Drug utilization 90%: an innovative method in assessing quality of drug prescription with specific reference to non-steroidal anti-inflammatory drugs prescription

Dhananjay Kulkarni; Kokila B. N.; Santosh Kumar Sahu; Ravindra Kumar G.

doi:10.18203/2319-2003.ijbcp20162893

Authors

Dhananjay Kulkarni Department of Pharmacology, Konaseema Institute of Medical Sciences and Research Foundation (KIMS & RF), Amalapuram, Andhra Pradesh, India
Kokila B. N. Department of Pharmacology, KVG Medical College, Sullia (DK), Karnataka, India
Santosh Kumar Sahu Department of Orthopaedics Konaseema Institute of Medical Sciences and Research Foundation (KIMS and RF), Amalapuram, Andhra Pradesh, India
Ravindra Kumar G. Department of Pharmacology, Konaseema Institute of Medical Sciences and Research Foundation (KIMS & RF), Amalapuram, Andhra Pradesh,India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20162893

Keywords:

DU90%, FDC, DDD, NSAID, Prescription pattern, GPA

Abstract

Background: DU90% is useful tool for assessing drug prescribing pattern. In this, drugs constituting 90% of the prescription volume are identified. Size of the DU90% segment helps us to assess rational prescribing. Large number of drugs in the DU90% segment indicates less rational prescribing, whereas small number suggests more rational prescribing.

Methods: Study was carried out in orthopaedic out-patient department (OPD) for a period of three months. Only OPD based NSAID containing prescriptions were included. Data was analyzed based on demographic parameters, prescription indices, fixed dose combinations (FDC) and co-prescription of gastro-protective agents (GPA). DU90% was calculated based on defined daily dose (DDD) with their respective value in Anatomical Therapeutic Chemical (ATC) classification code. Defined daily dose is calculated as DDD/1000/day.

Results: Diclofenac (38%) was the commonest NSAID prescribed. Diclofenac +chymotrypsin (25%) was the commonest FDC prescribed. Piroxicam (19%) was the commonest NSAID prescribed in monotherapy form. Co-prescription of GPA was high (96%). 5 of the 7 prescribed NSAIDs constitute to DU90% segment.

Conclusions: Preferential cyclooxygenase-2 (COX-2) inhibitor NSAIDs were more preferred. Number of prescribed NSAIDs constituting to DU90% is more, thus prescription pattern needs further rationalization. Further large scale study is required to bring out more details about NSAID prescription pattern and its rational use.

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References

Teichert M, Van der Aalst A, De Wit H, Stroo M, De Smet P. How useful are prescribing indicators based on the 90% method to distinguish the quality of prescribing between pharmacotherapy audit meeting with different level of functioning. Eur J Clin Pharmacol. 2007;63:1171-2.

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

Bergman ULF. Pharmacoepidemiology-from description to quality assessment: A Swedish perspective. Norwegian J Epidemiol. 2001;11(1):31-6.

Popa C. DU90% for the assessment of drug prescribing in primary care. Master of Pub Health (MPH). 2005;18:17-8.

Grimmsmann T, Wolfgang H. Discrepancies between prescribed and defined daily doses: a matter of patients or drug classes? Eur J Clin Pharmacol. 2011;11:1014-7.

Pincus T, Swearingen C, Cunmine P, Callahaw LP. Preference for non-steroidal anti-inflammatory drugs versus acetaminophen and concomitant use of both types of drugs in patients with osteoarthritis. J Rheumatol. 2000;27:1020-7.

Paul AD, Chauhan CK. Study of usage pattern of nonsteroidal anti-inflammatory drugs (NSAIDs) among different practice categories in Indian clinical setting. Eur J Clin Pharmacol. 2005;60:889-92.

Rahman MS, Begum ZA, Samad MK. Prescribing pattern of non-steroidal anti-inflammatory drugs at outpatient departments of teaching hospitals. Bangladesh J Pharmacol. 2007;2:1-6.

