■不合理的处方做法会对患者安全产生重大影响,并增加经济负担。不合理处方影响的真实例子有可能改善处方实践。在这种情况下,本研究旨在捕获和评估处方中偏离治疗指南的患病率,临床医生建议的偏差和纠正措施的潜在后果。
方法:这是一项在印度三级保健医院门诊部进行的横断面观察性研究,其中有13个印度医学研究理事会合理使用药物中心。处方不符合标准治疗指南和处方不完整,剂量,持续时间和频率被标记为“有偏差的处方”。可能导致药物相互作用的偏差,缺乏回应,成本增加,可预防的药物不良反应(ADR)和/或抗菌素耐药性被标记为“不可接受的偏差”。
结果:针对所有评估的处方,其中约十分之一(475/4838;9.8%)存在不可接受的偏差。然而,在2667/4838(55.1%)处方中,临床医生遵守了治疗指南.两千一百七十一张处方有偏差,其中475(21.9%)与泮托拉唑(n=54)有不可接受的偏差,雷贝拉唑+多潘立酮(n=35)和口服酶制剂(n=24)作为最常用的处方药,上呼吸道感染(URTI)和高血压作为最常见疾病,具有不可接受的偏差。偏差的潜在后果是成本增加(n=301),ADR(n=254),药物相互作用(n=81),缺乏治疗反应(n=77)和抗菌素耐药性(n=72)。建议考虑的主要纠正措施是发布行政命令(n=196)和进行在线培训计划(n=108)。
■发现偏差的总体发生率为45%,其中不可接受的偏差估计为9.8%。为了最小化偏差,临床医生建议将合理处方和行政指令的在线培训作为潜在干预措施.
UNASSIGNED: Irrational prescribing practices have major consequences on patient safety and also increase the economic burden. Real-life examples of impact of irrational prescription have potential to improve prescribing practices. In this context, the present study aimed to capture and evaluate the prevalence of deviations from treatment
guidelines in the prescriptions, potential consequence/s of the deviations and corrective actions recommended by clinicians.
METHODS: It was a cross-sectional observational study conducted in the outpatient departments of tertiary care hospitals in India wherein the 13 Indian Council of Medical Research Rational Use of Medicines Centres are located. Prescriptions not compliant with the standard treatment
guidelines and incomplete prescriptions with respect to formulation, dose, duration and frequency were labelled as \'prescriptions having deviations\'. A deviation that could result in a drug interaction, lack of response, increased cost, preventable adverse drug reaction (ADR) and/or antimicrobial resistance was labelled as an \'unacceptable deviation\'.
RESULTS: Against all the prescriptions assessed, about one tenth of them (475/4838; 9.8%) had unacceptable deviations. However, in 2667/4838 (55.1%) prescriptions, the clinicians had adhered to the treatment
guidelines. Two thousand one hundred and seventy-one prescriptions had deviations, of which 475 (21.9%) had unacceptable deviations with pantoprazole (n=54), rabeprazole+domperidone (n=35) and oral enzyme preparations (n=24) as the most frequently prescribed drugs and upper respiratory tract infection (URTI) and hypertension as most common diseases with unacceptable deviations. The potential consequences of deviations were increase in cost (n=301), ADRs (n=254), drug interactions (n=81), lack of therapeutic response (n=77) and antimicrobial resistance (n=72). Major corrective actions proposed for consideration were issuance of an administrative order (n=196) and conducting online training programme (n=108).
UNASSIGNED: The overall prevalence of deviations found was 45 per cent of which unacceptable deviations was estimated to be 9.8 per cent. To minimize the deviations, clinicians recommended online training on rational prescribing and administrative directives as potential interventions.