|Year : 2020 | Volume
| Issue : 2 | Page : 107-110
Assessment of knowledge regarding prescription of drugs among BDS interns
Surekha Rathod, Ishita Roy, Pranjali V Bawankar, Krutika Deshmukh, Vaishnavi K Gadbail
Department of Periodontics and Implantology, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
|Date of Submission||18-Dec-2019|
|Date of Decision||13-Jan-2020|
|Date of Acceptance||17-Mar-2020|
|Date of Web Publication||21-May-2020|
Dr. Pranjali V Bawankar
Department of Periodontics and Implantology, VSPM Dental College and Research Centre, Digdoh Hills, Hingna Road, Nagpur - 440 019, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Interns are the future professionals who would be treating patients on their own once they graduate, so it is mandatory that they be aware of correct prescribing. The present study aimed to assess the knowledge of dental interns regarding the prescription of drugs.
Methodology: A structured, self-administered questionnaire was designed and given to 68 interns. The data were collected and analyzed using SPSS version 21.
Results: A statistically significant number of interns were aware of the prescription of drugs for dental patients. However, it is essential for every intern to have sound knowledge regarding the pharmacodynamics, dosage, and prescription of drugs for dental infections in healthy as well as systemically compromised patients.
Conclusion: A majority of interns had moderate knowledge regarding drug prescription, and special efforts are required to educate the interns for the same.
Keywords: Attitude, drug, knowledge, practice, prescription
|How to cite this article:|
Rathod S, Roy I, Bawankar PV, Deshmukh K, Gadbail VK. Assessment of knowledge regarding prescription of drugs among BDS interns. Saudi J Oral Sci 2020;7:107-10
|How to cite this URL:|
Rathod S, Roy I, Bawankar PV, Deshmukh K, Gadbail VK. Assessment of knowledge regarding prescription of drugs among BDS interns. Saudi J Oral Sci [serial online] 2020 [cited 2020 Sep 19];7:107-10. Available from: http://www.saudijos.org/text.asp?2020/7/2/107/284699
| Introduction|| |
Prescription of medication is a fundamental and obligatory thing in dental practice, especially when it comes to undergraduates, graduates, and postgraduates, including medical or nonmedical use of prescription drugs and nonprescription drugs, and herbal products become a part and parcel of daily practice.
These drugs can offer great benefits to patients; however, the darker aspect of the adverse drug effects and interaction should also be taken into consideration. Prescribing is the primary intervention that most doctors offer to influence their patients' health – whatever career medical graduates decide to pursue, most will have to remain “specialists” in drug prescribing. Most junior doctors are unaware of the fact that prescribing errors may contribute to a significant rise in reported hospital adverse events and subsequent medicolegal problems. Unwise prescribing may assume several forms, such as under, inappropriate, over, irrational, and other prescribing errors.
The rational prescription process given by the World Health Organization (WHO) recommends the following steps such as (1) defining the patient's problem (diagnosis), (2) specifying the therapeutic objective, considering the different alternatives, (3) choosing a treatment with proven efficacy and safety, (4) initiating the treatment, (5) providing the clear information, instructions and warnings, and (6) stopping treatment, if the problem has been resolved or reexamining each step if the problem persists.
The most prescribed drugs in dentistry are the nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotics. Due to the characteristics of these drugs, it is mandatory to determine accurate doses and be aware of any adverse or toxic effects. Thus, knowledge of pharmacology is the most important component of the undergraduate teaching curriculum, where students learn about the art of prescription writing and different drug formulations. A dental graduate is expected to have inculcated sound theoretical knowledge, good clinical and diagnostic skills, and ability to prescribe effective and safe drugs as indicated. Various studies have been conducted among medical students regarding prescription knowledge, though there is a scarcity of literature among dental undergraduate students. The aim of the present cross-sectional study is to assess the knowledge of dental interns regarding the prescription of drugs.
| Methodology|| |
This observational study was conducted from March 2019 to September 2019 at our institute after the approval by the Institutional Ethics Committee and was in accordance with the Helsinki declaration of 1975, as revised in 2013. Written informed consent was obtained from all the participating students. The study was also approved by the Institutional Ethics Committee. Dental interns who were willing to participate in the study were included in the study, while those who had undergone a similar survey earlier were excluded from the study.
The sample size was calculated using the following formula:
n = ([Z1]2 [P(1 - P)] / d2
Confidence interval 95% and probability of α error 5%, power of the study was set at 80% assuming all the factors, sample size comes around 62 in this study. To avoid information bias like incomplete questionnaire filled, sample size increased to 68 subjects. A structured, self-administered questionnaire was designed and validated. The knowledge regarding the prescription of drugs was assessed using this questionnaire. The anonymity was maintained, and the data were collected from all the participants.
The descriptive data were expressed in proportions (percentage). A Chi-square test was used to compare the perception and knowledge of interns regarding the prescription of drugs. The data were analyzed using SPSS software version 21 for windows (SPSS Inc., Chicago, IL, USA).
| Results|| |
The obtained data were tabulated, as depicted in [Table 1]. Most of the study participants (79.4%) have highly statistically significant (P < 0.001) the presence of knowledge of rational prescription process given by the WHO. Most of the study participants (89.7%) have highly statistically significant (P < 0.001) the presence of knowledge of the mechanism of action of drug (pharmacodynamics). Almost all participants (92.6%) believed that NSAIDs are the most commonly prescribed drugs for pain and inflammation, and the presence of this knowledge was found to be highly statistically significant (P < 0.001). A majority of study participants (63.2%) had that disapproval of most common NSAIDs prescribed is naproxen (P < 0.001). There was a preponderance of the presence of knowledge regarding patients on aspirin, heparin, or warfarin drug that should be taken care of during any surgical procedure among the participants (89.7%) (P < 0.001). About half of the study participants (52.9%) disapproved of the statement that antihypertensive drugs not much relevant in dental treatments.
