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Table of Content Volume 6 Issue 3 - June 2018



 

Patterns of prescription in a psychiatry out-patient department in a tertiary teaching hospital

 

Rashmi Sharma1*, Brij Mohan Gupta2, Rakesh Banal3

 

{1Post Graduate, 2Professor, Department of Pharmacology}, {3Lecturer, Department of Psychiatry}, Government Medical College, Jammu-180001, Jammu and Kashmir, INDIA.

Email: rashmisharma_jmu@rediffmail.com

 

Abstract               Background: There is constantly increasing prevalence of psychiatric morbidity in Jammu and Kashmir State. Study of prescription pattern helps us to monitor, evaluate and if necessary suggest modifications in prescribing pattern so as to make medical care rational and cost effective. Aim: To analyze the drug prescribing pattern in outdoor patients of psychiatry department of Government Medical College Jammu, a tertiary care teaching hospital. Material and Methods: A total of 700 prescriptions of psychiatric outpatients were evaluated. Each patient’s demographic and clinical profiles, disease classification, pharmacological class of drug prescribed, dosage, banned drug formulations, generic versus brand drugs, average number of drugs per prescription was noted down. Results: Average number of drugs prescribed was calculated to be 2.63. Total number of 1752 psychotropic drugs with a range of 1 to 5 were prescribed, average being 2.50. Drugs prescribed by generic name were 7.83%. In 297 (42.43%) three psychotropic drugs were prescribed whereas five drugs were prescribed in 5 (0.71%) prescriptions. Conclusion: Prescription pattern of the psychotropic drugs were in accordance to the recommendations of various treatment guidelines. However, polypharmacy level was high. Overall drug prescribing by generic name and from EDL need to be increased to control the drug costs in the health service.

Key Words: Prescription pattern, Psychiatry Out-patient, psychotropic drugs, polypharmacy.

 

 

INTRODUCTION

Psychiatric disorders form an important public health priority and constitute a wide spectrum ranging from sub-clinical states to very severe forms of disorders. Jammu and Kashmir State has witnessed the twin problem of terrorism and migration, resulting in rising trend of psychiatric morbidity.1,2 Drug prescribing pattern varies in different geographical areas as it is influenced by patient characteristics, type of disease prevalent, cultural and environmental factors, available drugs and prescribing habit of physicians. Study of prescription pattern helps us to monitor, evaluate and if necessary suggest modifications in prescribing pattern so as to make medical care rational and cost effective.3 There are many studies which have evaluated the drug prescribing pattern and safety profile in psychiatric patients from India.4,5 However, there is paucity of data regarding prescribing pattern in psychiatric disorders from this part of our country. There is constantly increasing prevalence of psychiatric morbidity in Jammu and Kashmir State,1 warranting exploration of safer and better therapeutic options. These factors prompted to conceive the present study to analyze the drug prescribing pattern in outdoor patients of psychiatry department of Government Medical College Jammu, a tertiary care teaching hospital.

 

MATERIAL AND METHODS

The present cross-sectional, observational, one-point analysis was conducted in the Postgraduate Department of Pharmacology and Therapeutics in collaboration with Department of Psychiatric Diseases Hospital, Government Medical College, Jammu over a period of one year from November 2015 to October 2016. Study was conducted after necessary approval from the Institutional Ethics Committee. All the principles of bioethics were adopted, informed verbal consent of the patient or Legally Acceptable Representative (LAR) was taken as the present study falls under Category C, with no risk to the patient and was an observational study. Prescription was collected by an independent person by clicking its picture with mobile phone outside the OPD of Psychiatric Diseases Hospital without the knowledge of prescriber to avoid any bias. The name of the drug was used by generic name. Name of the prescriber and name of the patient was coded for all practical purposes to avoid any conflict of interest.

