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Indian Journal of Community Medicine

Prescribing Pattern Among Medical Interns at the Rural Health Centres of a Medical College, Manipal, Karnataka

Author(s): R. R. Pati

Vol. 29, No. 3 (2004-07 - 2004-09)

Abstract

Objectives: To study the pattern of drug prescription and consultation among medical interns and to identify prescribing errors.

Study design: Cross-sectional.

Setting: Rural health centers attached to Kasturba Medical College, Manipal.

Participants: Interns posted at the rural health centers.

Statistical analysis: Mean, standard deviation, percentages.

Results: The average consulting time was seven minutes. The number of drugs prescribed for each patient ranged from zero to seven with a mean of 2.7 (SD 1.29). The most commonly prescribed drugs were haematinics and vitamins. Out of 827 drugs prescribed, 56 drugs (6.7%) were prescribed either in wrong doses or their doses were not written at all.

Conclusion: The promotion of optimal drug prescribing and safe drug use should be emphasized during the internship and medical interns should only prescribe under direct supervision and guidance of their teachers and they should not be working independently.

Key words: Prescribing pattern, Medical interns, Rural health center

Introduction

The quality of health care, particularly the rational use of drugs, depends on many activities, such as making the correct diagnosis, prescribing the appropriate drugs in correct doses and dispensing them properly. Reports on drug prescription from a few developing countries including India indicate that the general pattern is of polypharmacy, frequent use of vitamins and wrong medications1-3. Inappropriate treatment is also common.

During internship, the medical graduates prescribe drugs and provide patient care under the guidance of their teachers. This is the period when they should form the habit of correct methods of prescribing appropriate drugs in correct doses. They should be encouraged to prescribe essential drugs. This study was undertaken in eleven rural health centers attached to medical college in Manipal, Karnataka, where medical interns provide health care under guidance. The aim of this study was to assess the pattern of drugs prescribed and to identify prescribing errors using WHO indicators4. The consultation time and time taken to dispense drugs for each patient were also noted.

Material and Methods

The present study was carried out in eleven rural health centers attached to the Department of Community Medicine, Kasturba Medical College, Manipal, Karnataka. These health centres are located in eleven different villages and are within fifteen miles from the medical college. Batches of interns visit each of these clinics once a week on a fixed day accompanied by a faculty member from the Department of Community Medicine and provide outreach services to the villagers. A cross-sectional descriptive study was conducted over a period of three months from May to July 1999.

Prospective data on the quality of patient care was collected by observing the consultation and examination of the patients. Observations were made in the consultation room without interrupting normal activities. Consultation time was taken to be the time of conversation between the patient and the intern. Once the patient was examined and prescribed drugs, his/her file was checked to see if the diagnosis was written properly or not and also to find out if the drugs given were appropriate for the patient's condition. Then the patient was followed to the drug dispensing counter. The time taken to dispense the drugs was noted and the prescription was analyzed. Details of drugs were entered on a previously prepared proforma. For each prescription, the name and the amount of the drug prescribed and its daily dose was recorded in the presence of the patient. If any error was found in the medication prescribed by the interns, the prescribing intern was consulted and the error corrected. A total of 300 prescriptions were thus analyzed.

Results

The average consulting time per patient was seven minutes. The number of drugs prescribed per patient ranged from zero to seven with a mean of 2.76 [SD 1.29]. The pattern of prescrptions is shown in Table II. Haematinics and vitamins were the most commonly prescribed drugs followed by analgesics.

Table I : Number of Drugs Prescribed Per Patient.

No. of drugs
per prescription
No. of prescriptions*
0 8 (2.6)
1 40 (13.3)
2 83 (27.6)
3 90 (30.0)
4 53 (17.6)
5 19 (6.3)
6 5 (1.6)
7 2 (0.6)
Total 300

* Figures in parentheses are percentages.

