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Study of Prescription Practices in the Field Practice Area of Kurnool Medical College, Kurnool, Andhra Pradesh

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Study of Prescription Practices in the Field Practice Area of Kurnool Medical College, Kurnool, Andhra Pradesh International Journal of Current Medical And Applied Sciences, 2017, June, 15(1),11-14. ORIGINAL RESEARCH ARTICLE Study of Prescription Practices in the Field Practice Area of Kurnool Medical College, Kurnool, Andhra Pradesh. Cynthia Subhaprada S.1, Vijaya kumari S.2 & Venkateswarlu U3 1 Associate professor, 2Assistant Professor, 3Post Graduate student, Department of Community Medicine, Kurnool Medical College, Kurnool-518002. Andhra Pradesh. India. --------------------------------------------------------------------------------------------------------------------------------------- Abstract: Introduction: Prescription is a document of instruction through which doctor, nurse and pharmacist communicate to deliver patient care. Many a time if these documents are not properly written or misinterpreted, patient care is at stake. WHO established prescribing indicators to analyze prescription writing and to promote rational drug use. Objectives: To describe the prescription and dispensing practices in the Primary Health Care facilities in the field practice area of Kurnool Medical College, Kurnool. Materials and methods: A cross sectional study was carried out in the primary health care facilities serving the field practice area under the Department of Community Medicine, Kurnool Medical College, Kurnool, Andhra Pradesh, during November-December, 2015, to study the prescription and dispensing practices, using a semi-structured questionnaire. A total of 501 prescriptions of patients who attended the Out-Patient Department (OPD) of these health facilities in the study area, were collected and evaluated. The data was subjected to descriptive statistical analysis using MS Excel 2007. Results: A total of 501 prescriptions were analyzed. Patient details, diagnosis, drug dosage, direction for use and duration of treatment were completely written in 100% of prescriptions. Abbreviations were used in 80.44% prescriptions and Medical officer’s signature present in 79.04%. Total 12172 drugs were prescribed in 501 prescriptions. Average number of drugs per prescription was 3.38±1.79 (Mean ± SD). Poly-pharmacy prescriptions were 71.25%. Percentage of encounters with antibiotics and injections was 60.47% and 11.37% respectively. 91.29% drugs were prescribed according to Essential Medicine List (EML) of the State of Andhra Pradesh. Conclusions: Poly - pharmacy and antibiotics prescription was high in the present study. Therefore, strict policy according to the standard treatment guidelines is required to promote rational use of drugs. Keywords: Dispensing Practices, Prescription Practices, Primary Health Care Facility, Rational Use of Drugs. Introduction Although drugs alone are not sufficient to provide Pradesh, in 2010, published essential medicines list adequate health care, they do play an important role in (EML) and standard treatment guidelines (STG) for use protecting, maintaining, and restoring health [1]. In in the primary health care facilities in the State [3]. 1977, WHO published the first Model List of Essential Irrational drug use is a major public health problem with Drugs and subsequently has attempted to improve drug- far reaching economic consequences [4]. Errors in the use practices in developing countries [2]. Shortages of prescription practices are probably one of the most essential drugs often occur due to inadequate selection common types of medical errors. These errors may be of drugs, improper storage, irrational prescribing and committed during prescription or dispensing or non-adherence by patients. The Government of Andhra administering of drugs. Address for correspondence: Dr. Cynthia Subhaprada S. Access this Article Online Associate Professor, Department of Community Medicine, Website: Kurnool Medical College, Kurnool-Andhra Pradesh. India : 518002. www.ijcmaas.com Email: [email protected] How to cite this article: Cynthia Subhaprada S. , Vijayakumari S. & Venkateswarlu U.: Study Of Subject: Prescription Practices in The Field Practice Area of Kurnool Medical Medical Sciences College, Kurnool, Andhra Pradesh. International Journal of current Quick Response Code Medical and Applied sciences; 2017, 15(1),11-14. IJCMAAS,E-ISSN:2321-9335,P-ISSN:2321-9327. Page | 11 Cynthia Subhaprada S. , Vijayakumari S. & Venkateswarlu U. Knowing where and when errors are most likely to Institutional Ethical committee clearance was occur is generally felt to be the first step in trying to obtained and informed consent was obtained from the prevent these errors. patients / their primary caregivers. Permission was According to WHO definition, "Rational use of drugs obtained from the Medical officers after explaining the requires that patients receive medications appropriate scope of the study. to their clinical needs, in doses that meet their own Prescriptions of patients attending Out Patient individual requirements for an adequate period of Department in these health facilities were evaluated, time, at the lowest cost to them and their community" specifically at the time of dispensing drugs at the [5]. Common types of irrational medicine use are poly- pharmacy. 