PRESCRIBING TRENDS AND DRUG-RELATED PROBLEMS AT TERTIARY HEALTHCARE FACILITY: A DESCRIPTIVE CROSS-SECTIONAL STUDY FROM PAKISTAN
Main Article Content
Keywords
Irrationality, Antibiotics, Adverse effects, Patient care indicators, Prescriptions
Abstract
Objective: Irrational drug use is a key factor in therapeutic failure, high treatment costs, antibiotic resistance, and increased adverse effects, negatively impacting patient quality of life. This study aimed to evaluate the WHO/INRUD core drug use indicators and drug problems at Fauji Foundation Hospital, Rawalpindi, Pakistan.
Material & Method: Data was collected from individual patient records in IPD and OPD using a structured form. Information from prescriptions between 1st March and 21st May 2024 was gathered retrospectively. Medication errors like drug-drug interactions, dosing errors, and contradictions were identified using Medscape (Interaction Checker) and pharmacopeia applications. Data analysis was done using SPSS.
Results: The study reviewed 3570 medicines across 600 prescription encounters, with an average of 5.95 drugs per prescription (SD 2.52), and only 3.36% prescribed by generic names. Antibiotics and injectables accounted for 12.9% and 33.7% of prescriptions, respectively, with 88.0% of drugs from the essential list. While 59% of patient consultations met WHO standards, 60% of dispensing times were shorter than recommended, and only 14% of patients had correct knowledge of dosages. Multimorbidity and older patients received more medications per prescription. Drug interactions and contradictions were found in 42% and 43% of prescriptions, respectively. Some prescriptions lacked essential drug and patient information.
Conclusion: The study highlighted significant gaps in patient knowledge and prescribing practices. High medication counts per prescription, low generic prescribing rates, frequent use of injectables, and prescribing errors contributed to drug interactions, contradictions, higher treatment costs, longer hospital stays, and more adverse effects. Improvements in prescribing practices and patient education are necessary for better outcomes and rational drug use.
Material & Method: Data was collected from individual patient records in IPD and OPD using a structured form. Information from prescriptions between 1st March and 21st May 2024 was gathered retrospectively. Medication errors like drug-drug interactions, dosing errors, and contradictions were identified using Medscape (Interaction Checker) and pharmacopeia applications. Data analysis was done using SPSS.
Results: The study reviewed 3570 medicines across 600 prescription encounters, with an average of 5.95 drugs per prescription (SD 2.52), and only 3.36% prescribed by generic names. Antibiotics and injectables accounted for 12.9% and 33.7% of prescriptions, respectively, with 88.0% of drugs from the essential list. While 59% of patient consultations met WHO standards, 60% of dispensing times were shorter than recommended, and only 14% of patients had correct knowledge of dosages. Multimorbidity and older patients received more medications per prescription. Drug interactions and contradictions were found in 42% and 43% of prescriptions, respectively. Some prescriptions lacked essential drug and patient information.
Conclusion: The study highlighted significant gaps in patient knowledge and prescribing practices. High medication counts per prescription, low generic prescribing rates, frequent use of injectables, and prescribing errors contributed to drug interactions, contradictions, higher treatment costs, longer hospital stays, and more adverse effects. Improvements in prescribing practices and patient education are necessary for better outcomes and rational drug use.
References
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11. Abbas M, Inam A, Tahira E, Qamar H, Shakil J, Bashir S. Prescribing practices at a secondary healthcare setting of Islamabad, Pakistan: a descriptive cross-sectional study. Journal of Pharmaceutical Health Services Research. 2021;12(2):152-8.
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15. Salgado DR, Silva E, Vincent J-L. Control of hypertension in the critically ill: a pathophysiological approach. Annals of Intensive care. 2013;3:1-13.
16. van Leeuwen RW, Jansman FG, van den Bemt PM, de Man F, Piran F, Vincenten I, et al. Drug–drug interactions in patients treated for cancer: a prospective study on clinical interventions. Annals of Oncology. 2015;26(5):992-7.
