Drug utilization evaluation among geriatric patients at a tertiary care hospital

Background: The elderly population is one of the most rapidly increasing populations in the world. Inter-individual differences in age related pharmacokinetic and pharmacodynamic changes as well as co-morbid conditions have to be considered while prescribing medicines in elderly population. This population is vulnerable to many diseases and drug related problems. There are various problems with medicine treatment in elderly population like inappropriate prescribing is more likely to occur in elderly patients since they may receive several drugs simultaneously on account of chronic diseases and/or multiple health problems and polypharmacy, altered drug response, adverse drug reactions (ADRs) and patient non-compliance.
Need for the Study: The elderly population is increasing rapidly worldwide. Their growth rate (1.9%) is higher than general population (1.2%). At present, India is the third country after China and USA with large elderly population in the world. Elderly population has special problems related to health, social support, and economic security. Their healthcare need differs from the younger people. Though elderly are reported to be responsible for half the total drug usage, less than 5% of randomized control trials have been designed for them. Therefore, data available from younger subjects are used to guide prescribing in elderly. Physiological and pharmacological variations in elderly population include decreased total body mass, blood flow to various organs, immunity, and nervous functions; down- or up regulation of various receptors; and disturbance in first pass metabolism, bioavailability, metabolism, and excretion. Presence of co-morbidities in elderly people require use of multiple medications which increase the irrational prescription, use of inappropriate medications, noncompliance, economic burden, adverse drug reactions (ADRs), and drug interactions.  The overall incidence of ADR is two to three times higher and most of them are potentially avoidable in elderly patients. These hurdles in pharmacotherapy can be overcome by periodic evaluation of drug utilization and optimizing prescribing pattern by forming prescription guidelines for geriatric patients. Drug utilization research is an important tool to analyze the use of drugs with special emphasis on medical, social, and economic consequences in a society.

Objective: Main aim of this study is to evaluate the drug utilization patterns among geriatric in-patientsat a tertiary care hospital.

Setting and Method: A prospective, cross-sectional, observational study would be conducted among geriatricpatients admitted to the General Medicine ward during an eight month period at a tertiary care hospital.

Main Outcome Measures: Drug utilization patterns in geriatric patients, dose adjustments, patient counselling needs, pharmaco-economic evaluation of prescribed medication, physicians’ adherence to guidelines, patient compliance to prescribed medication.

Drug utilization evaluation among neonatal and pediatric in-patients at a tertiary care hospital

Background:Although an abundance of information relating to drug utilization among adults is available, the literature pertaining to children is limited.There are various problems with medicine treatment in children likeheterogeneous nature of paediatric population and lack of standard dosage, inability to swallow solid dosage forms, less acceptance of bitter oral formulations, instability and unsafe excipients, needle phobias, calculation errors,poor adherence, lack of available dosage forms and concentrations which necessitate additional calculations and manipulation of commercially available dosage forms or preparation of extemporaneous formulations, lack of familiarity between adult and paediatric guidelines, confusion between adult and paediatric preparations, limited published information, administration errors and use of inappropriate measuring devices, lack of evidence for long term benefits with new  and innovative medicines having paediatric indication. There is paucity of published literature on drug utilization patterns among paediatric and neonatal patients from the state of Jammu and Kashmir, therefore this study is proposed to be undertaken at a Srinagar-based children’s tertiary care hospital to generate some baseline data on the subject. 

Need for the Study: Infants and children constitute a large proportion of population in developing countries. In India children constitute 39% of population and use of appropriate drug therapies and drug formulations in neonates and children poses several challenges. There are various problems with medical treatment in children like off label and unlicensed use of drugs, non-evidence based and inappropriate use of available over-the-counter, traditional and herbal medicines, no evidence of benefits and risks of new and innovative medicines in children. Thus drug utilization studies in NICU and PICU of the children’s tertiary care hospital will allow an analysis of the drug prescribing patterns and drug dispensing practices, drug use patterns, drug prices, availability, patient compliance. Such studies will provide useful feedback to the paediatricians and general practitioners and to the concerned hospital staff and hospital administration.

Aim & Objective: The main aim of the study is to evaluate the prescribing, dispensing and drug usage patterns among neonates and children at a children’s tertiary care hospital. 

Setting and Method: A prospective, observational study would be conducted among the neonatal and paediatric in-patients at neonatal and paediatric intensive care units of children’s tertiary care hospital for a period of six months. 

Main Outcome Measures: Drug utilization evaluation, prescribing patterns, dispensing patterns, drug usage patterns, availability, prices & affordability of children’s medicines, patient compliance/medication adherence, patient counselling needs.