DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20192652

Drug utilization pattern in Schizophrenia

Elza Joy Munjely, Bindu Latha Nair R., Varghese P. Punnoose

Abstract


Background: Pharmacotherapy is the mainstay of treatment in schizophrenia. The economic impact of this illness is wide ranging, long lasting and huge. The emergence of newer antipsychotics has changed the prescribing pattern. Purpose of this study is to determine the prescription pattern of antipsychotic drugs and to analyse the drug utilization in patients with schizophrenia based on WHO prescribing indicators.

Methods: A descriptive study was conducted for a period of 1-year duration at inpatient Department of Psychiatry of a Government Medical College in Kerala, India among 230 schizophrenic patients. The case sheets of patients meeting inclusion criteria were scrutinised to find out the antipsychotic prescription pattern and drug utilization was analysed using WHO prescribing indicators. Analysis was done using descriptive statistics.

Results: Newer antipsychotics (55.2%) were prescribed slightly more in preference to older antipsychotic (44.8%) drugs. Out of the newer drugs prescribed olanzapine (20.9%) was prescribed the most followed by risperidone (18%). Haloperidol (22.9%) was the most frequently prescribed older antipsychotic. Majority (71.3%) of the patients were given more than one antipsychotics during the hospital stay. Trihexyphenidyl (27.9%) was the most frequently co-prescribed drug with antipsychotics. Average number of drugs per encounter was 4.19, 73.4% of the drugs were prescribed in their generic name, 50.4% of the encounters were with an injection prescribed. 44.4%of the drugs were prescribed from the EDL (WHO-19th edition). Average drug cost per encounter was Rs.45.43. Percentage of drug cost spent on injections was 8.44%.

Conclusions: Newer antipsychotics were more prescribed for schizophrenia of which olanzapine was the commonest. Newer antipsychotics are preferred because of their propensity to cause less side effects and more efficacy. Study of pattern of drug utilization is useful for measuring the economic impact of drug use among patients thereby facilitating rational prescribing.


Keywords


Antipsychotics, Drug utilization, Prescription pattern, Schizophrenia, WHO prescribing indicators

Full Text:

PDF

References


Piparva KG, Parmar DM, Singh AP, Gajera MV, Trivedi HR. Drug utilization study of psychotropic drugs in outdoor patients in a teaching hospital. Indian J Psychol Med. 2011;33(1):54-8.

Rang HP, Dale MM, Ritter JM, Flower RJ, Henderson G. Rang and Dale's Pharmacology.7th ed. Edinburgh: Churchill Livingstone; Chapter 45: Antipsychotic drugs; 2012:553-563.

Zhu B, Svanum AH, Faries DE, Correll CU, Kane JM. Cost of antipsychotic polypharmacy in the treatment of schizophrenia. BMC Psychiatry. 2008;8(1):19.

He X, Wu J, Jiang Y, Liu L, Ye W, Xue H, et al. Health care resource utilization and direct medical costs for patients with schizophrenia initiating treatment with atypical versus typical antipsychotics in Tianjin, China. BMC Health Serv Res. 2015;15(1):149.

Ilyaz M, Baig MMA, Ramakrishna, Quadir MA, Fathima M, Khan SAS. Drug utilization study of antipsychotics and its common ADR’s in the psychiatry OPD of OHRC. Int J Pharm Pharm Sci. 2014;6(9). Available at: http://innovareacademics.in/journals/index.php/ijpps/article/view/1456 [cited 2015 Sep 24]

Weinbrenner S, Assion HJ, Stargardt T, Busse R, Juckel G, Gericke CA. Drug prescription patterns in schizophrenia outpatients: analysis of data from a German health insurance fund. Pharmacopsychiatry. 2009;42(2):66-71.

Loosbrock DL, Zhao Z, Johnstone BM, Morris LS. Antipsychotic medication use patterns and associated costs of care for individuals with schizophrenia. J Ment Health Policy Econ. 2003;6(2):67-76.

Park SC, Lee MS, Kang SG, Lee SH. Patterns of antipsychotic prescription to patients with schizophrenia in Korea: results from the health insurance review and Assessment Service-national patient sample. J Korean Med Sci. 2014;29(5):719-28.

Lahonak, Shetty HM, Paramel A, Sharma G. Retrospective drug utilization study of antidepressants in the psychiatric unit of a tertiary care hospital. J Clini and Diagc Res. 2011;5(5):1069-75.

Devi PD, Amarjeeth R, Sushma M, Guido S. Prescription patterns of psychotropic drugs in hospitalized schizophrenic patients in a tertiary care hospital. Calicut Med J. 2007;5(4):e3.

How to Investigate Drug Use in Health Facilities: Selected Drug Use Indicators - EDM Research Series No. 007: Chapter 2: Core drug use indicators: Group 1: Prescribing indicators [Internet]. [cited 2017 Nov 6]. Available at: http://apps.who.int/medicinedocs/en/d/Js2289e/3.1.html.

WHO | WHO Model Lists of Essential Medicines [Internet]. WHO. [cited 2016 Mar 8]. Available at: http://www.who.int/medicines/publications/essentialmedicines/en/

Judy MV. Psychiatric disorder. Cultural and demographic factors of schizophrenia. Int J Psychol Rehab. 2012;10(2):89-103.

Kim HY, Lee HW, Jung SH, Kang MH, Bae JN, Lee JS, et al. Prescription patterns for patients with schizophrenia in Korea: a focus on antipsychotic polypharmacy. Clin Psycho pharmacol Neurosci. 2014;12(2):128-36.

Bergman U, Popa C, Tomson Y, Wettermark B, Einarson TR, Åberg H, et al. Drug utilization 90%- a simple method for assessing the quality of drug prescribing. Eur J Clin Pharmacol. 1998;54(2):113-8.

Laporte JR, Porta M, Capella D. Drug utilization studies: a tool for determining the effectiveness of drug use. Br J Clin Pharmacol. 1983;16(3):301-4.

Drug Utilization Studies: Methods and Uses. Available at: http://apps.who.int/medicinedocs/en/d/Js21868en/. Accessed 8 November 2017.

Hartzema AG, Porta MS, Tilson HH, Serradell J, Bjornson DC, Hartzema AG. Drug utilization study methodologies: national and international perspectives. Drug Intell Clin Pharm. 1987;21(12):994-1001.

Bachhav SS, Kshirsagar NA. Systematic review of drug utilization studies and the use of the drug classification system in the WHO-SEARO Region. Indian J Med Res. 2015;142(2):120.

Lahon K, Paramel A, Shetty H, Sharma G. Pharmacoepidemiological study of antipsychotics in the psychiatry unit of a tertiary care hospital: a retrospective descriptive analysis. Int J Nutr Pharmacol Neurol Dis. 2012;2(2):135.

Drug prescribing pattern and cost analysis of antipsychotics at a tertiary care hospital | international journal of pharmaceutical sciences and research [Internet]. Available at: http://ijpsr.com/bft- article/drug-prescribing-pattern-and-cost-analysis-of-antipsychotics-at-a- tertiary-care-hospital/?view=fulltext. Accessed 6 November 2017.

Rode S, Salankar H, Verma P, Sinha U, Ajagallay RK. Pharmacoepidemiological survey of schizophrenia in Central India. Int J Res Med Sci. 2014;2(3):1058-62.

Thakkar KB, Jain MM, Billa G, Joshi A, Khobragade AA. A drug utilization study of psychotropic drugs prescribed in the psychiatry outpatient department of a tertiary care hospital. J Clin Diagn Res. 2013;7(12):2759-64.