501prescriptions written by medical pharmacy, inappropriate antimicrobial prescription, officers were selected by using simple random over-prescription of injections, failure to prescribe in sampling technique and evaluated. All prescriptions at accordance with clinical guidelines, very short the time of study were hand written on standard dispensing time and poor communication of drug printed prescription order sheets (e-aushadi). A check related information. list of essential parameters according to WHO Practitioners, both qualified and unqualified who guidelines for prescription writing was used to follow such irrational practices are especially common analyze the pattern of prescription [8]. in slums and rural areas, where majority of the public The prescriptions of these patients were reviewed to health problems exist and National Health programs know the details of medicines prescribed using the are poorly implemented. The problem is further standardized data collection form to calculate five compounded by the prevalence of a dispensing prescription indicators, i.e. (i) average number of practice wherein written prescriptions are not medicines per prescription, (ii) percentage of provided and patients' pressure for quick results leads medicines prescribed by generic name, (iii) to widespread dispensing of steroids and use of percentage of prescriptions with antibiotic, (iv) injections. There is wastage of resources due to percentage of medicines prescribed as per the increase in cost and reduced availability. Bacterial essential medicines list, and (v) percentage of resistance and adverse drug reactions will also be on prescriptions with injections. Poly-pharmacy the rise [6]. prescriptions were defined as prescriptions with more Hence the present study was conducted in the Primary than or equal to five drugs per prescription. Health Care facilities serving the field practice area of The patient care indicators were calculated as follows. Department of Community Medicine, Kurnool Medical During the study period, patients exiting from College, Kurnool, Andhra Pradesh, to describe the dispensing room of each health facility were observed, prescription practices and medicine dispensing to arrive at the dispensing time. They were practices. interviewed to know their knowledge about the Materials and Methods: dosage of medicines prescribed. The information A cross -sectional study was conducted in the Primary about the number of medicines prescribed, number of Health Center (PHC), Kallur, Rural Health and Training medicines actually dispensed, and number of Center (RHTC), Parla and Urban Health Center (UHC), medicines adequately labeled with respect to their Sri Ram Nagar, serving the field practice area of the strength, dosage and frequency was obtained from the Department of Community Medicine, Kurnool Medical prescriptions of these patients. College, Kurnool, during November – December, 2015. The facility based indicators i.e. availability of Kurnool city is governed by Kurnool Municipality, Essential Medicine List (EML) and Standard Treatment which comes under the Kurnool Metropolitan Region. Guidelines (STG) were assessed as follows. Physical As per the Census India reports 2011, the urban / verification of the availability of key essential metropolitan population of Kurnool is 478,124 of medicines in the Health centers was conducted by the which 239,401 are males and 238, 723 are females. investigators followed by an interview of the medical Average literacy rate of Kurnool is 78.15% of which officers to assess their awareness about EML and STG. male and female literacy rates were 83.99% and The data was subjected to descriptive statistical 72.39% respectively [7]. analysis using MS Excel 2007. Observations & Results: Observations made from the present study are as follows. Table 1: Characteristics of the prescriptions by Medical officers: Characteristics of the Observed (n) Total (N) Percentage prescription (%) Illegible 153 501 30.53% Patient’s details 501 501 100% Signs &symptoms 432 501 86.23% Diagnosis 501 501 100% Use of abbreviations 403 501 80.44% Drug details 501 501 100% Signature of the MO 396 501 79.04% Logic Publications @ 2017, IJCMAAS, E-ISSN: 2321-9335,P-ISSN:2321-9327. Page | 12 Logic Publications @ 2017, IJCMAAS, E-ISSN: 2321-9335,P-ISSN:2321-9327. All the Medical Officers (MOs) (100%) entered details of the patient such as name, age
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