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Pharmaco-epidemiological Studies using WHO Prescribing, Patient Care and Facility Indicators in Diabetic Patients in Southern Punjab region, Pakistan

Syed Nisar Hussain Shah

Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Hospital, New York, USA

Ayaz Ahmad

Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Hospital, New York, USA

Hina Javed

Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Hospital, New York, USA

Qalandar Khan

Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Hospital, New York, USA

Muhammad Yousuf

Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Hospital, New York, USA

Naveed Nisar

Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Hospital, New York, USA

Rabeea Anam

Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Hospital, New York, USA

DOI: 10.15761/PMCH.1000118

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Abstract

A careful prospective pharmaco-epidemiological study on diabetic patients using WHO prescribing, patient care and facility indicator was carried out in southern Punjab, Multan, Pakistan. The prescribing, patient care and facility indicators were evaluated using WHO indicator form. The results showed that average drug prescribed per patient has maximum value of 9 which indicates the trend of poly-pharmacy. The percentage of generic prescribing was very low which indicates that there is lot of trend of doctors to be influenced by the companies and prefer to prescribe the brand names, which cause health burden on poor peoples. The percentage of antibiotic prescribed was very high in most of the health care facilities and antibiotic was prescribed in 100% patients in Nishter hospital. The percentage of injection prescribed was also very high and close to 100% at most of the facilities except for PSSHMC hospital Muzafargarh, where trend was 76.7%. Injections are costly dosage form and cause health burden to the patients. The trend of prescribing from Essential drug list of Pakistan was checked and it was observed that none of the hospital has 100% prescribing from NEDL. The consultation time varies at different hospital and it was 1.6 min at Tehsil level hospitals which shows that physician spend very little time in counseling the patients. The average dispensing time varies from 50 seconds to 238 seconds it shows that the health care facilities do not follow similar trend there is need to establish similar protocol and standard operating procedure for dispensaries. The percentage of drug dispensed was 100% at only two facilities, which indicate that remaining 18 facilities need to rationalize their system of dispensing and availability of stock. The adequate knowledge of patient was very poor and there is need of proper counseling to the patients.

In summary, prescribing trend do not follow the international standards and there is a grave need to incorporate the role of pharmacist to monitor and check the trend of poly-pharmacy and drug interactions.

Key words

epidemiology, prescribing indicators, patient care indicators, facility indicators, diabetes, southern punjab region

Introduction

Diabetes is a public health problem and its incidence is increasing day by day. It is important to evaluate the prescribing trend of health facilities regarding diabetic patients [1,2]. The study was conducted among diabetic patients who met the patient’s inclusion criteria devised for the study [3]. The main study objective was to assess and evaluate the pattern and practice of physicians among diabetic patients by using standard WHO prescribing indicator forms [4], and to judge the patient’s behavior by using WHO patients care indicator forms and to judge the quality of health care facility by using WHO facility indicator forms. The trend of prescribing from Essential drug list of Pakistan was checked and it was observed that none of the hospital has 100% prescribing from NEDL. As NEDL of Pakistan was published in 2003 and many useful safe salts and therapeutic goods are being readily used, need is felt the revising of NEDL. The adequate knowledge of patient was very poor and there is need of proper counseling to the patients. There was not only a single facility where proper labeling of medicine was carried out [5,6]. The facility indicators were evaluated by using WHO facility indicator form. The availability of EDL was almost at 70% of the hospitals [7]. The availability of key drugs was 100% only at one facility. As diabetes is a major health problem so, key drugs should be available at most of the health center at all the times.

Methods

Sample size

A prospective study was carried out among diabetic patients to assess the prescribing, patient care and facility indicators in southern Punjab Pakistan. Sample size taken from each health facility was thirty hence data of total 600 patients was collected from twenty different health care centers of Southern Punjab.

Survey methodology

The study was conducted using WHO prescribing, patient care and facility indicator forms. Patients were enrolled in the study after taking informed consent.

Prescribing indictor

form was filled by checking the prescriptions of diabetic patients from twenty different health care facilities. At least 30 patients were considered from each facility. Forms were designed according to WHO standards and were approved by the research committee. Prescriptions were carefully noted on the forms including generic as well as brand names and dosage used.

Patient care indicators

were checked by interviewing the patients. Consultation time of each patient was noted carefully and dispensing time at the pharmacy was noted for the outpatients and inpatients. Numbers of drugs prescribed by the physician were noted by viewing the prescriptions and numbers of drugs actually dispensed were noted by visiting the pharmacy at the time of dispensing for outpatient and by visiting patients’ charts for indoor patients.

Facility indicator

form was developed by using standard WHO criteria. Full name of facility and its location was noted in the form. Availability of copy of EDL and key drugs were checked for each facility. A list of major key drugs for the diabetic patients was made and was approved by the research committee and then this list was checked at each facility.

Inclusion criteria

  1. People suffering from Diabetes Mellitus were included in the study.
  2. Patient of age above 18 years was included in the study.
  3. Patient who was visiting at least the secondary care hospital was included in the study.
  4. Patient who willingly provided data was included in the study.
  5. Patients of southern Punjab were included in the study.

Exclusion criteria

  1. Patients of age less than eighteen years were excluded from the study.
  2. Patients suffering from life threatening co-morbidity were excluded from the study.
  3. Patients who were not willing to provide the data were also excluded from the study.

