AbstractBackground: The inappropriate use of multiple medications, known as polypharmacy, is a growing concern for the elderly population in India, who are often prescribed multiple medications due to comorbid conditions. This can lead to serious adverse health outcomes, increased healthcare costs, and reduced quality of life. Screening tools, such as the Medication Appropriateness Index (MAI) and the STOPP/START criteria, can help identify potentially inappropriate medications (PIMs), and interventions, such as medication review clinics and prescribing audits, can help improve appropriateness. Collaborative medication review (CMR) involving a team approach is important to ensure that patients receive the best possible care. However, the cost of these interventions remains a concern, especially in countries where healthcare spending is high for the elderly population. Methods: This study will be conducted in 5 phases, where phase 1 involves developing a scoping review on CMR practices, followed by phase 2, which involves the drafting of SOPs to formulate the CMR team in the Indian context, defining their individual roles and responsibilities, the constitution of the CMR team, and training of the CMR team; phase 3 will assess the efficacy of CMR via standardized tools such as the MAI and STOPP/START criteria; and phase 4 will assess the challenges and barriers in the implementation of collaborative medication review (CMR) in the Indian health care setting. The final phase, phase 5, will evaluate the costs incurred in the implementation of CMR from a health system perspective. The study design will be a multicentred mixed-method study, where the qualitative component will assess the feasibility of collaborative medication review via in-depth interviews and focused group discussion to explore the challenges in the implementation of interdepartmental collaborative medication review to reduce PIM use in hospitalized elderly patients. The quantitative component of the study will be a quasi-experimental pre- and postinterventional study involving 280 hospitalized elderly participants' prescriptions from the admission day until 30 days post discharge by the CMR team members to estimate the costs incurred for the implementation of CMR in healthcare settings from the health care provider perspective and a reduction in the percentage of potentially inappropriate medications using the STOPP/START criteria, the medication appropriateness index (MAI) and post discharge adverse events. The assessment tool for hospital admissions related to medications-10 (AT-HARM10) will be used to identify hospital admissions related to medications. Discussion: The findings of this study provide valuable insights into the implementation and effectiveness of CMR in the Indian healthcare setting. This study helps to understand the facilitators of and barriers to implementing interdepartmental collaborative medication review (CMR) and the cost incurred in its implementation from a healthcare provider perspective in an Indian healthcare setting. Healthcare professionals from different departments or disciplines work together to review the medication needs of elderly patients, who more commonly suffer from multiple chronic conditions. This approach addresses the challenges of managing multimorbidity in India, such as professional isolation, inadequate guidelines and evidence-based medicine, and barriers pertaining to shared decision-making by treating clinicians. The collaborative medication review process allows for a more comprehensive and coordinated approach to medication management, potentially improving patient outcomes and reducing healthcare costs. Trial registration: The study has been registered with the Clinical Trials Registry–India (CTRI/2024/06/069220) registered on 19/06/2024.
Background: Diabetes is emerging as a major health care problem especially in developing countries. Adhering to the WHO indicators and judicious use of anti-diabetic drugs will be a promising step in health care system.Objective: To analyse the prescribing pattern of anti-diabetic drugs in a tertiary care hospital.Materials and Methods: A retrospective, cross-sectional study was done for six months in the Medical Records Department, Pondicherry Institute of Medical Sciences. The data was analysed using WHO core indicators and expressed as descriptive statistics.Results: The total number of encounters surveyed was 600. Present study found that the average number of drugs prescribed per encounter was 5.15. Percentages of drugs prescribed by generic name was found to be 25.37%, antibiotic drugs 22.66% and injections 20.5%. Drugs prescribed from an Essential Drug List (EDL) was 74.30%.
