Comparison of rational pharmacotherapy approach by medical students with and without Guide to Good prescribing guidelines

Abstract

Background: Knowledge of pharmacology forms the basis of rational pharmacotherapy practice. Teaching the medical students about systematic application of pharmacology in patients' care forms an essential component. It facilitates the medical students to develop a methodical approach in solving patients' clinical problems. Objective: To compare rational pharmacotherapy approach in management of essential hypertension and acute bronchial asthma by MBBS students before and after exposure to WHO GGP guidelines. Materials and Methods: Sixth-term MBBS students, conventionally trained in management of essential hypertension and acute bronchial asthma and randomly divided into group A (n=36) and group B (n=42), were asked to make a treatment plan for a hypothetical case of essential hypertension and acute bronchial asthma respectively in an open unstructured format. Following an interactive teaching session on WHO GGP guidelines for each group separately, both groups were asked to remake the treatment plan for the same hypothetical case in an objective structured format based on GGP. The treatment plan written before and after exposure to GGP was compared based on various steps of GGP. Paired student's t test was used for analysis. Results: The score enhancement with GGP (mean ± SD) in group A for defining the patient problem, setting up the therapeutic goal, selecting P drug, writing the prescription, providing the drug information, monitoring the drug treatment and updating drug information was 0.61±0.55, 0.53±0.51, 2.75±1.4, 9±1.24, 14.64±0.8, 6.08±1.59, and 3.39±1.02 respectively. The score enhancement (mean ± SD) in group B for the above mentioned steps was 0.85±0.36, 0.97±0.17, 1.73±1.57, 6.18±2.88, 6.21±1.47, 5.79±1.49 and 6.36±2.04 respectively. The score enhancement with GGP guidelines was statistically significant with p value 0.001 in both groups. Conclusion: With widely rampant irrational prescribing behaviour in our country, the study showed statistically significant improvement in rational pharmacotherapy approach by medical students after exposure to GGP guidelines.

A Rapid Review of Prescribing Education Interventions

“…This review also found that prescribing education interventions continue to be designed using the main concepts of the WHO GGP, demonstrating that despite its publication being back in 1994, the guideline continues to be the leading model for safe and rational prescribing to this day. This assertion is aided by the positive results yielded by interventions designed around the WHO GGP, both in assessment and student perception [28][29][30][31][32][33].…”

“…Six case-based interventions were conducted through exposing students to treatment-setting standards from the World Health Organization (WHO) Guide to Good Prescribing (GGP) to varying [28][29][30][31][32][33]. Two studies used a combination of didactic lectures and subsequent prescription-writing for specific paper case scenarios [28,31], two studies implemented an individualised instruction approach where students were provided with the WHO GGP to use individually for creating treatment plans [32,33], one study used an experiential approach where students learned through observing real-life patients [30] and one study implemented the WHO GGP across an entire curriculum and in a variety of teaching formats [29]. Keisjers et al [29] made extensive use of the WHO GGP through incorporating it into a whole medical curriculum, where all pharmacology and pharmacotherapy modules were modelled according to the learning goals of the WHO GGP, and the guide was heavily featured during whole-group lectures, small-group tutorials and practical sessions.…”

“…After delivering rational prescribing sessions and subsequently asking for the prescriptions to be rewritten, they assessed and provided feedback to the students according to the WHO GGP standards. Both Krishnaiah et al and Tichelaar et al [32,33] required students to use the WHO GGP as an aid in compiling treatment plans for hypothetical case scenarios; however, the purpose of Tichelaar et al's study [33] was to compare the impact of the WHO GGP to the 'SMART' criteria of goal setting on treatment planning. Thenrajan et al's study [30] used a test and a control group, both of whom were exposed to the WHO GGP guidelines of selecting the preferred drug following a clinical diagnosis.…”

Assessment of rational prescribing practice among interns: a questionnaire based observational study

“…They should know how to prescribe safely and correctly and for this the skills, knowledge, and attitudes needed to make good prescribing decisions should be inculcated. 10,11 However, despite all the measures still irrational prescribing is prevalent in our country. It is better we make interns be aware of RUM and motivate them for the rational prescribing.…”

Trends of articles published in National Journal of Physiology, Pharmacy and Pharmacology (NJPPP)

“…Most of the articles published in the NJPPP were belong to the subjects like, Physiology [11,15,18,22-24,26-29,33,34,38-40,44,45,47,50,51,55] , Pharmacology [8,14,19,20,25,30,35,36,43,46,58] , Pharmacotherapeutics [5,17,21,31,54,57,59] and Pharmacy [7,53,56,60,62] . As the name of the journal itself contains the name of these particular subjects, it attracts the researcher of that field or work done in that field to be published in this journal.…”