Experimental data source

The data for the research was collected from Tehsil Head Quarter Hospitals and District Head Quarter Hospitals in the southern Punjab, Pakistan. Data was also taken from social security hospital, Tayyeb Erdgan Hospital Muzafargarh and Nishter hospital Multan. Data was collected after taking permission from the research committees of the hospitals under study. 20 different health care centers were included in the study. Data was directly taken from the patients.

Period of data collection

The study period was six months from April 2014 to September 2014. In these six months’ data was collected from twenty different health centers of southern Punjab, Pakistan.

Statistical analysis

Software SPSS 16 was used to analyze the results statistically. Non -parametric test was applied for general parameters and chi square test and descriptive statistics was applied at 0.05 significant level. Data collected from different centers was also graphically analyzed and compared to evaluate the WHO core indicators of prescribing, patient care and health facility [8].

Results and Discussion

Prescribing indicators

The data was collected from twenty different health care facilities from southern Punjab and prescribing indicators were evaluated for each facility and results are described as:

The average drugs per encounter were calculated for all the health care facility to find out the occurrence of poly-pharmacy. Poly-pharmacy is a major issue in our health care system that leads to a number of different drug interactions and prolong stay of patients in the hospital. The results show that  the maximum poly pharmacy trend was in Nishter hospital Multan and least was in DHQ hospital Bhakkar and average encounter /patients in all health care facilities was 6.89, which shows that there is a trend of poly-pharmacy in southern Punjab hospital and there should be a role of pharmacist in monitoring the drug interaction and minimizing the trend of poly-pharmacy [8-10].

The data in the figure 1 (Table 1) reveals that the number of drugs prescribed in thirty patients at different health care facilities is the highest in Nishtar Hospital Multan which is a teaching hospital and the patients from different areas of southern Punjab which already has been exposed to the drugs, patients of critical nature are referred to this facility [11,12].

The numbers of drugs prescribed by their generic names were checked at different health care facilities included in the study. The results indicate that there is very low trend of generic prescribing in the hospital, except for social security hospital Muzafargarh where there is 100% trend of generic prescribing. At DHQ hospital muzafargarh only 4.4% of drugs were prescribed by their generic names (Figure 2, Table 2).

The numbers of drugs prescribed by their generic names were checked at different health care facilities included in the study [13,14] (Figure 3, Table 3). The results indicate that there is very low trend of generic prescribing in the hospital, except for social security hospital Muzafargarh where there is 100% trend of generic prescribing.

The numbers of antibiotics prescribed to the patients at twenty different health care facilities were checked by the prescriptions of patients. The results indicate that the maximum trend of antibiotic prescription was at Nishter hospital Multan and almost all the prescriptions contained the antibiotics. The least trend of antibiotic prescribing was at DHQ Vehari where nearly 63.3% patients were prescribed by the antibiotics (Figure 4, Table 4).

The numbers of patients prescribed with injections were calculated at different health care facilities and it was found that the trend of injection prescribed was 100% at most of the health centers. It shows the excessive use of injectable dosage form which is a costly dosage form and lead to the health burden to the patient as well as on the hospital (Figure 5, Table 5).

Essential drug list of Pakistan is formulated after a through feedback and taking into consideration the health care needs of the patients. The trend of prescribing from EDL was checked to assess that how much the prescriber takes the EDL into consideration. The results show that maximum trend of drugs prescribed from EDL was at DHQ Layyah that is 92% and minimum prescribing from EDL was at Nishter hospital Multan (Figure 6, Table 6,12).

Figure 1.Number of drugs prescribed in different facilities

Figure 2.Number of drug/encounter in different facilities
The figure depicts the average number of drugs per encounter at different health care facilities. The average drugs per encounter are maximum 9 at Nishter hospital Multan

