|Year : 2017 | Volume
| Issue : 1 | Page : 8-11
Utilization of drugs in patients with road traffic accident injuries
Havagiray R Chitme1, Mohamed Mubarak Salim Al Badri1, Abdullah Humaid Al Saadi2
1 Department of Pharmacy, Oman Medical College, Bousher Campus, Muscat, Sultanate of Oman
2 Out-Patient Department Pharmacy, Khoula Hospital, Muscat, Sultanate of Oman
|Date of Web Publication||25-Jan-2017|
Havagiray R Chitme
Department of Pharmacy, Oman Medical College, Muscat
Sultanate of Oman
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Drug utilization studies provide information on pattern of drug prescribing and consumption, occurrence of delayed adverse effects, cost influenced sales, and the volume of prescriptions having social, economic, and medical significance. Objective: The present study was designed with an objective to evaluate drug utilization in this field of pharmaceutical care. Materials and Methods: The present study was a retrospective, qualitative, cross-sectional, drug utilization study carried out for 1 year in Accident and Emergency Department of Khoula Hospital. Results: Results of the present study indicate that majority of patients complained dizziness by 24% and pain with 50%. Most common antibiotics used in prophylaxis and treatment were amoxiclav, cefuroxime, and ceftriaxone injections. As some cases complained of severe pain, they had received paracetamol, ibuprofen, diclofenac, and tramadol. The tetanus toxin injection was given as prophylaxis in 27.9% of cases against poisoning from entry of foreign bodies. Metoclopramide and promethazine are medications given to relieve nausea and vomiting. Analysis of results on use of medications for pain management has shown a significant (P < 0.01) correlation with road traffic injuries. Conclusion: We conclude from this study that majority of patients visiting accident are noted to have minor complications due to road traffic accidents (RTAs) and are treated successfully with most common and safe medications. However, we recommend future extensive studies considering the patients admitted to Inpatient Department and Intensive Care Unit to get clear information on pharmaceutical care provided to manage RTA and their complications.
Keywords: Accident, drug utilization, injury, management, patient, pharmaceutical preparations, road traffic accident, wounds
|How to cite this article:|
Chitme HR, Al Badri MS, Al Saadi AH. Utilization of drugs in patients with road traffic accident injuries
. Int J Nutr Pharmacol Neurol Dis 2017;7:8-11
|How to cite this URL:|
Chitme HR, Al Badri MS, Al Saadi AH. Utilization of drugs in patients with road traffic accident injuries
. Int J Nutr Pharmacol Neurol Dis [serial online] 2017 [cited 2018 Mar 19];7:8-11. Available from: http://www.ijnpnd.com/text.asp?2017/7/1/8/199069
| Introduction|| |
Drug utilization studies have found their ground due to the increased in introduction of new drugs, wide variations in the pattern of prescribing drug and consumption, occurrence of delayed adverse effects, cost influenced sales, and the volume of prescriptions., According to the World Health Organization studies, the medical and nonmedical determinants of drug utilization, the effects of drug utilization, as well as studies of how drug utilization relates to the effects of drug use, beneficial or adverse effects, are needed to provide an adequate basis for improving drug therapy. These studies have raised the standard of rational pharmaceutical care, thereby gaining enormous social, economic, and medical significance. Qualitative drug utilization studies compare the quality, medical necessity, and appropriateness of medical care based on indications for use, dose, dosing frequency, and duration of therapy. Quantitative studies involve the collection, organization, and estimation of drug use and assist in making purchase decisions or preparing drug budgets. However, these are generally considered suggestive, not conclusive with respect to quality of drug use.
The study of prescribing pattern is a part of the medical audit and seeks to monitor, evaluate, and, if necessary, suggest modification in prescribing practices to make medical care rational and cost-effective. Epidemiological evaluation of medicine use is now a highly visible topic, but hardly there are studies on drug utilization in road traffic accident (RTA) injuries. Oman is one of the innovative countries in evaluating and adopting the relevant practices to improve the burden of traffic accidents on the local and international levels. Establishing “Traffic Safety Institute,” funding research projects on RTA by “The Research Council,” and establishing “Road safety strategy” by the government are few of them. Drug utilization studies reported from Sultan Qaboos University Hospital’s (SQUH) Emergency Department (ED), from pediatric population, among adult epileptic patients, from pregnant women, and pharmacoepidemiological studies of antiepileptic drugs have brought innovation in therapeutic strategy and management of diseases and disorders. However, systematic, comprehensive, and evaluations of drug utilization review systems among patients injured in RTAs are hardly studied and published. The present study is a first of its kind in this direction and will remain as the model and guide for other researchers working in this field and take up this field of research at higher level.