17. Nawaz H, Ali A, Rehman T, Aslam A. Chronological effects of non-steroidal anti-inflammatory drug therapy on oxidative stress and antioxidant status in patients with rheumatoid arthritis. Clinical rheumatology. 2021;40:1767-78.
18. Siele SM, Abdu N, Ghebrehiwet M, Hamed MR, Tesfamariam EH. Drug prescribing and dispensing practices in regional and national referral hospitals of Eritrea: Evaluation with WHO/INRUD core drug use indicators. Plos one. 2022;17(8):e0272936.
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20. Bashir S, Nasir M, Grasic K, Moulin M, Ali S. Association between efficiency and quality of care of public healthcare facilities: Evidence from Pakistan. The International Journal of Health Planning and Management. 2022;37(4):2240-55.
21. Atif M, Azeem M, Sarwar MR, Shahid S, Javaid S, Ikram H, et al. WHO/INRUD prescribing indicators and prescribing trends of antibiotics in the Accident and Emergency Department of Bahawal Victoria Hospital, Pakistan. Springerplus. 2016;5(1):1928.
22. Atif M, Sarwar MR, Azeem M, Umer D, Rauf A, Rasool A, et al. Assessment of WHO/INRUD core drug use indicators in two tertiary care hospitals of Bahawalpur, Punjab, Pakistan. Journal of pharmaceutical policy and practice. 2016;9:1-8.
23. Martins M, Karataş Y. A pilot study on the rational use of medicines in four tertiary care hospitals through validated World Health Organization prescribing drugs indicators. Ann Ig. 2020;32(4):368-75.
24. Alehegn AA, Aklilu RG, Tadesse KA, Tegegne BA, Kifle ZD. Assessment of Drug Use Practices Using Standard WHO Indicators in Lumame Primary Hospital. Drug Healthc Patient Saf. 2021;13:59-69.
25. Ntirenganya RP, Nyirazinyoye L, Ntaganira J. Assessment of patient care indicators in three district hospitals in rural Rwanda: a cross-sectional study. IOSR Journal Of Pharmacy. 2018;8(7):36-9.
26. Sisay M, Mengistu G, Molla B, Amare F, Gabriel T. Evaluation of rational drug use based on World Health Organization core drug use indicators in selected public hospitals of eastern Ethiopia: a cross sectional study. BMC health services research. 2017;17:1-9.
27. Rabie D, Kheder SI. Assessment of prescribing and dispensing practices based on WHO core prescribing indicators in hospital and community pharmacies in Khartoum State-Sudan. Journal of Medical Informatics and Decision Making. 2020;1(3):1-11.
28. Bethi Y, Shewade DG, Dutta TK, Gitanjali B. Prevalence and predictors of potential drug–drug interactions in patients of internal medicine wards of a tertiary care hospital in India. European Journal of Hospital Pharmacy. 2018;25(6):317-21.
29. Gosney M, Tallis R. Prescription of contraindicated and interacting drugs in elderly patients admitted to hospital. The Lancet. 2015;324(8402):564-7.
30. Ismail M, Khan F, Noor S, Haider I, Haq I-u, Ali Z, et al. Potential drug–drug interactions in medical intensive care unit of a tertiary care hospital in Pakistan. International journal of clinical pharmacy. 2016;38:1052-6.
31. Al Hussain O. Clinical characteristics and Co-morbidities among patients admitted with COVID-19. Ann Med Surg (Lond). 2022;78:103898.
32. Schiøtz ML, Stockmarr A, Høst D, Glümer C, Frølich A. Social disparities in the prevalence of multimorbidity–A register-based population study. BMC public health. 2017;17:1-11.
33. Walckiers D, Van der Heyden J, Tafforeau J. Factors associated with excessive polypharmacy in older people. Archives of Public Health. 2015;73:1-12.