|Table 1: Assessment and comparison of knowledge regarding the prescription of drugs among BDS interns|
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The presence of knowledge regarding the excessive dose of local anesthesia containing adrenaline to be avoided in patients taking beta-blockers was found in 79.4% of the total study population (P < 0.001), while about 85.3% depicted the presence of knowledge regarding drug of choice to be altered in pregnant women (P < 0.001). Around 85.3% of the students had knowledge that drugs should be carefully given for patients with gastroesophageal reflux disease (P < 0.001). Many respondents (47.1%) disapproved the higher use of injections due to false assumptions of prescriber that it improves patient satisfaction, while 32.4% agree on the same.
A majority of the interns (79.4%) preferred amoxicillin as the most commonly prescribed antibiotic in dental infections, and about 83.8% had knowledge of the dose of amoxicillin. Almost all participants (80.9%) believed that control of blood sugar levels in diabetic patients is mandatory before any surgical procedure. A greater part of the study population (95.4%) believed that epinephrine is the drug of choice for cardiac arrest, while 85.3% believed that pain is the most common health condition treated in dental practice. The fact that antacids should be added into all prescriptions to avoid GI upset was believed by 89.7% of the interns.
| Discussion|| |
Prescribing medicines are a complex task that requires theoretical and clinical knowledge combined with practical skills. The present questionnaire-based study was performed among dental interns, who will be the future practitioners. It is very essential for the practitioner to have a sound knowledge regarding the pharmacokinetics and pharmacodynamics of the drugs and correct antibiotic dosage in given indicated cases. The curriculum strives hard to incorporate the basic knowledge regarding dental pharmacology in the 2nd year of the graduation course. However, it has been observed in the present study that not every intern was aware of the correct dosage of the drugs, nor have the knowledge of pharmacodynamics and pharmacokinetics of the drugs indicated for dental infections. Due to the vastness of the basic pharmacological information, the clinical perspective of pharmacological knowledge is lost. The teaching method often leaves the students to memorize drug information, it poorly prepares them to prescribe rationally, and thus, there is a sense of doubt and uncertainty when it comes to clinical prescribing.
When students advance into their internship where they are required to actively prescribe, a good pharmacological knowledge instills a sense of confidence in them. This study attempted to explore the manner in which the pharmacological principles learned in the 2nd year of the curriculum translates to the effective clinical practice of the interns.
In the present study, it was revealed that around 10% of the students were deprived of knowledge regarding the action of the drug. Moreover, the caution to be taken while prescribing to patients with systemic diseases, pregnancy, or lactating mothers or those on anticoagulant therapy was also not known to each and every intern. Taking into consideration the results of our study, it can be inferred that not every intern was a competent dental professional, and the knowledge of prescription of drugs was deficient. Special efforts should be taken by every institute to teach prescription writing practices in the classroom or organize special workshops, tutorials, problem-based learning, and e-learning using hypothetical or real clinical cases. The inherent flaw of open-ended questions is that respondents can answer; however, they wish; this can become an asset; however, as the responses may provide the researcher with new categories to investigate. Another advantage is that the responses can suggest new possibilities for relationships and hypotheses.
Even though these students were not yet fully responsible for prescribing, many deficiencies were noted in their practices. It is the responsibility of the institution and the professors to solve any such deficiencies so that graduating students become highly competent in their professional practice., Shahroom et al., in 2017, performed an online survey where they assessed the level of knowledge of drug prescription among dental and medical students during their clinical practice and found that the level of knowledge of drug prescription among the dental and medical students was moderate.
The most frequent reason for the prescription is an infection, when, in fact, pain is the main reason that patients go to the dentist. Often, pain is the result of infection; it should always be treated. It is very important to use appropriate diagnostic methods to differentiate the type and the origin of the pain so that proper treatment can be provided.,
The WHO Guide to good prescribing provides step by step guidance to the process of reasonable prescribing, together with many illustrative examples. It teaches skills that are necessary throughout a clinical career. This book can help the students as well as professionals to prescribe any medication. This can be introduced into the curriculum during the rotatory internship program of dental students. In the present study, about 21% of interns were unaware of the WHO guide for prescription of drugs.
Doshi et al. performed a cross-sectional study to assess the knowledge and practices of Indian dental students regarding the prescription of antibiotics and analgesics and concluded that undergraduate dental students have lower knowledge about medication prescription as compared to postgraduate students. Lomi et al. conducted a study to assess the knowledge, attitude, and practice (KAP) of antibiotic use and its resistance among undergraduate, intern, and postgraduate dental students. This study showed higher KAP mean scores regarding antibiotic use and its resistance in postgraduate students than interns and undergraduate students. Our findings are in accordance with these previous studies that interns had less knowledge of prescription. However, the limitations of the present study are the homogeneity of the study population, cross-sectional study design, and open-ended questions in the questionnaire rather than case-based questions.
| Conclusion|| |
Within the limitation of the study, it can be concluded that a majority of interns were aware and had knowledge regarding the prescription of drugs. However, not every intern had sound knowledge of the same. The knowledge of prescribing drugs is of the paramount need for good dental practice, and hence, it is essential to expand the knowledge related to pharmacological therapy and to know about the proper therapeutic guidelines. Further studies are needed to decide on whether this issue affects the quality of patient care and the usefulness and safety of treatments.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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