The present study is based on the hypothesis that Oman has significantly higher number of fatal and nonfatal RTAs in all age group population. The primary objective of this retrospective study was to study the utilization pattern of drugs prescribed in the Department of Accident and Emergency (A and E), Khoula Hospital, from January 2014 to December 2014 for patients injured in RTA. Specific objectives of our study were to delineate the various drugs, category of drugs, dosage forms, administration, regimens used in RTI cases at ED and to find discrepancies, if any, between the actual and the ideal prescribing pattern of drugs.
| Materials and Methods|| |
This drug utilization study was a hospital-based, retrospective, cross-sectional study among RTA injured patients at the Department of A and E, Khoula Hospital, for 1-year period from January 2014 to December 2014.
Among 765 RTA injury cases during the year 2014, 104 cases were randomly chosen by a computer for this study. Data collection was carried out by research team members along with a pharmacist of the hospital. Data were collected from the electronic medical record database, thus obviating Hawthorne’s bias on a structured case record form and then directly into Statistical Package for the Social Science (SPSS) (version 19; IBM, USA). Data were analyzed by a statistician from respective hospital and P < 0.05 was considered as statistically significant. The following data were collected from patient’s E-files:
Inclusion and exclusion criteria
The study includes RTA injury cases and those who had undergone treatment at Khoula Hospital during 2014. The study excluded prescription items such as blood products, oxygen, total parenteral nutrition, herbal drugs, oral rehydration salts, surgical dressings, electrolytes, catheter, needle, syringe, and other items routinely used in clinical assistance for the maintenance of peripheral venous access and drug administration.
Drug- and patient-related variables
Drug name, category, total numbers, dosage forms, administration forms, administration intervals, and drug presentation were recorded as drug-related variables. Gender and nationality of the patients were recorded as patient-related variables.
The Ministry of Health Ethics Committee approval is not required for this study as it was restricted to only Khoula Hospital, yet the study does not violate principles of medical ethics and protects the identity of the participants and findings at highest possible degree of confidentiality.
Medication data available from patient records were collected and transferred into SPSS datasheet with a code. Data analysis was performed in terms of frequency, percentage, Pearson correlation analysis, and Chi-square test. P < 0.05 was considered statistically significant.
| Results|| |
Demographic characteristics of road traffic injured patients
Out of 104 patients, 73 (70.2%) were males compared to 31 (29.8%) female patients. Out of 104 patients, 43 (41.3%) brought to the A and E Department were Omanis and 61 (58.7%) patients were expatriate [Figure 1].
Medical complaints of patients received at Accident and Emergency Department
The most common complaints seen in A and E Department were dizziness and pain. The number of patients had dizziness only was 25 which accounted for 24% and for those came with pain was 52 patients (50%). This was followed by nausea, vomiting, and ulcerated wound cases. Twenty-seven patients had more than one complaint depending on the severity of the RTA. Thirty-three patients out of 104 cases came to A and E Department had been admitted to the hospital and 71 patients left A and E Department without the need of admission [Figure 2].
Medications used in management of patient complaints
In our study, ten patients received amoxicillin-clavulanic acid injections, two patients received cefuroxime injections, 17 patients received ceftriaxone, while 75 patients did not receive any antibiotic. As mentioned above, the most common painkillers prescribed in A and E Departments were paracetamol, ibuprofen, diclofenac, tramadol, and sometimes more than one painkiller. In severe pain, some patients received injection form of analgesics. In total 25 patients received paracetamol, 6 patients received ibuprofen, 46 patients received diclofenac, 2 patients received tramadol, and around 25 patients got more than two medications for pain. The tetanus toxin injection was given to prevent any poisoning from entry of foreign bodies. Around 27.9% of patients have received tetanus toxin injections. Metoclopramide and promethazine were given to relieve nausea and vomiting. Twenty-five patients received metoclopramide injection and five patients received promethazine injections [Table 1].
Pearson correlation analysis of use of medications in road traffic accident injured patients
Pearson correlation analysis (two-tailed) was carried out to correlate the use of medications and RTA injury management. However, use of antibiotics, promethazine, metoclopramide, and tetanus, has no significant correlation with frequency of injuries. Analysis of results on use of medications for pain management has shown a statistically significant (P < 0.01) correlation with road traffic injuries [Table 2].
|Table 2: Crosstabs analysis of use of medications in road traffic accident injured patients|
Click here to view
| Discussion|| |
The present study was a retrospective qualitative study examining the use of drugs by collecting, organizing, and analyzing the report information on actual drug use in RTA injury cases admitted to the A and E Department of Khoula Hospital. The present study focuses on the medical necessities and appropriateness of medical care based on indications for use and dosage forms by referring prescribing data. Therefore, the present study is a first of its kind and will remain as the model and guide for other researchers working in the field of drug utilization in patients injured in RTA and take up this field of research at higher level.
Majority of injured patients reported to the hospital were male and only about 30% were female. These results are similar to the recently conducted case study in Dhofar region of Oman where accident causalities were about 67.3% for people aged between 20 and 40 years and 98.4% of accident causalities were with males. However, 61% of the cases were associated with expatriates which are higher than the national statistics where almost 80% of cases are with nationals. The difference could be because majority of expatriates live in Muscat, i.e., the location of Khoula Hospital.
