A STUDY OF DRUG PRESCRIBING PATTERN AND COST ANALYSIS AMONG DIABETIC PATIENTS IN A TERTIARY CARE TEACHING INSTITUTE IN NORTH INDIA’

Abstract

Diabetes mellitus is a chronic metabolic disorder associated with significant morbidity and mortality due to diabetic complications and other co-morbid conditions. Therefore, other drugs are also used commonly with antidiabetic drugs for the treatment of diabetic patients. A prescription is a written advice, mentioning the drugs and other instructions to a pharmacist to dispense the drugs properly to treat the disease. It becomes necessary to write the drugs and other parameters in a candid, concrete and clear manner on the prescription slip. It has been observed that prescriptions are generally vague which lead to misinterpretations and thereby resulting in failure of drug therapy, drug-drug interactions, overuse or underuse of drug and adverse drug reactions. WHO has set quality and quantity indicators to evaluate the use of drugs to be used in the hospitals/dispensaries. Prescription slips were randomly collected from the diabetic patients visiting the OPDs of the Guru Gobind Singh Hospital attached to Medical College, Faridkot, for analysis and evaluation. Prescriptions slips were taken from the patients after taking written consent and analyzed for quality and quantity prescriber indicators recommended by WHO. A total of 366 prescriptions were collected and analyzed for drugs used in diabetic patients. Average number of drugs prescribed is 4.98. The most commonly prescribed drugs were Oral antidiabetic agents, CVS related (antihypertensive, nitrate, antiplatelet, etc.), vitamins and minerals, insulin, GIT related drugs, lipid lowering drugs, antimicrobial, CNS related and NSAIDs and their percentages were 20.55%, 26.97%, 22.20%, 7.8%, 6.57%, 5.86%, 5.75%, 2.63% and 1.48% respectively. All the drugs were prescribed by non-generic (Trade) names, which included 31.36% drugs from the Essential Drugs List. Oral forms prescribed were 85.85% and injectable were 14.15% (insulin 7.8% and other injectable 6.35%).The average cost of the oral antidiabetic agent per day per prescription was ₹7.95/- and this cost increased to ₹10.15/- with addition of CVS related drugs, ₹17.23/- with vitamins& minerals and ₹10.57/- with lipid lowering agents and it was seen that if a patient was prescribed all these drugs then the average cost of the treatment got raised to ₹45/- (approx.) or $ 0.82 USD per day per prescription. There is a high tendency and frequency to prescribe more than two drugs but less used from the essential drugs list for the treatment of the diabetesand other co-morbid conditions. Most of the drugs prescribed were cardiovascular related drugs and multivitamins along with oral antidiabetic drugs. There is an urgent need to develop the prescription writing skills for budding doctors regarding the use of Essential Drugs List to reduce the cost of treatment. Key words: Prescription audit, prescribing indicators, Essential Medicine List (EML), Co-morbid conditions