Figure 3. Comparison of drugs prescribed and generic prescribed

Figure 4. Patients receiving antibiotics

Figure 5. Patients receiving injectable

Figure 6. Number of drugs prescribed from EDL

Table 1 Number of drugs prescribed /patient in facilities under study

Name of facility

No. of Drugs prescribed

Avg. drugs/encounter

DHQH M.Garh

182

6.1

DHQH Layyah

195

6.5

DHQH Bhakkar

176

5.9

DHQH Vehari

183

6.1

DHQH Khanewal

194

6.5

PSSHMCH M.Garh

238

7.9

Nishter Hospital Multan

269

9.0

DHQH D.G.Khan

227

7.6

KH..F.SSH Multan

193

6.4

T.E..H M.Garh

211

7.0

DHQH Rajanpur

203

6.8

THQH Kot addu

185

6.2

THQH Ali pur

202

6.7

THQH jatoi

188

6.3

THQH tounsa

228

7.6

THQH Jampur

193

6.4

THQH Rujhan

191

6.4

THQH Karoor

233

7.8

THQH Chobara

237

7.9

THQH Kabeer wala

199

6.6

Table 2. Number of generics prescribed in different facility

Name of facility

No. of Drugs prescribed

No. of generics prescribed

Percentage

DHQH M.Garh

182

8

4.4

DHQH Layyah

195

15

7.69

DHQH Bhakkar

176

11

56.3

DHQH Vehari

183

28

15.3

DHQH Khanewal

194

24

12.4

PSSHMCH M.Garh

238

238

100

Nishter Hospital Multan

269

0

0

DHQH D.G.Khan

227

30

13.2

KH.F.SSH Multan

193

20

10.4

T.E..H M.Garh

211

42

19.9

DHQH Rajanpur

203

35

17.2

THQH Kot addu

185

8

4.3

THQH Ali pur

202

30

14.9

THQH jatoi

188

19

10.1

THQH tounsa

228

36

15.8

THQH Jampur

193

32

16.6

THQH Rujhan

191

22

11.5

THQH Karoor

233

15

6.4

THQH Chobara

237

35

14.8

THQH Kabeer wala

199

29

14.6

Table 3. Percentage of patients receiving antibiotics in different facilities

Name of facility

Number of patients receiving antibiotics

Percentage of total cases

DHQH M.Garh

23

76.7

DHQH Layyah

24

80

DHQH Bhakkar

22

73.3

DHQH Vehari

19

63.3

DHQH Khanewal

22

73.3

PSSHMCH M.Garh

3

10

Nishter Hospital Multan

30

100

DHQH D.G.Khan

24

80

KH..F.SSH Multan

22

73.3

T.E..H M.Garh

23

76.7

DHQH Rajanpur

23

76.7

THQH Kot addu

25

83.3

THQH Ali pur

24

80

THQH jatoi

24

80

THQH tounsa

26

86.7

THQH Jampur

26

86.7

THQH Rujhan

23

76.7

THQH Karoor

21

70

THQH Chobara

25

83.3

THQH Kabeer wala

22

73.3

Table 4. Percentage of patients receiving injectable in different facilities

Name of facility

Number of patients receiving injectable

Percentage of total cases

DHQH M.Garh

30

100

DHQH Layyah

29

96

DHQH Bhakkar

30

100

DHQH Vehari

30

100

DHQH Khanewal

30

100

PSSHMCH M.Garh

23

76.7

Nishter Hospital Multan

30

100

DHQH D.G.Khan

30

100

KH.F.SSH Multan

30

100

T.E..H M.Garh

30

100

DHQH Rajanpur

26

86.7

THQH Kot addu

30

100

THQH Ali pur

30

100

THQH jatoi

30

100

THQH tounsa

30

100

THQH Jampur

30

100

THQH Rujhan

30

100

THQH Karoor

25

83.3

THQH Chobara

30

100

THQH Kabeer wala

30

100

Table 5. Percentage of patients receiving injectable in different facilities

Name of facility

Number of patients receiving injectable

Percentage of total cases

DHQH M.Garh

30

100

DHQH Layyah

29

96

DHQH Bhakkar

30

100

DHQH Vehari

30

100

DHQH Khanewal

30

100

PSSHMCH M.Garh

23

76.7

Nishter Hospital Multan

30

100

DHQH D.G.Khan

30

100

KH.F.SSH Multan

30

100

T.E..H M.Garh

30

100

DHQH Rajanpur

26

86.7

THQH Kot addu

30

100

THQH Ali pur

30

100

THQH jatoi

30

100

THQH tounsa

30

100

THQH Jampur

30

100

THQH Rujhan

30

100

THQH Karoor

25

83.3

THQH Chobara

30

100

THQH Kabeer wala

30

100

Table 6. Number of drugs prescribed from EDL at different health care facilities

Name of facility

Number of Drugs prescribed

Number of drugs from EDL

Percentage

DHQH M.Garh

182

142

78

DHQH Layyah

195

180

92

DHQH Bhakkar

176

146

83

DHQH Vehari

183

151

82.5

DHQH Khanewal

194

156

80.4

PSSHMCH M.Garh

238

182

76.5

Nishter Hospital Multan

269

206

76.6

DHQH D.G.Khan

227

184

81.1

KH.F.SSH Multan

193

155

80.3

T.E..H M.Garh

211

169

80.1

DHQH Rajanpur

203

160

78.8

THQH Kot addu

185

165

89.2

THQH Ali pur

202

165

81.7

THQH jatoi

188

150

79.8

THQH tounsa

228

187

82

THQH Jampur

193

150

77.7

THQH Rujhan

191

153

80.1

THQH Karoor

233

185

79.4

THQH Chobara

237

185

78.1

THQH Kabeer wala

199

160

80.4

Table 12. Availability of copy of EDL at different facilities

Name of facility

Availability of copy of EDL

DHQH M.Garh

Yes

DHQH Layyah

Yes

DHQH Bhakkar

Yes

DHQH Vehari

Yes

DHQH Khanewal

Yes

PSSHMCH M.Garh

NO

Nishter Hospital Multan

Yes

DHQH D.G.Khan

Yes

KH..F.SSH Multan

No

T.E..H M.Garh

Yes

DHQH Rajanpur

Yes

THQH Kot addu

Yes

THQH Ali pur

NO

THQH jatoi

NO

THQH tounsa

NO

THQH Jampur

Yes

THQH Rujhan

NO

THQH Karoor

Yes

THQH Chobara

No

THQH Kabeer wala

Yes

Total

Yes=23

No=7

Patient care indicators

The consultation time of patients was recorded at different health care centers in the southern Punjab. The results indicate that the average consultation time of physicians vary greatly at different health care centers. The consultation time was maximum at Tayyab Erdagen hospital Muzafargarh which is Turkish based hospital. The minimum average consultation time was at THQ chobara, which means that doctors spend very little time with patients at tehsil headquarters (Figure 7, Table 7).

