Very few private doctors write correct prescriptions

The Indian healthcare industry has come a long way in the past two decades. The irony, however, is that private practitioners seem to be stuck dangerously in the past.

A recent study has revealed that only six of 106 private practitioners in the city wrote the correct prescription for treating tuberculosis (TB), a figure similar to those found in a survey conducted in 1991.

Poor prescribing practices have been a major factor fuelling the multidrug resistant tuberculosis (MDR-TB) epidemic. For instance, the incidence of MDR-TB among treated cases at Hinduja hospital is allegedly 60%. Moreover, a report from Mumbai has shown that about 10% of all MDR-TB cases were extensively drug-resistant tuberculosis or XDR-TB, a form of TB caused by bacteria that are resistant to the most effective anti-TB drugs.

“Two decades ago, a similar study highlighted the poor prescribing practices of private medical practitioners. Recently, we found an alarming trend of increasing incidence of multidrug-resistant (MDR-TB) in the samples sent to PD Hinduja Hospital. We therefore decided to go for another audit of private practitioners,” said Dr Zarir Udwadia, chest physician, PD Hinduja hospital.

The prevalence of MDR-TB has grown significantly in India, accounting for 20% of global MDR-TB cases reported in 2006. The actual levels of MDR-TB may be much higher than those projected by national estimates, as patients diagnosed and managed in the private sector never get reported.

A recent study in Mumbai found prevalence rates of MDR-TB to be 24% among newly diagnosed, previously untreated patients and rates of 41% among first-line drug failures.

“The quality of prescriptions for MDR-TB was even more dismal than those for drug-susceptible TB. Only 5 of the 106 respondents could write an appropriate prescription with a minimum of 3 new second-line drugs in the right doses for a right duration. We also found that these practitioners had never been approached or oriented by the local TB programme,” said Dr Udwadia.

He further added that if replacing the TB epidemic by a MDR-TB epidemic is to be avoided, the Revised National Tuberculosis Control Programme (RNTCP) will have to invest in and help extend its own successes to the private sector. “Measurable progress will be possible only with the creation of structures and staff to work with the private sector at the national, state and district levels,” Dr Udwadia said.

Agreeing about the urgent need to rope in private practitioners in the tuberculosis programme, Dr Yatin Dholakia, secretary and technical advisor, Maharashtra State Anti TB Association, said, “Private practitioners not being able to provide a correct prescription for treating TB has been a problem for a long time. The Indian Medical Association has been training private practitioners along international standards for TB care. This will hopefully help us solve the problem.”

MDR-TB and XDR-TB has been a serious concern in a developing country like India which houses 25% of the world’s MDR-TB cases.

Dr Om Shrivastav, infectious diseases consultant, Jaslok hospital, said, “Tuberculosis is no longer a poor man’s disease. It doesn’t discriminate among people and I am seeing more and more people from all parts of society. The manifestation of the disease has changed and no longer restricted to the chest. We are getting TB infections in the scalp, skin and even nails; there are more aggressive forms of TB.”