Drug prescription pattern audit is an important aspect of patient care, which is a part of the clinical audit which serves as a measure of the quality of care provided to the patient and helps in the improvement of patient care by changing or implementing the needed changes (1). This is also an integral part of medical education which helps clinicians in improving prescription quality and ultimately better patient care. Many of the recent research studies recommended constant evaluation of the quality of prescribing patterns. The prescription error is an unacceptable medication error that is very common in many hospitals worldwide. The prescription pattern audit studies are highly useful tools in assessing the prescribing pattern and dispensing medicines prevalent in a particular area. The main aim of these studies is to facilitate the rational use of medicines (2). Nowadays due to various reasons like a boost in new drugs marketing, wide variations in the pattern of prescription and consumption of drugs, growing concern about delayed adverse effects, and cost of drugs all enhance the importance of prescribing patterns audit (3). Currently, rational use of medicines is an important requirement due to many reasons, among them; antimicrobial resistance is one of the important concerns. Irrational prescribing or overuse of medicines is an arising major problem worldwide. According to World Health Organization (WHO), more than half of all medicines prescribed, dispensed inappropriately. Overuse, underuse or misuse of medicines, will lead to drug resistance, cost of treatment and duration of treatment increases which ultimately leads to wastage of resources and widespread health hazards. WHO defines the rational use of medicines (RUM) as “Patients should receive medications appropriate to their clinical needs, in doses that meet their requirements, for an adequate period, and at the lowest cost to them and their community (4). Presently, the WHO and the National Health Policy of India, has focused on prescribing drugs by generic names from the list of essential medicines, because prescribing with the generic name is also one of the major issues to fix in India and many other countries (5-6). This type of study is imperative to bridge the areas such as rational use of drugs, pharmacovigilance, pharmacoeconomics, pharmacogenetics, antimicrobial stewardship and evidence-based medicine.
The WHO developed core medication Use Indicators, which includes Prescription Indicators intended with an aim to evaluate the services provided to the population concerning medications (7). These are universally useful for any settings in the world in any nation which are highly standardized and are recommended for inclusion in any drug usage study using these indicators. Accordingly, drug use indicators provide a simple tool for quickly and reliably assessing a few critical aspects of pharmaceutical use in primary health care (8). Results with these indicators point towards the particular drug use issues that need examination in more detail (8).WHO core prescription indicators allow to assess the therapeutic actions taken in similar institutions, enabling subsequent comparison of parameters between them, and to evaluate the population’s medication needs and determine the most commonly used medications in a given locality, to identify the prescription profile and quality of services offered to the population by the hospital. This study was designed to study the drug prescribing pattern at the medical outpatient department at our tertiary care centre which is a teaching medical college cum hospital, by using the following prescription indicators (8):
The WHO prescribing indicators include:
- The average number of drugs per prescription.
- Percentage of drugs prescribed by generic name
- Percentage of prescriptions containing antimicrobial agents (antibiotics)
- Percentage of injections per prescription
- Percentage of drugs prescribed from the EML.
Evaluation of all the prescribing indicators irrespective of the diagnosis in a particular department like in our study would enable capturing a wider picture of the current trends rather than evaluating only some particular group of drugs like antiepileptics, antimicrobials, antiasthmatics and antihypertensive drugs (5). The present study was conducted to evaluate the rational drug use in the department of Internal medicine, in an institute of national importance, using the WHO prescribing indicators.