A comprehensive study conducted by the Indian Council of Medical Research (ICMR) has brought to light concerning irregularities in drug prescriptions across major government hospitals in India. The research, a part of ICMR’s Rational Use of Medicines (ICMR-RUM) project, disclosed that a staggering 45 percent of prescriptions deviated from established treatment guidelines, with nearly 10 percent exhibiting “unacceptable deviations.”
Published in the Indian Journal of Medical Research in February, the study scrutinized 7,800 prescriptions from outpatient departments of 13 tertiary care hospitals and medical colleges, including prestigious institutions such as AIIMS in New Delhi and Bhopal, KEM Hospital in Mumbai, PGIMER in Chandigarh, and JIPMER in Puducherry. Notably, the analysis also included Christian Medical College (CMC) in Vellore, the sole non-government hospital in the study.
The prescriptions deemed to have unacceptable deviations posed risks such as drug interactions, lack of response, increased costs, preventable adverse reactions, and antimicrobial resistance. Of particular concern was the indiscriminate prescription of the heartburn medication pantoprazole, which featured prominently in such problematic prescriptions.
The study, titled “Evaluation of prescriptions from tertiary care hospitals across India for deviations from treatment guidelines & their potential consequences,” identified other frequently prescribed medications associated with unacceptable deviations, including a fixed-dose combination of rabeprazole and domperidone and oral enzyme preparations.
Conditions such as upper respiratory tract infections and hypertension were commonly linked with these deviations. Dr. Yashashri Shetty, lead author of the study and an assistant professor at KEM Hospital in Mumbai, expressed concern over the widespread prescription of pantoprazole without due consideration for potential drug interactions, emphasizing the need for more cautious prescribing practices.
The study involved the meticulous assessment of 7,800 prescriptions, with only 55.12 percent deemed appropriate according to guidelines. Pantoprazole emerged as the most frequently prescribed drug associated with unacceptable deviations, followed by rabeprazole with domperidone and oral enzyme preparations.
Factors contributing to these prescribing irregularities include time constraints faced by junior doctors, inadequate emphasis on rational prescribing in medical training, and potential influence from pharmaceutical promotions. Dr. Nilima A. Kshirsagar, co-author of the study and a senior pharmacologist, emphasized the importance of ongoing training initiatives to address these issues and highlighted the need for administrative directives to enforce rational prescribing practices.
The findings of the ICMR study underscore the urgent need for interventions to ensure adherence to established treatment guidelines and mitigate the risks associated with inappropriate drug prescriptions in Indian hospitals.