[india-drug] Prescription audit in Maharashtra

[Sunitha Srinivas <s.srinivas@ru.ac.za>]

(From Pharmabiz with thanks.
It would be a good experience if the Technical Coordinators of all the
states could share the baseline studies and / or post intervention
studies of drug use indicators from the various states in India. A
cumulative document for DSPRUD could be facilitated. Thanks?SS) 
Antibiotics amongst largest group of drugs prescribed in state govt
hospitals: Prescription audit

Monday, December 15, 2003 08:00 IST 
Prabodh Chandrasekhar, Mumbai

Systemic antibiotics, drugs used for alimentary tract ailments, nervous
system, respiratory system and musculoskeletal system are the top five
groups of drugs prescribed in the Maharashtra Health Systems
Development Project (MHSDP) or the government hospitals in the state,
according to the findings of a prescription audit made by the
Hyderabad-based Administrative Staff College of India (ASCI). The main
objective of the 'Prescription Audit of Outpatient Attendees' of MHSDP
was to provide inputs for use of drugs in the project hospitals. 

Thirty two hospitals from eight districts, representing eight zones of
the state participated in the study. All the four categories of MHSDP
hospitals namely district hospitals and sub district hospitals (SDH)
with 100 and 50 beds (DH 100 and SDH 50) and Community Health Centres
(CHC PI) are represented equally (eight in each category) in the study.
The sample included tribal as well as non-tribal hospitals. 14,004
carbon copies of the 'first encounter prescription' provided by 212
doctors, representing 10 OPDs, are the basis of analysis presented in
the audit. The study was done during May-June 2003. 

"The study is a fact finding mission and not a fault finding mission.
The audit was meant to study how the prescription patterns could be
improved upon so that no medicine is wasted and the patients get good
quality and optimum medicine for the right diseases," said Dr RM
Jotkar, assistant director, Directorate of Health Services,
Maharashtra.

The study found that among the 400 drugs identified from prescriptions,
first twenty drugs accounted for 70 per cent of the total drugs
prescribed and first 30 accounted for almost 80 per cent of the usage. 

The top five diseases handled by the MHSDP hospitals during the period
were - diseases of respiratory system, certain infectious and parasitic
diseases, diseases of musculoskeletal system, digestive system, skin
and subcutaneous diseases. 

Prescriptions given to females were three per cent more than the
prescriptions given to males. However, in case of tribal hospitals the
proportion of prescriptions given to females (49.1 per cent) is
marginally less than those given to males (50.9). Similarly, the
proportion of females is comparatively lower in the children and
adolescent age groups. 

Occurrence of dorsalgia, malaise and fatigue (anemia), head ache,
dizziness and giddiness were in higher proportion to females, while
treatment for injury of unspecified body region, dog bite, foot injury
and conjunctivitis were high among the males. In case of tribal
hospitals prescriptions for fevers with chill, coughs, abdominal pain,
headache, dizziness and giddiness is higher compared to non-tribal
hospitals. In case of non-tribal hospitals occurrence of respiratory
tract infections, supervision of normal pregnancy is higher compared to
tribal hospitals. 

The top 25 drugs account for between 96 per cent (dental OPD) to 68 per
cent (skin OPD) of the drugs prescribed by different OPDs. Only three
drugs, namely multivitamin Biotech complex, ibuprofen and ranitidine
among the top 25 are used by all the ten OPDs. Nine out of the ten OPDs
prescribes Paracetamol and diclofenac. 

Prescription audit is part of the World Bank sponsored MHSDP. World
Bank had recommended the prescription audit scheme as early as 1996.
States like Karnataka, Madhya Pradesh, Punjab, West Bengal, and Orissa
have been implementing the scheme since then.

MHSDP is considering to institute a mechanism for continuous
'Prescription Audit' for a period of may be 2-3 years, till the doctors
adopt rational prescription practices, voluntarily.


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