Prescription audit of outpatient attendees of secondary level government hospitals in Maharashtra

OBJECTIVE: The main objective of the prescription audit of the secondary level government hospitals under the Maharashtra Health Systems Development Project (MHSDP) was to develop a list of essential drugs. Other objectives were to articulate measures for improving the prescription practices and to generate information on the core prescribing indicators proposed by the World Health Organization (WHO). MATERIALS AND METHODS: The study was conducted among a representative sample of 31 secondary level hospitals under MHSDP. A copy of the prescription was obtained with the help of a pre-inserted carbon, in a special format. Data for only ′first encounter prescriptions′ was collected for all patients attending the Outpatient Department (OPD). RESULTS: About 77 percent of the prescriptions contained only one diagnosis. The average number of drugs per prescription was 3.1. About 60 percent of the drugs were prescribed by generic names and about 23 percent of the prescribed drugs were in combination. About 25 percent of the prescriptions contained at least one injection, while 35 percent contained at least one antibiotic. In 16 percent of the prescriptions a vitamin or tonic was prescribed. About 46 percent of the single ingredient formulations were as per the WHO 2003, Essential Medicines List (EML). Based on the findings of the Prescription Audit an EML was prepared for each category of the secondary level hospitals, for use in the OPD. CONCLUSIONS: Prescription audits are useful in generating data on morbidity, which forms the basis for preparing the list of essential medicines. Mechanisms necessary for improving prescription practices are suggested.