One in every two Indian medical prescriptions stray from guidelines, finds study; here’s how it can affect you

A recent study conducted by researchers, including those from the All India Institute of Medical Sciences (AIIMS) Delhi, has revealed a concerning trend in medical prescriptions across India. 

According to NDTV, the research found that one in every two prescriptions deviates from standard treatment guidelines, with approximately 10% showing “unacceptable deviations.” This comprehensive analysis of 4,838 prescriptions issued between August 2019 and August 2020 at 13 Rational Use of Medicines Centres (RUMC) set up by the Indian Council of Medical Research (ICMR) highlights potential risks for patients, including unnecessary medication, increased treatment costs, and possible adverse drug reactions. 

Of particular concern is the frequent misuse of gastroprotective drugs like pantoprazole and rabeprazole domperidone for conditions where they are not indicated, such as Herpes Zoster and upper respiratory tract infections.

Key factors contributing to the high rate of deviations

Dr Narayanswamy S, medical director at Athreya Super Speciality Hospital, tells indianexpress.com, “A significant proportion of Indian physicians may lack awareness of or access to the latest evidence-based treatment guidelines. This could be attributed to insufficient continuing medical education (CME) opportunities, limited access to peer-reviewed journals, or language barriers.”

Overburdened healthcare systems and high patient volumes often lead to rushed consultations and a reliance on ingrained prescribing habits rather than a thorough review of guidelines, he adds.

Dr Narayanswamy agrees that the pharmaceutical industry marketing and patient expectations can also sway prescribing behaviour. “Direct-to-consumer advertising, promotional activities, and patient requests for specific medications may create pressure to deviate from guidelines.”

Inappropriate prescribing increases the risk of adverse drug reactions and interactions (Source: Freepik)

How deviations in prescriptions impact patient health outcomes and healthcare costs 

Deviations in prescriptions impact patient health outcomes and healthcare costs in the long term, in the following ways according to Dr Narayanswamy:

Suboptimal Treatment Outcomes: Non-adherence to guidelines can result in suboptimal drug choices, incorrect dosages, or inappropriate treatment durations. This can lead to treatment failure, delayed recovery, increased hospitalizations, and higher morbidity and mortality rates.

Adverse Drug Events (ADEs): Inappropriate prescribing increases the risk of adverse drug reactions and interactions, leading to patient harm and additional healthcare costs.

Antimicrobial Resistance (AMR): Unnecessary or inappropriate antibiotic prescriptions are a major driver of AMR, rendering infections more difficult to treat and increasing healthcare costs due to prolonged illnesses and more expensive treatment options.

Economic Burden: Prescription deviations can contribute to increased healthcare expenditures due to the need for additional tests, treatments, and hospitalizations to manage complications arising from suboptimal therapy.

How to address these deviations 

Dr Narayanswamy talks about what can be done to address these issues:

Knowledge Translation: Bridge the gap between research and practice by actively disseminating and translating guideline recommendations into actionable steps for physicians.

Infrastructure and Resources: Ensure that healthcare facilities have the necessary infrastructure, resources, and technology to access and implement guidelines effectively.

Behavioural Interventions: Design interventions that target cognitive biases and address the psychological and social factors influencing prescribing behaviour.

Collaboration and Partnerships: Foster collaboration between medical associations, regulatory bodies, academic institutions, and pharmaceutical companies to develop and implement effective strategies for guideline adherence.

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