34. Rieckert A, Trampisch US, Klaaßen-Mielke R, Drewelow E, Esmail A, Johansson T, et al. Polypharmacy in older patients with chronic diseases: a cross-sectional analysis of factors associated with excessive polypharmacy. BMC family practice. 2018;19:1-9.
35. Ahmad B, Khairatul K, Farnaza A. An assessment of patient waiting and consultation time in a primary healthcare clinic. Malaysian family physician: the official journal of the Academy of Family Physicians of Malaysia. 2017;12(1):14.
36. Onyedikachi EA, Ogochukwu AM, Chinwendu AK. Evaluation of drug-drug interactions among chronic kidney disease patients of nephrology unit in the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State. Journal of Basic and Clinical Pharmacy. 2017;8(0):49-53.
37. Shetty V, Chowta MN, Chowta K N, Shenoy A, Kamath A, Kamath P. Evaluation of potential drug‐drug interactions with medications prescribed to geriatric patients in a tertiary care hospital. Journal of aging research. 2018;2018(1):5728957.
38. Pasina L, Djade CD, Nobili A, Tettamanti M, Franchi C, Salerno F, et al. Drug–drug interactions in a cohort of hospitalized elderly patients. pharmacoepidemiology and drug safety. 2015;22(10):1054-60.
39. Ierodiakonou D, Theodorou E, Sifaki‐Pistolla D, Bouloukaki I, Antonopoulou M, Poulorinakis I, et al. Clinical characteristics and outcomes of polypharmacy in chronic obstructive pulmonary disease patients: A cross‐sectional study from Crete, Greece. The Clinical Respiratory Journal. 2021;15(12):1310-9.
40. Alwhaibi M, Balkhi B, Alhawassi TM, Alkofide H, Alduhaim N, Alabdulali R, et al. Polypharmacy among patients with diabetes: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia. BMJ open. 2018;8(5):e020852.
41. Mousavi S, Ghanbari G. Potential drug-drug interactions among hospitalized patients in a developing country. Caspian journal of internal medicine. 2017;8(4):282.
42. Wolff J, Hefner G, Normann C, Kaier K, Binder H, Hiemke C, et al. Polypharmacy and the risk of drug–drug interactions and potentially inappropriate medications in hospital psychiatry. Pharmacoepidemiology and Drug Safety. 2021;30(9):1258-68.
43. Alhumaidi RM, Bamagous GA, Alsanosi SM, Alqashqari HS, Qadhi RS, Alhindi YZ, et al. Risk of Polypharmacy and Its Outcome in Terms of Drug Interaction in an Elderly Population: A Retrospective Cross-Sectional Study. J Clin Med. 2023;12(12).
2. Aslam F, Khan FU, Yue Y. Rational Prescription and Cost-Effective Medication: Challenges and Opportunities in Pakistan. INNOVATIONS in pharmacy. 2020;11(4).
3. Organization. WH. Promoting rational use of medicines: core components. 2019 [Available from: https://www.who.int/medicines/areas/rational_use/en/.
4. Lima MG, Álvares J, Guerra AA, Costa EA, Guibu IA, Soeiro OM, et al. Indicators related to the rational use of medicines and its associated factors. Revista de Saúde Pública. 2017;51(suppl 2):23s.
5. Hafeez H, Akbar J, Munir AB, Qamar-uz-Zaman M, Faiz S, Abbas SMM, et al. Evaluation of rational drug use among pediatrics by using WHO core drug use indicators in selected hospitals of Pakistan. International Journal of Pharmaceutical Research. 2020(1).
6. Sarwar MR, Atif M, Scahill S, Saqib A, Qamar-uz-Zaman M, Babar Z. Drug utilization patterns among elderly hospitalized patients on poly-pharmacy in Punjab, Pakistan. Journal of pharmaceutical policy and practice. 2017;10:1-16.
