UTILIZATION OF SELECTED NON STEROIDAL ANTI-INFLAMATORY DRUGS IN RURAL TERTIARY TEACHING HOSPITAL

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• UTILIZATION OF SELECTED NON STEROIDAL
  ANTI-INFLAMATORY DRUGS IN RURAL TERTIARY TEACHING
  HOSPITAL
• REVATHI P , ARBIND KC,
  BALASARASWATHI T, MANICKAVASAGAM S,
  
• 
  THIRUMALAIKOLUNDUSUBRAMANIAN P
• DEPARTMENT OF PHARMACOLOGY, CHENNAI MEDICAL
  COLLEGE HOSPITAL RESEARCH CENTRE (SRM GROUP),
  IRUNGALUR, TIRUCHIRAPALLI-621 005.
• Correspondenceltreva1923_at_yahoo.comgt

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INTRODUCTION

• The World Health Organization (WHO)
• addressed drug utilization(DU) as-
• the marketing, distribution, prescription and
  
• use of drugs in a society, considering its
  
• consequences, either medical, social, and
• economic.

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• DU- aim to evaluate factors related to the
• prescribing,
• dispensing
• administering
• taking of medication and
• its associated events
• (either beneficial or adverse).
• DU studies are an evolving area.

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• a valuable resource in pharmacoepidemiology
• builds bridge with other health related areas,
• such as-4 Ps
• public health,
• pharmacovigilance eco-pharmacovigilance
• pharmacoeconomics,
• pharmacogenetics.

IMPORTANCE OF DU STUDIES
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IMPORTANCE OF THIS DU STUDY

• Health budgeting
• Purchase of medicine
• Designing areas for CMEs
• Monitoring a mean for surveillance activity
• Improve quality of prescription rational use of
  drugs

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• NSAIDs are among the most commonly prescribed
  categories of drugs worldwide in the treatment of
  pain and inflammation in many conditions.
• Irrational prescriptions availability of the
  NSAIDs as over-the-counter (OTC) products has
  made NSAIDS as a widely misused and abused drug.
• Moreover, their use is not always without severe
  adverse effects.

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS(NSAIDs)
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• To find out the utilisation of NSAIDs(oral form)
  in a rural tertiary teaching hospital
• To identify the preferred group of NSAIDs
• To elicit seasonal variation.

OBJECTIVES
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• Research Design - A retrospective Study
• Period of study - September 2009 to August
• 2010
  (12months)
• Place of study
• Department of Pharmacology Pharmacy,
• Chennai Medical College Hospital Research
  Centre (SRM Group), Irungalur Tiruchirapalli,
  India
• Institutional ethical clearance obtained

MATERIAL METHODS
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• Computer registries are used for collecting
  information on drug utilization.
• Institutional prescriptions entered in the
  computer over a period of 12 consecutive months
  were retrieved and analysed in relation to NSAIDs
  and season.
• Limited formulations of NSAIDs (Group I, II and
  IV) were available at the store uninterruptedly

MATERIALS
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• INCLUSION CRITERIA
• Prescriptions of adult Patients of NSAIDs (oral
  forms) were included in this study.
• EXCLUSION CRITERIA
• Paediatric preparations were not excluded
• Statistical analysis Data were analyzed by
  simple descriptive statistics

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• Group1 Selective COX1 inhibitors Low dose
  aspirin
• Group2 Non-selective COX inhibitors High
  dose aspirin,
• diclofenac, ibuprofen,
  Indomethacin , Mefenamic
• acid, naproxen,
  paracetamol, piroxicam
• Group3 Selective COX2 inhibitors Ketorolac,
• meloxicam, nabumetone,
  nimuselide
• Group4 Highly Selective COX2 inhibitors
  Celicoxib,
• rofecoxib
• - Group III were not used in this
  hospital

CLASSIFICATION OF NSAIDs
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DISTRIBUTION OF PATIENTS PRESCRIPTION ON
NSAIDs
RESULTS
.
. .
s
S
used
used
.
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Fig.1- UTILIZATION OF NSAIDs IN
Group1-COX1 selective, Group3-
Selective COX2,
Group2-Non-selective, Group4 -
Highly selective COX2 agents.
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SEASONALITY USE OF NSAIDS
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Utilization of NSAIDs in a tertiary care hospital
. .
.
.
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Fig-2 UTILIZATION OF NSAIDs IN GROUP II()
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DISCUSSION

• Tertiary level hospitals are chosen in general
  for DU studies, because the prescribing pattern
  of the outpatient departments of tertiary level
  hospitals are often copied by community
  practitioners and health workers.
• However overall DU of NSAIDs among all the
  departments of hospitals can not be considered as
  rational, though we recommend and insist on RUDs.
  
• Analysis of feedback from prescribers are
  essential for proper utilization of NSAIDs

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• In our hospital generic formulations were
  purchased provided. However, doctors continue
  to write brand name, hence there is a need to
  reorient prescribers.
• 60 of prescriptions were made during winter and
  late winter months (September to March) and the
  rest were distributed almost equally in the
  remaining of 6 months.

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STRENTHS LIMITATIONS OF THE STUDY

• STRENGTHS Computer based data and hence no
  missing of data.
• LIMITATIONS
• Non inclusion of injectable formulations
• Non inclusion of paracetamol syrup
• Analysis in relation of Departments, individuals,
  disease/ illness, age group and institutional
  policies for purchase were not made
• Adverse effects of NSAIDs were not studied

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• 2 out of 3 prescription carried one or other
  NSAIDs
• Group II drugs were most frequently prescribed
  and were in the order of paracetamol, diclofenac
  and ibubrufen
• 60 of prescriptions were made during rainy
  seasons, winter and late winter months (September
  to March) More preferred combination is
  paracetamol ibubrufen
• Seasonal variation correlated with morbidity
  pattern observed in this institution.

CONCLUSIONS
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RECOMMENDATIONS

• Orientation programmes to prescribers on the
  cautious aspects of NSAIDs as many patients had
  comorbid illness.
• Awareness programmes to patients care givers
  on adverse effects
  

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AREAS FOR WORK

• Analysis with references to patients, illnesses,
  prescribers formulations
• Questionnaire survey to elicit preferences and
  knowledge improvement programmes
• ADR monitoring among those received NSAIDs
• Analysis of NSAIDs self medicated
• Interdepartmental programmes for RUD

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• Frolich JC. A classification of NSAIDs according
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