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Business News/ News / India/  ICMR study finds anomalies in prescriptions at major central run hospitals

ICMR study finds anomalies in prescriptions at major central run hospitals

ICMR study highlights deviations in prescriptions at leading government hospitals, attributed to the workload of junior doctors and non-compliance with guidelines.

Lack of emphasis on rational prescribing in medical curriculum and drug promotion also play a role in the emergence of anomalies in prescriptions.Premium
Lack of emphasis on rational prescribing in medical curriculum and drug promotion also play a role in the emergence of anomalies in prescriptions.

New Delhi: Doctors at some of India's top government-run hospitals stray from established guidelines while prescribing medicines, an Indian Council of Medical Research (ICMR) investigation has found.

Many of these are junior doctors unable to prioritize and multi-task while seeing a large number of patients in limited time at outpatient departments (OPDs), found the study, which was published in the Indian Journal of Medical Research.

While prescribing, doctors are supposed to adhere to guidelines of by the World Health Organization and the Union health ministry. But nearly 10% of prescriptions showed "unacceptable deviations," from the guidelines, and 45% departed from normal treatment standards, found the study, which was conducted as part of the ICMR's Rational Use of Medicines (ICMR-RUM) task force project.

The study titled “Evaluation of prescriptions from tertiary care hospitals across India for deviations from treatment guidelines and their potential consequences", found that the prescriptions with unacceptable deviations could have been written by junior doctors who have to cater to a large number of patients and are unable to prioritize and multitask within the fixed time allotted for OPD duties.

"Besides this, inadequate emphasis on rational prescribing in medical curriculum and drug promotion by pharmaceutical industries may also have contributed to the inappropriate prescribing and non-compliance to guidelines," the study noted.

The study is based on 4,838 prescriptions s from outpatient departments which were analyzed from 13 RUMCs of 13 tertiary care hospitals and medical colleges, including the prestigious All India Institutes of Medical Sciences (AIIMS) in New Delhi and Bhopal, KEM Hospital in Mumbai, Post Graduate Institute of Medical Education & Research (PGIMER) in Chandigarh, and Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) in Puducherry.

Dr Rima Dada, media in-charge, AIIMS Delhi, said, “Our prescriptions are comprehensive, we write generic medicines -- the dosage and duration of the medicines properly explained in prescriptions. And not only that, we explain that clearly to patients in OPD. Some of the OPD are running till 11pm and see about 20,000 patients daily. We have a floating population of junior and senior resident doctors, so we take training on regular basis so that they are also trained as to how to write prescriptions and how to explain to the patients." 

The prescriptions were for patients OPDs of different specialities, including community medicine, general medicine, surgery, obstetrics and gynaecology, paediatrics, dermatology, ophthalmology, otorhinolaryngology, psychiatry, orthopaedics, chest medicine, dentistry and superspeciality OPDs.

"In the present study, the OPD having maximum deviations was from the community medicine OPD, followed by ENT (ear, nose and throat) and paediatrics. It is possible that the deviations in the community medicine OPDs were more in number as such OPDs are run by junior doctors," the study noted.

The study also revealed that deviations in prescriptions were found in ENT OPDs due to non-specific therapy, e.g., combinations of analgesics with either proton pump inhibitors, trypsin-chymotrypsin combinations or serratiopeptidase prescribed for dyspepsia, upper respiratory tract infections (URTI) or acute otitis media, or respiratory tract infections.

The most common diagnosis in the prescriptions was URTI – followed by hypertension, osteoarthritis and diabetes. URTI was commonly diagnosed as individuals with this illness are typically managed by doctors attending various OPDs such as medicine, paediatrics, community medicine and ENT. Similarly, individuals presenting with joint pains visit either the medicine or orthopaedics OPD, resulting in more prescriptions having the diagnosis of osteoarthritis.

Inappropriate use of medicines includes is not limited to injectable forms or drugs, failure to adhere to clinical guidelines and non-compliance by patients to prescribed drug regimens but also rise of antimicrobial resistance which has already been a matter of concern in India.

"Inappropriate prescribing is still a problem and worldwide over 50% of the medications may be prescribed or dispensed inappropriately and 50% of the patients may be non-compliant to their medication. Inappropriate prescriptions can lead to an increase in adverse drug reactions, hospitalization and increase in cost of treatment. To resolve this problem, we need to inculcate rational prescribing amongst medical student right from the undergraduate days and reinforce these principles during their further professional development," the study noted.

Quries mailed to the Union health ministry, PGI Chandigarh and JIPMER Pondicherry remained unanswered at print time.

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Published: 19 Apr 2024, 07:43 PM IST
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