7. Rasool MF, Maqbool I, Imran I, Ramazan B, Butt MD, Iqbal MO, et al. A Cross-Sectional Study to Assess the WHO/INRUD Drug Use Prescribing Core Indicators at Tertiary Care Hospital of Punjab, Pakistan. Latin American Journal of Pharmacy. 2021;40(5):936-45.
8. Babar H, Hussain S, Maqsood Z, Dad H, Khan M, Rahman A, et al. Adherence to prescription format and compliance with who core prescribing indicators. Journal of Pharmaceutical Sciences and Research. 2014;6(4):195.
9. Farooq MA, Khan I, Khan DH, Ahsan A, Hussain A, Mansoor I, et al. WHO Indicators and its Compliance by General Practitioners of Lahore, Pakistan: WHO Indicators and its Compliance by General Practitioners of Lahore, Pakistan. Iranian Journal of Pharmaceutical Sciences. 2019;15(1):67-74.
10. Khursheed M, Perveen F, Ahmed N, Mujeeb R, Feroze A, Orakzai S. Incidence of Poly pharmacy among emergency patients at a Tertiary Care Hospital in Karachi: An Ignored Paradigm for Quality Drug Therapy. Asia Pacific Journal of Medical Toxicology. 2021;10(3).
11. Abbas M, Inam A, Tahira E, Qamar H, Shakil J, Bashir S. Prescribing practices at a secondary healthcare setting of Islamabad, Pakistan: a descriptive cross-sectional study. Journal of Pharmaceutical Health Services Research. 2021;12(2):152-8.
12. Bano N, Najam R, Qazi F. Irrational drug use based on self medication for some common clinical conditions in an educated population of Karachi. 2012.
13. Atif M, Azeem M, Sarwar MR, Shahid S, Javaid S, Ikram H, et al. WHO/INRUD prescribing indicators and prescribing trends of antibiotics in the Accident and Emergency Department of Bahawal Victoria Hospital, Pakistan. Springerplus. 2016;5:1-7.
14. Yu J, Wang Y, Ragueneau-Majlessi I. Pharmacokinetic drug-drug interactions with drugs approved by the US Food and Drug Administration in 2020: mechanistic understanding and clinical recommendations. Drug Metabolism and Disposition. 2022;50(1):1-7.
15. Salgado DR, Silva E, Vincent J-L. Control of hypertension in the critically ill: a pathophysiological approach. Annals of Intensive care. 2013;3:1-13.
16. van Leeuwen RW, Jansman FG, van den Bemt PM, de Man F, Piran F, Vincenten I, et al. Drug–drug interactions in patients treated for cancer: a prospective study on clinical interventions. Annals of Oncology. 2015;26(5):992-7.
17. Nawaz H, Ali A, Rehman T, Aslam A. Chronological effects of non-steroidal anti-inflammatory drug therapy on oxidative stress and antioxidant status in patients with rheumatoid arthritis. Clinical rheumatology. 2021;40:1767-78.
18. Siele SM, Abdu N, Ghebrehiwet M, Hamed MR, Tesfamariam EH. Drug prescribing and dispensing practices in regional and national referral hospitals of Eritrea: Evaluation with WHO/INRUD core drug use indicators. Plos one. 2022;17(8):e0272936.
19. Saqib A, Atif M, Ikram R, Riaz F, Abubakar M, Scahill S. Factors affecting patients’ knowledge about dispensed medicines: A Qualitative study of healthcare professionals and patients in Pakistan. PloS one. 2018;13(6):e0197482.
20. Bashir S, Nasir M, Grasic K, Moulin M, Ali S. Association between efficiency and quality of care of public healthcare facilities: Evidence from Pakistan. The International Journal of Health Planning and Management. 2022;37(4):2240-55.
21. Atif M, Azeem M, Sarwar MR, Shahid S, Javaid S, Ikram H, et al. WHO/INRUD prescribing indicators and prescribing trends of antibiotics in the Accident and Emergency Department of Bahawal Victoria Hospital, Pakistan. Springerplus. 2016;5(1):1928.
