Drug Utilization Study of Psychotropic Drugs in Outdoor Patients in a Teaching Hospital

Article excerpt

Byline: K. Piparva, D. Parmar, A. Singh, M. Gajera, H. Trivedi

Background: Psychotropic drugs have had a remarkable impact in psychiatric practice. However, their utilization in actual clinical practice, effectiveness and safety in real life situation need continuous study. Materials and Methods: A prospective cross sectional study was carried out for 6 months. Patients of all ages and both sexes were included in the study while in-patients, referred patients and patients of epilepsy were excluded. Using World Health Organization basic drug indicators, the prescribing pattern was analyzed. Results: The numbers of psychotropic drugs prescribed per patient were 2.96. Anti-anxiety drugs (82.83%) were most frequently prescribed psychotropic drugs in various psychiatric disorders. Usage of antipsychotic drugs was in 70.15% cases. Atypical antipsychotic drugs (43.83%) were prescribed more frequently than the typical antipsychotic drugs (26.32%). Prescribing frequency of selective serotonin reuptake inhibitors (36.66%) was more than the tricyclic antidepressant (21.96%) and atypical antidepressant drugs (1.83%) in major depression. Use of mood stabilizers was restricted only to bipolar mood disorders. Central anticholinergic drug was co-prescribed in as many as 88.15% patients receiving antipsychotic drugs. Conclusion: Anti-anxiety drug (Benzodiazepine (BZD)) usage was extensive in various psychiatry disorders. Rational use of BZD requires consideration/attention to dose and duration of usage as well as drug interactions with other psychotropic drugs. Routine use of central anticholinergic drug along with atypical antipsychotic drugs also, could not be justified.

Introduction

The rapidly expanding field of psychopharmacology is challenging the traditional concepts of psychiatric treatment and research, and is constantly seeking new and improved drugs to treat psychiatric disorders. In this way, psychiatrists are continuously exposed to newly introduced drugs that are claimed to be safe and more efficacious. [sup][1] Although psychotropic medications have had a remarkable impact on psychiatric practice that legitimately can be called revolutionary, their utilization and consequences on real life effectiveness and safety in actual clinical practice need continuous study. [sup][2]

Drug utilization study has been defined by the World Health Organization (WHO) as "The marketing, distribution, prescription and uses of drugs in a society with special emphasis on the resulting medical and social and economical consequences." [sup][3] The principle aim of the drug utilization research is to facilitate the rational use of the drugs. Without the knowledge of how the drugs are being prescribed, it is difficult to suggest the measures to improve prescribing habits. [sup][4]

Present study was undertaken to analyze the pattern of drug utilization of psychotropic medications in outdoor patients of psychiatry department of a tertiary care teaching hospital in Jamnagar.

Materials and Methods

A prospective cross sectional study of 6 months duration was carried out in outdoor patients (OPD) of the Psychiatry department of Guru Gobind Singh hospital, Jamnagar. Permission of the Institutional Ethical Committee was obtained for conducting the study. Patients of all ages and both sexes were included in the study. In-patients, referred patients, patients of epilepsy as well as those cases where diagnoses were not certain were excluded from the study. Informed consent was obtained verbally from the patient or legal guardian (when patient was not able to give consent). Patient related information (age, sex, diagnosis) and drug-related information (drugs, dose, dosage form, route of administration) were recorded on a customized data collection sheet. If any clarification was required, the doctors on duty were interviewed. Total 600 cases were analyzed. The WHO drug indicators that were selected to analyze the prescribing pattern included: (1) Average number of the psychotropic drugs prescribed per encounter,

(2) Percentage of the psychotropic drugs prescribed by generic name, (3) Percentage of the psychotropic drugs prescribed from essential drug list, (4) Frequency of psychotropic drugs usage as per indication, (5) Average psychotropic drug cost per encounter. …