Prescribing pattern of analgesics used for postoperative pain and its correlate with patient and doctor satisfaction

Background: Post operative pain is difficult to assessment and its management has been neglected at times. Moreover, the drug treatment involves administration of drug on as and when basis which leads to inadequate control. Methods: This observational, prospective study was conducted in 100 post-operative patients i.e., 50 each from surgery and orthopedics departments. Investigator enrolled post-operative patients within 24 hours of surgery and followed them for next 5 days or till hospital discharge, whichever was earlier. Analgesic prescribing pattern, self-assessment of pain, patient and doctor satisfaction using ASSIST questionnaire were recorded in Case Record Form and analysed. Results: Out of 100 patients, average number of analgesics prescribed post-operatively was 1.49±0.5 (baseline and all follow-up). 76.5% patients received NSAIDs which included diclofenac (44.29%) and paracetamol (30.87%). Opioids in the form of tramadol were prescribed in 23.49% patients. Mean least pain experienced by patients on day 1 was 2±0.75 which decreased to 1.32±0.63 on day 5. Mean worst pain decreased from 6.64±1.43 on day 1 to 3.38±1.17 on day 5. Average percentage of duration of severe pain was 35.2%±16.48 on day 1 which successively decreased to 16.32±8.26 on day 5. Average pain relief observed in 62.3% patients on day one increased to 80.88% on day 5. Patient satisfaction increased as pain score decreased (r=-0.73) and a strong positive correlation was observed between doctor satisfaction and patient satisfaction (r=0.91). Conclusions: Inadequate control of post-operative pain affects effective patient management and recovery. Incorporation of effective pain assessment scores in pain management is desirable.

Knowledge, attitude and practice among consumers about adverse drug reaction reporting

Background: Background: Adverse Drug Reaction (ADR) reporting by consumers is quite low in India. Assessing knowledge and attitude of consumers regarding ADR reporting and observing practice of ADR reporting among them can help explore probable causes for underreporting of ADRs by consumers.Methods: This was a cross-sectional study conducted in a tertiary care teaching hospital using investigator-administered questionnaire and interviewing indoor patients of Surgery, Medicine, Obstetrics & Gynaecology and Dermatology departments. The questionnaire was prepared to assess knowledge, attitude and practice of consumers about ADR reporting. Data was analysed using mean, standard deviation and percentages.Result: A total of 820 consumers of medicines were included. It was found that 32.2% consumers were not aware that a drug can produce adverse effects. After being explained about adverse drug reactions, 94.6% consumers felt that adverse drug reactions should be reported. However, 98.8% consumers were not aware of Pharmacovigilance Programme of India. After consulting about consumer reporting programme, majority of respondents (96.1%) felt that the direct consumer reporting programme helps reporting of ADRs. Moreover, 93.7% of consumers were willing to use it to report ADRs in future. Consumers preferred the Telephonic method with a Toll free number for ADR reporting followed by informing a health care professional.Conclusion: Poor knowledge and awareness about ADR reporting is the major factor for low to nearly absent ADR reporting by consumers in India.

Over prescribing and resistance to chloroquine.

Malaria is a major health concern in the developing world including India. Overdiagnosis and overprescribing of malaria may lead to increase morbidity, mortality and increases risk of resistance to antimalarial drugs and hence increase the economical burden to health care system. The present study was carried out to determine the actual cases of malaria and extent of chloroquine resistance at Civil Hospital Ahmedabad, a tertiary care teaching hospital in Gujarat, India. After Institutional Ethics Committee approval, adult patients of either gender, presenting with a history of fever at the Out Patient Department (OPD), diagnosed to be suffering from malaria and prescribed chloroquine were included in the study. Peripheral thick blood smear test and OptiMAL-rapid diagnostic test (RDT) were carried out. RDT was performed in these patients on day 0 before the start of chloroquine treatment and after completion of the 3 day chloroquine treatment. They were again subjected to RDT on day 4. The positive cases on RDTon day 4 were considered as resistant to chloroquine. During the study period of 12 months, out of the 250 clinically suspected cases of malaria who were prescribed chloroquine, 80 (31%) cases (35 cases of P. vivax and the 45 of P. falciparum ) were positive for malaria (by the peripheral smear and the Rapid Diagnostic Test (RDT) OptiMAL test). Thirty out of the 35 cases of P. vivax malaria, responded to the three- day chloroquine treatment. Out of the 45 cases of P. falciparum malaria, 30 responded to chloroquine while 15 patients (35%) continued to be OptiMAL positive on 4th day and required change of treatment. It suggests that an early diagnosis, definitive treatment and avoiding overprescribing could delay drug resistance and reduce the morbidity and mortality due the disease.