INTRODUCTION:
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”[1].
The principal aim of drug utilization research is to facilitate rational use of
drugs in populations. The DU90% segment reflects the number of drugs that
account for 90% of drug prescriptions and adherence to local or national
prescription guidelines in this segment [2]. The cardiovascular
system constitutes one of the major coordinating and integrating systems of the
body. The function of cardiovascular system is to supply oxygen, nutrients and
other essential substances to the tissues of the body and to remove carbon
dioxide and other metabolic and products from the tissue [3].
Cardiovascular disorder commonly
consist coronary heart disease, ischemic heart disease, myocardial infarction,
angina pectoris, heart failure , hypertensive heart disease, peripheral
vascular disease, rheumatic heart disease, valvular heart disease etc. [4].
Cardiovascular disorder is the leading
cause of death worldwide. CVS is responsible for more deaths annually than any
other disease since1900 [5]. It has been proved that cardiovascular
diseases are the most frequent cause of morbidity and mortality throughout the
world It causes
major impact on life expectancy [6]. Significantly contribute to
morbidity and mortality in middle aged population. Common cause of premature
death and contribute to deterioration of quality of life. 50% of population in
developed countries die of cardiovascular diseases and the highest coronary
mortality is seen at present in north Europe and Scotland, United Kingdom [7].
In India cardiovascular diseases progression is very high and leading cause of
mortality in people of age group 25 to 69 year [8]. IHD is the major
cause of mortality in India. It is projected that IHD will result in two and
one half million Indian deaths up to 2020. Males are affected more than females
[9].
Drug utilization studies are needed to
identify the trends as well as to set the priorities, not only in the interest
of the regulatory control, but also as a basis of the planning program of
education and information[10]. The risk of cardiovascular diseases
is being frequently monitored. Hence, it is need to do drug utilization study
on cardiovascular disorders. Incidence of CVD, Acute Coronary Syndrome (ACS) is
rapidly increasing in India and causes high mortality [11]. Long
term survival inpost -ACS patients depends largely on how well post-ACS and
post cardiovascular diseases period is managed [9]. Therefore, drug utilization
studies, which evaluate, and analyze the medical, social, and economic outcomes
of the drug therapy are more meaningful, and observe the prescribing attitude
of physicians with the aim to provide drug rationally [12]. Aim for
carry drug utilization study is check the Pattern of different drug use (Aspirin
- Clopidogrel, Beta blockers, Statins, ACE inhibitors/ Angiotensin Receptor
Blockers) dose, regimen, compliance, follow up [13]. How much the
prescription conforms to standard treatment guideline. And how much drug
prescribed from essential drug list or formulatory [14].
The study of drug utilization is
a component evaluates prescribing practices & recommends necessary
modifications to achieve rational drug use [15]. An attempt to
delineate essential drug information requirements relevant to cardiovascular
diseases for the benefit of physicians is one of the objectives of this study.
Previously lots of drug utilization study done on cardiovascular diseases.
Study gives important data about cardiovascular disorder. Standard treatment,
drug available for cardiovascular diseases for drug utilization study
prescription based survey is considered to be one of the most effective methods
which have been used to assess and evaluate the prescribing attitude of
physicians [16].
Though there are many study
carried out and drug therapy has improved over time but incidence of
cardiovascular diseases is not controlled as expected. And in which large
proportion of population is suffered. Incidence rate, morbidity and mortality
rate is not reduced as expected because lack of awareness of disease, poor
knowledge of about best treatment option and it’s easily availability, poorly
follow the guidelines of drug utilization. Morbidity and mortality of
cardiovascular diseases is controlled by good managing post cardiovascular
diseases period. It majorly included appropriate utilization of drug. Essential
drug list give idea about the drug use and it’s easily availability. It
satisfies the priority health care needs of population. They are selected with
due regards to public health relevance, evidence on efficacy and safety and
comparative cost effectiveness. Drugs are intended to be available within the
context of functioning health system at all times and in adequate amount. Aim
of this study is to study drug utilization pattern in post cardiovascular
diseases patients in their follow up visit and in admitted patients. And how
much drug prescribed from essential drug list or formulatory. Study of drug
utilization in cardiovascular diseases is very necessary for controlling
morbidity and mortality rate in worldwide and also in India. DU is an
essential tool for making the health policies and to check the rationality of
prescriptions in CVS. The overuse of drug causes adverse Effect on health of
patient and under use may lead exaggerated and uncontrolled disease. And DU 90%
has appeared as a very good quality indicator for drug prescription in this
condition.
