Seminars on Prescription pattern ORANGHIS.pptx

Prescription pattern ORANGHIS

1. STATE SPECIALIST HOSPITAL, OKE-ARO AKURE Department of Pharmacy (Clinical meeting) Presenting: Pharm Olawanle Taye Franklin T o p i c : A REVIEW OF PRESCRIPTION PATTERN MONITORING STUDIES (PPMS) AND THIER EFFECTIVENESS IN PROMOTING RATIONAL USE OF MEDICINES ( R U M ) IN INSURANCE (NHIA &ORANGHIS) SSH,AKURE.

2. Prescription pattern monitoring studies (PPMS) are a tool for assessing the prescribing, dispensing and distribution of medicines. The main aim of PPMS is to facilitate rational use of medicines (RUM). This review was done to assess the effectiveness of prescription pattern monitoring studies in promoting RUM

3. PPMS using WHO prescribing indicators were also included. It was observed in the studies that some physicians do not adhere to the guidelines made by regulatory agencies leading to irrational use of medicines,which may in turn leads to increased incidence of

4. t reatment failure, antimicrobial resistance and economic burden on the patient and the community as a whole. The treatment of diseases by the use of essential drugs, prescribed by their generic names, has been emphasized by the WHO.

5. We conclude that the prescription monitoring studies provide a bridge between areas like rational use of drugs, pharmacovigilance, pharmacoeconomics, pharmacogenetics and ecopharmacovigilance.

6. Medicines are an integral part of the health care, and modern health care is impossible without the availability of necessary medicines. They not only save lives and promote health, but prevent epidemics and diseases too .

7. Accessibility to medicines is the fundamental right of every person. However, to bring optimal benefit, they should be safe, efficacious, cost-effective and most importantly rational.

8. Prescription pattern monitoring studies (PPMS) are drug utilization studies with the main focus on prescribing, dispensing and administering of drugs. They promote appropriate use of monitored drugs and reduction of abuse or misuse of monitored drugs.

9. Prescription Patterns explain the extent and profile of drug use, trends, quality of drugs, and compliance with regional, state or national guidelines like standard treatment guidelines, usage of drugs from essential medicine list and use of generic drugs.

10. P PRESCRIPTION P A T T ERN M O N I TORING O F A N T I D I ABETIC DRUGS

11. P rescription pattern monitoring studies was carried out within the period of the last 3 months in diabetic patients who visited the Insurance in SSH,Oke-Aro Akure to access healthcare .

12. The 90 diabetic patients were involved, out of which 48 ( 5 3 . 3 % ) were male and the rest female. A t o t a l o f 1 3 5 d r u g s w e r e p r e s c ribed , o u t of w h ich antidiabetic drugs appea r e d a b out 1 + t i m e s ( 9 . 8 % ) , a n d o t h e r d r u g s w e r e a n t i biotics , v i t a m i n s , a n t i m a larial , topica l s a n d a n t i h y pertensives . In monotherapy,that is when single drugs are prescribed metformin was mostly prescribed. Glimepiride and metformin w e r e frequently prescribed together

13. Metformin was the most frequently prescribed drug in the diabetes patient. Metformin and glimeperide being the most frequent combination used. Majority of the prescriptions followed standard guidelines of PG 90 of Standard treatment guidelines '08

14. P PRESCRIPTION PATTERN MONITORING O F ANTIHYPERTENSIVE DRUGS

15. Hypertension is a leading contributor to the global burden of cardiovascular morbidity and mortality. Non compliance to antihypertensive therapy is also a reason for uncontrolled hypertension.

16. Elderly hypertensive patients commonly have multiple pathologies leading to polypharmacy, and altered pharmacokinetics and pharmacodynamics, are prone to adverse drug reactions from inappropriate medication .

17. The study was carried out on hypertensive patients that visited Insurance,SSH in last 3 months. From the analysis it was seen that the ages were between 40- 80.

