Changing physician behavior: interventions to improve prescription writing practices in a secondary level hospital in Delhi

Authors

  • Dipanweeta Routray Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
  • Jyotiranjan Sahoo Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
  • Prateek Singh Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
  • Kulen Das Hospital Administration, Maharshi Valmiki Hospital, Pooth Khurd, New Delhi, India
  • Satyavir Singh Department of Community Medicine, Maulana Azad Medical College, New Delhi, India

Keywords:

Antibiotics, Completeness of prescription, Core prescribing indicators, Essential drugs, Generic drugs, Rational drug use

Abstract

Background: According to a report by World Health Organization (WHO) in 2003, approximately 50% of all patients fail to take their medicine correctly. This is due to errors in prescription, underuse or misuse of medicines and ignorance of prescribers, dispensers, and patients.

Methods: It is a hospital-based interventional-study carried out in a secondary level multispecialty hospital of Delhi. Investigators collected 536 prescriptions from the outpatient department of various departments and studied according to WHO core prescribing indicators for assessing drug prescription writing pattern. Interventions to improve the prescribing pattern included one continued medical education session and one workshop on prescription writing (providing essential drug list [EDL] etc.,), sharing the baseline data with the physicians and administrative approach. Evaluation of the prescribing pattern after 6 weeks of the intervention was done to find out the impact.

Results: On an average 3.43 drug per encounter before intervention increased to 3.46 drugs per encounter. Inclusion of generic drugs and from EDL increased significantly from 54.8% to 73.4% and 76.9% to 88.4% respectively.. Prescribing antibiotics and injectables showed no significant reduction from baseline. The completeness of the prescriptions with respect to the various components improved significantly.

Conclusion: Combining different intervention seems a noble approach to improve the prescription writing practices with respect to completeness and inclusion of generic drugs, drugs from EDL.

References

Haldar D, Naskar TK, Sarkar TK, Ray SK, Taraphdar P, Biswas A. Prescribing and dispensing pattern: implication in the right of access to essential medicine. Health. 2011;2(4):143-7.

Karande S, Sankhe P, Kulkarni M. Patterns of prescription and drug dispensing. Indian J Pediatr. 2005;72(2):117-21.

Paniz VM, Fassa AG, Maia MF, Domingues MR, Bertoldi AD. Measuring access to medicines: a review of quantitative methods used in household surveys. BMC Health Serv Res. 2010;10:146.

Access to Essential Medicines. The World Medicines Situation. Geneva: World Health Organization; 2004. Available at http://www.apps.who.int/medicinedocs/en/d/Js6160e/9.html. Accessed 10 Jan 2014.

Hazra A, Tripathi SK, Alam MS. Prescribing and dispensing activities at the health facilities of a non-governmental organization. Natl Med J India. 2000;13(4):177-82.

MSH, WHO. Managing Medicine Supply – The Selection, Procurement, Distribution and Use of Pharmaceuticals. 2nd Edition. West Hartford: Management Science for Health, Euro Health Group and WHO Collaboration, Action Programme on Essential Medicines; 1997.

National Pharmaceuticals Pricing Policy, 2012 (NPPP-2012). Available at http://www.pharmaceuticals.gov.in/NPPP2012.pdf. Accessed 15 Jan 2014.

World Health Organization. Equitable access to essential medicines: a framework for collective action, 2004. Available at http://www.whqlibdoc.who.int/hq/2004/WHO_EDM_2004.4.pdf. Accessed 15 Feb 2014.

International Network for Rational Use of Drugs and World Health Organization. How to Investigate Drug use in Health Facilities: selected Drug use Indicators. EDM Research Series No. 7 [WHO/DAP/93.1]. Geneva: World Health Organization; 1993.

Razon Y, Ashkenazi S, Cohen A, Hering E, Amzel S, Babilsky H, et al. Effect of educational intervention on antibiotic prescription practices for upper respiratory infections in children: a multicentre study. J Antimicrob Chemother. 2005;56(5):937-40.

World Health Organization. Interventions and Strategies to Improve the Use of Antimicrobials in Developing Countries: a Review. [WHO/CDS/CSR/DRS/2001.9]. Switzerland: World Health Organization; 2001.

Shapiro E. Injudicious antibiotic use: an unforeseen consequence of the emphasis on patient satisfaction? Clin Ther. 2002;24(1):197-204.

Banerjee I, Bhadury T. Prescribing pattern of interns in a primary health center in India. J Basic Clin Pharm. 2014;5(2):40-3.

Omojasola A, Hernandez M, Sansgiry S, Jones L. Perception of generic prescription drugs and utilization of generic drug discount programs. Ethn Dis. 2012;22(4):479-85.

Theodorou M, Tsiantou V, Pavlakis A, Maniadakis N, Fragoulakis V, Pavi E, et al. Factors influencing prescribing behaviour of physicians in Greece and Cyprus: results from a questionnaire based survey. BMC Health Serv Res. 2009;9:150.

Shrank WH, Liberman JN, Fischer MA, Girdish C, Brennan TA, Choudhry NK. Physician perceptions about generic drugs. Ann Pharmacother. 2011;45(1):31-8.

Isha AO, Laing R, Quick J, Mabadeje AFB, Santoso B, Hogerzell H, et al. Development of reference values for the WHO health facility core prescribing indicators. West Afr J Pharmacol Drug Res. 2002;18:6-1.

