Evaluation of prescription patterns using World Health Organization prescribing indicators in outpatient department at a tertiary care hospital in Central India
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20252892Keywords:
WHO indicators, Rational use, NLEM, OPDAbstract
Background: Rational prescribing entails administration of safe, efficacious, and cost-effective medications. Adherence to standards in medical treatment can enhance quality of life in developing countries. One approach to promote rational use is the evaluation of drug utilization patterns in healthcare facilities. Objective of the study was to evaluate prescribing practices in outpatient department (OPD) of a tertiary care hospital using World Health Organization (WHO) standards.
Methods: Total 2000 randomly selected OPD prescriptions from patients of all ages and genders were collected from 1/09/2024 to 28/02/2025 and analysed for WHO standards and completeness of prescription. Institutional Ethics Committee approval was obtained vide reference no 93/31/08/2024.
Results: Among 6235 prescribed drugs in 2000 prescriptions, the average number of medicines was (3.1±1.49). Adherence to National List of Essential Medicine (NLEM) was high (90.67%), while generic prescribing was suboptimal (52.09%). Antimicrobial use was more (32.8%), injectable use was low (5.32%), brand names were used in 47.9%, and fixed drug combinations (FDCs) in 32.57%. The most frequently prescribed drugs were pantoprazole (54.57%), Diclofenac (38.5%), and Amoxycillin (28.7%). Prescriptions completeness in demographic information (90.67%), diagnosis (48.8%), legible handwriting (59.2%), capital letters (6.8%), abbreviations (100%), vernacular instructions (78.6%), and signature, designation, registration number, and qualification (36.9%).
Conclusions: Prescribing practices deviated from WHO standards, with incomplete documentation of patient-related information. The study identified inappropriate prescribing, including polypharmacy (3.1±1.49), limited generic drug use (52.09%), and high use of NLEM drugs (90.67%). Prescription completeness was low (52.09%). These practices could result in adverse health outcomes and higher costs, indicating the need for continuous education of healthcare professionals.
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References
Ofori-Asenso R, Agyeman AA. Irrational Use of Medicines-A Summary of Key Concepts. Pharmacy (Basel). 2016;4(4):35. DOI: https://doi.org/10.3390/pharmacy4040035
Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al. Antibiotic resistance-the need for global solutions. Lancet Infect Dis. 2013;13(12):1057-98. DOI: https://doi.org/10.1016/S1473-3099(13)70318-9
World Health Organization. Promoting rational use of medicines. Geneva: WHO Regional Office for South-east Asia. 2011. Available at: https://www.who.int/activities/promoting-rational-use-of-medicines. Accessed on 23 July 2025.
World Health Organization. Promoting Rational Use of Medicines. Available at: https://www.who.int/activities/promoting-rational-use-of-medicines. Accessed on 23 July 2025.
World Health Organization. How to Investigate Drug Use in Health Facilities: Selected Drug Use Indicator. 1993. Available at: https://www.who.int/publications/i/item/who-dap-93.1. Accessed on 23 July 2025.
Dhanya TH, Sanalkumar KB, Andrews MA. Prescription auditing based on the World Health Organization (WHO) prescribing indicators in outpatient department of a teaching hospital in Kerala. Asian J Pharm Clin Res. 2021;14(5):147-51. DOI: https://doi.org/10.22159/ajpcr.2021.v14i5.41305
Mulkalwar S, Patel A, David S, Pabari K, Math P, Tilak AV. Prescription Audit for WHO Prescribing Indicators and Prescription Errors in a Tertiary Care Teaching Hospital. Med J Dr. D.Y. Patil Vidyapeeth. 2024;17(2):299-303. DOI: https://doi.org/10.4103/mjdrdypu.mjdrdypu_640_22
Verma N, Vinayagam S, Mittal N, Mittal R, Bansal N. Prescription Audit in Outpatient Pharmacy of a Tertiary Care Referral Hospital in Haryana Using World Health Organization/International Network of Rational Use of Drugs (WHO/INRUD) Core Prescribing Indicators: A Step Towards Refining Drug Use and Patient Care. Pharmacy. 2025;13(2):48. DOI: https://doi.org/10.3390/pharmacy13020048
Meena DK, Mathaiyan J, Thulasingam M, Ramasamy K. Assessment of medicine use based on WHO drug‐use indicators in public health facilities of the South Indian Union Territory. Br J Clin Pharmacol. 2022;88(5):2315-26. DOI: https://doi.org/10.1111/bcp.15165
Goruntla N, Ssesanga J, Bommireddy BR, Thammisetty DP, Kasturi Vishwanathasetty V, Ezeonwumelu JOC, et al. Evaluation of Rational Drug Use Based on WHO/INRUD Core Drug Use Indicators in a Secondary Care Hospital: A Cross-Sectional Study in Western Uganda. Drug Healthc Patient Saf. 2023;15:125-35. DOI: https://doi.org/10.2147/DHPS.S424050
Galappatthy P, Ranasinghe P, Liyanage CK, Wijayabandara MS, Mythily S, Jayakody RL. WHO/INRUD Core drug use indicators and commonly prescribed medicines: a National Survey from Sri Lanka. BMC Pharmacol Toxicol. 2021;22(1):67. DOI: https://doi.org/10.1186/s40360-021-00535-5
Jaiswal S, Chandra Ns, Agrawal M, Sheohare R, Mishra A. Evaluation of Drug Prescription using WHO Prescription Indicators at a Tertiary Care Teaching Hospital, Raipur Chhattisgarh, India: A Cross-sectional Study. J Clin Diagnost Res. 2024;18(9). DOI: https://doi.org/10.7860/JCDR/2024/73906.19827
Shivgunde PP, Kodilkar AD. Investigation of drug use at primary health centres in Nashik, Maharashtra, India. Int J Res Med Sci. 2020;8(1):290. DOI: https://doi.org/10.18203/2320-6012.ijrms20195925
Rasool MF, Maqbool I, Imran I, Ramazan B, Butt MD, Iqbal MO, et al. A Cross-Sectional Study to Assess the WHO/INRUD Drug Use Prescribing Core Indicators at Tertiary Care Hospital of Punjab, Pakistan. Latin Am J Pharm. 2021;40(5):936-45.
