Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
Indian Council of Medical Research, New Delhi, India.
Indian J Pharmacol. 2022 Nov-Dec;54(6):407-416. doi: 10.4103/ijp.ijp_878_21.
The concept of listing essential medicines can lead to improved supply and access, more rational prescribing, and lower costs of drugs. However, these benefits hinge on the prescription of drugs from an Essential Medicines List (EML). Several studies have highlighted the problem of underutilization of EMLs by prescribers. Therefore, as part of prescription research by the Indian Council of Medical Research-Rational Use of Medicines Centres Network, we evaluated the extent of prescription of drugs not listed in the National List of Essential Medicines (NLEM).
Prescriptions of outpatients from participating centers were included after obtaining verbal/written informed consent as approved by the Ethics Committee, and evaluated for prescription of drugs from the NLEM 2015.
Analysis of 4838 prescriptions from 13 tertiary health-care institutes revealed that 2677 (55.33%) prescriptions had at least one non-NLEM drug prescribed. In all, 5215 (31.12%) of the total 16,758 drugs prescribed were not in NLEM. Of these, 2722 (16.24%) were single drugs and 2493 (14.88%) were fixed-dose combinations (FDCs). These comprised 700 different drug products - 346 single drugs and 354 FDCs. The average number of non-NLEM drugs prescribed per prescription was 1.08, while the average number of all drugs prescribed was 3.35 per prescription. It was also found that some of the non-NLEM drugs prescribed had the potential to result in increased cost (for example, levocetirizine), increased adverse effects (dextromethorphan), and less effectiveness (losartan) when compared to their NLEM counterparts. Nonavailability of an essential drug (oral hydroxocobalamin) was another important finding of our study.
This study highlights the extent and pattern of drugs prescribed from outside the NLEM at the tertiary health-care level and the need for training and enhanced awareness among prescribers for greater utilization of the NLEM.
将基本药物列入清单的概念可以改善供应和获得途径，使处方更合理，并降低药物成本。然而，这些好处取决于从基本药物清单（EML）开处方。有几项研究强调了开方者未充分利用 EML 的问题。因此，作为印度医学研究理事会-合理用药中心网络处方研究的一部分，我们评估了处方中未列入国家基本药物清单（NLEM）的药物的程度。
获得伦理委员会批准的口头/书面知情同意后，纳入参与中心的门诊患者处方，并评估其是否按照 2015 年 NLEM 开处方。
对来自 13 家三级保健机构的 4838 张处方进行分析，发现 2677 张（55.33%）处方至少开了一种非 NLEM 药物。总共，16758 种开处方的药物中，有 5215 种（31.12%）不在 NLEM 中。其中，2722 种（16.24%）为单一药物，2493 种（14.88%）为固定剂量组合（FDC）。这些包括 700 种不同的药品-346 种单一药物和 354 种 FDC。每张处方开非 NLEM 药物的平均数量为 1.08，而每张处方开的所有药物的平均数量为 3.35。还发现，与 NLEM 药物相比，一些开处方的非 NLEM 药物具有增加成本（例如左西替利嗪）、增加不良反应（右美沙芬）和降低疗效（氯沙坦）的潜力。我们的研究还发现了另一个重要发现，即某些基本药物（口服羟钴胺）不可用。
本研究强调了在三级保健水平上开处方时超出 NLEM 范围的药物的程度和模式，以及需要对开方者进行培训和提高认识，以更充分地利用 NLEM。
