A Study on Prescription Pattern of Drugs in Orthopedics Inpatient Department of Navodaya Medical College Hospital and Research Centre in Raichur

Background: Periodic evaluation of drug utilization pattern is necessary to promote rational drug use by. In orthopaedics practice, the prescribing pattern needs to be regularly monitored since many of the drugs prescribed carry untoward adverse effects. In this backdrop, the present study was conducted to explore the prescribing pattern in orthopaedics outpatient department (OPD) of Navodaya medical college hospital and research centre in Raichur. Methods: This is a prospective observational study conducted for 3 months, in Navodaya medical college hospital and research centre in Raichur, a 1000 bedded tertiary care rural based, teaching hospital. Total 100 patients were included in this study. Results: Total 1216 drugs were prescribed in 100 prescriptions. Average number of drugs per prescription was 7.34. Average duration of prescription was 9 days. Percentage of drugs prescribed by generic name was 29.7%. Percentage of encounter with an Antibiotic prescribed was 60.23% i.e. out of 100 prescriptions antibiotics were prescribed in 60. Percentage of encounter with an Injection prescribed was 60% which means out of 100 prescriptions, injectables were prescribed in 60. Percentage of drugs prescribed from National Essential Medicine List was 52.63%. Percentage of drugs prescribed from WHO model List was 32.46%. Diclofenac (14.25%) was most commonly prescribed drug. Incidence of polypharmacy was quite high in context of Analgesics. Almost 19% of prescriptions had 3 drugs. Orally prescribed Analgesics were 62.4%, Injectables 34% and Topical 3.6%. Conclusion: The study provides an insight into the prescribing pattern in orthopaedics in-patients. It highlights the importance of emphasizing rational drug prescribing and toward improving awareness of the physicians and medical students to the WHO recommended standards on prescribing indicators.


INTRODUCTION
Drug utilization has been defined as the marketing, distribution, prescription, and use of drugs in a society with special emphasis on the resultant medical and social consequences. [1]In developing countries like India, where the financial resources are scarce and the affordability of the patients is less, implementation of the rational use of medicines becomes important. [2].The principal aim of drug utilization research is to facilitate the rational use of drugs in populations.For individual patient, the rational use of a drug implies the prescription of a well-documented drug at an optimal dose, together with the correct information, at an affordable price.Without knowledge of how drugs are being prescribed and used, it is difficult to initiate a discussion on rational drug use or to suggest measures to improve prescribing habits.Information on the past performance of prescribers is the linchpin of any auditing system.Drug utilization research in itself does not necessarily provide answers, but it contributes to rational drug use in important ways.Drug utilization research can increase our understanding of how drugs are being used as follows. [3] It can describe the extent of use at a certain moment and/or in a certain area (e.g. in a country, region, community or hospital).In order for such descriptions to be meaningful, they should form part of a continuous evaluation system, which allows for the tracking of patterns over time and the identification of trends in drug use.• On the basis of epidemiological data on a disease, researchers can estimate the extent to which drugs are properly used, overused, or underused.• A drug use profile and alternative drugs used to treat particular conditions can be determined through this method.• Comparisons can be made between observed patterns of drug use for a specific disease and current recommendations. [4]n General, in orthopedics departments studies are carried mainly on surgical procedures.Very rarely any study of drug distributions type are planned.Because of communication gap between nonclinical pharmacologists and clinical surgical orthopedics consultants who are mostly interested in surgery and have less time also for drug discussions on rational therapy very rarely such studies are conducted.Drug utilization studies do help in finding a new way to implement the rational drug therapy and areas of improvement in terms of better, effective, economic treatment with lesser adverse effects, lesser suffering to patient (1kaur).So WHO promotes Rational drug therapy. [5]The prescribing pattern in orthopedics needs to be regularly monitored since most of the drugs prescribed carry untoward adverse effects.Earlier research conducted with similar objectives has revealed that drugs commonly prescribed in orthopaedics department were nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, and ulcer protectives. [6]he discipline of orthopaedics plays a pivotal role in addressing a myriad of conditions affecting the bones, joints, muscles, ligaments, and tendons.With the aging population, traumatic injuries, and lifestyle-related disorders on the rise, the Orthopaedics Inpatient Department stands at the forefront of managing a diverse patient demographic.The prescription patterns within this specialized department not only reflect the evolving nature of orthopaedic care but also present an opportunity to enhance therapeutic outcomes and streamline healthcare practices. [7]The significance of this study extends beyond its regional scope, as orthopaedic conditions are pervasive globally.By examining the prescription patterns in a specific setting, we can draw parallels and contrasts with similar healthcare institutions worldwide, fostering a more comprehensive understanding of the challenges faced by orthopaedic practitioners universally.Consequently, the findings of this research have the potential to contribute to the development of standardized guidelines, best practices, and improved global orthopaedic healthcare strategies. [8]A literature search was conducted which consisted of a Medical Literature Analysis and Retrieval System Online database search and a World Wide Web search using the following keywords: drug utilization study, orthopaedics, and OPD.The search revealed that there exists a paucity of data on the prescribing pattern in orthopedics OPD, particularly in India.Though the pattern of NSAIDs use in orthopaedics, OPD has been studied in India, data regarding overall drug utilization in orthopaedics OPD is absolutely lacking.A study with such objective has been conducted in Nepal , which was however limited by the fact that a total number of prescriptions evaluated fell short of WHO guidelines on the conduct of drug utilization studies.In this backdrop, the present study was conducted to investigate the prescribing pattern in orthopedics OPD in a tertiary care medical college India using WHO suggested prescribing indicators. [9]Studies on the utilization of drugs in the orthopaedics department are lacking in hospitals in India.Such studies are necessary to obtain baseline data on drug use and create a database for comparison with future studies.Hence, to give continuation to the effort of promoting Rational Use of Drugs (RUD) we have planned the present study.This study is aimed at assessing the drug prescribing trends in inpatients of orthopaedics department and recommend changes to improve prescribing pattern, if required.

