Study of Drug Utilization 90% in Health Centre 

 

Pradip Awale¹*, Devendra Sonawane¹, Sangle Dhananjay², Disha Mhatre³, Chetna Misal³ Zainab Shaikh³, Shamsundar Gulbhile², Santosh Khambalkar², Amit Naik²

¹Department of AYUSH, Maharashtra University of Health Sciences (MUHS), Nashik.

²University Department of Interpathy Research and Technology (UDIRT), Maharashtra University of Health Sciences (MUHS), Nashik.

³Garware Institute of Cancer Education and Development, Mumbai University, Mumbai

*Corresponding Author E-mail:- pradip.awale@rediffmail.com

Objective:  The primary objective was to evaluate the drug utilization 90% for drugs prescribed at a health center, Mumbai. The secondary objective was to assess proportion of generic drugs, essential drugs, injectable drugs, and cost of drugs prescribed in these prescriptions.

 

Method: This cross sectional study was conducted at Health Center of Mumbai University over a period of three months. Prescriptions from 200 patients visiting health center were collected after written informed consent. All drug utilization was quantified in terms of Defined Daily Dose (DDD), and retail cost, and classified according to Anatomic Therapeutic Chemical (ATC) system. Descriptive statistics was used to analyze data as per age, gender, drugs satisfying Drug Utilization 90 percent (DU90%), generic drugs, essential drugs, use of injectable drugs, cost of prescription, class of drugs.

 

Result: Total 200 prescriptions were studied. Where, 133 prescriptions belonged to males and 67 to females. Most of the patients belonged to age above 30 years. Analgesic, Antipyretic, Antihistaminic, Antispasmodic, Antibiotic, H2 blockers are utilized 90 percent. The number of drugs per prescription varied from 1 to 5 drugs with almost half of the prescriptions (51%) containing three drugs. 8.5% of drugs were in injectable form .95% of prescriptions contained drugs by generic name while 92% prescriptions contained essential drugs. Analgesic and antipyretic, Antibiotics, H2 blocker are the most frequently prescribed drug classes.

 

Conclusion: This study concluded that Analgesic, Antipyretic, Antihistaminic, Antispasmodic, Antibiotic, H2 blockers are utilized 90 percent. Practice of prescribing drugs by generic names and prescribing essential drugs was satisfactory.

 

 

INTRODUCTION:

Drug therapy is primary therapeutic intervention for majority of diseases. More than 80% of population in Western countries takes at least one medication during any given week and many patients are prescribed multiple medications¹. Appropriate prescription of drugs is probably the most cost effective technology in all health care. The writing of the prescription is the final common pathway in therapeutic decision making, which involves such diverse forces and disciplines as anthropology, decision science, health economics, ethics, and politics, as well as pharmacology and clinical medicine.

 

Although drugs only represent a small part of the health care utilization, the precisions with which medications are used can yield substantial influences on the rest of health care utilization.² Increasingly, it’s also recognized that resources available to meet health care needs are limited. Therefore, careful assessment of the use of medical technology, including drug therapy, can conceivably increase the efficiency of the health care delivery system.³ It is recognized that good prescribing is an important issue in terms of quality of care. It is also known that the poor prescribing is associated with illness and increased costs due to unwanted side effects and interactions, and also costs from using drugs of limited clinical value and possibly inappropriate use of expensive pharmaceutical products. The number of products in the DU90% segment and adherence to prescription guidelines may serve as general quality indicators⁴.

Drug utilization research was defined by WHO in 1977 as “The marketing, distribution, prescription and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences”⁵. DU90 is an innovative approach to assess drug prescribing.  DU90 identifies the number of drugs making up 90% of the total volume⁶. The basic assumption in the DU90 is that “Physicians manage to prescribe only a limited number of drugs in order to achieve a good prescribing”⁷. Furthermore, the approach can be used to assess what proportion of the drugs that represents 90% of the volume is made up by drugs recommended by local drug committees⁷.

 

Objectives:

The primary objective was to test feasibility of DU90 approach for evaluation of prescribing practices. The secondary objective was to assess proportion of generic drugs, essential drugs, injectable drugs, and cost of drugs.

 

Methodology:

This cross sectional study was conducted at Health Center of Mumbai University over a period of three months. Prescriptions from 200 patients visiting health center were collected after written informed consent. Once the consultation by the physician were over, the prescriptions were copied, and their prescriptions were studied everyday and analysis were done as per WHO indicators as mentioned.

 

All drug utilization was quantified in terms of defined daily dose (DDD), and retail cost, and classified according to Anatomic Therapeutic Chemical (ATC) system. Descriptive statistics was used to analyze data as per age, gender, drugs satisfying DU90 percent, generic drugs, essential drugs, use of injectable drugs, cost of prescription, class of drugs.

 

RESULT:

Table 1: Gender wise distribution of patients

No.of encounters surveyed	Males	Females
200	133	67

 

Table 2: Age wise distribution of patients

Age group(years)	Males	Females	Total
Below 18	14	7	21
18-30	33	21	54
Above 30	86	39	125
Total	133	67	200

 

Most of the patients belonged to age above 30 years.