22. Atif M, Sarwar MR, Azeem M, Umer D, Rauf A, Rasool A, et al. Assessment of WHO/INRUD core drug use indicators in two tertiary care hospitals of Bahawalpur, Punjab, Pakistan. Journal of pharmaceutical policy and practice. 2016;9:1-8.
23. Martins M, Karataş Y. A pilot study on the rational use of medicines in four tertiary care hospitals through validated World Health Organization prescribing drugs indicators. Ann Ig. 2020;32(4):368-75.
24. Alehegn AA, Aklilu RG, Tadesse KA, Tegegne BA, Kifle ZD. Assessment of Drug Use Practices Using Standard WHO Indicators in Lumame Primary Hospital. Drug Healthc Patient Saf. 2021;13:59-69.
25. Ntirenganya RP, Nyirazinyoye L, Ntaganira J. Assessment of patient care indicators in three district hospitals in rural Rwanda: a cross-sectional study. IOSR Journal Of Pharmacy. 2018;8(7):36-9.
26. Sisay M, Mengistu G, Molla B, Amare F, Gabriel T. Evaluation of rational drug use based on World Health Organization core drug use indicators in selected public hospitals of eastern Ethiopia: a cross sectional study. BMC health services research. 2017;17:1-9.
27. Rabie D, Kheder SI. Assessment of prescribing and dispensing practices based on WHO core prescribing indicators in hospital and community pharmacies in Khartoum State-Sudan. Journal of Medical Informatics and Decision Making. 2020;1(3):1-11.
28. Bethi Y, Shewade DG, Dutta TK, Gitanjali B. Prevalence and predictors of potential drug–drug interactions in patients of internal medicine wards of a tertiary care hospital in India. European Journal of Hospital Pharmacy. 2018;25(6):317-21.
29. Gosney M, Tallis R. Prescription of contraindicated and interacting drugs in elderly patients admitted to hospital. The Lancet. 2015;324(8402):564-7.
30. Ismail M, Khan F, Noor S, Haider I, Haq I-u, Ali Z, et al. Potential drug–drug interactions in medical intensive care unit of a tertiary care hospital in Pakistan. International journal of clinical pharmacy. 2016;38:1052-6.
31. Al Hussain O. Clinical characteristics and Co-morbidities among patients admitted with COVID-19. Ann Med Surg (Lond). 2022;78:103898.
32. Schiøtz ML, Stockmarr A, Høst D, Glümer C, Frølich A. Social disparities in the prevalence of multimorbidity–A register-based population study. BMC public health. 2017;17:1-11.
33. Walckiers D, Van der Heyden J, Tafforeau J. Factors associated with excessive polypharmacy in older people. Archives of Public Health. 2015;73:1-12.
34. Rieckert A, Trampisch US, Klaaßen-Mielke R, Drewelow E, Esmail A, Johansson T, et al. Polypharmacy in older patients with chronic diseases: a cross-sectional analysis of factors associated with excessive polypharmacy. BMC family practice. 2018;19:1-9.
35. Ahmad B, Khairatul K, Farnaza A. An assessment of patient waiting and consultation time in a primary healthcare clinic. Malaysian family physician: the official journal of the Academy of Family Physicians of Malaysia. 2017;12(1):14.
36. Onyedikachi EA, Ogochukwu AM, Chinwendu AK. Evaluation of drug-drug interactions among chronic kidney disease patients of nephrology unit in the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State. Journal of Basic and Clinical Pharmacy. 2017;8(0):49-53.
37. Shetty V, Chowta MN, Chowta K N, Shenoy A, Kamath A, Kamath P. Evaluation of potential drug‐drug interactions with medications prescribed to geriatric patients in a tertiary care hospital. Journal of aging research. 2018;2018(1):5728957.
