Prescribing Pattern in Diabetic Outpatients in a Tertiary Care Teaching Hospital in Nepal 248-255
Dinesh K Upadhyay, M.Pharm, Assistant Professor. Department of Hospital and Clinical Pharmacy/ Pharmacology, Manipal Teaching Hospital/Manipal College of Medical Sciences, Pokhara, Nepal. Tel.: 061-526420/526416 (Extn 221); e-mail:firstname.lastname@example.org
Background: Diabetes is a chronic disease associated with significant morbidity and mortality. Diabetics are at a higher risk of polypharmacy and more vulnerable to irrational prescription. Data regarding drug use pattern in diabetes is lacking in South Asian countries.
Objectives: The present study was conducted with the objectives of collecting the demographic details of diabetes patients, studying the pattern of drug prescribing among diabetic outpatients, calculating the mean prescription cost for the diabetes patients and analysing the prescriptions according to prescribing indicators.
Methods: A cross-sectional study was carried out at the Out-patient Pharmacy (OPP), Manipal Teaching Hospital, Pokhara, Nepal, from 22nd August to 7th December 2006. All the diabetes patients who visited the OPP during the study period were enrolled after getting verbal consent and interviewed by the researchers, based on the study objectives. The details were entered in the structured patient profile form, and the filled forms were analysed.
Results: Altogether 182 patients, 103 males (56.59%) and 79 females (43.41%), were enrolled. Among these, 69 (37.91%) were in the age group 51â€“60 years, 128 (70.33%) had a diabetic history of less than 5 years and 136 (74.72%) had at least one concurrent illness. Two, three and four drugs were prescribed in 39 (21.43%), 35 (19.23%) and 40 (21.98%) patients, respectively. Altogether, 685 drugs were prescribed with an average of 3.76 drugs per prescription. Antidiabetics were accounted for 314 (45.84%) of the total drugs. Among the various antidiabetics, biguanides were accounted for 161 (51.27%) of the total antidiabetic medications. Among the study patients, 28 (15.38%) had an encounter with an injection prescribed and 16 (2.34%) of the total drugs were fixed-dose combinations and 0.88% (n = 6) of the drugs were antibiotics. The duration of prescription of medicines ranges from 29 to 35 days for 41.17% (n = 282) of the total drugs and 57 to 63 days for 44.23% (n = 303) drugs. Majority [650 (94.89%)] of the drugs were prescribed in oral dosage form. The average cost per prescription was NPR 1156.15 (US $16.17). Antidiabetic medications constituted 58.93% of the total cost. Among the antidiabetic medications insulin accounted for 41.07% of the total cost followed by biguanides (32.60%).
Conclusions: Insulin and biguanides were the most commonly prescribed antidiabetics. Our study was done for a short period of time, and the number of patients studied was low. Hence, similar studies covering large number of patients are needed to confirm our findings.