Drug utilization
is defined by the World Health Organization (WHO) as the “marketing,
distribution, prescription, and use of drugs in society, with special emphasis
on the resulting medical, social, and economic consequences [1]. A drug
utilization evaluation (DUE) is therefore a study designed to
describe-quantitatively and qualitatively-the population of users of a given
drug or class of drugs and the conditions of their use (for example,
indications, duration of treatment, dosage, previous or associated treatments
and compliance) [2]. Drug utilization evaluation has created a broad arena for
the development of innovative approaches to improve drug use. That is why WHO
has recommended that more recognition and support should be given to Drug
Utilization Studies and related work and governments should be made aware of
the importance of such studies [3]. For the
individual patient, the rational use of a drug implies the prescription of a
well documented drug at an optimal dose, together with the correct information,
at an affordable price. DUE can play a key role in helping the healthcare
system to understand, interpret and improve the prescribing, administration and
use of medications [4,5]. These studies are powerful exploratory tools to
ascertain the roles of medicines in society. They create a sound socio-medical
and health economic basis for healthcare decision making [6]. Thus overall
objectives of drug utilization research are to ascertain and ensure rational
prescribing, rational dispensing and rational use of safe, efficacious and
standard quality drugs in the society.
In the year 2009, Department of Pharmaceutical Sciences started
post-graduate degree programmes in five different specializations of
Pharmaceutical Sciences, one of them being M.Pharm. (Pharmacy Practice).
Introduction of Masters Degree Programme in Pharmacy Practice has given a new
orientation to the pharmacy education and research in J&K state with focus
gradually shifting from a pharmaceutical product to a patient and from
laboratory bench side to the hospital bed side. The programme is aimed at
carving a niche for the qualified pharmacists of the state and incorporate them
as an inherent part of the healthcare team that so far comprised of only
doctors and nurses. Over the past five years main focus of Pharmacy Practice
Research group has been on Drug Utilization Research in this part of the globe.
During this period a series of drug utilization studies have been conducted to
ascertain the pattern of drug prescribing, dispensing and usage among Kashmiri
population attending various tertiary care hospitals of the state with a view
to generate data on baseline assessment of the situation on ground that has not
been documented so far in the published literature.
In the year 2014, Public Health Foundation of India
(PHFI) conducted a “baseline study to
assess the access to medicines situation in India” across nine Indian
states including the state of J&K. In J&K state, PHFI partnered with our
research group to undertake the study. The study was fully funded by PHFI,
New Delhi and was successfully completed in time and the report submitted to
PHFI for onward submission to the Govt. of India. Project was aimed at undertaking situational
analysis vis-à-vis medicines access with a view to generate baseline data and
scale up medicines access across India including J&K in anticipation of
Govt. of India’s scheme to provide free medicines for all at govt. health
institutions. Ministry of Health and Family Welfare, Govt. of India had
given its clearance for the study and necessary permission was also obtained
from the Ministry of Health, F.W and Medical Education, Govt. of J&K for
conducting the study in J&K state.
In the coming days this research group intends to conduct a
study on “Hospital and community based drug utilization study among
Kashmiri population using WHO devised methodology”, with financial support
expected from ICMR, New Delhi. This study, which is the first of its kind in
J&K state shall generate data on prescribing practices of doctors and
dispensing practices of pharmacists in primary/community health centres and on
drug utilization patterns of community households in selected districts of
Kashmir province so as to pave way for development and effective implementation
of a comprehensive policy framework necessary for promoting equitable access
and ensuring rational use of medicines in the community. Two more studies are
currently underway on drug utilization patterns among pediatric and geriatric
patients at two Srinagar-based speciality care centres. A gist of the ongoing
and completed studies of the research group is given as under.
1. Drug utilization studies of statins in
patients of diabetes mellitus at a tertiary care hospital (completed).
2. Evaluation of the prescribing patterns
of anti-hypertensive drugs in patients of hypertension with associated
co-morbidities at a tertiary care hospital (completed).
3. Drug utilization patterns and risk
assessment for primary and secondary prevention of cardiovascular disease at a
tertiary care hospital (nearing completion).
4. Drug utilization patterns and risk
assessment for renal impairment patients at a tertiary care hospital (nearing
completion).
5. Drug utilization studies with special
reference to off-label use of drugs among pediatric patients at a tertiary care
hospital (ongoing).