Atal S, Jhaj R, Mathur A, Rai N, Misra S, Sadasivam B. Outpatient prescribing trends, rational use of medicine and impact of prescription audit with feedback at a tertiary care centre in India. Int J Health Planning Management. 2021;36(3):738-53. DOI: https://doi.org/10.1002/hpm.3116
Kanagasabapathy S, Rajagopal A, Murugan V, Balagurumoorthy M, Vasudevan K. Analysis of the pattern of drug use using WHO core drug indicators among general OPD patients in rural Puducherry. J Family Med Prim Care. 2024;13(11):5193-7. DOI: https://doi.org/10.4103/jfmpc.jfmpc_922_24
Meenakshi R, Selvaraj N, Anandabaskar N, Dhamodharan A, Badrinath AK, Rajamohammad MA. Prescription audit of a teaching hospital in South India using World Health Organization core prescribing indicators - A cross-sectional study. Perspect Clin Res. 2022;13(3):132-6. DOI: https://doi.org/10.4103/picr.PICR_172_20
Singh T, Banerjee B, Garg S, Sharma S. A prescription audit using the World Health Organization-recommended core drug use indicators in a rural hospital of Delhi. J Educ Health Promot. 2019;8:37. DOI: https://doi.org/10.4103/jehp.jehp_90_18
Wendie TF, Ahmed A, Mohammed SA. Drug use pattern using WHO core drug use indicators in public health centers of Dessie, North-East Ethiopia. BMC Med Inform Decis Mak. 2021;21(1):197. DOI: https://doi.org/10.1186/s12911-021-01530-w
Kilipamwambu A, Bwire GM, Myemba DT, Njiro BJ, Majigo MV. WHO/INRUD core prescribing indicators and antibiotic utilization patterns among primary health care facilities in Ilala district, Tanzania. JAC Antimicrob Resist. 2021;3(2):dlab049. DOI: https://doi.org/10.1093/jacamr/dlab049
Farid Habibyar A, Nazari QA. Evaluation of prescribing patterns using WHO core drug use indicators in a pediatric hospital of Kabul Afghanistan: A prospective cross-sectional study. Heliyon. 2023;9(11):e21884. DOI: https://doi.org/10.1016/j.heliyon.2023.e21884
Shrestha JTM, Tiwari S, Kushwaha DK, Bhattarai P, Shrestha R. Drug Prescription in the Department of Medicine of a Tertiary Care Hospital according to the World Health Organization/International Network for Rational Use of Drugs Core Indicators: A Descriptive Cross-sectional Survey. JNMA J Nepal Med Assoc. 2021;59(240):745-8. DOI: https://doi.org/10.31729/jnma.5612
Sunny D, Roy K, Benny SS, Mathew DC, Naik GJ, Gauthaman K. Prescription audit in an outpatient pharmacy of a tertiary care teaching hospital—A prospective study. J Young Pharm. 2019;11:417-20. DOI: https://doi.org/10.5530/jyp.2019.11.85
Yimer YS, Addis GT, Alemu MA. Evaluation of prescription completeness, rational drug-use patterns using WHO prescribing, patient-care and facility indicators in Debre Tabor Comprehensive Specialized Hospital, Ethiopia: A cross-sectional study. SAGE Open Med. 2022;10:20503121221122422. DOI: https://doi.org/10.1177/20503121221122422
Joshi R, Medhi B, Prakash A, Chandy S, Ranjalkar J, Bright HR, et al. Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian tertiary care centers: A multicentric study by Rational Use of Medicines Centers-Indian Council of Medical Research network under National Virtual Centre Clinical Pharmacology activity. Indian J Pharmacol. 2022;54(5):321-8. DOI: https://doi.org/10.4103/ijp.ijp_976_21
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