|Year : 2013 | Volume
| Issue : 1 | Page : 22-24
A study of prescription writing practices of doctors in medical units in a teaching hospital
G Sudheer1, K Srinivasan2, G Ravi Prabhu3
1 Department of Pharmacology, S.V. Medical College, Tirupati, Andhra Pradesh, India
2 Department of Community Medicine, Government Medical College, Anantapur, Andhra Pradesh, India
3 Department of Community Medicine, S.V. Medical College, Tirupati, Andhra Pradesh, India
|Date of Web Publication||13-Mar-2013|
G Ravi Prabhu
Department of Community Medicine, S.V. Medical College, Tirupati - 517 507, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Background: Prescription order is an important transaction between the physician and the patient. Irrational prescribing is found throughout the world but because of scarcity of funds and resources, assumes increasing importance in the developing countries.
Aim: To find out the elements of prescription writing in a tertiary care hospital.
Settings and Design: Teaching hospital, Tirupati, Andhra Pradesh. The subjects were selected using systematic random sampling design.
Materials and Methods: The study was carried out during January-March 2011 among 180 patients (both out-patient and in-patient) of the medical units.
Statistical Analysis Used: The prescriptions were analyzed using MS Excel and Epiinfo 3.3.4 software and appropriate statistical tests of significance tests applied.
Results: In all cases, prescription was written in lower writing case with a short signature. Although, superscription and transcription was satisfactory, the inscription dose, route, and duration were mentioned only in 52.8%, 33.9%, and 21.7% cases respectively, while subscription was satisfactory in 21.1% only. The prescription was written for inappropriate duration and dose in 78.3% and 47.2%, respectively.
Conclusions: The prescription writing does not conform to the stipulated guidelines in majority of cases.
Keywords: Antibiotics, inscription, prescription, subscription
|How to cite this article:|
Sudheer G, Srinivasan K, Prabhu G R. A study of prescription writing practices of doctors in medical units in a teaching hospital. J NTR Univ Health Sci 2013;2:22-4
|How to cite this URL:|
Sudheer G, Srinivasan K, Prabhu G R. A study of prescription writing practices of doctors in medical units in a teaching hospital. J NTR Univ Health Sci [serial online] 2013 [cited 2020 Apr 4];2:22-4. Available from: http://www.jdrntruhs.org/text.asp?2013/2/1/22/108508
| Introduction|| |
Prescription order is an important transaction between the physician and the patient. It brings into focus the diagnostic acumen and therapeutic proficiency of the physician with instructions for palliation or restoration of the patient's health.  It has been observed frequently that many doctors are adopting the concept of polypharmacy leading to a steep hike in the cost of the treatment as well as adverse drug effects.  Irrational prescribing is found throughout the world but because of scarcity of funds and resources, assumes increasing importance in the developing countries. 
Antibiotics are the most commonly prescribed drugs in most countries of the world including India where it varies from 24% to 67%. Antibiotics account for 15-30% of the health budget in India and constitute over 50% of the total value of drugs sold. The increased and most often indiscriminate use of antibiotics is associated with the development of resistance against many commonly used antibiotics as well as several drug induced adverse effects.  At present, the number of drugs prescribed for each patient is usually more than what is actually required. In most cases, the number of injections prescribed is indeed very large and unnecessary.
In a study in Allahabad, it was found that 85% of the prescriptions were without the basic identification data; subscription was not mentioned in 71%, inscription, transcription and signature were inadequate in 50%, 18%, and 35%, respectively. The average number of drugs prescribed was found to be 5.1. 
In this context, the present study was conducted in out-patients and in-patients in the medical wards of a tertiary care hospital in Tirupati to evaluate the elements of prescription writing.
| Materials and Methods|| |
This study was cross-sectional and conducted in the out-patient units and medical wards (in-patients) of a tertiary care hospital, Tirupati. The study was conducted for duration of 3 months from 1 st January 2011 to March 2011. A total of 180 patients attending the Department of Medicine formed the subjects of study. Half of the required patients (90) were selected by using systematic random sampling technique from the out-patient section while the remaining 90 patients were selected again by systematic random sampling among in-patients. In each month, 30 out-patients and 30 in-patients were selected in 3 working days with an average gap of 10 days. Thus, in each working day, 10 patients were selected separately for outpatient and inpatient section using systematic sampling technique. All the required information from each patient was obtained using a pre-tested questionnaire developed after a pilot study. The data analysis was done using Epi-info 3.3.4 software of CDC, Atlanta, USA.
| Results and Discussion|| |
It was found that among the in-patients, assistant or associate professor prescribed the treatment for the majority of cases (78.9%) while among the out-patients, post-graduates (44.4%) and house-surgeons (43.3%) had prescribed treatment in the majority of cases. In both in-patients and out-patients, the writing case was found to be "lower case" and in majority of the cases, short signature was noticed [Table 1].
|Table 1: Comparison between treating doctor, writing case, and signature between inpatients and outpatients|
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It can be noted that superscription and transcription were written in almost all patients (99.4% and 97.8%, respectively). The inscription dose, route, and duration were mentioned in 52.8%, 33.9%, and 21.7% cases, respectively. The subscription was written only in 21.1% patients [Table 2]. Allahabad study  found similar findings that superscription was not mentioned in 71% of patients while inscription and subscription were deficient in 50% and 18%, respectively.
|Table 2: Comparison of prescription writing between inpatients and outpatients|
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It was found that out of a total of 675 drugs prescribed, generic names of drugs were mentioned for 396 (58.7%) and brand name of drugs was written for 279 (41.3%). Lucknow study  found the proportion of generic drugs prescribed to be 27.1% only. A study in Madurai  however, revealed a lower proportion of brand drugs (3.5%). Around half (48.9%) of patients were prescribed antibiotics. A similar proportion of 42.8% was found in a study in Nepal.  In the present study, at least one injection was prescribed in 42.2% cases [Table 3].
|Table 3: Comparison of type of drugs prescribed between inpatients and outpatients|
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The prescription was written for inappropriate duration, dose, and frequency in 78.3%, 47.2%, and 6.1% cases, respectively [Table 4]. Prescription was given for inappropriate duration in comparatively higher proportion of in-patients while it was for dose and frequency in a higher proportion among out-patients. The study in Pune  found that more than 30% prescriptions were irrational in terms of dose, duration, and frequency.
|Table 4: Comparison of inappropriate elements of prescriptions between inpatients and outpatients|
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Among in-patients, majority (52.2%) of cases were prescribed five or more drugs while among out-patients, majority (29.4%) were prescribed three drugs [Table 5]. The mean number of drugs was found to be 3.8 per patient. The study in Hyderabad  found a lower mean number of drugs (2.2) while the study in Lucknow  has found a comparable number of mean drugs per patient of 3.1. The study in Nepal  found a higher mean level of 5.3 while Allahabad study  found the mean number to be 5.1 being higher in private compared to government sector.
|Table 5: Comparison of number of drugs prescribed between inpatients and outpatients|
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| Conclusion|| |
The present study found that the prescription writing does not conform to the stipulated guidelines in majority of cases. There is a definite overuse of drugs especially, antibiotics and also injections. Hence, there is a need to train the doctors especially, young doctors like house surgeons and post-graduates on the importance of prescription writing with regard to dose, duration, route, and frequency of drug administration.
| Acknowledgments|| |
We thank Dr. K. Indira, Professor of Pharmacology, Osmania Medical College, Hyderabad and Dr. M. S. Sridhar, Professor of General Medicine & Principal, S.V. Medical College, Tirupati for their valuable guidance in this study.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]