The oral bioavailability of cefuroxime axetil is enhanced by food. This study was done to compare the effect of two types of Indian breakfast on the bioavailability of cefuroxime axetil in healthy volunteers.Eight healthy male volunteers participated in the crossover study. Subjects were randomized to receive either one of the two types of breakfast, Diet-A or Diet-B, 10 min before single dose of 500 mg cefuroxime axetil. After a washout period of one week the study was repeated with the other type of diet. Diet-A included idly with chutney. Diet-B included poori and dal-fry. Blood samples for pharmacokinetic analysis were obtained prior to dosing and at 0.25, 0.50, 0.75, 1.0, 1.5, 2.0, 2.5, 3.0, 4.0, 5.0, 6.0 and 8.0 h following dosing and urine collections were done for 8 h. The serum and urine samples were assayed by using HPLC.The AUC and Cmax were significantly increased after oral administration of cefuroxime axetil with Diet-B, when compared to Diet-A (P < 0.01 and P < 0.02 respectively). The values of apparent absorption rate constant, lag-time, Tmax and t1/2 beta for the two regimens were not significantly different. The volume of distribution and plasma clearance for cefuroxime were significantly lower (P < 0.02, P < 0.001 respectively) in the regimen with Diet-B. The 8 h urinary recovery of cefuroxime was 16.59 and 28.44 per cent (P < 0.005) with Diet-A and Diet-B respectively.The administration of cefuroxime axetil with poori and dal-fry may enhance the bioavailability when compared with idly and chutney.
Background: To investigate the prevalence of potentially inappropriate medications (PIMs) using updated Beers criteria 2012 and drug utilization study among the elderly patients attending the various outpatient departments (OPDs) of a tertiary care hospital at Pondicherry in India.Methods: This prospective, observational study involving patients aged 65 years and above, was planned and conducted over a period of six months, who attended the various OPDs were included in the study. Prescriptions were collected from the consulting rooms and pharmacy.Results: A total of 600 patients aged 65 years and above were involved in our study. Majority (61.83%) were in the age group of 65-70 years. There was a male preponderance (61.83%). Total of 1769 drugs were prescribed, giving an average of 2.98 drugs per person (range 1 to 9). Polypharmacy (≥ 5drugs) were observed in 99 patients. Of the total 748 disease conditions, cardiovascular diseases were the most prevalent (29.33%) among the elderly patients. Almost 114 patients had comorbid conditions. General medicine department was the highest (28.83%) visited patients. Frequently prescribed drugs belong to the category of analgesic and anti-inflammatory agents (16.50%). Fixed Dose Combination (FDC) was 31%. Almost 110 patients received PIMs from Beers list; majority were belonging to category 1. NSAIDs (30.66%) were the highest PIMs prescribed to musculoskeletal disorders. With regard to WHO indicator, 377(21.31%) drugs were prescribed by generic name. Utilization from Indian national list of essential medicine was 76.82%. Percentage of encounters in which an antibiotic and injections was prescribed to 23.5% and 26.33% respectively.Conclusions: Study has shown the prevalence of disease pattern, comorbidity, drug usage in elderly. PIMs, polypharmacy and FDC were high among the elderly. Prescribers need to be educated about Beers criteria and encouraged for rational prescription.
Background: Antimicrobials are one of the most commonly used group of drugs. Their overuse and inappropriate use is one of the major concerns today. Assessment of prescribing pattern of antimicrobials provides insight into the health consequences and helps update antimicrobial usage guidelines. Hence this study was conducted with an objective to analyse the prescribing pattern of the antimicrobials.Methods: A cross sectional study was conducted based on the prescriptions collected from Department of Pharmacy, Pondicherry Institute of Medical Sciences (PIMS), Puducherry. A total of 838 outpatient prescriptions were collected from four clinical departments, viz. General Medicine, General Surgery, Pediatrics and Obstetrics & Gynecology for a period of four months. The data collected were analysed using descriptive statistics.Results: Among 838 prescriptions 188 (22.43%) contained antimicrobials. Among the various departments, number of prescriptions with antimicrobials were more in department of General surgery (34.42 %) followed by Obstetrics & Gynecology (24.77 %). The commonly prescribed antibiotics were penicillins (25.47%), fluoroquinolones (12.73%), cephalosporins (10.84%), macrolides (8.96%), nitroimidazoles (6.60%) and tetracyclines (4.71%). Among the total antimicrobials, percentage of drugs prescribed by generic name and from National list of essential medicines (NLEM) were 38.20% and 80.18% respectively. Majority of antimicrobials (58.01%) were prescribed as oral tablets/ capsules.Conclusions: It was found that penicillins were the most commonly prescribed group of antimicrobials, significantly less number of antimicrobials were prescribed by generic name, 80.18% of antimicrobials were prescribed from NLEM and tablets/ capsules were the most common dosage forms.