 

 

 

Table 3: Table of DU90%

Sr.no	Drug name (brand name)	DDD of drug (gm)	Total volume used in gms	% of utilised drug
1	Voveran	0.1	88.12	13.52
2	Newmol	3.00	80.69	12.38
3	Cetrizine dihydrochloride	0.01	71.87	11.02
4	Restmax	1	62.25	9.55
5	LIB-cpm	0.012	62.06	9.52
6	Spaspar	1.04	48.42	7.43
7	Doxycycline	0.1	36.87	5.66
8	Curahist	0.457	29.52	4.53
9	Ciprotop	1	21.24	3.26
10	Nor tz	2	20.62	3.16
11	Zintab 150	0.3	19.62	3.01
12	Aquasol A	0.028	18.52	2.84
13	Nice	0.2	18.3	2.81

Analgesic, Antipyretic, Antithistaminic, Antispamodic, Antibiotic, H₂ blockers are utilized 90 percent.

 

Table 4: No. of drugs prescribed per prescription

Sr.No.	No.of drugs prescribed per prescription	No.of prescriptions(%)
1	1	14(7%)
2	2	60(30%)
3	3	102(51%)
4	4	19(9.5%)
5	5	5(2.5%)

Half of the prescriptions contained three drugs.

 

Table 5: No. of drugs prescribed by generic name per prescription

Sr.No.	No. of drugs prescribed by generic name per prescription	No. of prescriptions (%)
1	0	10(5%)
2	1	50(25%)
3	2	69(34.5%)
4	3	66(33%)
5	4	5(2.5%)

Practice of prescribing drugs by generic names was good with 95% of prescriptions containing drugs by generic name.

 

Table 6: No. of patients to whom injection is prescribed

Sr.No.	Injection name	Injections given to no. of patients
1	Inj.TT	12
2	Inj.REBIFER	2
3	Inj.Dexamethasone	2
4	Inj.Penidure	1

Out of the total prescriptions 8.5% of drugs were in injectable form.

Table 7: No. of drugs from essential drug list per prescription

Sr.No.	No. of drugs from essential drug list per prescription	No. of prescriptions (%)
1	0	16(8%)
2	1	74(37%)
3	2	101(50.5%)
4	3	8(4%)
5	4	1(0.5%)

 92% prescriptions contained essential drugs.

 

Table 8: No. of prescriptions per class of drug

Sr.No.	Class of drug	No. of prescriptions (%)
1	Antibiotic	110(55%)
2	Analgesic	57(28.5%)
3	Antihistaminic	80(40%)
4	Laxatives	2(1%)
5	Aniemetics and antinauseants	3(1.5%)
6	Diuretics	1(0.5%)
7	Mouth ulcer healing agent	3(1.5%)
8	Bronchodilator	1(0.5%)
9	Antimotility	2(1%)
10	H2 blocker	60(30%)
11	Antifilarial	1(0.5%)
12	Vaccines	14(7%)
13	Steroids	6(3%)
14	Antihypertensive	1(0.5%)
15	Cough syrup	9(3%)
16	Antihelminthic	1(0.5%)
17	Antispasmatic	13(6.5%)
18	Sedatives	2(1%)
19	Alkalising solution	1(0.5%)
20	Proton pump inhibitor	1(0.5%)
21	Antipyretic	1(0.5%)
22	Analgesic and antipyretic	139(69.5%)
23	Nutrition supplement	32(16%)

Analgesic and antipyretic, Antibiotics,H2 blocker are the most frequently prescribed drug classes.

 

DISCUSSION:

This was a descriptive study where DU90 approach was used for a rapid assessment of the drug of the drug prescribing. All the drugs prescribed in health centre in three months of study were taken into account.

 

This study shows that Analgesic, Antipyretic, Antihistaminic, Antispasmodic, Antibiotic, H2 blockers are utilized 90 percent. Analgesics were found to be most commonly prescribed drugs in this study. Diuretics, Sedatives, Laxative, Antihelmenthic, and Proton pump inhibitor, Antiemetic, Antimotility and Bronchodilators are utilized 10 percent. The drugs satisfying DU 90 percent were already in essential drug list. But as the follow up of the patients was not assessed in the study, the effectiveness of these drugs couldn’t be evaluated.

 

The number of drugs per prescription varied from 1 to 5 drugs with almost half of the prescriptions containing three drugs indicating polytherapy. Physicians should be aware of drawbacks of polytherapy like drug interactions, adverse drug reactions, decreased compliance, and increased cost of therapy. Out of the total prescriptions 8.5% of drugs were in injectable form.

Practice of prescribing drugs by generic names was good with 95% of prescriptions containing drugs by generic name.92% of the prescriptions contained essential drugs and 100% of drugs were labeled. Analgesic and antipyretic, Antibiotics, H2 blocker are the most frequently prescribed drug classes. These classes satisfy most of DU 90 percent criteria.

 

The DU90% is an inexpensive, flexible, and simple method for assessing the quality of drug prescribing in routine health care. The weakness of this study was that it did not relate DU90 to direct quality measures or health outcomes. Study duration was less as compared to its counterpart studies. We could not determine the DDD of vaccines and analgesic gels; hence these were not taken into DU90 calculations.

 

CONCLUSION:

This study concluded that Analgesic, Antipyretic, Antihistaminic, Antispasmodic, Antibiotic, H2 blockers are utilized 90 percent.   Practice of prescribing drugs by generic names and prescribing essential drugs was less commonly found.

 

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Accepted on 20.06.2013                © RJPT All right reserved