38. Pasina L, Djade CD, Nobili A, Tettamanti M, Franchi C, Salerno F, et al. Drug–drug interactions in a cohort of hospitalized elderly patients. pharmacoepidemiology and drug safety. 2015;22(10):1054-60.
39. Ierodiakonou D, Theodorou E, Sifaki‐Pistolla D, Bouloukaki I, Antonopoulou M, Poulorinakis I, et al. Clinical characteristics and outcomes of polypharmacy in chronic obstructive pulmonary disease patients: A cross‐sectional study from Crete, Greece. The Clinical Respiratory Journal. 2021;15(12):1310-9.
40. Alwhaibi M, Balkhi B, Alhawassi TM, Alkofide H, Alduhaim N, Alabdulali R, et al. Polypharmacy among patients with diabetes: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia. BMJ open. 2018;8(5):e020852.
41. Mousavi S, Ghanbari G. Potential drug-drug interactions among hospitalized patients in a developing country. Caspian journal of internal medicine. 2017;8(4):282.
42. Wolff J, Hefner G, Normann C, Kaier K, Binder H, Hiemke C, et al. Polypharmacy and the risk of drug–drug interactions and potentially inappropriate medications in hospital psychiatry. Pharmacoepidemiology and Drug Safety. 2021;30(9):1258-68.
43. Alhumaidi RM, Bamagous GA, Alsanosi SM, Alqashqari HS, Qadhi RS, Alhindi YZ, et al. Risk of Polypharmacy and Its Outcome in Terms of Drug Interaction in an Elderly Population: A Retrospective Cross-Sectional Study. J Clin Med. 2023;12(12).
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Nov 14, 2024
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How to Cite
Ghaffar, M. Y. ., Mazhar, B. ., Niaz, M., Naeem, T., Tabassam, M. ., Abbas, M. ., Imtiaz, A. I., & Amjad, M. S. A. (2024). PRESCRIBING TRENDS AND DRUG-RELATED PROBLEMS AT TERTIARY HEALTHCARE FACILITY: A DESCRIPTIVE CROSS-SECTIONAL STUDY FROM PAKISTAN. Journal of Population Therapeutics and Clinical Pharmacology, 31(11), 278-291. https://doi.org/10.53555/c9551536
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Author Biographies
Muhammad Yasir Ghaffar
HBS College of Pharmacy, Hostel City, Park Road, Islamabad, Pakistan
Bisma Mazhar
Faculty of Pharmacy, Capital University of Science and Technology, Islamabad Expressway, Islamabad, Pakistan
Mobeen Niaz
Faculty of Pharmacy, Capital University of Science and Technology, Islamabad Expressway, Islamabad, Pakistan
Tajwer Naeem
Faculty of Pharmacy, Capital University of Science and Technology, Islamabad Expressway, Islamabad, Pakistan
Muneeba Tabassam
Hamdard University, Park Link Road, Chak Shahzad, Islamabad, Pakistan
Mateen Abbas
Faculty of Pharmacy, Capital University of Science and Technology, Islamabad Expressway, Islamabad, Pakistan
Afzaal Imtiaz Imtiaz
Faculty of Pharmacy, Capital University of Science and Technology, Islamabad Expressway, Islamabad, Pakistan
Muhammad Saad Amjad Amjad
Faculty of Pharmacy, Capital University of Science and Technology, Islamabad Expressway, Islamabad, Pakistan
How to Cite
Ghaffar, M. Y. ., Mazhar, B. ., Niaz, M., Naeem, T., Tabassam, M. ., Abbas, M. ., Imtiaz, A. I., & Amjad, M. S. A. (2024). PRESCRIBING TRENDS AND DRUG-RELATED PROBLEMS AT TERTIARY HEALTHCARE FACILITY: A DESCRIPTIVE CROSS-SECTIONAL STUDY FROM PAKISTAN. Journal of Population Therapeutics and Clinical Pharmacology, 31(11), 278-291. https://doi.org/10.53555/c9551536