Around 10% doctors’ prescriptions carry unacceptable deviations 

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Evaluation of prescriptions from tertiary care hospitals across India for deviations from treatment guidelines

Around 10 per cent of prescriptions from tertiary care and teaching hospitals analysed had “unacceptable deviations” such as inappropriate prescription of medications or more than one diagnosis. The overall prevalence of deviations found was 45 per cent of which unacceptable deviations was estimated to be 9.8 per cent, as per a study.

The study “Evaluation of prescriptions from tertiary care hospitals across India for deviations from treatment guidelines & their potential consequences” analysed 4,838 prescriptions which was published in the Indian Journal of Medical Research (IJMR).  It was a cross-sectional observational study conducted by ICMR from August 2019 to August 202 in the outpatient departments of tertiary care hospitals in India wherein the 13 Indian Council of Medical Research Rational Use of Medicines Centres (RUMCs) are located including Delhi AIIMS and Safdarjung Hospital.

A total of 7800 prescriptions were collected and 4838 prescriptions were analyzed from 13 RUMCs as per the protocol. The prescriptions collected were from all the zones, north – 2879, south – 778, west – 881 and east-300. All the prescribers were postgraduates in their respective disciplines and on average were in practice for 4-18 yr.

Of the 4838 prescriptions assessed, about one tenth of them (475) had unacceptable deviations, as per the study. A total of 2968 (61.34%) prescriptions were found as complete, of which 2667 prescriptions were appropriate and in accordance with guidelines. Out of total analysed prescriptions, 2171 had deviations of which 475 (21.9%) had unacceptable deviations with pantoprazole, rabeprazole+domperidone and oral enzyme preparations as the most frequently prescribed drugs and upper respiratory tract infection (URTI) and hypertension as most common diseases with unacceptable deviations, said the study. Of the 475 prescriptions that had deviations, 102 had stated more than one diagnosis and in some of them drugs were prescribed inappropriately.

The study underlined that the most common drug prescribed inappropriately in the prescriptions with unacceptable deviations was pantoprazole. The potential consequence of the unacceptable deviations reported by the clinician was increased cost of treatment, it said. A deviation that could result in a drug interaction, lack of response, increased cost, preventable adverse drug reaction (ADR) and/or antimicrobial resistance was labelled as an ‘unacceptable deviation’.