In the A and E Department, most of the cases were clean wound or fractures which were considered as noninfectious diseases do not need antibiotics. However, in some cases, it was necessary to give prophylactic antibiotics to prevent growth of bacteria and further complications. Most common antibiotics used were ceftriaxone followed by amoxiclav and cefuroxime injections. These results are similar to a retrospective, cross-sectional study conducted in 2013 which indicated that the second most common category of drugs utilized was antibiotics (16%) and paracetamol was the most prescribed drug in the patients (13%). Tetanus toxin injection is given to prevent any poisoning from entry of foreign bodies into the body.
Detailed investigations on the types of complaints experienced by those injured patients varied but the most complaints seen in A and E Departments were dizziness and pain and sometimes accompanied by nausea, vomiting, and ulcerated wounds. Metoclopramide was the most common drug used in the management of nausea and vomiting, followed by promethazine. The most common painkillers used in the management of pain with injured patients at the A and E Department was diclofenac, followed by paracetamol, combinations, and tramadol. These results supports drug utilization study conducted in the ED at SQUH, a tertiary care hospital, in Muscat, the Sultanate of Oman, shown that nonsteroidal anti-inflammatory drugs were the most commonly prescribed class of drugs (38%), followed by the gastrointestinal tract drugs (19%) and central nervous system drugs (13%). The present study has proven that there is a significant amount of correlation exists in use of pain medications and RTA injury management. A descriptive epidemiological study of headache has also shown acetaminophen (83.1%), followed by mefenamic acid (24.6%), which were the most commonly used drugs.
| Conclusion|| |
Based on the results, this study concludes that majority of patients visiting the A and E Department of Khoula Hospital are noted to have minor complications due to RTAs and are treated successfully with most common and safe medications. However, future studies are recommended considering inpatients and Intensive Care Unit patients to get clear information on pharmaceutical care provided to manage RTA injuries and their complications.
We acknowledge the assistance of pharmacists and statisticians who have contributed with their time, knowledge, skills, analysis, and support without which the research would not have been completed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Wettermark B, Hammar N, Fored CM, Leimanis A, Otterblad Olausson P, Bergman U et al.
The new Swedish prescribed drug register – Opportunities for pharmacoepidemiological research and experience from the first six months. Pharmacoepidemiol Drug Saf 2007;16:726-35.
Rosholm JU, Gram LF, Isacsson G, Hallas J, Bergman U. Changes in the pattern of antidepressant use upon the introduction of the new antidepressants: A prescription database study. Eur J Clin Pharmacol 1997;52:205-9.
Andersen M. Is it possible to measure prescribing quality using only prescription data? Basic Clin Pharmacol Toxicol 2006;98:314-9.
Zafar F, Ali H, Naveed S, Korai OU, Rizvi M, Naqvi GR et al.
Drug utilization pattern in cardiovascular diseases: A descriptive study in tertiary care settings in Pakistan. J Bioequiv Availab 2015;7:59-62. doi: 10.4172/jbb.1000215.
Sachdeva PD, Patel BG. Drug utilization studies – Scope and future perspectives. Int J Pharm Biol Res 2010;1:11-7.
Venkateswaramurthy N, Murali R, Sampath Kumar R. The study of drug utilization pattern in pediatric patients. Int J Pharm Pharm Sci 2013;5:140-4.
Al Balushi KA, Al-Shibli S, Al-Zakwani I. Drug utilization patterns in the emergency department: A retrospective study. J Basic Clin Pharm 2013;5:1-6.
Al Balushi KA, Al-Sawafi F, Al-Ghafri F, Al-Zakwani I. Drug utilization pattern in an Omani pediatric population. J Basic Clin Pharm 2013;4:68-72.
Al Za’abi M, Ahmed R, Al Asmi A, Al-Zakwani I. Utilization patterns of antiepileptic drugs among adult epileptic patients at a tertiary hospital in Oman. Int J Pharm Pract 2013;21:117-22.
Al-Riyami IM, Al-Busaidy IQ, Al-Zakwani IS. Medication use during pregnancy in Omani women. Int J Clin Pharm 2011;33:634-41.
Hanssens Y, Deleu D, Al Balushi K, Al Hashar A, Al-Zakwani I. Drug utilization pattern of anti-epileptic drugs: A pharmacoepidemiologic study in Oman. J Clin Pharm Ther 2002;27:357-64.
Farag SG, Hashim IH, El-Hamrawy SA. Analysis and assessment of accident characteristics: Case study of Dhofar Governorate, Sultanate of Oman. Int J Traffic Transp Eng 2014;3:189-98.
Bernadette B. Driving home the truths. Road Safety 2013: A Supplement With Times of Oman; 2013. p. 18-20.
Deleu D, Khan MA, Humaidan H, Al Mantheri Z, Al Hashami S. Prevalence and clinical characteristics of headache in medical students in Oman. Headache 2001;41:798-804.
[Figure 1], [Figure 2]
[Table 1], [Table 2]