1. Evaluation of drug prescription pattern differences among several
specialties in West Azerbaijan province –Iran in 2014-2015
Lavin Ali Asgharloo1,Hamdolah Sharifi1,2, Hassan Malekinejad1,2 Dorna Sadeghi3
1- Rational Use of Drug Committee, Urmia University of Medical Sciences
2- Department of Pharmacology, Pharmacy Faculty, Urmia University of Medical Sciences , Urmia ,Iran
3- Pharmacy student , Pharmacy Faculty, Urmia University of Medical Sciences , Urmia-Iran
Introduction
Medicines play an important role in health care and disease prevention. Irrational drug use is
prevalent, especially in the developing countries due to health care irrational prescribing,
dispensing, and administration of medications. The rational use of drugs requires the patients to
receive medicines appropriate to their clinical needs, in doses that meet their own individual
requirements, for an adequate period of time and at the lowest cost (1,2). Also, the World Health
Organization (WHO) reports that more than half of all medicines are prescribed, dispensed or
sold inappropriately and that half of all patients fail to take them correctly (3). The impact of
irrational prescription of drugs leads to an increase in the incidence of adverse drug events and
the emergence of drug resistance, economic drawback and increases morbidity and mortality.
Irrational prescriptions and use of drugs is caused by polypharmacy, excessive use of antibiotics
and injections and use of drugs of doubtful efficacy (4). Most health expenditure of developing
countries is on drugs and medical sundries but inappropriate use of such resources is common
(5). The present study was undertaken with an aim to develop baseline data on drug prescribing
pattern and evaluate the rationality of the prevalent prescribing practices using WHO prescribing
indicators6 for adoption in drug utilization studies.
Materials and methods
A cross-sectional study design was done between March 21, 2014 to March 20, 2015 to verify
the prescription pattern of drugs during in an annual period. A prescription processing software
program, named Pardazesh Nosakh was used to analyze prescriptions. The software was
prepared by national committee of rational drug use. Statistical analyze of prescriptions were
done. Factors such as total number of prescription strips, mean number of drugs per
prescription, mean cost, scrips containing more than 4 drugs, percentage of patients receiving
antimicrobial agents, injectable drugs and corticosteroids were reported by the software. It was
not a descriptive study; statistical analysis was done and reported.
Results
A total of 501699 prescriptions were evaluated. Antibiotics were the most prescribed drugs by
ENT (33.66%) , gynecologists (25.48%), infectious disease specialists (24.18%), urologists
(23.67%) and general surgeons (18.53%) but have been used less by orthopedics (5.87%),
neurosurgeons(2.85%) and cardiologists (1.21%). Musculoskeletal prescribed mostly by
orthopedists , neurosyrgeons and cardiologists (35.66%, 21.90% and 12.90 % respectively).
The most prescribers of corticosteroids were : neurosyrgeons, general practitioners and ENT
specilists. Drugs used in central nervous system (CNS) disorders were prescribed mostly by
neurosurgeons (46.63%), orthopedists (34.03%) and cardiologists (32.2%) (Table-1). The most
prescribed drugs by cardiologists were drugs that named to cardiovascular drugs(50%), these
drugs prescribed by pediatricians less than other specialists (0.76%)(Figure-1).
Drug Medical Specialty Groups
Antibiotic ENT Gynecologist Infectious Disease
Corticosteroid Neurosurgeon General Practitioner ENT
NSAID Orthopedist General Practitioner Urologist
Musculoskeletal Orthopedist Neurosurgeon Cardiologist
Cardiovascular Cardiologist Infectious Disease Urologist
CNS Drugs Cardiologist Neurosurgeon Orthopedist
0
10
20
30
40
50
60
Cardiologist ENT General
Practitioner
Gynecologist Infectious
Disease
Internist Neurosurgeon Orthopedist Pediatric General
Surgeon
Urologist
Antibiotic
Corticosteroid
NSAIDs
Musculoskeletal Drugs
Cadiovascular Drugs
CND Drugs
Dicussion
The most common drug prescribed was antibiotics (24.13%), followed by CNS drugs (18.65%)
and Musculoskeletal drugs (10.69%). The percentage of prescriptions with antibiotics in a study
carried out by Lalan et al. was 46.17% (3). It was expected for specialists, especially for
infectious diseases specialists to prescribe more antibiotics comparing to other physicians, but
as
it was reported by the results, ENT specialists and gynecologists were tended to prescribe
more antibiotics than infectious diseases specialists. ENT specialists have the most prescription
of this group of drugs but Sadeghian et al. reported that general practitioners rather than other
physicians ordered antibiotic (6). According to WHO 15- 25% of prescriptions with antibiotics is
expected in most of the developing countries where infectious diseases are more prevalent. The
prescribers need to be extra cautious before prescribing any antibiotic to avoid unnecessary
burden on patient and development of resistance. (3).
