Volume : 4, Issue : 4, FEB 2020
IN THE THROES OF PRESCRIPTION DRUGS; INDIA’S MISUSE OF MEDICATION
Neenu Rachel Santhosh, Pavan Kalyan Gadela
Objective: Half the family spending on health care services in India is on superfluous drugs or diagnostic tests. Polypharmacology, promoting both medication misuse and abuse, is presently an entrenched feature of today’s healthcare system. This review focuses on the extent of misuse and explains the underlying factors leading to it. Methods: This review was conducted by analyzing relevant articles published after 2000, which included topics on drug use and misuse in India. Articles, case reports etc dealing with substance abuse were excluded. 50 articles were acceptable and were included. Results: The literature shows that India has widespread medication misuse. The factors influencing this misuse involve all levels of the health care system including regulation, enforcement and policy, patients, pharmacist, medical practitioners, and hospital management. Conclusion: This review explains the widespread nature of the problem and also gives a complete picture of factors leading to medication misuse in India. Medication usage, the knowledge, attitudes and behaviors of medical practitioners, pharmaceutical providers and consumers are studied. It appears that the health system in India is worsening, thereby warranting urgent action.
Medication abuse, India's misuse, Polypharmacology, Superfluous drugs.
Article : Download PDF
Cite This Article
Article No : 1
Number of Downloads : 8
1. Bate R, Tren R, Mooney L et al. Pilot study of essential drug quality in two major cities in India. PLoS One. 2009 Jun 23;4(6):e6003.
2. Balarajan Y, Selvaraj S, Subramanian SV et al. Health care and equity in India. The Lancet. 2011 Feb 5;377(9764):505-15.
3. Laxminarayan R, Chaudhury RR. Antibiotic resistance in India: drivers and opportunities for action. PLoS medicine. 2016 Mar 2;13(3):e1001974.
4. Das J, Hammer J. Money for nothing: the dire straits of medical practice in Delhi, India. J Dev Econ. 2007 May 1; 83(1):1-36.
5. Reddy KS, Patel V, Jha P et al.Towards achievement of universal health care in India by 2020: a call to action. The Lancet. 2011 Feb 26; 377(9767):760-8.
6. Patel V, Kumar AS, Paul VK et al. Universal health care in India: the time is right. Lancet 2011; 377(9764):448.
7. Chandy SJ. Consequences of irrational use of antibiotics. Indian J Med Ethics. 2008 Oct;5(4):174-5.
8. Berman PA. Rethinking health care systems: Private health care provision in India. World Development. 1998; 26(8):1463-79.
9. World Health Organisation. Essential medicines and health products. WHO. http://www.who.int/medicines/services/essmedicines_def/ en/ .Accessed 10 May 2019.
10. Masih S, Cynthia Stephen S, Joy Armstrong L et al. Use and misuse of glucocorticoids in the community of Raxaul Block, North Bihar. TROP DOCT. 2015 Apr; 45(2):68-72.
11. Greenhalgh T. Drug prescription and self-medication in India: an exploratory survey. Soc sci med.1987; 25(3):307-18.
12. Badiger S, Kundapur R, Jain A et al.Self-medication patterns among medical students in South India. The Australas Med J. 2012; 5(4):217.
13. Brownlee S, Chalkidou K, Doust J et al. Evidence for overuse of medical services around the world. The Lancet. 2017; 390(10090):156-68.
14. Ravishankar K. Medication overuse headache in India. Cephalalgia. 2008; 28(11):1223-6.
15. Travasso C. India draws a red line under antibiotic misuse. BMJ .2016; 352: i1202.
16. Gautam CS, Aditya S. Irrational drug combinations: need to sensitize undergraduates. Indian J Pharmacol. 2006 ;38(3):169
17. Saradamma RD, Higginbotham N, Nichter M et al. Social factors influencing the acquisition of antibiotics without prescription in Kerala State, south India. Soc Sci Med. 2000 Mar 1; 50(6):891-903.
18. Nehru M, Kohli K, Kapoor B et al. Drug utilization study in outpatient ophthalmology department of Government Medical College Jammu. JK Science. 2005;7(3):149-51
19. Jin J, Sklar GE, Oh VM et al. Factors affecting therapeutic compliance: A review from the patient’s perspective. Ther Clin Risk Manag. 2008 Feb;4(1):269
20. Nayak B, Gupta S, Kumar G et al. Socioeconomics of long-term glaucoma therapy in India. Indian J Ophthalmol. 2015 Jan; 63(1):20.
21. Vengurlekar S, Shukla P, Patidar P et al. Prescribing pattern of antidiabetic drugs in Indore city hospital .Indian J Pharm Sci.2008 Sep;70(5):637.
22. Sathish T, Kannan S, Sarma SP et al. Peer Reviewed: Screening Performance of Diabetes Risk Scores Among Asians and Whites in Rural Kerala, India. Prev Chronic Dis. 2013; 10.
23. Gupta S. Emerging Indian OTC Markets. AJMST. 2013 Oct;1:24-9
24. Basak SC, Sathyanarayana D. Evaluating medicines dispensing patterns at private community pharmacies in Tamilnadu, India. South. Med Rev. 2010 Oct 1;3(2):27-31
25. Leendertse AJ, Visser D, Egberts AC et al. The relationship between study characteristics and the prevalence of medication-related hospitalizations. Drug Saf. 2010 Mar 1; 33(3):233-44.