Inclusion Criteria

  • Aged 18 to 60 years
  • Patients of both genders
  • Patient/LAR who gives consent
  • No organic disorder

Exclusion Criteria

  • Age group < 18 years or > 60 years
  • Revisit was excluded
  • Organic disorders
  • Indoor psychiatric patients

A total of 700 prescriptions of psychiatric outpatients which fulfilled the inclusion criteria were evaluated. Data collected from the prescriptions was entered in the predesigned proforma especially prepared from the World Health Organization (WHO) guidelines on how to investigate drug use in health facilities.6 Each patient’s demographic and clinical profiles, disease classification, pharmacological class of drug prescribed, dosage, route of administration, frequency, duration, over-prescribing, banned drug formulations, generic versus brand drugs, fixed dose combination (FDC) prescribing rate, average number of drugs per prescription was noted down. Basic indicators referred to as core indicators were used as measure of performance in three general areas related to rational use of drugs.6

Statistical Analysis: The data collected was tabulated, interpreted and analyzed as numbers and percentage and presented with the help of appropriate tables and diagrams.

 

RESULTS

The mean age of the study population was 37.26 years with a range of 18 to 60 years, with median age being 36 years. Maximum patients were young in the age group of 21 to 30 years (29.86%), followed by age group of 31-40 years (23.28%). A total number of 1839 drugs with a range of 1 to 6 were prescribed in 700 prescriptions studied. In all prescriptions dosage form, route of administration, frequency, dose and duration of drug was mentioned.

 

Table 1: Total Number of Prescriptions and Drugs Prescribed

Total Number of Prescription Studied

n=700

Total Number of Drugs Prescribed
(Range)

1839
(1 – 6)

Average Number of Drugs Prescribed per prescription

2.63

Total Number of Psychotropic Drugs Prescribed
(Range)

1752
(1 – 5)

Average Number of Psychotropic Drugs Prescribed per prescription

2.50

Percentage of Drugs Prescribed by Generic Name

7.83%

Percentage of Patient Encounters with an Injection

2%

Percentage of Psychotropic Drugs Prescribed from

Essential Drugs List

22.09%

Average number of drugs prescribed was calculated to be 2.63. Total number of 1752 psychotropic drugs with a range of 1 to 5 were prescribed, average being 2.50. Drugs prescribed by generic name were 7.83%. Two per cent patients had encounter with an injection. Percentage of psychotropic drugs prescribed from EDL was 13.53% (Table 1).

 

Table 2: Distribution of Patients According to Diagnosis (DSM IV Classification)

Diagnosis

N (%)

Schizophrenia

323 (46.14%)

Bipolar Disorder

168 (24%)

Major Depressive Disorder

130 (18.57%)

Brief Psychotic Episode

15 (2.14%)

Substance Related Disorders

15 (2.14%)

Panic Disorder

11 (1.57%)

Obsessive Compulsive Disorder

9 (1.28%)

Adjustment Disorder

7 (1%)

Post-traumatic Stress Disorder

5 (0.71%)

Generalized Anxiety Disorder

5 (0.71%)

Conversion Disorder

4 (0.57%)

Postpartum Psychosis

3 (0.42%)

Sleep Disorder

3 (0.42%)

Schizoaffective Disorder

2 (0.28%)

Total

700 (100%)

According to DSM IV classification, schizophrenia was diagnosed in 46.14% patients, bipolar disorder in 24% and major depressive disorder in 18.57%. Brief psychotic episode and substance related disorders were diagnosed in 2.14% patients each (Table 2).

 

Table 3: Number of Psychotropic Drugs Prescribed per Prescription (n=700)

Number of Psychotropic Drugs Prescribed

n (%)

One

80 (11.43%)

Two

241 (34.43%)

Three

297 (42.43%)

Four

77 (11%)

Five

5 (0.71%)

Total

700 (100%)

In majority of the prescriptions i.e., 297 (42.43%) three psychotropic drugs were prescribed whereas five drugs were prescribed in 5 (0.71%) prescriptions.

