Pharmacoepidemiological and Socio economical Aspects of Antipsychotic Drugs Usage in Pakistan

Abstract

The provision to appropriate medicines should be vital right of each individual. The swelling costs pose a burden upon the otherwise scarce health care funds. Therefore, there is the need of time to use drug rationally. This rational drug consumption is vital fragment of every country’s health strategy. The main purpose of Pharmacoepidemiological investigations encompasses efficient and economical use of medicines in the population and thus improve health outcomes. In the light of this scenario, the basic aims of present study were to address the Pharmacoepidemiological aspects and socioeconomic aspects of antipsychotics drugs usage in Pakistan. With this basic aim of research the trends and practice of antipsychotic drug’s consumption in the formal allopathic health facilities in Rawalpindi/Islamabad, Faisalabad, Gujranwala, Lahore, Multan, Peshawar, Sukkur and Hyderabad with respect to gauging the level and magnitude of the problem and suggesting remedial actions for its appropriate use. Therefore the research work was divided into six isolated studies according to aims and objectives of our investigations. (i) First study dialogues about investigation of prescribing patterns of antipsychotics in tertiary healthcare facilities and talks about outlining the psychiatric disorders and their magnitude of comorbidities. (ii) Second study detailed the assessment of medication adherence of patients on antipsychotic therapy. (iii) Third study was to gauge the quality of medicines of branded generics using in Pakistan. The said aspect was considered because poor quality may inadvertently lead to healthcare failures and life-threatening issues. (iv) Fourth study was to estimate the trends of intercontinental medical statistics data with facts on the information that may have an impact on the patterns of medicines consumption and enables the access to drug utilization data which will serve to help identifying public health glitches associated to the safety of medicines. (v) Fifth study was to assess the socioeconomic status of Pakistani population on antipsychotic disorders and therapy. (vi) Sixth andlast study was to explore factors influencing prevalence of psychiatric disorders and prescribing behaviors of physicians. Results indicated that the health liability of antipsychotic medication is well acknowledged, but the inconsistent effect on women as equated with men is under- valued. There was no significant difference (X 2=0.242) found in the prescribing pattern of both male and female populations. The least prescribed drug in each population was Flupenthixol DRSML QAU viii 0.7% and 0.8% respectively among atypical while aripiprazole 0.9% and 1.7% among typical antipsychotics respectively. The most prescribed atypical drug in both genders was risperidone 19.95% and 17.45% while haloperidol 4.15% and 3.55% was found most prescribed typical antipsychotic. Total of 93% patients received only one antipsychotic with other drugs while 1.9% of patients received more than two antipsychotics and 5.1% of patients received two antipsychotics drugs in single prescription. The rate of co-morbidities was high in patients with schizophrenia and insomnia. There were four major factors which affect medication compliance; (i) long duration of treatment (83%), (ii) poor financial resources (69%), (iii) side effects of medication (73%) and (iv) bad experience to treat like acute episodes and relapse (68%). In case of quality of medicine, descriptive statistics showed that mean dissolution profiles are 88.3 + 0.619 with the 95% CI (87.05, 89.54). On the other hand, descriptive statistics for mean assay profile was 99.51 + 0.502 with the 95% CI (98.50, 100.53). Inferential statistics for dissolution and assay showed that there was substantial variance (p = 0.000) found in dissolution profile of various brands. Trends of IMS data assessed that the maximum units consumed were 7,235,900 (17.46% of total antipsychotics units from year 2010 to 2017) in the year 2017. The leading brand consumed in these years was RISP with share of 21.44%. The least units consumed were 2,673,497 (6.45%) in the year 2017. The least brand consumed was Benzisox (risperidone) with share of 0.48%. Results also suggested that socioeconomic status influenced the prescribing of antipsychotics in Pakistan. The qualitative study identified patient’s age and cost. This research concluded that optimum patient carefulness should be the objective of balanced pharmacotherapy, whereby the financial burden of treatment is just one of the essentials to be considered on selecting proper treatment. The optimal care may be achieved through good clinical use of drugs.