CNS drugs are the other most prescribed drug group in our study specially by neurosurgeons,
orthopedists and cardiologists. This may be so due to patients demand or irrational prescribing.
Our results also revealed that neurosurgeons, general practitioners ENT specialists were those
prescribing more corticosteroid drugs. In other reports, comparison of general physicians with
specialists has also suggested the overuse of long-term oral corticosteroids and underuse of
inhaled corticosteroids by GP for acute exacerbations of asthma (7-8). Unfortunately, over-
prescription and overuse of corticosteroids without indication occur during recent years in Iran.
This study has shown that there exist significant differences in the usage pattern of NSAIDs
among different practice categories but this drug prescribed in low percentage compared to
other studies(9).
Based on what the results revealed in this study, there is an inevitable need to improve
prescription habits among different specialties, especially GPs. This causes the policymakers to
put more emphasis on priorities such as continuous education and supporting the researches
concerning the current situation assessment and prescription analysis.
ABSTRACT
Objective:. To evaluate the prescribing pattern of drugs in the outpatient setting and to point out the prescribing behavioral differences among several specialties . Methods: A cross-sectional study was carried
out on a collection of prescriptions collected from health insurance companies from March 21, 2014 to March 20, 2015 . For analysis of prescriptions, we used Pardazesh Nosakh, a prescription processing
software program, provided by the National Committee of Rational Drug Use. Results: A total of 501699 prescriptions were evaluated. Antibiotics were the most prescribed drugs by ENT (33.66%) ,
gynecologists (25.48%), infectious disease specialists (24.18%), urologists (23.67%) and general surgeons (18.53%) but have been used less by orthopedics (5.87%), neurosurgeons(2.85%) and cardiologists
(1.21%). Musculoskeletal prescribed mostly by orthopedists , neurosyrgeons and cardiologists (35.66%, 21.90% and 12.90 % respectively). The most prescribers of corticosteroids were : neurosyrgeons, general
practitioners and ENT specilists. Drugs used in central nervous system (CNS) disorders were prescribed mostly by neurosurgeons (46.63%), orthopedists (34.03%) and cardiologists (32.2%) . Conclusion:
Antibiotics and corticosteroids were the most prescribed drugs by most specialists that followed by musculoskeletal and CNS drugs. It seems that specialist clinicians regardless of their expertise visit the
patients or cover the other disorders of patients in their prescriptions without having to refer them to specialists.
Key Words: specialists, drug prescription, patient
References
1. Ansari KU, Singh S, Pandey RC. Evaluation of prescribing pattern of doctors for rational drug therapy. Indian J Pharmacol. 1998;30:43-46.
2. Desai S. Essential drugs and rational drug therapy. Bull Soc Rational Ther. 2001; 12: 2-7.
3. Lalan BK, Hiray RS, Ghongane BB, Drug prescription pattern of outpatients in a tertiarycareteaching hospital in Maharashtra, Department of Pharmacology, Int J Pharm Bio Sci 2012 July; 3(3): P 225 - 229 .
4. Isenalumehe AE, Oviawe O. Polypharmacy Its Cost Burden and Barrier to Medical Care in a Drug Oriented Health Care System. Int J. Health Serv. 1988; 18: 335–342.
5. NA Hussain, Pattern of prescription drug use in Nigerian army hospitals ET Adebayo.
6- Sadeghian GH, Safaeian L, Ali-Reza Mahdanian AR, Salami S, Kebriaee-Zadeh J. Prescribing Quality in Medical Specialists in Isfahan, Iran. Iranian Journal of Pharmaceutical Research (2013), 12 (1): 235-241.
7- Carpi J. Generalists trail allergists in giving inhaled steroids. Internal Medical News (1995) 15: 1.
8- Paul AD, Chauhan CK. Study of usage pattern of nonsteroidal anti-inflammatory drugs
(NSAIDs) among different practice categories in Indian clinical setting. Eur J Clin Pharmacol (2005) 60: 889–892.
Table-1
Figure-1
‫ارومیه‬ ‫پزشکی‬ ‫علوم‬ ‫دانشگاه‬
‫دارو‬ ‫منطقی‬ ‫مصرف‬ ‫و‬ ‫تجویز‬ ‫کمیته‬