Table II : Pattern of Drugs Prescribed

Drugs No. (%) of total Prescription % of total days
Haematinics & vitamins 119 (66.3) 24.1
Analgesics 119 (39.6) 14.4
Antihypertensives 105 (35.0) 12.7
Cough syrup 82 (27.3) 9.9
Calcium 80 (26.6) 9.7
Anti-inflammatory drugs 37 (12.3) 4.5
Antipyretics 24 (8.0) 2.9
Antihistaminics 23 (7.6) 2.8
Antacids 15 (5.0) 1.8
Antibiotics 12 (4.0) 1.4
Other 131 (43.6) 15.8
Total 827 100

Out of a total of 827 drugs prescribed only 133 (16%) were prescribed using their generic names. The diagnosis was either not written or improperly written on the patient's file in fifteen cases (5%). In 56 cases (18.7%) either the dose of a drug was not written or wrong doses were written. The medicines given were not appropriate for the patient's condition in eight (2.7%) instances. All the drugs prescribed were included in the essential drugs list published by the WHO5. The average dispensing time was 42 seconds.

Discussion

The average consultation time (7 minutes) was adequate. All the patients were examined thoroughly by the interns. The mean number of drugs prescribed per patient (2.76) was comparable with the findings of studies from C.M.C. Vellore (2.4 drugs) and Pune (2.8 drugs)2,6. However in the study reported by A.B. Guyon et al7 from Bangladesh, the mean number of drugs prescribed per patient were only 1.447.

In the present study, haematinics and vitamins were the most commonly prescribed drugs followed by analgesics, antihypertensives, cough syrup, calcium tablets and anti-inflammatory drugs. A drug survey by Krishnaswamy et al has listed nutritional products, sulfonamides, antibiotics, analgesics and anti-inflammatory drugs to be the most frequently prescribed drugs8. In the present study, antibiotics were prescribed to only 4% of the patients. This is much lower than the figures reported from other studies4,5. In our study, most of the patients coming to the rural clinics were above the age of 40 years. Their common problems were weakness, osteoarthritis, hypertension and cough and cold. That may explain the frequent prescription of vitamins, analgesics, antihypertensives and cough syrups. Haematinics and vitamins were prescribed to 66% of the patients. This was rather high. Unnecessary overuse of multivitamins increases the cost of treatment and should be discouraged.

Essential drugs are distributed to patients free of cost in these rural clinics. Each intern is given a list of these essential drugs and advised to prescribe essential drugs. So, all the 827 drugs prescribed were essential drugs. However, only 16 percent of the drugs were prescribed in their generic names. Out of 827 drugs prescribed, 56 drugs (6.7%) were prescribed either in wrong doses or their doses were not written at all. In eight instances, the drugs, prescribed, were inappropriate for the patient's disease. These observations emphasize the importance of training of interns on how to prescribe drugs properly.

The promotion of optimal drug prescribing and safe drug use should be emphasized during the internship when medical students learn and practice prescribing and should be continued throughout their professional career in the form of continued medical education.

References

  1. Shekhar C, Raina K, Pillai K. Some aspects of drug use in Ethiopia, Trop Doct 1981; 11: 116-18.
  2. Rashid MV, Chowdhury SAR, Islam N. Pattern of antibiotic use in two teaching hospitals. Trop Doct 1986; 16: 152-54.
  3. Kshirsagar MJ, Langade D, Patil S, Patki PS. Prescribing pattern among medical practitioners in Pune, India. Bull World Health Organ 1998; 76(3) : 271-5.
  4. Hogereil HV, Bimo, Ross Degnan D, Laing RO. Field tests for rational drug use in twelve developing countries. Lancet, 1993; 342: 1408-10.
  5. World Health Organization. Model list of essential drugs. Geneva. World Health Organization, 1988.
  6. Kuruvilla A, George K, Rajaratnam A, John KR. Prescription pattern and cost analysis of drugs in a base hospital in South India. Natl Med J India. 1994; 7(4) : 167-8.
  7. Guyon AB, Barman A. A baseline survey on use of drugs at the primary health care level in Bangladesh. Bull World Health Org. 1994; 72(2) : 265-71.
  8. Krishnaswamy K. Dinesh Kumar D. Radhiah GA. A drug survey - precepts and practices. Eur J Clin Pharmacol 1985; 29: 363-70.

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