Background: Iron deficiency anemia (IDA) is a major nutritional problem globally, which is especially true in the developing countries like India. Even though the treatment is simple and effective, there is a high prevalence of IDA. The reason for this is partly due to non-compliance of the patients and partly due to ineffective or incomplete treatment by the physicians. Hence, the present study was done with the objective to study the treatment pattern in patients with IDA.Methods: This retrospective observational study was conducted in the Medical Records Department, Pondicherry Institute of Medical Sciences (PIMS), Puducherry for a period of 1-year with a sample size of 100 patients. Patients of all ages and either sex diagnosed to have mild to severe IDA were included in the study. The following data like: demographic details, hemoglobin, drugs used to treat the anemia, duration of treatment were obtained. The data will be presented as descriptive statistics.Results: Out of the 100 patients scrutinized 57% had severe IDA, 39% moderate IDA, and 4% had mild IDA. Of the 100 patients, 71% were females and 29% were males. For 14% of the patients, no treatment was given and for 19% of the patients treatment was given but the duration of treatment was not mentioned.Conclusions: The results of the present study showed that majority of the patients with IDA did not receive the recommended WHO treatment. The present study shows that even though the treatment of a common nutritional disorder-IDA is simple and effective, the prevalence of the same is high, and the majority of the patients are being undertreated. Patients should also be educated about the implications of the disorder and the importance of its treatment.
Aim: To evaluate the anti-nociceptive activity of Emblica officinalis using acetic acid induced writhing test and eddy’s hot plate method in mice and to investigate the role of opioid receptors in the central anti-nociceptive activity of Emblica officinalis. Materials and Methods: Peripheral analgesic activity of Emblica officinalis was evaluated using acetic acid induced writhing test. Indomethacin (10 mg/kg, p.o) was used as the standard drug and Emblica officinalis was used at a dose of 300 mg/kg, p.o. Central anti-nociceptive activity of Emblica officinalis was evaluated using eddy’s hot plate method. Morphine (5 mg/kg,i.p) was used as the standard drug and Emblica officinalis was used at a dose of 300 mg/kg, p.o. To assess the role of opioid system, the other groups of animals were pretreated with μ opioid receptor antagonist (CTAP-1 mg/kg, i.p), δ opioid receptor antagonist (Naltrindole-1 mg/kg, i.p) and κ opioid receptor antagonist(Nor-Binaltorphimine-1 mg/kg,i.p) and then treated with vehicle/Emblica officinalis. Results were analysed using one way ANOVA followed by Tukey’s multiple comparison test. p value of
The aim was to study and compare knowledge, attitude and practices regarding self-medication in healthcare and nonhealthcare university students.Suitably constructed, structured and pretested questionnaires were distributed to 350 students in each group; data were documented in SPSS software version 20.0 and analyzed using χ2-test and multivariate logistic regression analysis.Completed questionnaires only were analyzed, which were 314 and 310 in healthcare and nonhealthcare groups, respectively. The majority of students practiced self-medication (84.4% vs. 68.1%; p<0.001) with the most common indications being fever (46.4% vs. 37.9%; p<0.001) and cough and common cold (30.9% vs. 37%; p=0.004). Most commonly self-medicated drugs were antipyretics (67.9% vs. 52.6%; p=0.03) and multivitamins (28.7% vs. 16.8%; p<0.001). A few of them experienced adverse drug reactions due to self-medication (6.8% vs. 1.9%; p<0.001). Independent risk factors for self-medication were younger age group (OR=2.93, CI 95% 1.09-7.85), storage of medicines at home (OR=2.49, CI 95% 1.21-5.12), healthcare students (OR=2.54, CI 95% 1.72-3.74), higher knowledge scores (OR=1.65, CI 95% 1.08-2.52), those consuming homeopathic preparations (OR=9.19, CI 95% 1.24-68.11), multivitamins (OR=6.7, CI 95% 2.88-15.6) or health supplements (OR=6, CI 95% 2.15-16.74), participants who strongly agreed that self-medication is a part of self-care (OR=3.97, CI 95% 1.56-10.09), and those self-medicating with an old prescription for same illness (OR=0.04, CI 95% 0.01-0.15) or over advice from home (OR=0.11, CI 95% 0.04-0.3).Though self-medication is common in university students, there is a dearth in their knowledge regarding the same. This highlights the need for increasing awareness among students regarding hazards of self-medication.
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