The dispensing time at different health care facilities was calculated and it was concluded that maximum dispensing time was 238sec at social security hospital and minimum was at THQH chobara (Figure 8, Table 8).

The number of drugs dispensed out of total drugs prescribed was calculated at different health care facilities. It was concluded in the study that maximum % age of dispensed drugs was at Tayyab erdagan hospital muzafargarh and PSSHMCH Muzaffargarh where the rate was 100% which show the good stock position at these two hospitals and efficiency of dispensing staff at these hospitals (Figure 9, Table 9).

The number of drugs adequately labeled was almost zero at all the health care centers in southern Punjab which results in poor compliance of patients. It is due to absence of adequate pharmacist at health care centers which leads to poor compliance (Figure 10, Table 10).

The knowledge of patients about correct doses was checked at different health care centers and it was concluded that the patient’s knowledge was very poor because of poor literacy rate in these areas. Poor knowledge leads to poor compliance of medication regimen [15,16] (Figure 11,12, Table 11).

Figure 7. Average consultation time at different facilities

Figure 8. Average dispensing time at different facilities

Figure 9. Number of drugs dispensed

Figure 10. Number of drugs adequately labeled

Figure 11. Patients knowledge of doses at different facilities

Figure 12. Percentage of patients having adequate knowledge about doses

Table 7. Average consultation time of different facilities

Name of facility

Total consultation time (min)

Average consultation time (min)

DHQH M.Garh

135

4.5

DHQH Layyah

136

4.53

DHQH Bhakkar

130

4.2

DHQH Vehari

95

3.2

DHQH Khanewal

113

3.8

PSSHMCH M.Garh

121

4

Nishter Hospital Multan

162

5.4

DHQH D.G.Khan

140

4.7

KH.F.SSH Multan

96

3.2

T.E..H M.Garh

313

10.4

DHQH Rajanpur

130

4.3

THQH Kot addu

119

4

THQH Ali pur

11

3.7

THQH jatoi

72

2.4

THQH tounsa

127

4.2

THQH Jampur

101

3.4

THQH Rujhan

105

3.5

THQH Karoor

97

3.2

THQH Chobara

47

1.6

THQH Kabeer wala

112

3.7

Table 8. Average dispensing time of different facilities

Name of facility

Total dispensing time (sec)

Average dispensing time (sec)

