According to Stedmans Medical Dictionary rational drug use is “a plan of treatment of disease based on the correct interpretation of the symptoms and knowledge of the physiologic action of the remedies.”
What is Irrational Prescribing?
According to the WHO, the following constitute irrational prescribing:
- Incorrect prescribing: When wrong drug is prescribed for the patient. It can be due to wrong diagnosis, wrong route of administration, ignorance of drug actions and side effects or inadequate knowledge about the drug.
- Inappropriate prescribing: It is the non-selection of the most appropriate drug. For example: A costly antibiotic instead of a cheaper one for a common infection.
- Over prescribing: Prescribing drug that is not needed, prescribing a high dose of the drug or prescribing drug for a longer than needed period.
- Multiple prescribing: It is the use of more number of drugs than needed for treatment, simultaneously.
Requirements of Rational Prescribing
- Proper knowledge of disease.
- Proper knowledge of drug including its indications, contraindications, drug interactions, side effects, pharmacokinetics and their costs.
- Depend only on reliable source of information.
- Avoid patient pressure on prescription and pharmaceutical pressure on drug selection.
When to Use Drug Combinations?
Fixed drug combinations are permitted only if they have proven advantage over single drugs and the dosage of the ingredients meet the requirements of a defined population. Check national drug formularly regarding sanctioning of the drug combination and their doses.
Advantages of Drug Combination
- Improved compliance
- More convenience in administration
- Prevents drug abuse
- Decrease cost
- Will be synergestic
- Will avoid drug resistance development to the minimum.
Disadvantages of Drug Combination
- Dosage might be unsuitable when individualisation of treatment is considered.
- Increased risk of adverse reaction since there is multiple drug exposure.
PRESCRIPTION WRITING
A Sample Model Prescription
Points to be Noted While Prescribing
While Deciding on Drug
- Use appropriate and needed drugs, in the correct dose for required period
- Use drugs with proven efficacy
- Check for drug allergies
- Is the patient pregnant or does he/she have any specific disease?
- Always give a follow up date
- Avoid drugs with more inherent hazard
- Avoid fixed drug combinations, which are not sanctioned.
While Writing
- Must be legible and simple
- Give details of patients name, age, sex, address
- Give details of the doctor-name, address, telephone and registration number
- It is a medico-legal document. So it is advisable to use ink and keep a copy
- Take special care for drugs with similar names
- Use calibrated measures
- Use MKS system for measures and Arabic numerical
- Avoid short forms and over writing
- Always use non-proprietary name (and proprietary name in bracket if needed)
- Order pharmacist how to dispense and give instruction to them on use
- Write it with confidence in the presence of the patient
- Recheck after writing
- Put signature at the end
- Avoid pharmacy and drug advertisements on the prescription slip
- Give multiple copies for controlled drugs. One for the pharmacists to maintain records.
While Explaining
Spend time with the patient for describing quantity, frequency, when to take, duration of intake, route of administration, and on special instructions, if any.
NON-COMPLIANCE
Failure of the patient to follow the doctor's guidelines is called non-compliance. Incidence of non-compliance varies from 10–90% in different studies.
Important Reason for Non-compliance
- Lack of proper explanation regarding drug use
- Inability to comprehend the prescription
- Wrong interpretation by the patient
- Due to difficulties of the patients like illness, age, hearing difficulty, etc.
- Does not fit into the patients need, taste and routine needs individualisation
- Cost constrain.
Always Check for the Following Before Prescribing
- Will it be economical and feasible for the patient?
- Did you explain the disease and drug details to the patient and make sure that they have comprehended it?
- Did you explain the probable common side effects?
How to Cross-check in the Follow-up Visit for Compliance?
- Directly asking the patient
- Pill counting
- Clinically by improvement and occurrence of ADR
- Pharmacokinetically by drug level monitoring.
ADVERSE DRUG REACTION
It is defined as “A response to a drug that is noxious and unintended and occurs at doses normally used in man for prophylactic, diagnosis or therapy of disease or for modification of physiological function”. Adverse reaction constitutes 2–3% of medical consultation and 3% of hospital ICU admissions. It is very common in:
- >60 year old
- <1 month old
- Females
- Those with hepatic or renal disease
- Those with past history of drug reactions.
Hence, extra care has to be given when prescribing to these subgroups of people.