Prescription pattern study of drugs in Orthopedics Outpatient department (OPD) of a Rural Medical College Hospital & Research centre in MP

Background: The aim of this study was to study the level of the WHO drug use indicators and drug prescription indicators in the OPD of orthopedics department and find out the rationality of use of various drugs. Materials & Methods: An observational, prospective, descriptive, study of prescription patterns of 200 patients for six months duration in 2013 was done. Patients demographic details were noted on predesigned forms downloaded from WHO website. Considering WHO indicators of drug utilization & prescription indicators, Generic name and cost of the drugs were evaluated using Indian drug review 2014. NLEM 2011 was used. Results: Of the 200 patients, 60.2% were male and 39.8% females. About 70.7% patients coming to OPD are senior citizens having Cold orthopedics causes like  low back pain, cervical & lumbar radicular pain, Rheumatoid ,Gouty arthritis, stiffeness of joints, Cervical Spondylities, Osteoporosis etc. requiring mainly medicines only. Around 29.3% patients were fractures related complications. Analgesics(39.6%), NSAID, Tramadol plus Paracetamol fixed drug combinations, Diclofenac, Aceclofenac, Piroxicam were the most common. Average drugs per prescription were 5.1. Polypharmacy is the rule. Analgesics(39.6%) were used in most of the cases. Second were peptic ulcer prevention drugs(20.2%). Third were anti-microbials(19.6%). Around 98% drugs were branded. NLEM drugs were 84% were from essential drug list. Oral route was common in 99%. Injectables were less than 1%. Topical gels containing Diclofenac, Methyl Salicylate, transdermal Fantanyl are used in inflammatory conditions. Senior citizens 20.2% were already receiving anti-hypertensives and anti-diabetics, anti-gout drugs anti-anginal, Glucosamines, Vitamin D & Calcium(5.7%) etc. Mean cost of drugs per prescription was Rs. 250 INR. Because of chronic nature duration of drugs was mentioned only in 74%. The frequency of drug administration was recorded in 100% cases. Conclusion: Polypharmacy is the rule, use of generic drugs is also very low, Rational use of drugs must be promoted through regular interaction between pharmacology and orthopedics department. Regular workshops on rational drug use should be organized. There are seasonal variations which need to be further be explored in larger population for longer duration. Keywords: OPD, Rheumatoid arthritis, Gout, Rational, Irrational, NSAIDS. Cold Orthopedics. National model list of essential medicines, NLEM, EDL, DMARDs, Transdermal patches, gels