Manohar VS, Vinay M, Jayasree T, Kishan PV, Ubedulla S, Dixit R. Prescribing pattern of gastroprotective agents with non-steroidal anti-inflammatory drugs. J Pharmacol Pharmacother. 2013;4:59-60.

Nonsteroidal Antiinflammatory Drugs and Antipyretic-Analgesics. In: KD Tripathi; Essentials of Medical Pharmacology. 7th ed. New Delhi: Jaypee brothers; 2013:192-209.

Usher C, Bennett K, Teeling M, Feely J. Characterizing new users of NSAIDs before and after rofecoxib withdrawal. Br J Clin Pharmacol. 2006:64(4):494-7.

Vogt MT, Henderson BF, Duggal A, Ansani NT, Gillespie J, Starz T. NSAID usage: impact of safety data and product withdrawals on prescribing trends. P&T Journal. 2007;32(5):284-7.

Samad MK. Consumption patterns of non-steroidal anti-inflammatory drugs by the community without prescription in Dhaka city. Bangladesh J Pharmacol. 2009;4:43-5.

Lanas A, Garci-Tell G, Armada B, Oteo-Alvaro. Prescription patterns and appropriateness of NSAID therapy according to gastrointestinal risk and cardiovascular history in patients with diagnoses of osteoarthritis. BMC Med. 2011;9:38.

Amaro F, Machan S, Carmona L, Alvaro GI, Daaz GF. Pattern of use and safety of non-steroidal anti-inflammatory drugs in rheumatoid arthritis patients. A prospective analysis from clinical practice. Reumatol Clin. 2009;5(6):252-8.

Jaksch W, Dejaco C, Schirmer M. 4 years after withdrawal of rofecoxib where do we stand today? Rheumatol Intern. 2008;28(12):1187-95.

Sharma T, Dutta S, Dhasmana DC. Prescription pattern of NSAIDs in orthopaedic OPD of a tertiary care teaching Hospital in Uttaranchal. JK Science. 2006;8(3):160-2.

Balat JD, Gandhi AM, Patel PP, Dikshit RK. A study of use of fixed dose combinations in Ahmedabad, India. Indian J Pharmacol. 2014;46(5):503-9.

Poudel A, Palaian S, Shankar PR, Jayasekara J, Izham MIM. Irrational fixed dose combinations in Nepal: Need for intervention. Kathmandu University Med J. 2008;6(3):399-405.

Kastury N, Singh S, Ansari KU. Fixed dose combinations and rational drug therapy. Indian J Pharmacol. 2001;33:458-9.

Introduction to drug utilization research. WHO collaborating centre for drug utilization research. WHO library catalogue. 2003:33.

Shankar PR, Upadhyay DK, Subish P, Bhandari RB, Das B. Drug utilization among older inpatients in a teaching Hospital in Western Nepal. Singapore Med J. 2010;51(1):28-34.

Ćalasan J, Mijatović V, Horvat O, Varga J, Sabo A, Stilinović N. The outpatient utilization of non-steroidal anti-inflammatory drugs in South Bačka District, Serbia. Ind J Clin Pharmacol. 2011;33:246-51.

Lee SH, Han CD, Yang IH, Ha CW. Prescription pattern of NSAIDs and the prevalence of NSAID-induced gastrointestinal risk factors of Orthopaedic patients in clinical practice in Korea. J Korean Med Sci. 2011;26:561-7.

Gupta M, Malhotra S, Jain S, Aggarwal A, Pandhi P. Pattern of prescription of non-steroidal anti-inflammatory drugs in orthopedic outpatient clinic of a North Indian tertiary care hospital. Indian J Pharmacol. 2005;37(6):404-5.

Teeling M, O‘Connor H, Feely J, Bennett K. What therapies have replaced rofecoxib in Ireland? Br J Clin Pharmacol. 2007;64(4):536-41.