MATERIALS AND METHODS
This prospective observational study was conducted for a period of three months from November 2023 to January 2024 in Navodaya Medical College Hospital & Research Centre (NMCH & RC) Raichur.Permission was obtained from Institutional Ethics Committee of Navodaya Medical College Hospital and Research Centre.The study was approved by the committee by issuing ethical clearance certificate.Data Collection : Data was collected using data entry form, case sheet.The data were documented in a predesigned case record form.It comprised patient demographics, clinical diagnosis, duration of hospital stay, and details on drugs prescribed which included total number of drugs prescribed, name and group of drugs, route of administration, number of antibiotics prescribed, number of fixed-dose combinations (FDCs), generic names of drugs (from Indian drug review 2015), and whether present in national list of essential medicines (NLEM, 2015) or not.

Inclusion Criteria:
Patients of all ages and both sexes were included.Exclusion Criteria: Those patients who were later admitted in wards of orthopedics department/other referred patients to orthopedics department by other departments Sample Size: After applying inclusion & exclusion criteria, 100 patients were selected for this prospective observational study in the year.Demographic data was then entered in pre decided forms.A specially designed structured data entry format was used to enter all patient details.Provision is given in the format to enter investigations like diagnosis, drug therapy problems, comorbidities, drugs prescribed, drug interactions and any interventions.The information obtained from case files about study participants were kept confidential and only the collected data was processed.Based on the responses obtained, data were analysed.The data from the study were analyzed using descriptive statistics namely total numbers, percentage and mean.Microsoft excel and word were used to generate graphs, tables and results etc.

Statistical analysis:
The analysis was carried out by descriptive statistics using SPSS Version 20.The results are expressed as mean ± standard deviation, frequency, or percentages as applicable

