Study by the Indian Council of Medical Research flags the need for continuous training of doctors to prevent prescription violations
Inappropriate prescription of medicines remains a serious problem in India with just about half the doctors even in major hospitals adhering to standard treatment guidelines. A study by the Indian Council of Medical Research has found that the overall prevalence of deviations was 45 per cent of which 9.8% were what the researchers called “unacceptable deviations.”
The observational study was conducted in the outpatient departments of tertiary care hospitals in India wherein the 13 Indian Council of Medical Research Rational Use of Medicines Centres are located. “Against all the prescriptions assessed, about one tenth of them (475/4838; 9.8%) had unacceptable deviations. However, in 2667/4838 (55.1%) prescriptions, the clinicians had adhered to the treatment guidelines. Two thousand one hundred and seventy-one prescriptions had deviations, of which 475 (21.9%) had unacceptable deviations with pantoprazole (n=54), rabeprazole+domperidone (n=35) and oral enzyme preparations (n=24) as the most frequently prescribed drugs and upper respiratory tract infection (URTI) and hypertension as most common diseases with unacceptable deviations,” the researchers reported in the Indian Journal of Medical Research. Pantoprazole, rabiprazole are drugs known as proton pump inhibitors that take care of digestive problems while domperidone is an anti nausea medication.
Standard treatment guidelines have been in place for some time now but the study once again proves that Indian doctors even in some of the best medical centres choose to ignore those. Prescription audits that should be undertaken by hospitals on a regular basis are followed only in exception. The potential consequences of these deviations could be increased cost to the patient (301, 63%) and/or a probability of increase in the number of adverse drug reactions (254, 53%), drug interactions (81, 17%), anti microbial resistance (72, 15%) or even treatment failure (77, 16%), the study noted.
The community medicine OPD, followed by ENT and paediatrics had the most deviations. It is possible that the deviations in the community medicine OPDs were more in number as such OPDs are run by junior doctors.
“We recommend that the national and local treatment guidelines should be updated on a regular basis based on evidence, disseminated to the clinicians and prescribing according to these guidelines must be mandated by responsible local authorities. Moreover, training modules with case studies based on real-life scenarios that focus on rational prescribing and adherence to treatment guidelines need to be designed on an urgent basis for all prescribers, especially junior doctors,” the researchersrecommended.