The quality of prescribing in an Indian district

There has been no previous broad-based study in India which analyses the rationality of prescriptions in relation to the diseases for which they are given. We performed such an analysis in a representative district of Maharashtra.

During 1993, 3582 prescriptions of a district-level stratified purposive sample of 49 doctors from the Satara district in Maharashtra were assessed. The prescriptions were collected prospectively from the outdoor clinics of these doctors from widely varying health sectors--private practice, government employment, differing educational qualifications and diverse socio-economic zones and geographic locations. With the help of Prescription Analysis Guidelines (PAGs) and a scoring system developed for this study, these prescriptions were compared with standard prescriptions, and were ranked on a quantitative rationality scale. The rationality scores of various categories of doctors were then compared.

The average score per prescription was 14.2 out of 30. The score increased significantly with educational qualification. The use of drugs was irrational in 19% of prescriptions, unnecessary in 47% and hazardous in 11%. Unnecessary injections were given in 24% of cases. Prescriptions given by doctors working in the public sector were significantly better than those given by private sector doctors in all respects, except for the use of unnecessary injections.

Overall, the quality of prescriptions, especially in the private sector is low with a high prevalence of undesirable drug use.