Systemic antibiotics, drugs used for alimentary tract ailments, nervous system, respiratory system and musculoskeletal system are the top five groups of drugs prescribed in the Maharashtra Health Systems Development Project (MHSDP) or the government hospitals in the state, according to the findings of a prescription audit made by the Hyderabad-based Administrative Staff College of India (ASCI). The main objective of the 'Prescription Audit of Outpatient Attendees' of MHSDP was to provide inputs for use of drugs in the project hospitals.

Thirty two hospitals from eight districts, representing eight zones of the state participated in the study. All the four categories of MHSDP hospitals namely district hospitals and sub district hospitals (SDH) with 100 and 50 beds (DH 100 and SDH 50) and Community Health Centres (CHC PI) are represented equally (eight in each category) in the study. The sample included tribal as well as non-tribal hospitals. 14,004 carbon copies of the 'first encounter prescription' provided by 212 doctors, representing 10 OPDs, are the basis of analysis presented in the audit. The study was done during May-June 2003.

"The study is a fact finding mission and not a fault finding mission. The audit was meant to study how the prescription patterns could be improved upon so that no medicine is wasted and the patients get good quality and optimum medicine for the right diseases," said Dr RM Jotkar, assistant director, Directorate of Health Services, Maharashtra.

The study found that among the 400 drugs identified from prescriptions, first twenty drugs accounted for 70 per cent of the total drugs prescribed and first 30 accounted for almost 80 per cent of the usage.

The top five diseases handled by the MHSDP hospitals during the period were - diseases of respiratory system, certain infectious and parasitic diseases, diseases of musculoskeletal system, digestive system, skin and subcutaneous diseases.

Prescriptions given to females were three per cent more than the prescriptions given to males. However, in case of tribal hospitals the proportion of prescriptions given to females (49.1 per cent) is marginally less than those given to males (50.9). Similarly, the proportion of females is comparatively lower in the children and adolescent age groups.

Occurrence of dorsalgia, malaise and fatigue (anemia), head ache, dizziness and giddiness were in higher proportion to females, while treatment for injury of unspecified body region, dog bite, foot injury and conjunctivitis were high among the males. In case of tribal hospitals prescriptions for fevers with chill, coughs, abdominal pain, headache, dizziness and giddiness is higher compared to non-tribal hospitals. In case of non-tribal hospitals occurrence of respiratory tract infections, supervision of normal pregnancy is higher compared to tribal hospitals.

The top 25 drugs account for between 96 per cent (dental OPD) to 68 per cent (skin OPD) of the drugs prescribed by different OPDs. Only three drugs, namely multivitamin Biotech complex, ibuprofen and ranitidine among the top 25 are used by all the ten OPDs. Nine out of the ten OPDs prescribes Paracetamol and diclofenac.

Prescription audit is part of the World Bank sponsored MHSDP. World Bank had recommended the prescription audit scheme as early as 1996. States like Karnataka, Madhya Pradesh, Punjab, West Bengal, and Orissa have been implementing the scheme since then.

MHSDP is considering to institute a mechanism for continuous 'Prescription Audit' for a period of may be 2-3 years, till the doctors adopt rational prescription practices, voluntarily.