DHQH M.Garh

4170

139

DHQH Layyah

4060

135.3

DHQH Bhakkar

4260

142

DHQH Vehari

3680

122.7

DHQH Khanewal

3870

129

PSSHMCH M.Garh

2745

238

Nishter Hospital Multan

5460

182

DHQH D.G.Khan

3780

126

KH.F.SSH Multan

2940

98

T.E..H M.Garh

4660

155.3

DHQH Rajanpur

4140

138

THQH Kot addu

3540

118

THQH Ali pur

3320

110.7

THQH jatoi

2670

89

THQH tounsa

3390

113

THQH Jampur

3150

105

THQH Rujhan

2970

99

THQH Karoor

3450

115

THQH Chobara

1500

50

THQH Kabeer wala

3510

117


Table 9. Number of drugs dispensed at different facilities

Name of facility

No. of Drugs prescribed

No. of drugs dispensed

Percentage

DHQH M.Garh

182

170

93.4

DHQH Layyah

195

191

97

DHQH Bhakkar

176

170

96.6

DHQH Vehari

183

166

90.7

DHQH Khanewal

194

177

91.2

PSSHMCH M.Garh

238

238

100

Nishter Hospital Multan

269

252

93.7

DHQH D.G.Khan

227

195

85.9

KH..F.SSH Multan

193

173

89.6

T.E..H M.Garh

211

211

100

DHQH Rajanpur

203

180

88.7

THQH Kot addu

185

168

90.8

THQH Ali pur

202

173

85.6

THQH jatoi

188

170

90.4

THQH tounsa

228

198

86.8

THQH Jampur

193

169

87.6

THQH Rujhan

191

144

75.4

THQH Karoor

233

199

85.4

THQH Chobara

237

195

82.3

THQH Kabeer wala

199

173

86.9

Table 10. Number of drugs adequately labeled

Name of facility

No. of drugs dispensed

No. of drugs adequately labelled

DHQH M.Garh

170

0

DHQH Layyah

191

0

DHQH Bhakkar

170

0

DHQH Vehari

166

0

DHQH Khanewal

177

0

PSSHMCH M.Garh

238

0

Nishter Hospital Multan

252

0

DHQH D.G.Khan

195

0

KH.F.SSH Multan

173

0

T.E..H M.Garh

211

0

DHQH Rajanpur

180

0

THQH Kot addu

168

0

THQH Ali pur

173

0

THQH jatoi

170

0

THQH tounsa

198

0

THQH Jampur

169

0

THQH Rujhan

144

0

THQH Karoor

199

0

THQH Chobara

195

0

THQH Kabeer wala

173

0

Table 11. Patients knowledge of dosage at different facilities

Name of facility

Patient knowledge of dosage

Percentage of patients

DHQH M.Garh

5

16.7

DHQH Layyah

5

16.7

DHQH Bhakkar

7

23.3

DHQH Vehari

5

16.7

DHQH Khanewal

9

30

PSSHMCH M.Garh

5

16.7

Nishter Hospital Multan

9

30

DHQH D.G.Khan

6

20

KH..F.SSH Multan

9

30

T.E..H M.Garh

8

26.7

DHQH Rajanpur

4

13.3

THQH Kot addu

6

20

THQH Ali pur

7

23.3

THQH jatoi

2

6.7

THQH tounsa

9

30

THQH Jampur

2

6.7

THQH Rujhan

0

0

THQH Karoor

4

13.3

THQH Chobara

1

3.3

THQH Kabeer wala

8

26.7

Facility indicators

The number of key drugs available at different health care facilities was checked after making a list of key drugs with reference to diabetic patients and the results shows that only one facility has 100% availability of all the key drugs. As the diabetes is more prevalent in Pakistan and its incidence is increasing so it is recommended that the key drugs should be available at the health care center [17,18] (Figure 13, table 13).

The pharmaco-epidemiological study of diabetic patients was carried our using WHO prescribing, patient care and facility indicators [19-22]. The study was carried out in twenty different health care facilities of southern Punjab in different districts. The results of prescribing indicators show that overall there is trend of poly-pharmacy (Table 14). It was concluded that the trend of poly-pharmacy prevails in majority of health care facilities. The results of generic prescribing shows that there is very least trend of generic prescribing except of social security hospital Muzafargarh. The percentage of antibiotics prescribed was evaluated and results indicate that there is excessive trend of antibiotic prescribing in all the health care facilities. The results concluded that in Nishter hospital Multan there is 100% trend of antibiotic prescribing. Similarly, there is excessive trend of injection prescribing in all the health care facilities. The results of patient care prescribing indicate that consultation time varies from 1.6 minutes to 10.4 minutes in the hospitals under study. The dispending time varies from 50 seconds to 238 seconds which is very low and may lead to error in dispensing causing serious threat to the e health of patient. The percentage of drugs dispensed varies from 75.4% to 100% at different hospitals which need to be improved where it was not maximum. The study of facility indicator shows that almost 70% facilities have availability of EDL and only one facility had 100% availability of key Drugs.

Figure 13. Number of key drugs available at different facilities

Table 13. Availability of key drugs at hospital

Name of facilitty

Number of key drugs available

DHQH M.Garh

3

DHQH Layyah

4

DHQH Bhakkar

3

DHQH Vehari

3

Table 14.Consolidated data of drug use indicators at different facilities

Facility

Avg. drugs prescribed

Percentage

Generic drugs

Percentage of Antibiotics

Percentage of Injections

Percentage on EDL

Avg.

Consult time

(min)

Avg.

Dispense

Time

(sec)

Percentage of drugs dispensed

DHQH M.Garh

6.1

4.4

76.7

100

78

4.5

139

93.4

DHQH Layyah

6.5

7.69

80

96

92

4.53

135.3

97

DHQH Bhakkar

5.9

56.3

73.3

100

83

4.2

142

96.6

DHQH Vehari

6.1

15.3

63.3

100

82.5

3.2

122.7

90.7

DHQH Khanewal

6.5

12.4

73.3

100

80.4

3.8

129

91.2

PSSHMCH M.Garh

7.9

100

10

76.7

76.5

4

238

100

NH Multan

9.0

0

100

100

76.6

5.4

182

93.7

DHQH D.G.Khan

7.6

13.2

80

100

81.1

4.7

126

85.9

KH..F.SSH Multan

6.4

10.4

73.3

100

80.3

3.2

98

89.6

T.E..H M.Garh

7.0

19.9

76.7

100

80.1

10.4

155.3

100

DHQH Rajanpur

6.8

17.2

76.7

86.7

78.8

4.3

138

88.7

THQH Kot addu

6.2

4.3

83.3

100

89.2

4

118

90.8

THQH Ali pur

6.7

14.9

80

100

81.7

3.7

110.7

85.6

THQH jatoi

6.3

10.1

80

100

79.8

2.4

89

90.4

THQH tounsa

7.6

15.8

86.7

100

82

4.2

113

86.8

THQH Jampur

6.4

16.6

86.7

100

77.7

3.4

105

87.6

THQH Rujhan

6.4

11.5

76.7

100

80.1

3.5

99

75.4

THQH Karoor

7.8

6.4

70

83.3

79.4

3.2

115

85.4

THQH Chobara

7.9

14.8

83.3

100

78.1

1.6

50

82.3

THQH Kaber wala

6.6

14.6

73.3

100

80.4

3.7

117

86.9

Mean

6.89

18.29

75.17

97.14

80.89

4.1

126.1

89.9

Minimum

5.9

0

10

76.7

76.5

1.6

50

75.4

Maximum

9.0

100

100

100

92

10.4

238

100

Conclusion

 It was concluded from the current study that prescribing trend do not follow the international standards and there is a grave need to incorporate the role of pharmacist to monitor and check the trend of poly-pharmacy and drug interactions. There should be the availability of pharmacist per 50 beds to properly counsel the patient regarding drug usage. Proper labeling of the medicines according to the WHO Standards should be ensured to avoid any mishap and to achieve the goal of effective patient care.

