European Journal of Cardiovascular Medicine

The Drug utilization studies are essential tools for the monitoring various healthcare system.¹ According to the World Health Organization (WHO), a drug utilization study is "the marketing, distribution, prescription, and drug usage in a society, leading to medical, social, and economic consequences". Rational drug use requires that patients receive medications appropriate their clinical needs, in doses their individual requirement for the right duration, and at the lowest cost to the community.²

In contrast, inappropriate management and irrational use of drugs lead to wastage of resource, prolonged suffering, increased morbidity and mortality,  loss of confidence in the healthcare system.³ In outpatient departments (OPDs) of tertiary care teaching hospitals, can help to identify areas for improvement in optimizing drug use, enhancing patient outcomes, and pharmaceutical care.

Several factors contribute to irrational drug use, including patient load, number of prescribers, supply systems, and workplace factors.^{4, 5} Development of DUS made it possible of drug use in a scientific manner, providing a valuable tool for assessing healthcare systems in tertiary care teaching hospitals. ^{6, 7}

The objectives of drug utilization study is analyze and identify drug related problems and their consequences. Drug utilization study encourages the rational prescribing of drug, contributes to the knowledge of current use of drugs in the society and explore whether a particular intervention affects the drug use in the population by observing the drug use pattern.⁸

The observational, prospective study was conducted in the Outpatient Departments (OPDs) of General Medicine, ENT, Surgery, Orthopedic, and Dermatology at Adesh Medical College and Hospital, Shahabad Mohri, Haryana, India, located in a rural area. The study was complete acceding to World Health Organization (WHO) guidelines and approved by the Institutional Ethics Committee (Ref. No. AMCH/IEC-BHR/2023/02/06). After approve the study was continue and conducted from March 2023 to July 2023, spanning six months.

During this period, prescriptions were randomly collected from each OPD, and analyze, recorded the data. A total of 650 patients prescriptions were included in this research study and patients of each gender were taken.^{9, 10}

Inclusion Criteria

1. Patients age between 18 years and 65 years.
2. Patients attending the selected departmental OPD in a hospital.
3. Patients Prescribe with a valid prescription including eligible handwriting and complete medical recordes from the selective OPD.
4. Patients with various medical conditions, such as skin diseases, hypertension, diabetes, osteoporosis, respiratory diseases, etc.

Exclusion Criteria

1. Patients age below 18 years and above 61 years.
2. Patients admitted to the hospital and with life-threatening conditions.
3. Patients lack of prescription and without a valid prescription.
4. Patients incomplete or missing medical records.

Number of Average Drugs per Encounter

The number of average drugs per encounter was calculated by dividing the total number of drugs prescribed by the number of encounters surveyed.

Percentage of Drugs Prescribed by Generic Name

The percentage of drugs prescribed by generic name was calculated by dividing the number of drugs prescribed by generic name by the total number of drugs prescribed, multiplied by 100.

Percentage of Encounters with Antibiotic or Injection Prescribed

The percentage of encounters with an antibiotic prescribed and the percentage of encounters with an injection prescribed were calculated by dividing the number of patient encounters where an antibiotic or injection was prescribed by the total number of encounters surveyed, multiplied by 100.

Percentage of Drugs Prescribed from Essential Drugs List

The percentage of drugs prescribed from the essential drugs list was calculated by dividing the number of products prescribed listed on the essential drugs list by the total number of products prescribed, multiplied by 100 (WHO, 2019).

Average Consultation Time

To measure the time that medical personnel spend with patients in the process of consultation and prescribing.

Average Dispensing Time

To measure the average time that personnel dispensing drugs spend with patients.

Patient Knowledge of Correct Dosage

To measure the effectiveness of the information given to patients on the dosage schedule of the drugs they received.

Demographic of patients

Out of 650 Patients were divided into two groups based on their gender. The largest patients are found in female patients 345 (53%) comprising male patients 305 (47%). the higher proportion of female patients is shows in comparison to male patients.

Table 1: Demographic of patients distribution accosting gender

Figure 1: Number of Average Drugs per prescription.

Out of 650 patient’s prescription study, total 2446 medicine was prescribed and average.

Data Analysis Considerations

The average number of drugs calculation per encounter, two or more in drug combinations were considered as a single drug. For the remaining indicators, combinations were split into individual drugs and counted separately.11, 12

number medicine (4) per prescription was prescribed. Some prescription shows polypharmacy.

Figure 2: Drugs prescribed by Brand/Generic name.

Out of 650 patients’s prescription, total number of 2446 drugs were prescribed. Average number drugs of per prescription by Generic name were 271 (11%) and Brand name 2175 (89%).

Figure 3: Drugs prescribed by routes with Antibiotic per prescriptions.

Overall prescribed drugs 2446 were found 89% oral drug, 4.7% inhalation, 6.3% injections, and 6.5%   Antibiotics prescriptions.

