Abstract

DRUG PRESCRIBING PATTERNS AMONG GERIATRIC OUTPATIENTS IN A TERTIARY CARE TEACHING HOSPITAL: A CROSS-SECTIONAL STUDY USING WHO CORE PRESCRIBING INDICATORS

Dr. Shadab Alam*, Prof. Devendra Katiyar, Dr. Ankit Kumar

ABSTRACT

The global population is ageing at an unprecedented rate, making healthy ageing and appropriate healthcare for older adults a major public health priority. According to the World Health Organization (WHO), the proportion of individuals aged 60 years and above is increasing rapidly due to improved life expectancy and advances in medical care. India is also experiencing a significant demographic transition, with the elderly population expected to rise substantially over the coming decades. Ageing is accompanied by progressive physiological changes, reduced functional reserve, and an increased prevalence of chronic non-communicable diseases such as hypertension, diabetes mellitus, cardiovascular diseases, chronic kidney disease, chronic obstructive pulmonary disease, and osteoarthritis. Consequently, elderly individuals require long-term pharmacotherapy and frequent healthcare utilization, making rational prescribing an essential component of geriatric care. However, age-related pharmacokinetic and pharmacodynamic changes alter drug absorption, distribution, metabolism, and elimination, increasing susceptibility to adverse drug reactions and medication-related complications. These factors make elderly patients one of the most vulnerable groups requiring careful evaluation of prescribing practices. The coexistence of multiple chronic diseases in older adults frequently results in polypharmacy, commonly defined as the concurrent use of five or more medications. Although multiple medications are often clinically justified, inappropriate polypharmacy substantially increases the risk of drug–drug interactions, adverse drug reactions, medication non-adherence, falls, cognitive impairment, hospitalization, and mortality. The complexity of prescribing is further influenced by multiple healthcare providers, frequent changes in therapy, and inadequate medication review. Potentially inappropriate medications (PIMs), as identified by explicit tools such as the American Geriatrics Society (AGS) Beers Criteria and the STOPP/START criteria, remain a major concern in geriatric pharmacotherapy. Studies conducted in India and other countries have consistently reported a high prevalence of polypharmacy and inappropriate prescribing among elderly patients attending tertiary care hospitals. These findings highlight the need for systematic prescription audits and continuous monitoring to improve medication safety and optimize therapeutic outcomes in this vulnerable population. The World Health Organization has developed standardized Core Prescribing Indicators under the International Network for Rational Use of Drugs (INRUD) to assess the quality of prescribing practices. These indicators include the average number of drugs per encounter, the percentage of drugs prescribed by generic name, the percentage of encounters with antibiotics and injections, and the percentage of drugs prescribed from the National List of Essential Medicines (NLEM). These objective indicators facilitate comparison of prescribing patterns across different healthcare settings and help identify irrational prescribing practices requiring corrective interventions. Rational prescribing is particularly important in elderly patients because inappropriate medication use not only compromises clinical outcomes but also increases healthcare costs and contributes to antimicrobial resistance. Despite several prescription audit studies conducted in India, comprehensive evaluations of prescribing patterns among geriatric outpatients using WHO prescribing indicators remain limited, particularly in tertiary care teaching hospitals of North India. Therefore, there is a continuing need to generate institution-specific evidence to guide interventions aimed at improving rational drug use in elderly populations. In view of the increasing burden of multimorbidity, polypharmacy, and medication-related problems among older adults, systematic evaluation of prescribing practices has become an important component of quality healthcare. Assessment of prescriptions using WHO Core Prescribing Indicators provides reliable evidence regarding the rationality of drug use and identifies areas requiring improvement in prescribing behaviour. Such evidence can support clinicians, hospital administrators, and policymakers in implementing prescription audit programs, promoting generic prescribing, improving adherence to the National List of Essential Medicines, and strengthening antimicrobial stewardship initiatives. Therefore, the present study was undertaken to evaluate the prescribing patterns among geriatric patients attending the outpatient department of a tertiary care teaching hospital using WHO Core Prescribing Indicators, with the aim of generating evidence that may contribute to safer, more rational, and evidence-based pharmacotherapy for the elderly population.

Keywords: behaviour. Such evidence can support clinicians, hospital administrators, and policymakers in implementing prescription audit programs, promoting generic prescribing, improving adherence to the National List of Essential Medicines, and strengthening antim