Drug utilization studies using WHO prescribing indicators from India: A systematic review

Objective: The World Health Organization (WHO) provides standard drug use indicators used globally for drug utilization studies. This systematic review examines and reports the drug utilization profiles captured by individual drug utilization studies conducted in India's different states using World Health Organization prescribing indicators. Methods: PubMed, ScienceDirect, and Google Scholar resource databases were searched up to April 2020. The search included drug utilization studies conducted in India using WHO prescribing indicators and focused on all drug classes and had a considerable variance with study design, data source, and sample size. Results: A total of 561 studies were scanned and retrieved from the database. Forty-two studies met the inclusion criteria and were selected for the final analysis. The prescription pattern was mixed across different geographic locations in India. The average number of drugs prescribed per encounter from the included studies was found to be 3.08. Whereas 24 studies (60%) reported more than 30% of encounters with an antibiotic. The percentage of drugs prescribed using a generic name was poor, and none of the studies recorded 100% prescribing using the generic name. Use of injections as the route of administration was low, and only five studies (14%) had reported more than 20% use of injections. Out of 42 selected studies, 37 (81%) studies reported the percentage of drugs prescribed from the list of essential medicines (ELM). However, only one (2.4%) study reported 100% of drugs prescribed from ELM. Conclusion: Drug utilization research helps to attain rational and cost-effective treatment and contributes to monitoring, appraising, and improving the prescribing practices. Further studies at regular intervals help in updating recommended guidelines, directly benefiting patients. Public interest summary: Out of pocket expenditure on health is one of the reasons for people falling into poverty in India. These health care expenses can be minimized by promoting the rational use of medicine. The current systematic review attempts to highlight the scenario of drug utilization studies conducted in health care facilities from different regions of India using WHO prescribing indicators. The present systematic review findings showed that the percentage of antibiotics prescribed was very high, and fewer drugs were prescribed using the generic name. This is a deviation from the standards recommended by the World Health Organization. Besides, the percentage of drugs prescribed from the essential list of medicines was reassuring and can be further improved; the percentage of prescribed injectable drugs was in an optimal range. Though the data seen in the existing systematic review is heterogeneous in nature, researchers and policymakers can use the information collected from this review as baseline data to improve prescribing practices.