A recent government investigation has shown significant data about prescription procedures in India, specifically in tertiary care and teaching hospitals. The year-long examination evaluated prescriptions from August 2019 to August 2020 and discovered major deviations from treatment guidelines.
Approximately 10% of the prescriptions evaluated contained "unacceptable deviations," which ranged from incorrect pharmaceutical prescriptions to the inclusion of additional diagnoses. These differences represent significant risk factors, including increased treatment costs, a greater probability of adverse drug reactions, and possibly treatment failure.
The study, "Evaluation of prescriptions from tertiary care hospitals across India for deviations from treatment guidelines and their potential consequences," was published in the Indian Journal of Medical Research (IJMR) and examined 4,838 prescriptions. These prescriptions were obtained from 13 ICMR Rational Use of Medicines Centres (RUMCs) located at tertiary care teaching hospitals and medical colleges throughout India, including well-known institutions such as Delhi AIIMS and Safdarjung Hospital.
The study looked at nearly 5,000 prescriptions from top hospitals across India. It lasted a year and involved 13 medical centers. The aim was to observe if prescriptions followed the rules or not and what kind of problems were there.
Out of all the prescriptions studied, around 10% had serious mistakes. This means nearly one out of ten prescriptions had issues that could harm patients or make their treatment less effective.
The study found various types of problems with prescriptions. Some had the wrong medicines for the sickness, while others had too many diagnoses listed. Some prescriptions also used drugs that weren't required or weren't supported by good evidence.
These prescription mistakes could make patients spend more money on unnecessary drugs or even cause them harm. They could also lead to more adverse drug reactions or treatment failures, which means patients might not get better. This could also add to the burden on the healthcare system.
The irregularities included prescribing drugs incorrectly or writing several diagnoses on a single prescription. Some commonly prescribed drugs with deviations were pantoprazole, rabeprazole and domperidone combination, trypsin/chymotrypsin, serratiopeptidase, ranitidine, azithromycin, cefixime, amoxicillin, clavulanic acid combination, and aceclofenac. For example, medicines such as pantoprazole were prescribed unnecessarily, potentially leading to side effects. Moreover, certain drug combinations, like azithromycin and amoxicillin plus clavulanic acid, were prescribed inappropriately, contributing to antimicrobial resistance.
Most physicians, about 55%, followed disease-specific guidelines provided by the Indian Council of Medical Research (ICMR). However, deviations still occurred, indicating gaps in adherence. In cases where Indian guidelines were unavailable or outdated, physicians relied on international guidelines. Despite this, deviations from guidelines persisted, suggesting a need for better adherence and updates in treatment protocols.
To minimize prescription deviations, clinicians recommended various interventions. These included online training on rational prescribing and administrative directives. Educating healthcare providers about appropriate prescribing practices and providing updated guidelines could help reduce deviations and improve patient outcomes.
Inappropriate prescribing is a global concern, with over 50% of medications worldwide being prescribed or dispensed inappropriately. This contributes to adverse drug reactions, hospitalizations, and increased treatment costs. Key issues include selecting expensive drugs when cheaper alternatives are available, polypharmacy, unwarranted antibiotic use, and failure to adhere to clinical guidelines.
Inappropriate prescribing poses significant risks to patient safety, efficacy, and healthcare costs. The study highlights the importance of rational medicine use and adherence to treatment guidelines. Recommendations include ongoing education and training for healthcare providers, regular updates to treatment protocols, and stricter monitoring of prescription practices. By addressing these issues, healthcare systems can improve patient outcomes and reduce the burden of inappropriate prescribing.
(Input from various resources)
(Rehash/ Susmita BhandaryMSM)