Conflict of interest

Author declared no conflict of interest

Acknowledgment

All authors hereby acknowledged all members of Nishter hospital, Multan, Pakistan

Compliance with ethical statement

Informed Consent

The authors declared that they have do this survey under the permission of hospital and letter issued by university 1203/PEC/18.

Contribution of authors

Syed Nisar Hussain Shah: Research Supervisor

Ayaz Ahmad: Doing research survey

Hina Javed: manuscript writing and corresponding author

Qalander Khan: Help in conducting survey

Nida Javed: Assist in manuscript writing

 Muhammad Yousuf: Help in data collection

Rabeea Anum: Help in data collection

References

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Editorial Information

Editor-in-Chief

Article Type

Research Article

Publication history

Received date: October 11, 2018
Accepted date: October 26, 2018
Published date: October 30, 2018

Copyright

© 2018 Javed H. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation

Javed H, Shah SNH, Ahmad A, Khan Q, Javed N, et al. (2018) Pharmaco-epidemiological studies using who prescribing patient care and facility indicators in diabetic patients in southern Punjab region, Pakistan. Prev Med Commun Health 1: DOI: 10.15761/PMCH.1000118

Hina Javed

Charles Ascher-Walsh

Faculty of Pharmacy, Department of Pharmaceutics, Bahauddin Zakariya University Multan Pakistan

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

Figure 1.Number of drugs prescribed in different facilities

Figure 2.Number of drug/encounter in different facilities
The figure depicts the average number of drugs per encounter at different health care facilities. The average drugs per encounter are maximum 9 at Nishter hospital Multan

