Deviations of prescriptions from standard guidelines

Sir,

We read with interest the article by Shetty et al¹ titled ‘Evaluation of prescriptions from tertiary care hospitals across India for deviations from treatment guidelines & their potential consequences,’ published in the February 2024 issue of the Indian Journal of Medical Research.

We congratulate the authors on conducting such an extensive study across 13 centres; however, we have a few comments.

The study was conducted at the Indian Council of Medical Research (ICMR) - Rational Use of Medicines Centres, where the use of drugs is more likely to be rational. Despite this, clinicians adhered to treatment guidelines in only 55.1 per cent of prescriptions. This issue needs to be addressed.

In a study by Terrier et al², clinicians’ adherence rates were found to be low, ranging from 16 per cent to 26.4 per cent. Additionally, another study³ from York University previously highlighted the patchy implementation of NICE guidance³.

It would be interesting to study the appropriateness of prescriptions in real-world scenarios, especially for outpatients, where irrational prescribing may be more prevalent.

This underscores the pressing need for Continuing Medical Education (CME) for healthcare personnel, emphasizing repeated training on the rational use of drugs.