MATERIALS AND METHODOLOGY:
This is an observational
prospective cross sectional study. Study was conducted in compliance with the
protocol, ICH GCP, Schedule ‘Y’ guidelines and Indian regulatory requirements.
Approval of Institutional ethics committee was taken prior to initiation of
study. Enrollement of patient was done as per inclusion and exclusion criteria.
Before collecting the data or observing a prescription, signed dated written
informed consent was taken from all subjects after providing them with patient
information sheet and informed consent form before screening. It was the study
of prescriptions among the patient of cardiovascular diseases. Data from
prescriptions was collected at the cardiac OPD, IPD of Private Hospital Nashik,
Maharashtra, from the patients of age group above 18 years.
Total 100 prescriptions were
collected from the patient and data from prescription were recorded in Case
Record Form with the help of interview of patient. Core indicators were also
studied, with help core indicators we can make out the pattern of drug use in
cardiovascular diseases. Formula for core indicator is given below. The data
collected from each prescription were summarized. Analysis from the whole data,
appropriate statistical methods applied according to the objectives. Prescriptions were studied and
analysis was done as per WHO drug utilization study guidelines. After obtaining the Statistical
analysis discussion & conclusion were drawn.
Core
Indicators:
I)
prescribing indicator:
a)
Average number of drugs per encounter = Total number of drugs prescribed
Total number of drugs encounters surveyed
b)
Percentage of drugs prescribed by generic name = Drugs prescribed by generic
name x 100
Total number of drugs
prescribed
c)
Percentage of encounters with an antibiotic prescribed = Total number of
patients having more antibiotics x 100
Total number of encounters
d)
Percentage of encounters with an injection prescribed = Number of patients
received one or more injections x 100
Total number of encounters
e) Percentage of drugs
prescribed from essential drug list =Number of products prescribed from
Essential drug list x 100
Total
number of drugs prescribed
II)
Patient care indicator:
a) Average consulting time =
Total time for a series of consultations
Actual number of consultations
b) Average dispensing time =
Total time for dispensing drugs to a series of patients
Total number of encounters
c) Percentage of drugs actually
dispensed = Number of drugs actually dispensed at the health facility x 100
Total
number of drugs prescribed
d) Patients knowledge of correct
dosage = Total number of patients reporting correct dosage x 100
Total
number of patient interviewed
DDD/1000/day:
DDD was calculated as per
guidelines for ATC classification and DDD assignment (2000) as given by WHO
collaborating centre for drug statistics methodology, Oslo, Norway DDD/1000 population/day
= Total no.
of dosage units prescribed X Strength of each dose unit X 1000
DDD (ATC) X Duration of study in weeks X
Total sample size
DDD% = DDD/1000/DAY of particular drug
x
100
Sum of DDD/1000/DAY Total drugs
Study Duration:10 Weeks
Sample
size:- 100
Primary
Objective:
1) To
evaluate drug utilization 90% in Private Hospital for cardiovascular diseases.
2) To
evaluate the percentage of drug utilization from essential drug list for
cardiovascular diseases.
Secondary
Objective:
1) To
assess that the drug utilization of antibiotics that used in cardiovascular
diseases.
2) To
determine percentage of Generic and Branded Medicines prescribed cardiovascular
diseases.