Adebayo ET, Hussain NA. Pattern of prescription drug use in Nigerian army hospitals. Ann Afr Med. 2010;9(3):152-8.

Bhartiy SS, Shinde M, Nandeshwar S, Tiwari SC. Pattern of prescribing practices in the Madhya Pradesh, India. Kathmandu Univ Med J (KUMJ). 2008;6(1):55-9.

Ravi Shankar P, Partha P, Nagesh S. Prescribing patterns in medical outpatients. Int J Clin Pract. 2002;56(7):549-51.

Maini R, Verma KK, Biswas NR, Agrawal SS. Drug utilization study in dermatology in a tertiary hospital in Delhi. Indian J Physiol Pharmacol. 2002;46(1):107-10.

Alam K, Mishra P, Prabhu M, Shankar PR, Palaian S, Bhandari RB, et al. A study on rational drug prescribing and dispensing in outpatients in a tertiary care teaching hospital of Western Nepal. Kathmandu Univ Med J (KUMJ). 2006;4(4):436-43.

Nsimba SE. Assessing prescribing and patient care indicators for children under five years old with malaria and other disease conditions in public primary health care facilities. Southeast Asian J Trop Med Public Health. 2006;37(1):206-14.

Guyon AB, Barman A, Ahmed JU, Ahmed AU, Alam MS. A baseline survey on use of drugs at the primary health care level in Bangladesh. Bull World Health Organ. 1994;72(2):265-71.

Hamadeh GN, Dickerson LM, Saab BR, Major SC. Common prescriptions in ambulatory care in Lebanon. Ann Pharmacother. 2001;35(5):636-40.

Salazar JA, Poon I, Nair M. Clinical consequences of polypharmacy in elderly: expect the unexpected, think the unthinkable. Expert Opin Drug Saf. 2007;6(6):695-704.

Viktil KK, Blix HS, Reikvam A. The Janus face of polypharmacy – Overuse versus underuse of medication. Nor Epidemiol. 2008;18(2):147-52.

Garjani A, Salimnejad M, Shamsmohamadi M, Baghchevan V, Vahidi RG, Maleki-Dijazi N, et al. Effect of interactive group discussion among physicians to promote rational prescribing. East Mediterr Health J. 2009;15(2):408-15.

Rehan HS, Lal P. Drug prescribing pattern of interns at a government healthcare centre in Northern India. Trop Doct. 2002;32(1):4-7.

Rishi RK, Sangeeta S, Surendra K, Tailang M. Prescription audit: experience in Garhwal (Uttaranchal), India. Trop Doct. 2003;33(2):76-9.

Mastura I, Teng CL. The effect of “group detailing” on drug prescribing in primary care. Med J Malaysia. 2008;63(4):315-8.

Vallès JA, Barreiro M, Cereza G, Ferro JJ, Martínez MJ, Escribà JM, et al. A prospective multicenter study of the effect of patient education on acceptability of generic prescribing in general practice. Health Policy. 2003;65(3):269-75.

Biswas NR, Biswas RS, Pal PS, Jain SK, Malhotra SP, Gupta A, et al. Patterns of prescriptions and drug use in two tertiary hospitals in Delhi. Indian J Physiol Pharmacol. 2000;44(1):109-12.

Rehan HS, Singh C, Tripathi CD, Kela AK. Study of drug utilization pattern in dental OPD at tertiary care teaching hospital. Indian J Dent Res. 2001;12(1):51-6.

Indirakumari S, Chandy SJ, Jeyaseelan L, Kumar R, Suresh S. Antimicrobial prescription patterns for common acute infections in some rural & urban health facilities of India. Indian J Med Res. 2008;128(2):165-71.

Nyquist AC, Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis. JAMA. 1998;279(11):875-7.

Welschen I, Kuyvenhoven M, Hoes A, Verheij T. Antibiotics for acute respiratory tract symptoms: patients’ expectations, GPs’ management and patient satisfaction. Fam Pract. 2004;21(3):234-7.

Colgan R, Powers JH. Appropriate antimicrobial prescribing: approaches that limit antibiotic resistance. Am Fam Physician. 2001;64(6):999-1004.

McVea KL. Lay injection practices among migrant farmworkers in the age of AIDS: evolution of a biomedical folk practice. Soc Sci Med. 1997;45(1):91-8.

Mallet HP, Njikam A, Scouflaire SM. Evaluation of prescription practices and of the rational use of medicines in Niger. Sante. 2001;11(3):185-93.

Burmester MK, Dionne R, Thiagarajan RR, Laussen PC. Interventions to reduce medication prescribing errors in a paediatric cardiac intensive care unit. Intensive Care Med. 2008;34(6):1083-90.

Bauchner H, Pelton SI, Klein JO. Parents, physicians, and antibiotic use. Pediatrics. 1999;103(2):395-401.

De Santis G, Harvey KJ, Howard D, Mashford ML, Moulds RF. Improving the quality of antibiotic prescription patterns in general practice. The role of educational intervention. Med J Aust. 1994;160(8):502-5.

Downloads

Published

2017-01-27

How to Cite

Routray, D., Sahoo, J., Singh, P., Das, K., & Singh, S. (2017). Changing physician behavior: interventions to improve prescription writing practices in a secondary level hospital in Delhi. International Journal of Basic & Clinical Pharmacology, 3(5), 840–844. Retrieved from https://www.ijbcp.com/index.php/ijbcp/article/view/1114

Issue

Section

Original Research Articles