A Rational Use of Medicine Consensus Committee was formed, including clinicians and clinical pharmacologists, with the objective of developing the assessment framework for diarrhoea and ARI prescriptions. Both clinicians and pharmacologists evaluated the prescriptions independently for appropriateness and the identification of deviation from the standard treatment guidelines (WHO, Ministry of Health & Family Welfare, Government of India, ICMR, 2019 and Standard Treatment Guideline, Institute of Health & Family Welfare, Govt. of West Bengal, 2011) [9 ,14 ,15 ,17 ].
Since all the guidelines are mostly targeted at general practitioners in public health settings, they do not cover many additional drugs, such as probiotics, antihistamines, leukotriene receptor antagonists, bronchodialators, mucolytics, etc., which are commonly prescribed in medical college settings. In such cases, both pharmacologist and clinician performed the assessment based on the scientific rationale and their clinical expertise.
Furthermore, the pharmacologist judged the prescriptions as appropriate or inappropriate on the basis of the signs and symptoms prescribed, the adverse effects of drugs, the route of administration, the dose (appropriate as per age and body weight, individualization, and the maximum dose per day mentioned for acute drugs), duration being correct as per documented indication, the possibility of drug interaction, and the prescription of generic names. The clinician judged the prescriptions independently as appropriate or inappropriate according to the above criteria as well as their clinical judgement, particularly optimising symptom remission and tolerating adverse effects. Acceptability of Deviation was determined using theTable 1 :
In case of a disagreement between pharmacologist and clinician, acceptability of the prescription was discussed in the RUMC committee and a case-to-case decision was taken based on the understanding of significant harm over benefit.
Statistical Analysis: descriptive statistics were used to analyse and present the data in terms of proportion (percentage), and mean with standard deviation (SD). The percentage of prescriptions adhering to each indicator was calculated overall and in the subgroups of patient age (below and above 18 years) and different types of prescribers. Agreement between clinicians and pharmacologists for the appropriateness of prescriptions was determined by Cohen’s Kappa statistics.
Since all the guidelines are mostly targeted at general practitioners in public health settings, they do not cover many additional drugs, such as probiotics, antihistamines, leukotriene receptor antagonists, bronchodialators, mucolytics, etc., which are commonly prescribed in medical college settings. In such cases, both pharmacologist and clinician performed the assessment based on the scientific rationale and their clinical expertise.
Furthermore, the pharmacologist judged the prescriptions as appropriate or inappropriate on the basis of the signs and symptoms prescribed, the adverse effects of drugs, the route of administration, the dose (appropriate as per age and body weight, individualization, and the maximum dose per day mentioned for acute drugs), duration being correct as per documented indication, the possibility of drug interaction, and the prescription of generic names. The clinician judged the prescriptions independently as appropriate or inappropriate according to the above criteria as well as their clinical judgement, particularly optimising symptom remission and tolerating adverse effects. Acceptability of Deviation was determined using the
In case of a disagreement between pharmacologist and clinician, acceptability of the prescription was discussed in the RUMC committee and a case-to-case decision was taken based on the understanding of significant harm over benefit.
Statistical Analysis: descriptive statistics were used to analyse and present the data in terms of proportion (percentage), and mean with standard deviation (SD). The percentage of prescriptions adhering to each indicator was calculated overall and in the subgroups of patient age (below and above 18 years) and different types of prescribers. Agreement between clinicians and pharmacologists for the appropriateness of prescriptions was determined by Cohen’s Kappa statistics.
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