) inhibitors-A10BH and insulin-A10A. The and/or anti-diabetic drugs were selected using systematic random prescription pattern for cardiovascular and anti-diabetic drugs was sampling. The two consultation days were listed and alternate days evaluated according to gender and age. The percentage of were selected. On each day, every fourth prescription from MOPD cardiovascular and anti-diabetic drugs prescribed in generic and was selected. Prescriptions included in the study were those from the Essential Drug List (EDL) was also assessed. Nigeria and containing at least one CV and/or anti-diabetic drug prescribed from FCT EDL were utilized. The WHO prescribing indicators as MOPD for patients above 18 y. cardiovascular drugs are those used recognized by the World Health Organization/International for hypertension and heart failure. Excluded prescriptions are those Network for Rational Use of Drugs (WHO/INRUD) were analyzed for written without sex, age. There was no replacement. the prescriptions. The prescribing indicators include the average number of drugs per prescription, percentage of drugs prescribed by Data collection
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