RESULTS AND DISCUSSION
There were more male participants 73.16% (n=73) compared to the female group 26.84% (n=27).More patients were from the age group >60 years 25.70% (i.e.20 males and 6 females).There were 23.08% patients from age group 21-30 years and the least from the age group <20 years 11.62% (i.e. 10 male and 1 female patients).A total of 1216 drugs were prescribed.A brief description of the demographic data is presented.This is a prospective observational study conducted for 3 months, in Department of Orthopedics, at Navodaya Medical College Hospital and Research Centre, Raichur.A total of 100 prescriptions were observed during the study period.A total of 1216 drugs were prescribed.It was observed that majority of patients were in the age group of >60yrs followed by 23.08% patients from age group 21-30 years.A greater proportion of older persons have been also seen in patients in previous studies done in northern India. [10]A possible reason could be the high proportion of old people develop age related bone changes which make them prone to fractures after trivial trauma.The next peak in age group of 21-30 years may be because this age group is more active and communicating therefore there are more chances for them to meet accidents.Sex wise distribution of patients shows that male patients (73 out of 100) were found more than females (27 out of 100) in this study.This may be due to male dominance in society, as they are involved in outdoor activities and are earning members of the family, thus they are more exposed to trauma.The most common diagnosis in our study, for which patients admitted was Fracture of different parts of body.The commonest indications were low back ache and spondylosis in study done in Nepal. [4]This may be because only out patients were included in their study.The low rate of prescribing of essential drugs is a matter of concern.Excessive use of multivitamin and combination preparations may be one of the factors responsible.It must be noted though that Essential drugs are primarily meant for primary healthcare systems while we studied drug utilization in a tertiary care hospital.Prescribing from WHO List was even lower (32.46%).The extensive use of the Diclofenac, which is not on the WHO list, may be contributory factor.Prevalence of Analgesics (NSAIDs) was 25.25% which is same when compared to various other studies done in urban setup, which has showed varied Analgesics (NSAIDs) prevalence pattern.In St. John's Medical College and Hospital Bangalore, frequency of Analgesics (NSAIDs) prescription was 24.52%.Similarly, study done in Dubai showed 23.4% of Analgesics (NSAIDs) prescription prevalence.However, study done in Raichur showed very less Analgesics prescription prevalence (14%). [12]NCLUSION This study exposes a deficient level of rationality in the prescription patterns.It is crucial to establish clear standards for drug prescriptions and devise effective strategies to ensure adherence to these standards.Particularly, addressing issues like irrational polypharmacy and prolonged durations is imperative.One approach to tackle this is by making it obligatory for prescribers to regularly participate in Continuing Medical Education (CME) programs, ensuring they stay updated on current knowledge.CME should focus on instilling awareness about appropriate drug usage, potential adverse effects, and adherence to standard prescription guidelines, contributing significantly to rational drug prescriptions.Controlling the influence of pharmaceutical companies within healthcare institutions is essential to minimize their impact on drug prescriptions.Implementing these measures will significantly contribute to providing patients with optimal, affordable, and efficacious medications.

ACKNOWLEDGEMENT
Authors take it as a privilege to acknowledge Medical superintendent, physicians, nursing staffs and other • Email: editor@ijfmr.comIJFMR240319961 Volume 6, Issue 3, May-June 2024 7 healthcare professionals for their support during the study

CONFLICT OF INTEREST
The author declare no conflict of interest

Table 3 : Prescribing indicators Prescribing indicators
Data of all the 100 patients was collected and analysed for the Prescribing Indicators.Total 1216 drugs were prescribed in 100 prescriptions.Average number of drugs per prescription was 7.34.Average duration of prescription was 9 days.Percentage of drugs prescribed by generic name was 29.7%.Percentage of encounter with an Antibiotic prescribed was 60.23% i.e. out of 100 prescriptions antibiotics were prescribed in 60.Percentage of encounter with an Injection prescribed was 63% which means out of 100 prescriptions, injectables were prescribed in 63.Percentage of drugs prescribed from National Essential Medicine List was 51.63%.Percentage of drugs prescribed from WHO model List was 33.46%.Analysis of antibiotic use Total number of antibiotics prescribed were 106.Antibiotics were prescribed in 60 patients.Out of which 37 patients (37%) of them were prescribed two antibiotics.Four antibiotics in 3 patients (3%) have been prescribed and single antibiotic in 20 patients (20%).Average number of antibiotic per patient was 2.3 and average duration of antibiotic prescription is 7.8 days.Analysis of analgesic useTotal number of Analgesics prescribed were 165 which is 14% of total drugs.Average number of analgesics per prescription was 1.65 drugs per prescription.Incidence of polypharmacy was quite high in context of Analgesics.Almost 20% of prescriptions had 2 drugs, 23% had 3 drugs and 4% had >3 drugs prescribed.Orally prescribed Analgesics were 62.6%, Injectables 34.38% and Topical 3.02%.Analgesics prescribed as FDC were 35.8%.Prescriptions with two or more oral preparations were 28.68%.Gastro protective Agents were coprescribed in all instances to reduce or prevent the gastrointestinal irritation caused by NSAIDs.