Prescribing Behaviour of Physicians

Abstract

To improve drug-use-related problems appropriately, demonstration of the inap propriate use of drugs alone is not sufficient. Data on its causation and suitable interventions are essential. Hence, a prospective randomised controlled study was conducted with the objective to identify drug-use-related problems in acute upper respiratory infections and non-specific acute diarrhoea with a special focus on use of antibiotics in 32 dispensaries and seven colony (15-bedded) hospitals in Delhi. An educational intervention in the form of small group discussions was introduced in the study group to improve the appropriate use of antibiotics. The control group did not participate in the small group discussions. The principal finding of the qualitative assessment was that the prescriber's knowledge of anti biotic use and risks was generally sufficient, yet they overused antibiotics. The reasons or underlying factors encouraging the use of antibiotics in ARI and non- rehydration therapy (antidiarrhoeals, antibiotics, antiamoebics) and hindering the use of oral rehydration therapy in diarrhoea were worries regarding precise aetiology, to prevent secondary infections, the deterioration of the patient's con dition, to meet the demand of patients and the fear of losing patients. The aver age number of drugs prescribed in ARI reduced significantly in both the groups (control group 2.82±0.88 vs. 2.63±0.58; study group 2.72±0.38 vs. 2.54±0.38) following intervention (p < 0.001). There was a significant reduction in the use of antibiotics in ARI in the study group from 64.86 to 51.30 per cent after inter vention (p < 0.003). There was no change (60.5 vs. 63.9 per cent) in the control group in ARI. In diarrhoea too the average number of drugs prescribed reduced significantly (p < 0.0001) in both the groups (study group 2.25±0.59 vs. 2.27±0.77; control group 2.31±1.76 vs. 2.76±0.73). Antibiotic use declined significantly in all health facilities in both the study groups (intervention group 82.1 per cent vs. 68.90 per cent; control group 80.3 vs. 62.3 per cent). In diarrhoea all the health facilities in the study group fell in the category of 50 to 80 per cent or more antibiotic use before intervention. About 75 per cent of the drugs were prescribed by generic names and more than 90 per cent were from the essential drugs list. The results of the study show that though antibiotic use declined after inter vention, there is a need for such interventions regularly to bring about long- lasting changes in prescribing behaviour.