26. Banerjee S, Varma RP. Factors affecting non-adherence among patients diagnosed with unipolar depression in a psychiatric department of a tertiary hospital in Kolkata, India.Depress Res Treat .2013.
27. Agarwal S, Yewale VN, Dharmapalan D et al. Antibiotics use and misuse in children: a knowledge, attitude and practice survey of parents in India. JCDR. 2015 Nov;9(11):SC21.
28. Kotwani A, Chaudhury RR, Holloway K et al. Antibiotic-prescribing practices of primary care prescribers for acute diarrhea in New Delhi, India. Value Health. 2012 Jan 1; 15(1):S1169.
29. Bharathiraja R, Sridharan S, Chelliah LR et al. Factors affecting antibiotic prescribing pattern in pediatric practice. Indian J Pediatr. 2005 Oct 1; 72(10):877-9.
30. Global Antibiotic Resistance Partnership (GARP)-India Working Group. Rationalizing antibiotic use to limit antibiotic resistance in India. Indian J Med Res. 2011 Sep; 134(3):281.
31. Saha S, Hossain MT. Evaluation of medicines dispensing pattern of private pharmacies in Rajshahi, Bangladesh. BMC Health Serv Res.2017 Dec;17(1):136.
32. Zaidi AK, Awasthi S, Janaka deSilva H et al. Burden of infectious diseases in South Asia. Bmj. 2004 1; 328(7443):811-5.
33. Ahmad A, Patel I, Mohanta GP et al. Evaluation of self-medication practices in rural area of town Sahaswan at Northern India. Ann Med Health Sci Res 2014; 4(8):73-8.
34. Shet A, Sundaresan S, Forsberg BC et al. Pharmacy-based dispensing of antimicrobial agents without prescription in India: appropriateness and cost burden in the private sector. ANTIMICROB RESIST IN. 2015 Dec;4(1):55
35. Dua V, Kunin CM, White LV et al. The use of antimicrobial drugs in Nagpur, India. A window on medical care in a developing country. Soc Sci Med. 1994 Mar 1; 38(5):717- 24.
36. Dongre Y, Mahadevappa B, Rohini R et al. Building access to healthcare in rural India: possibility and feasibility of low-cost medicine. Int J Pharm Healthc Mark. 2010 Nov 23; 4(4):396-407.
37. Newman C, Ajay VS, Srinivas R et al. Drugs for cardiovascular disease in India: perspectives of pharmaceutical executives and government officials on access and development-a qualitative analysis. J Pharm Policy Pract. 2016 Dec;9(1):16.
38. Sleath BL, Krishnadas R, Cho M et al. Patient-reported barriers to glaucoma medication access, use, and adherence in southern India. Indian J Ophthalmol 2009 Jan; 57(1):63.
39. Jain SS, Bavdekar SB, Gogtay NJ et al. Off-label drug use in children. Indian J Pediatr 2008 Nov 1; 75(11):1133.
40. Chandy SJ, Thomas K, Mathai E et al. Patterns of antibiotic use in the community and challenges of antibiotic surveillance in a lower middle-income country setting: a repeated cross-sectional study inVellore,southIndia. JAntimicrobChemother2013; 68(1):229–36.
41. May PA. Alcohol and drug misuse prevention programs for American Indians: needs and opportunities. J Stud Alcohol. 1986 May;47(3):187-95
42. Deshpande PR, Vantipalli R, Lakshmi CC et al. Clinical pharmacists: The major support to Indian healthcare system in near future. J Pharm Bioallied sci.2015;7(3):16
43. Hajjar ER, Cafiero AC, Hanlon JT et al. Polypharmacy in elderly patients. The American journal of geriatric pharmacotherapy.2007 Dec 1;5(4):345-51
44. Coondoo A. Topical corticosteroid misuse: the Indian scenario. Indian J Dermatol.2014 Sep; 59(5):451.
45. Harugeri A, Joseph J, Parthasarathi G et al. Prescribing patterns and predictors of high- level polypharmacy in the elderly population: A prospective surveillance study from two teaching hospitals in India. Am J Geriatr Pharmacother. 2010 Jun 1; 8(3):271-80.
46. Rehan HS, Lal P. Drug prescribing pattern of interns at a government healthcare centre in northern India. TROP DOCT. 2002 Jan; 32(1):4-7.
47. Celin AT, Seuma J, Ramesh A et al. Assessment of drug related problems in stroke patients admitted to a South Indian tertiary care teaching hospital. Indian J Pharm Pract. 2012 Oct;5(4):28-33
48. Grover S, Avasthi A, Sinha V et al. Indian Psychiatric Society multicentric study: Prescription patterns of psychotropics in India. Indian J Psychiatry. 2014 Jul; 56(3):253.
49. Shamshy K, Begum IM, Perumal P et al. Drug utilization of antimicrobial drug in pediatrics population in a tertiary care hospital in Erode, Tamilnadu, India. Int J PharmTech Res. 2011;3(3):1530-6
50. Gupta R, Prakash H, Gupta RR et al. Economic issues in coronary heart disease prevention in India. J Hum Hypertens. 2005 Aug; 19(8):655