Prescribing trends-branded versus unbranded generics and rational use of medicine at public health facilities in Maharashtra, India

Background: Irrational prescribing practices, inappropriate use of medicines, and the high cost of essential medications are significant health policy concerns in India. To address the issue of accessibility, a generic medicine scheme called Jan Aushadhi (JA translates to People’s Medicine) was revamped and expanded in 2015. Additionally, physicians were advised to comply with the erstwhile Medical Council of India’s regulation of prescribing medicines by their salt names. This is the first study which not only assessed the quality of prescriptions in public health facilities, but also examined whether the doctors' prescribing behaviours in public facilities are in sync with the government’s intent to improve access to medicines through promotion of generics. Methods A survey was conducted at JA pharmacies near 11 public healthcare facilities in Mumbai and Palghar. Prescription slips written by doctors from the public healthcare system were collected from all patients who visited the JA pharmacies. After excluding prescriptions with illegible handwritings and incomplete data, a total of 330 prescriptions were included in the analysis. Results: The mean number of drugs per prescription was 2.7 and 4 for outpatients and inpatients, respectively. More than 53% of the outpatient prescription slips had no diagnosis on them, nearly 60% were devoid of patients’ signs and symptoms, and listed branded medicines instead of generics. Among outpatient prescriptions, 1% contained injectable, while 32% included antibiotics. However, for those hospitalised, 82% of their prescriptions included injectable, and 64% contained antibiotics. Nearly 78% of the medicines prescribed came from the JA list. A total of 85% of drugs were prescribed from the Maharashtra State essential medicine list (EML) with 86% of OPD drugs and 83% of IPD drugs falling under this category. Conclusion: The analysis reveals highly unsatisfactory prescribing practices in public health facilities. This underscores the urgent need to review the current laws regulating the practice of medicines, particularly those concerning the requirements for writing legible prescriptions, documenting patients' signs and symptoms, recording complete medical histories, selecting appropriate medications, making accurate diagnoses, and providing proper follow-up care. Equally important is to arm the public health authorities to ensure the implementation of these prescription regulations.