Quality of medical prescriptions in diabetes and hypertension management in Kerala and its associated factors

Abstract

Background: Kerala is facing challenges in the secondary prevention efforts of non-communicable diseases (NCDs). In spite of being the top performer in health parameters among Indian states, the burden of NCDs, especially diabetes mellitus (diabetes) and hypertension, is higher in Kerala. This research endeavours to identify the role of quality of medical prescriptions in secondary prevention of diabetes and hypertension and suggest corrective measures. Methods: This cross-sectional study involved collection of prescription data and other details from consenting doctors across seven districts in Kerala. After the quality of prescription was assessed using a checklist, scores were generated, and cutoff points were used to classify the prescriptions. PASW version 18 software, was used for data analysis which included univariate and bivariate analyses and logistic regression. The proportion of quality prescriptions was estimated after adjusting for clustering, and the proportion of doctors writing quality prescriptions was also estimated. Prior to the study, ethical clearance from Independent ethics committee in Health action by People (HAP) and informed consent from all the study participants were obtained. Results: After assessing 9199 prescriptions from 344 doctors, it was found that about 37.2% (95% CI: 34.9-39.4%) of the prescriptions were of good quality, and 48.2% (95% CI: 42.9-53.7%) of the doctors provided quality prescriptions. Factors associated with quality prescriptions were found to be knowledge about NCD guidelines, quality certifications of hospitals and usage of patient data management software. Conclusions: In the context of rising prevalence of NCDs and the challenges in the secondary prevention efforts, this is one of the first studies in Kerala to evaluate the quality of prescriptions to manage NCDs as prescriptions often reflect the quality of medical management. The study also addresses other factors associated with quality medical management. The findings indicate that the scope for improvement is more than 50%, when considered for the overall quality of prescriptions in diabetes and hypertension management. Further, it was found that appropriate training of doctors, adherence to treatment guidelines and the use of technology may improve the overall quality of prescriptions.

Availability, price and affordability of essential medicines for managing cardiovascular diseases and diabetes: a statewide survey in Kerala, India

“…A systematic review reported that a significant proportion of both physicians and pharmacists consider generic medicines inferior, despite 35 of 38 trials demonstrating clinical equivalence between OB and generic versions of multiple CVD medicines [42,43]. Although both Central and Kerala State governments mandate that physicians should prescribe by generic name, a recent study indicates an enormous need for improving the quality of prescriptions for diabetes and hypertension in Kerala, by training doctors in prescribing and improving adherence to treatment guidelines [44]. In this regard, the government should optimise medicine procurement list and the supply system at GSDP and government hospitals, inform patients about the added value of obtaining medicines from these facilities, strictly enforce generic prescribing [45], and increase the coverage of GSDPs so that more patients can purchase medicines at the discounted/lower prices.…”

Hypertension control in Kerala, India: A prescription-based study at primary and secondary level health care institutions

“…The detailed methodology of the study has been published earlier. 13 We used a cross-sectional design wherein 344 doctors from primary and secondary level institutions (public – 182, private - 162) from seven districts in Kerala were recruited. Prescriptions issued by the selected doctor in a period starting six months prior to the date of consent to six months after that date were included.…”

“…Prescription quality was determined using a checklist and this was reported in the earlier publication. 13 Hypertension control implied a BP < 140/90 mm Hg. Diabetes mellitus control was defined as fasting blood sugar <126 mg/dl, post-prandial blood sugar or random blood sugar <200 mg/dl or HbA1C < 6.5%.…”

Generalizability of hypertension risk factors and achieving blood pressure control in educator populations in India

“… Although teachers have unsurprisingly high health literacy, we see in this study that only around half of participants are treating their hypertension. While it may be difficult to effect change in the general population, if we can improve hypertension control among teachers and health professionals and show a visible reduction in end-outcomes for all hypertension subtypes, 4 the general population may in turn begin viewing them more as health role models and, along with other traditional avenues such as lifestyle initiatives and improvements in prescription and counseling quality, 5 be more likely to achieve hypertension control. …”