18. T h e s t u d ies s h o w e d t he most common drug classes involved in the study was Calcium Channel Blockers ( A m l o dipine , n i f e d i p i n e ) 37% followed by Angiotensin II receptor antagonists ( V a l s a rtan , t e m i s a r t a n , c a n d e s a r t a n , l o s a r t a n ) 21% , A C E I ( L i s i n o pril , r a m i p r i l ) 1 5 % and the most commonly prescribed drugs in the study population were Amlodipine, Lisinopril , bisoprolol, propranolol, valsartan and Telmisartan.

19. There is considerable use of different antihypertensive drug combinations for the treatment of hypertension and such practice has a positive impact on the overall blood pressure control S i g n i ficant P h a r m a cist i n t e r v e n tion o c c u r s w h e n h y p e r tensi v e p a t i e n t s complained o f c o u g h a f t e r t a k i ng Lisinopril , t h e strength of the drug w a s advised to be reduced or t h e d r u g s u b s t i tut e d i f c o u g h g o t w o r s e

20. P R E S C R IB I N G IND I C A TO R S

21. Prescribing indicators utilize prescriptions to measure the performance of health care providers related to the appropriate use of drugs.

22. P PRESCRIPTION PATTERN MONITORING OF A N T I B IOTICS D R U G S

23. Monitoring the antibiotic utilization pattern is of growing concern due to increase in antibiotic resistance, lack of adherence to standard treatment guidelines and rise in health care expenditure.

24. P E R C ENTAGE O F ENCOUNTERS WITH ANTIBIOTICS P R E S C R I B E D T h e percentage of encounters with antibiotic prescribed is calculated by dividing the number of clinical encounters in which one or more antibiotic was prescribed by the total number of encounters and expressed as a percentage. The WHO indicates that optimally, this value should be (<30%) I t w a s f o u n d t o b e 2 8 . 6 % , w h i c h f a l l s w i t h t h e W H O indicator for antibiotics prescription

25. A higher percentage of encounters resulting in the use of antibiotics (exceeding proposed reference values o f < 3 % ) may potentially be signifying an indiscriminate use of antibiotics. While a high antibiotic use may highlight increased rate of local infections, it may be a sign of prescriber’s inexperience or a weak local health system characterized by a lack of diagnostic facilities that often lead to presumptive treatment of cases.

26. A V ERAGE N UMBER OF D R U G S P E R E N C O U N T ER T h i s the total number of different medicines prescribed divided by the number of encounters The WHO proposes that optimally, this should be <2, and in determining this value, combination medicines should be counted as one T h e a v e r age n u mber o f d r u g s p e r p e r son w a s c a l c u l a t e d t o b e 3 . 4 w h i c h m o r e t h a n t h e r e f e r ence s t a n d a rd f o r m t h e W H O The average number of medicines prescribed per encounter is important to assess if poly‑pharmacy is an issue. Higher medicines per patient encounter may also indicate weaker health systems characterized by a shortage of essential medicines prompting prescribers to combine medicines to deliver the maximum clinical effect.

27. PERCENTAGE O F M E D I CIN E S P R E S C R B E D F R O M E S S E NTIAL D R U G S L I S T ( E D L ) T h i s i s the total number of medicines prescribed from list of essential medicines divided by the total number of medicines prescribed multiplied by 100. 1 % The main focus of this indicator is to assess whether prescribing practices conform to drug use policy as pertaining to the use of essential medicines list (EML). An EML is a list of medicines that satisfy the priority health care needs of a population.

28. PERCENTAGE O F E N C O U NTERS WITH A N I N J ECTION P R E S C RIBED T h i s i s calculated by dividing the number of clinical or drug use encounters in which an injectable form of medicine was prescribed by the total number of encounters studied and expressed as a percenta g e . This indicator describes the frequency with which injectable forms of medicines are prescribed 1 3 % The WHO proposed an optimal value for this indicator to be (<20%).

29. The percentage of encounters with an injection prescribed highlight if there is a reasonable use of injectable medications. An increase in the rate of use of injections may highlight prescriber’s skill issues, emergency issues, and/or a biased understanding on the potency of various medicine formulations (oral versus injectable forms).