 

DISCUSSION

A total number of 1839 drugs with a range of 1 to 6 were prescribed in 700 prescriptions studied. Average number of drugs prescribed was 2.63. Lahon K et al, carried out an observational analysis of the case records of patients who received antidepressants at the psychiatry outpatient clinic of a tertiary care hospital. The average number of drugs per prescription was 2.32.7 Odo HO et al evaluated the pattern of drug utilization at a regional neuropsychiatric hospital. They reported an average of 2.88 drugs prescribed per encounter. The results of both these studies are in agreement with the present study.8 However, Schorr SG et al analyzed prescribing patterns of 323 chronic psychiatric patients and reported an average of 4.6 drugs per prescription.9 Salman S et al screened 602 prescriptions of psychiatrists in private clinics. The prescriptions were collected from the indoor patients and the study reported an average of 3.34 drugs prescribed per prescription.10 The results of both these studies are in contradiction with our results because of the selection of studied subjects. These studies were conducted on chronic and indoor patients. This indicator helps in investigating poly-medication, which is a major factor contributing to adverse drug reaction (ADR). This indicator was relatively low in the present study but still there is scope for improvement as WHO recommends <2 drugs per encounter. In the present study, a total number of 1752 psychotropic drugs with a range of 1 to 5 were prescribed, average being 2.50. Piparva KG et al carried out a prospective cross-sectional study to analyze the pattern of drug utilization of psychotropic medications in outdoor patients of psychiatry department of a tertiary care teaching hospital. They reported psychotropic drugs prescribed per patient to be 2.96.11 Rode SB et al carried out a prospective, observational study to find out prescribing trends of psychotropic drugs and observed average number of psychotropic drugs per prescription to be 2.1.5Sabahi A et al assessed the pattern and utilisation of psychotropic drug prescriptions by psychiatrists in a cross-sectional study. The mean number of drugs per prescription reported was 2.9.12 The results of these studies are in consonance with our study. However, Thakkar KB et al conducted a study on patients with psychiatric disorder and reported average number of psychotropic drugs per prescription to be 1.79, which is on lower side as compared to our study.13 Drugs prescribed by generic name were 7.83% in the present study. Percentage of psychotropic drugs prescribed from Essential Drug List (EDL) was 22.09%. Rode SB et al reported in their study that about 28.75% drugs were prescribed by generic name and utilization from the WHO essential drug list was also 28.57%.5Lahon K et al reported the number of drugs which were prescribed by their generic names was 88.54% and the number of drugs which were prescribed from WHO EDL was 1.56%.7Odo HO et al observations were dramatically different. In their study in Nigeria 94.38% of the drugs were prescribed using their generic names, while 99.2% of all the drugs prescribed were from the Essential Drugs List.8Summoro TS et al reported average percentages of drugs prescribed by generic name and from the Essential Drugs List to be 95.8 and 94.1, respectively. The results of all these studies are in variance with that of our study.14 Overall drug prescribing by generic name and from EDL was low in the present study. This indicator needs to be increased to control the drug costs in the health service. This may be due to marketing influence as well as patient’s less confidence in generic drugs, which is ideally recommended by WHO as 100 per cent. Polypharmacy was more prevalent in the present study. Polypharmacy in psychiatry is commonly referred to as the concurrent use of 2 or more psychotropic medications in the same patient.15In the study of Chakrabarti S and Kulhara P, 64% patients received only a single antidepressant, while two antidepressants were used in conjunction in 18% patients and in 12% patients a third or a fourth drug was used.16Adeponle AB et al analyzed patterns of polypharmacy among psychiatric outpatients and reported that out of a total of 278 patient 92% were given two or more psychotropic agents, which is similar to the present study.1

 

CONCLUSION

In the present study, no banned drug was prescribed. Prescription pattern of the psychotropic drugs were in accordance to the recommendations of various treatment guidelines. However, Polypharmacy level was high. Overall drug prescribing by generic name and from EDL was low in the present study. This indicator needs to be increased to control the drug costs in the health service.

 

REFERENCES

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