Figure
no. 1:Defined Daily Doses in Percentage Which Achieved DU 90%
CORE INDICATORS:
Table no. 2: Details for Prescription Indicator
in patients prescriptions
|
Name of Indicator
|
Result
|
|
Average no. of drugs per
prescription
|
4.93
|
|
Percentage of drug prescribed
by generic name
|
00%
|
|
Percentage of antibiotic
prescribed
|
24%
|
|
Percentage of injection
prescribed
|
22%
|
|
Percentage of drugs from
essential drug list
|
59.37%
|
Figure
no. 2:Name of Drugs Prescribed from Essential Drug List and their frequency
Table no. 3: Details for Patient
Care Indicator in patients prescriptions
|
Name of Indicator
|
Result
|
|
Average consultation Time
|
5.48 min
|
|
Average Dispensing Time
|
4.02 min
|
|
Percentage of drugs actually
dispensed
|
100 %
|
|
Percentage of patients
knowledge on correct dosage
|
94 %
|
DISCUSSION:
Drugs play an important role in
improving human health and promoting well being. To produce the desired effect,
they have to be safe and efficacious and also have to be used rationally. In
modern clinical practice, analyzing drug utilization is an important tool for
achieving rational drug therapy in any clinical setting [17]. It is
necessary for identification of a problem, and then for following effectiveness
of corrective interventions, undertaken by management of health facility. The
irrational use of drugs is a common occurrence throughout the world. Drug
prescriptions form a very important point of contact between doctors and
patients. The cardiovascular diseases burden increased worldwide as well as in
India [5]. Total 100 patients according to selection criteria were
selected for present study of which 24 % were female patients and 76% were male
patients. The common cardiovascular diseases found in this study were IHD,
Hypertension, CCF, Angina pectoris, MI etc. IHD was the major cardiovascular
disease found in most of study participant. To treat the IHD and to maintain
good blood supply to heart antiplatelet aggregating drugs utilized most
commonly and frequently. Aspirin was oral antiplatelet aggregating drug
utilized 39.58 % and Clopidogrel utilized 19.57% for same indication. The
Clopidogrel combination therapy with Aspirin may offer benefits over either
drug used alone. Clopidogrel and Aspirin decrease the rate of combined end
point of cardiovascular deaths, non fatal MI or stroke by 20% in patients with
acute coronary syndromes previous study found same result [18]. The
patient of Hypertension and CCF were treated with Diuretics like Frusemide,
Chlorthalidone, spiranolactone. Drug utilization of Frusemide was 5.44%,
Chlorthalidone 1.56%, spiranolactone 1.51% in this study which was increased as
same as the previous study in Delhi [19]. Most of hypertensive
patients had hyperacidity so that they were treated with Proton pump inhibitor
drug like Pantoprazole which was utilized 6.12%.Rosuvastatin and Atorvastatin
these lipid lowering agents utilized more and they achieved DU 90% the same
result stated in previous study [20]. Atenolol anti hypertensive
drug was utilized 4.34% which was beta blocker drug. Antianginal drug Glyceryl
trinitrate utilized 4.14%. In cardiovascular diseases antibiotics was utilized
24%.Total 493 drugs were prescribed for cardiovascular diseases in private
hospital. The Percentage of drugs prescribed from essential drug list was
59.37% Which was less from previous study [11]. observed that 75 %
drugs prescribed from essential drug list. All the 493 drugs were prescribed by
brand name only means 100% drugs prescribed by brand name. Branded medicines
were more costly than generic medicines hence cost burden of diseases were
increased on patients treated in private hospital due to branded medicines and
consultation charges. The average consultation time in private hospital was 5
minutes 48 seconds so number of patients gave sufficient time for history
taking, clinical finding, and examination. The percentage of patients knowledge
on correct dosage was 94% which was high because patients visited to private
hospital were well educated and having awareness and compliance with
medication. The drug utilization of Diuretics for hypertension was increased as
compare to other antihypertensive drugs. Diuretics like Frusemide,
Chlorthalidone, Spiranolactone achieved DU 90%. Diuretics are said to be
superior to α-blockers, CCBs, and ACEIs in preventing one or more forms of
CVDs, including stroke and heart failure [21]. Most of prescriptions
were got prescribed with knowing drug indication and therefore drugs got
prescribed relevant to symptoms and diagnosis of patients. Private hospital was
show rational prescribing pattern with proper examination as well as
consultation of patients. And also had knowledge of drug action, duration,
frequency, dose etc. Antibiotic and injectable drugs were prescribed as
symptoms and necessity of patients with proper combination and monitoring.
Present study showed that there was need for improvement in prescription
writing for prescribed more generic medicines as compare to branded medicines
for the benefits and safety of patients and society.
CONCLUSION:
The present study found that
there were substantial increased in both the utilization of and expenditure for
cardiovascular drugs. In this study the incidence of poly pharmacy was high.
Trade names were used more often when compared to generic names. If only
generic names are used the financial burden on the patient can decrease.
Overall, awareness among the physician should be get increased by doing DU
studies to make health care society more responsible and satisfies the priority
health care needs of population. Further studies from time to time are required
in drug utilization pattern and standard treatment guidelines to be circulated
among practicing physicians.
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