Figure 3. Comparison of drugs prescribed and generic prescribed

Figure 4. Patients receiving antibiotics

Figure 5. Patients receiving injectable

Figure 6. Number of drugs prescribed from EDL

Figure 7. Average consultation time at different facilities

Figure 8. Average dispensing time at different facilities

Figure 9. Number of drugs dispensed

Figure 10. Number of drugs adequately labeled

Figure 11. Patients knowledge of doses at different facilities

Figure 12. Percentage of patients having adequate knowledge about doses

Figure 13. Number of key drugs available at different facilities

Table 1 Number of drugs prescribed /patient in facilities under study

Name of facility

No. of Drugs prescribed

Avg. drugs/encounter

DHQH M.Garh

182

6.1

DHQH Layyah

195

6.5

DHQH Bhakkar

176

5.9

DHQH Vehari

183

6.1

DHQH Khanewal

194

6.5

PSSHMCH M.Garh

238

7.9

Nishter Hospital Multan

269

9.0

DHQH D.G.Khan

227

7.6

KH..F.SSH Multan

193

6.4

T.E..H M.Garh

211

7.0

DHQH Rajanpur

203

6.8

THQH Kot addu

185

6.2

THQH Ali pur

202

6.7

THQH jatoi

188

6.3

THQH tounsa

228

7.6

THQH Jampur

193

6.4

THQH Rujhan

191

6.4

THQH Karoor

233

7.8

THQH Chobara

237

7.9

THQH Kabeer wala

199

6.6

Table 2. Number of generics prescribed in different facility

Name of facility

No. of Drugs prescribed

No. of generics prescribed

Percentage

DHQH M.Garh

182

8

4.4

DHQH Layyah

195

15

7.69

DHQH Bhakkar

176

11

56.3

DHQH Vehari

183

28

15.3

DHQH Khanewal

194

24

12.4

PSSHMCH M.Garh

238

238

100

Nishter Hospital Multan

269

0

0

DHQH D.G.Khan

227

30

13.2

KH.F.SSH Multan

193

20

10.4

T.E..H M.Garh

211

42

19.9

DHQH Rajanpur

203

35

17.2

THQH Kot addu

185

8

4.3

THQH Ali pur

202

30

14.9

THQH jatoi

188

19

10.1

THQH tounsa

228

36

15.8

THQH Jampur

193

32

16.6

THQH Rujhan

191

22

11.5

THQH Karoor

233

15

6.4

THQH Chobara

237

35

14.8

THQH Kabeer wala

199

29

14.6

Table 3. Percentage of patients receiving antibiotics in different facilities

Name of facility

Number of patients receiving antibiotics

Percentage of total cases

DHQH M.Garh

23

76.7

DHQH Layyah

24

80

DHQH Bhakkar

22

73.3

DHQH Vehari

19

63.3

DHQH Khanewal

22

73.3

PSSHMCH M.Garh

3

10

Nishter Hospital Multan

30

100

DHQH D.G.Khan

24

80

KH..F.SSH Multan

22

73.3

T.E..H M.Garh

23

76.7

DHQH Rajanpur

23

76.7

THQH Kot addu

25

83.3

THQH Ali pur

24

80

THQH jatoi

24

80

THQH tounsa

26

86.7

THQH Jampur

26

86.7

THQH Rujhan

23

76.7

THQH Karoor

21

70

THQH Chobara

25

83.3

THQH Kabeer wala

22

73.3

Table 4. Percentage of patients receiving injectable in different facilities

Name of facility

Number of patients receiving injectable

Percentage of total cases

DHQH M.Garh

30

100

DHQH Layyah

29

96

DHQH Bhakkar

30

100

DHQH Vehari

30

100

DHQH Khanewal

30

100

PSSHMCH M.Garh

23

76.7

Nishter Hospital Multan

30

100

DHQH D.G.Khan

30

100

KH.F.SSH Multan

30

100

T.E..H M.Garh

30

100

DHQH Rajanpur

26

86.7

THQH Kot addu

30

100

THQH Ali pur

30

100

THQH jatoi

30

100

THQH tounsa

30

100

THQH Jampur

30

100

THQH Rujhan

30

100

THQH Karoor

25

83.3

THQH Chobara

30

100

THQH Kabeer wala

30

100

Table 5. Percentage of patients receiving injectable in different facilities

Name of facility

Number of patients receiving injectable

Percentage of total cases

DHQH M.Garh

30

100

DHQH Layyah

29

96

DHQH Bhakkar

30

100

DHQH Vehari

30

100

DHQH Khanewal

30

100

PSSHMCH M.Garh

23

76.7

Nishter Hospital Multan

30

100

DHQH D.G.Khan

30

100

KH.F.SSH Multan

30

100

T.E..H M.Garh

30

100

DHQH Rajanpur

26

86.7

THQH Kot addu

30

100

THQH Ali pur

30

100

THQH jatoi

30

100

THQH tounsa

30

100

THQH Jampur

30

100

THQH Rujhan

30

100

THQH Karoor

25

83.3

THQH Chobara

30

100

THQH Kabeer wala

30

100

Table 6. Number of drugs prescribed from EDL at different health care facilities

Name of facility

Number of Drugs prescribed

Number of drugs from EDL

Percentage

DHQH M.Garh

182

142

78

DHQH Layyah

195

180

92

DHQH Bhakkar

176

146

83

DHQH Vehari

183

151

82.5

DHQH Khanewal

194

156

80.4

PSSHMCH M.Garh

238

182

76.5

Nishter Hospital Multan

269

206

76.6

DHQH D.G.Khan

227

184

81.1

KH.F.SSH Multan

193

155

80.3

T.E..H M.Garh

211

169

80.1

DHQH Rajanpur

203

160

78.8

THQH Kot addu

185

165

89.2

THQH Ali pur

202

165

81.7

THQH jatoi

188

150

79.8

THQH tounsa

228

187

82

THQH Jampur

193

150

77.7

THQH Rujhan

191

153

80.1

THQH Karoor

233

185

79.4

THQH Chobara

237

185

78.1

THQH Kabeer wala

199

160

80.4

Table 7. Average consultation time of different facilities

Name of facility

Total consultation time (min)

Average consultation time (min)

DHQH M.Garh

135

4.5

DHQH Layyah

136

4.53

DHQH Bhakkar

130

4.2

DHQH Vehari

95

3.2

DHQH Khanewal

113

3.8

PSSHMCH M.Garh

121

4

Nishter Hospital Multan

162

5.4

DHQH D.G.Khan

140

4.7

KH.F.SSH Multan

96

3.2

T.E..H M.Garh

313

10.4

DHQH Rajanpur

130

4.3

THQH Kot addu

119

4

THQH Ali pur

11

3.7

THQH jatoi

72

2.4

THQH tounsa

127

4.2

THQH Jampur

101

3.4

THQH Rujhan

105

3.5

THQH Karoor

97

3.2

THQH Chobara

47

1.6

THQH Kabeer wala

112

3.7

Table 8. Average dispensing time of different facilities

Name of facility

Total dispensing time (sec)

Average dispensing time (sec)