Figure 4: Drugs Prescribed by National list of Essential Medicines

Majority of prescribed drugs in NLEM (National List of Essential Medicines) over of prescribed 2446 drugs were found 1120 (45.8%) in NLEM and 1326 (55.2%) drugs were prescribed out of NLEM.

Figure 5: Average consolation and dispensing time per Prescriptions

Out of 650 patients’ prescription total consultation time was 4970 Minutes so average time of per prescription is 7.6 minutes and total time of dispensing medication 2987 minutes average time in person presents 9.2 minutes.

Figure 6: Patient knowledge of correct dosage,

Number of Drugs per Encounter dispenses and

 Average Cost of per prescription

Out of 650 patients’ prescription only 260 (40%) patents knowledge of correct dosage, route of drugs administration most of the drugs prescribe were through oral route and frequency of drugs administration.

Out of 650 patient’s prescription study, total  medicine and other instrument like ORS, normal saline, syringe, globs, cotton antiseptic etc, total prescription of cost is 4232450 rupees average cost of per prescription is 1298 rupees per patient it does not include investigation and travelling charges.

The Drug Utilization Study (DUS) provided new insights into drug utilization patterns in various Outpatient Departments (OPDs). This study analyzed 650 patient prescriptions, which prescribed a total of 2446 drugs. The average number of drugs prescribed by per patient is 4. Similar studies reported average numbers of drugs prescribed per patient as follows: 3.42, 2.3, 3.28, 2.82, 2.73, 2.85, and 2.76.^13-19 Our study's result is higher to compared to similar studies. Our study show Polypharmacy, defined as the use of multiple medications, increases the cost of therapy, particularly when prescribed drugs are brand-name. It also decreases patient compliance. Therefore, drugs should be used judiciously. According to previous studies, polypharmacy increases the risk of drug interactions: approximately 6% of patients taking two to four medications, 50% of those taking five to eight medications, and 100% of those taking more than 10 medications.²¹

In the present study, 11% of prescribed drugs were by generic name. This finding is lower compared to other studies, which reported percentages of 13.48%, 15.26%, and 30.70%.^{16, 21, 22} However, our result is higher than Simpson's study, which reported 5.75% and 5.41% in teaching clinicians.^{16, 21, 22, 23}

Prescribing drugs by generic name avoids confusion, makes therapy cheaper and more rational, and promotes the use of essential drugs. Teaching institutions should encourage the use of generic names, as seen in scientific journals, textbooks, and research publications. However, most doctors prescribe drugs by their brand names due to aggressive promotion, tradition, and the availability of multi-ingredient fixed-dose combinations.²¹

National and international bodies encourage prescribing by generic names to promote rational drug use. Prescribing generic names also allows pharmacists to dispense cheaper drugs, reducing the cost of therapy for patients.

The present study revealed that 6.50% of prescriptions included antibiotics. This percentage is lower compared to other studies, which reported antibiotic prescription rates of 16.66%, 19.55%, 60%, and 78.15%.^{16, 21, 24}

Judicious use of antibiotics in the correct regimen is crucial. Injudicious use of antibiotics can lead to antibiotic resistance, a global problem, particularly in developing countries with a high infectious disease burden and limited financial resources to replace older antibiotics with newer, more expensive ones.²⁵

Our study found that 6.3% of prescriptions included injections, which is lower than another study (14.10%) but higher than others (4.33% and 1.08%).^26-28 Injections (parenteral route) should only be used when necessary, as they can transmit blood-borne diseases like Hepatitis B and C, HIV, and Malaria. Additionally, injections require trained personnel and pose a higher risk of infection and acute adverse reactions compared to oral or inhaler routes, increasing the economic burden on patients.²⁹

The present study revealed that 45.8% of prescribed drugs were from the National List of Essential Medicines (NLEM). Other similar studies reported higher percentages: Vidisha

M (50%), Shruti C (72.91%), B.K. Moharty (57.7%), and Mudassir S (83%).^{22, 24, 26, 30} Prescribing essential drugs during consultations provides maximum benefits with limited resources, assists in developing standard treatment protocols, promotes rational drug use, and increases economic advantages.³¹

Appropriate use of drugs play a significant role to improve standard healthcare service and  promote rational use of antibiotic, existing knowledge on drug utilization patients, promoting generic drug use, potential benefits regarding cost effectiveness, possible keeping the number of drug is low, minimize risk and improve patient safety. The prescribing drug by NLEM was fair and use of injection is low.

Above study findings that significant help to promoting the design policy, education, awareness programs and motivate physician for the rational use of drugs.

ACKNOWLEDEMENT

Authors are very thankful to Prof and Head Dr. Naresh Joyti Delmotra and all the faculty Department of Pharmacology in Adesh Medical College and Hospital Mohri, to motivate and cooperation during this study.

Funding: No funding sources

Conflict of interest: None declared  

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