6. Drug utilization studies among geriatric
patients at an internal medicine unit of a tertiary care hospital (ongoing).
7. Prospective adverse drug reaction
monitoring studies in Kashmiri population (completed; funded by University Grants Commission, New Delhi to the tune of Rs. 1.8
lakhs).
8. Design, development and implementation of
Pharmaceutical Care services to patients of respiratory medicine (completed).
9. Baseline evaluation of access to
medicines across eight Indian states (completed; funded by Public Health Foundation of India (PHFI), New Delhi to the tune
of Rs. 5.8 lakhs).
10. Knowledge, attitude and prescribing
patterns of doctors towards hormone replacement therapy in pre- and post-menopausal
women of Kashmir region (completed).
11. Evaluation of availability, prices and
affordability of essential medicines as per WHO-HAI methodology across ten
districts of Kashmir province (completed).
12. Evaluation of availability and
affordability of essential commodities required for maternal, neonatal, reproductive
and child health across ten districts of Kashmir province (completed).
13. Design and development of a comprehensive
medicines management policy framework for tertiary care hospitals (ongoing).
14. Anti-genotoxic potential of some essential oils using mouse
bone-marrow test system (completed).
Research Publications of the group (2010-2013):
1.
Geer, M. I. Mushrooming
of medical stores in J&K state–reasons and solutions. Physicians Academy
2010;4(7);75-76.
2.
Geer, M. I. Deficiencies
in the draft Drug Policy of J&K government. Physicians Academy 2011; 5(2):
16-19.
3.
Geer, M. I., Mir J.I.,
Koul P. A. Optimizing Clinical Outcomes through Pharmaceutical Care. Physicians
Academy 2011;5(9): 117-121.
4.
Geer M.I., Tasaduq H.,
Mir J.I., Mohsin B.M. Risk-benefit analysis of combination versus unopposed HRT
in post-menopausal women. International Journal of User-driven Health
2011;1(4): 61-76.
5.
Geer M.I. Magnitude of
spurious drug trade in J&K – Mountain or a molehill? Physicians Academy
2012; 6(1):2-9.
6.
Geer M.I. Approved drug
policy of J&K government – A Review. Physicians Academy 2012;6(2): 27-37.
7.
Geer M.I. Generic Drug
Prescribing in J&K - Boone or bane? Physicians Academy 2012; 6(5): 82-87.
8.
Geer M. I. Improvements
in Drug Policy of Indian state of J&K through persistent advocacy and
logical interventions by Civil Society Forum. Drug Safety 2012; 35(10): 938.
[Impact Factor = 3.4]
9.
Mir J.I., Geer M. I.,
Koul P.A. Identification and resolution of Drug-related Problems in respiratory
medicine patients at a tertiary care hospital. Drug Safety 2012; 35(10): 941.
[Impact Factor = 3.4]
10.
Geer M.I., Koul P.A.,
Tanki S.A., Shah M.Y. Incidence, category, severity, avoidability, extension of
hospital stay and costs of drug related adverse effects among Kashmiri
population at a tertiary care hospital. Jour of Pharmacol and Toxicol Methods
2013; 68(1): e19. [Impact Factor = 2.15]
References:
1. WHO. Introduction to drug utilization research/WHO
International Working Group for Drug Statistics Methodology, WHO Collaborating
Centre for Drug Statistics Methodology, WHO Collaborating Centre for Drug
Utilization Research and Clinical Pharmacological Services 2003.
2.
Hartzema
AG, Porta M, Tilson HH. Pharmacoepidemiology: An Introduction, 3rd Edition.
1998. Cincinnati: Harvey Whitney Books.
3. WHO drug
utilization research group. Report of the meeting held at Cologne, 7-8 November
1985.
4. American Society of Hospital Pharmacists. ASHP guidelines on Medication
Use Evaluation, 1996.
(Available at http://www.ashp.org/DocLibrary/BestPractices/FormGdlMedUseEval.aspx, Accessed on 04.03.2015)
5. Sathvik BS. Drug utilization review/evaluation, in
Parthasarathi G, Nyfort-Hansen K, Nahata MC (eds), A textbook of Clinical
Pharmacy Practice. 1st ed., Orient Longman, India, pp 362-375, 2004.
6. Baksaas I, Lunde PKM. National drug policies: the need
for drug utilization studies. Trends Pharmacol Sci 1986;7:331-34.
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