DHQH M.Garh

4170

139

DHQH Layyah

4060

135.3

DHQH Bhakkar

4260

142

DHQH Vehari

3680

122.7

DHQH Khanewal

3870

129

PSSHMCH M.Garh

2745

238

Nishter Hospital Multan

5460

182

DHQH D.G.Khan

3780

126

KH.F.SSH Multan

2940

98

T.E..H M.Garh

4660

155.3

DHQH Rajanpur

4140

138

THQH Kot addu

3540

118

THQH Ali pur

3320

110.7

THQH jatoi

2670

89

THQH tounsa

3390

113

THQH Jampur

3150

105

THQH Rujhan

2970

99

THQH Karoor

3450

115

THQH Chobara

1500

50

THQH Kabeer wala

3510

117


Table 9. Number of drugs dispensed at different facilities

Name of facility

No. of Drugs prescribed

No. of drugs dispensed

Percentage

DHQH M.Garh

182

170

93.4

DHQH Layyah

195

191

97

DHQH Bhakkar

176

170

96.6

DHQH Vehari

183

166

90.7

DHQH Khanewal

194

177

91.2

PSSHMCH M.Garh

238

238

100

Nishter Hospital Multan

269

252

93.7

DHQH D.G.Khan

227

195

85.9

KH..F.SSH Multan

193

173

89.6

T.E..H M.Garh

211

211

100

DHQH Rajanpur

203

180

88.7

THQH Kot addu

185

168

90.8

THQH Ali pur

202

173

85.6

THQH jatoi

188

170

90.4

THQH tounsa

228

198

86.8

THQH Jampur

193

169

87.6

THQH Rujhan

191

144

75.4

THQH Karoor

233

199

85.4

THQH Chobara

237

195

82.3

THQH Kabeer wala

199

173

86.9

Table 10. Number of drugs adequately labeled

Name of facility

No. of drugs dispensed

No. of drugs adequately labelled

DHQH M.Garh

170

0

DHQH Layyah

191

0

DHQH Bhakkar

170

0

DHQH Vehari

166

0

DHQH Khanewal

177

0

PSSHMCH M.Garh

238

0

Nishter Hospital Multan

252

0

DHQH D.G.Khan

195

0

KH.F.SSH Multan

173

0

T.E..H M.Garh

211

0

DHQH Rajanpur

180

0

THQH Kot addu

168

0

THQH Ali pur

173

0

THQH jatoi

170

0

THQH tounsa

198

0

THQH Jampur

169

0

THQH Rujhan

144

0

THQH Karoor

199

0

THQH Chobara

195

0

THQH Kabeer wala

173

0

Table 11. Patients knowledge of dosage at different facilities

Name of facility

Patient knowledge of dosage

Percentage of patients

DHQH M.Garh

5

16.7

DHQH Layyah

5

16.7

DHQH Bhakkar

7

23.3

DHQH Vehari

5

16.7

DHQH Khanewal

9

30

PSSHMCH M.Garh

5

16.7

Nishter Hospital Multan

9

30

DHQH D.G.Khan

6

20

KH..F.SSH Multan

9

30

T.E..H M.Garh

8

26.7

DHQH Rajanpur

4

13.3

THQH Kot addu

6

20

THQH Ali pur

7

23.3

THQH jatoi

2

6.7

THQH tounsa

9

30

THQH Jampur

2

6.7

THQH Rujhan

0

0

THQH Karoor

4

13.3

THQH Chobara

1

3.3

THQH Kabeer wala

8

26.7

Table 12. Availability of copy of EDL at different facilities

Name of facility

Availability of copy of EDL

DHQH M.Garh

Yes

DHQH Layyah

Yes

DHQH Bhakkar

Yes

DHQH Vehari

Yes

DHQH Khanewal

Yes

PSSHMCH M.Garh

NO

Nishter Hospital Multan

Yes

DHQH D.G.Khan

Yes

KH..F.SSH Multan

No

T.E..H M.Garh

Yes

DHQH Rajanpur

Yes

THQH Kot addu

Yes

THQH Ali pur

NO

THQH jatoi

NO

THQH tounsa

NO

THQH Jampur

Yes

THQH Rujhan

NO

THQH Karoor

Yes

THQH Chobara

No

THQH Kabeer wala

Yes

Total

Yes=23

No=7

Table 13. Availability of key drugs at hospital

Name of facilitty

Number of key drugs available

DHQH M.Garh

3

DHQH Layyah

4

DHQH Bhakkar

3

DHQH Vehari

3

Table 14.Consolidated data of drug use indicators at different facilities

Facility

Avg. drugs prescribed

Percentage

Generic drugs

Percentage of Antibiotics

Percentage of Injections

Percentage on EDL

Avg.

Consult time

(min)

Avg.

Dispense

Time

(sec)

Percentage of drugs dispensed

DHQH M.Garh

6.1

4.4

76.7

100

78

4.5

139

93.4

DHQH Layyah

6.5

7.69

80

96

92

4.53

135.3

97

DHQH Bhakkar

5.9

56.3

73.3

100

83

4.2

142

96.6

DHQH Vehari

6.1

15.3

63.3

100

82.5

3.2

122.7

90.7

DHQH Khanewal

6.5

12.4

73.3

100

80.4

3.8

129

91.2

PSSHMCH M.Garh

7.9

100

10

76.7

76.5

4

238

100

NH Multan

9.0

0

100

100

76.6

5.4

182

93.7

DHQH D.G.Khan

7.6

13.2

80

100

81.1

4.7

126

85.9

KH..F.SSH Multan

6.4

10.4

73.3

100

80.3

3.2

98

89.6

T.E..H M.Garh

7.0

19.9

76.7

100

80.1

10.4

155.3

100

DHQH Rajanpur

6.8

17.2

76.7

86.7

78.8

4.3

138

88.7

THQH Kot addu

6.2

4.3

83.3

100

89.2

4

118

90.8

THQH Ali pur

6.7

14.9

80

100

81.7

3.7

110.7

85.6

THQH jatoi

6.3

10.1

80

100

79.8

2.4

89

90.4

THQH tounsa

7.6

15.8

86.7

100

82

4.2

113

86.8

THQH Jampur

6.4

16.6

86.7

100

77.7

3.4

105

87.6

THQH Rujhan

6.4

11.5

76.7

100

80.1

3.5

99

75.4

THQH Karoor

7.8

6.4

70

83.3

79.4

3.2

115

85.4

THQH Chobara

7.9

14.8

83.3

100

78.1

1.6

50

82.3

THQH Kaber wala

6.6

14.6

73.3

100

80.4

3.7

117

86.9

Mean

6.89

18.29

75.17

97.14

80.89

4.1

126.1

89.9

Minimum

5.9

0

10

76.7

76.5

1.6

50

75.4

Maximum

9.0

100

100

100

92

10.4

238

100