A Study on Medicine Utilization Pattern in Outpatient Departments of Tertiary Care Centre in Kathmandu

Abstract

The main objective of this study is to analyze the prescribing pattern of medicine in outpatient departments of tertiary care centre in Kathmandu using World Health Organization (WHO) drug use prescribing indicators. As per WHO consideration, 100 prescriptions were taken from each outpatient departments (OPD) of Nepal medical college including Orthopedics, Obstetrics and Gynecology, Surgery, Medicine, Ophthalmology, Otorhinolaryngology, Pediatrics, Dermatology and Psychiatry. Analysis of variance (ANOVA) was used to assess the statistical significance between means between all departments. Among a total of 900, 47.7% were male and 52.3% were female. Average medicine per prescription was 2.43±0.039. Number of Medicines by generic name 76 (3.4%), antibiotics 416 (19.0%), Injection 34 (1.5%), from Essential Medicine List (EML) 1,312 (60.1%), Fixed Dose Combination (FDC) 468 (21.4%) and the polypharmacy (≥4) was 129 (14.3%). The average cost was NPR 404.72±19.3 (3.69$; 1$=109.41NPR) and duration of treatment was 16.43±0.73 days. Patient’s age had positive correlation with number of medicines (p=0.002) and negative correlation with antibiotics (p=0.988). Cost of treatment had positive correlation with number of medicines (p=0.00), EML (p=0.00), duration of treatment (p=0.00) and antibiotics (p=0.33). Average medicines, from EML, and antibiotic use were high in Otorhinolaryngology with statistical significance of difference between mean. Prescription with FDC and intravenous were significantly high in Obstetrics and Gynecology. Cost and treatment duration were significantly high in Psychiatry. Tertiary healthcares need to develop and implement specific guidelines for prescriptions writing and also should develop a system to record them.

The Outpatient Use of Furosemide in a Public Hospital

“…In contrast of our study, Rimoy et al [18] reported that bendrofluazide was the most prescribed diuretics in the outpatient setting. Similar to our study, Furosemide was the most prescribed diuretics as reported by Thapa and Singh [19] and by Shalavadi et al [20].…”

Evaluation of Rational Use of Medicine Using WHO/INRUD Core Drug Use Indicators at Teda and Azezo Health Centers, Gondar Town, Northwest Ethiopia

“…Similarly, higher results were recorded in studies from different parts of Ethiopia (ranging from 1.9 to 3), 22,[24][25][26][27][28][29][30][31] and other developing countries (ranging from 2.30 to 3.98). 32,34,35,37,40,43,44,46,48,49,54 On the contrary, the average number of medicines per prescription within the acceptable range was reported by other studies from Ethiopia (ranging from 1.65 to 1.8). 17,18,36 The prescription of many medicines for a patient may decrease adherence to treatment, increase the cost of medicine incurred by the patient, elevate the risk of drug interaction, and expose the patient to unnecessary potential side effects of the medication.…”

“…14,65 Similarly, prescription of medicine by generic name is below the optimal value in most of the previous studies in different parts of Ethiopia (ranging from 79.2%to 99.25%), [22][23][24][25][26][27][28][29][30][31]36 and many other developing countries (ranging from 0% to 95.4%). 32,34,37,43,44,[46][47][48][49]52,53,55 However, results per the WHO/INRUD expectation were obtained in the study done at West Shewa Zone, Oromia, Ethiopia (100%) 17 and at 4 different emirates, UAE (100%). 50 In lowincome countries like Ethiopia where resources are often scarce, generic prescribing substantially reduces the cost of medicine paid by patients as well as the cost of medicine incurred by facilities because generics are relatively affordable, accessible, and recallable compared to brand counterparts.…”

“…50 However, the WHO/INRUD recommendation was not achieved in the most of previous studies in different parts of Ethiopia (ranging from 79.8% to 99.5%), [22][23][24][25][26][27][28][29][30][31]36 and many previous study reports outside of Ethiopia (ranging from 22.57% to 98.80%). 32,34,37,43,44,46,47,49,52,54,55 The prescription of medicine from the essential drug list in the facilities should be preserved since it is one of the major tools for implementing RUM. The adoption of such a list for any health facility can significantly improve the effectiveness of therapy; it decreases the amount of unwanted medicine prescription and promotes RUMs because medicines from the list are well known, already tested in practice, with established clinical use, and of lower cost than newer.…”

Morbidity profile and prescription audits using WHO core prescribing indicator in government hospitals of Province 1, Nepal

“…17,18 In this study, the number of prescriptions encountered with injection was low (1.8%). Recent studies conducted in hospital outpatients in Kathmandu, Nepal (1.5) 25 , central Nepal (0.7) 18 also reported lower values of injectable been prescribed. However, a survey performed in hospitals of south Ethiopia (38.1%) 26 and Iran (41%) 27 has shown higher rates of injectable encounters in prescriptions.…”