The purpose of this study was to compare the choices and prescribing patterns of two supervised levels in teaching hospitals in Karachi.
The Cross Sectional questionnaire based study was conducted in May 2016. Students and House officers of Altamash Institute of Dental Medicine, Jinnah Medical and Dental College, Jinnah Postgraduate Medical Centre and Ziauddin College of Dentistry participated. The response rate was 72.6%. Half of the sample was of final Year Students and the other Half was of House Officers.
Results showed some similarities and few differences in choices and prescription patterns of Final Year students and House Officers.Out of 69 Final year Students 46.4% Prescribed NSAIDS, 59.4% prescribed for pain. Panadol was prescribed by 66.7% and 44.9%prescribed a combination of Amoxicillin and Metronidazole. According 71% of final year students they gave advice or supporting medication to counter the side effects of Drugs. Out of the Final Year Students, 53.6 % said that their choice of drugs was dependent upon Information from their Professor. From 69 House Officers 65.2%Prescribed NSAIDS, 58% prescribed for pain. Ibuprofen was prescribed by 39.1% and 69.6% prescribed a combination of Amoxicillin and Metronidazole. According to 69.6% of House Officers they gave advice or supporting medication to counter the side effects of Drugs. Out of the House Officers, 56.5% said that their choice of drugs was dependent upon Information from their Professor.
The choice and prescribing patterns of final year students and house officers seemed to be non-uniform. This strongly suggests that the training of both supervised levels is incomplete and a very high proportion of practioners-to-be are making uninformed decisions.
An undergraduate course of Dentistry in Pakistan lasts for four years. It is followed by a training period of a year which is known as house job.After completion of House job, Dentists are licensed to work independently. Increasing evidence has been found, that dentists in most countries have inadequate pharmacological knowledge and that they make errors in drug prescription 1. This indicates that the training of dentists needs to improve during their undergraduate years or during house job so that they make good choices.Students start prescribing drugs in their final year, when they begin their clinics in the Departments of Surgery, Operative dentistry and Endodontics and then during House JobThere is reduced exposure to clinical pharmacology. Poor prescribing is widespread including overuse of medicines or underuse of effective medicines2.
The most common drugs used in dentistry include local anesthetics for procedures, non-steroidal anti-inflammatory drugs and antibiotics 3-6. The success of a treatment is dependent on proper choice and prescription patterns of these drugs.
It is the House officers and the Final Year Students that make the future workforce, it is therefore, necessary that their knowledge should be sufficient. Any deficiency in their final year should be overcome during the course of their house job 7.
Although in the past, the knowledge of dental students has been evaluated, this study covers a vast sample size from four public and private Dental institutions. It compares the practices of both supervised levels, which include the Final Year Students and the House Officers.
The data was collected in May 2016, from four public and private institutions, in different areas of Karachi. A questionnaire with six close-ended questions was distributed amongst 190, Final Year Students and House officers. It was returned by 138 respondents out of which, 69 were house officers and the 69 were final year students. The results were stored in excel sheets and analyzed through SPSS software (version 24).
The most common response was regarded as the most significant. According to 32 (46.4%) Final Year Students and 45 (65.2%) House officers, Non- Steroidal Anti Inflammatory Drugs are the most common drugs prescribed in their clinical practice (Fig1). The most common condition for prescribing was pain according to 41 (59.4%) of Final Year Students and 40 House Officers (58%) (Figure2).According to 46 (66.7%) Final year students the most common NSAID prescribed in clinical practice is Paracetamol. Whereas, 27 (39.1%) House Officers prescribe Ibuprofen for pain (Figure 3).
When asked about the antibiotic of choice, 31 (44.9%) final year students and 48 (69.6%) House Officers most commonly prescribed a combination of Amoxicillin and Metronidazole (Figure 4). According to 49 (71%) final year students and 48 (69.6%) House Officers gave advice or supporting medication to counter the side effects of Drugs (Figure 5). Out of the Final year students, 37 (53.6 %) and 39 (56.5%) of House Officers the choice of drugs was dependent upon Information from their Professor. However, 18 (26.6%) Final Year Students confessed that their choice was influenced by medical Representatives and 5 (7.2%) students made their choices by asking friends or colleagues (Figure 6).
In the past, very few comparative studies have been conducted.This was a multicenter study in Karachi.It recorded choices from four different institutions present in different areas. Dental Students cover a course of pharmacology in Pakistan in their second year of study. They are under direct supervision of their teachers and faculty when writing prescriptions in their final year and house job.
It is expected that the standard of all Dental Students and House officers is similar as all dental institutions cover the same syllabus approved by the HEC and PMDC. However, differences in preferences of Final year students and House Officers were noted.
According to the present study the most common drug prescribed in clinical practice by both final year students and House officers were NSAIDS and the most common condition for which they prescribed was pain. This matched the results of previous studies conducted in India byJain et al 8. A significantly high proportion of final year students and House officers also prescribed for infection as was investigated by Gulzamen Alvarez et al the findings of in his study and Asad Mahmood et al in his study in Punjab, Pakistan1, 9.Removing pain is greatly important when treating dental patients, for both the patient and the clinician 10. Pain is a symptom that signals greater underlying problems. Major cause of pain is due to activation of sensory nocioceptors around the tooth by release of inflammatory mediators 4. Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely prescribed analgesics for management of post-operative pain in dental patients 11.
In this study we analyzed that Final Year Students chose Paracetamol as the most common Painkiller advised. This is similar to the choice of Final year students participating in the study conducted by Guzman Alvarez et al.1 Most final year students probably choose this because they regard Panadol as the safest medication as compared to other painkillers available. In contrast, House officers in Karachi chose Ibuprofen as the most common painkiller followed by Paracetamol. Paracetamolhas analgesic and antipyretic actions but little or no anti-inflammatory properties 12.The preference of Ibuprofen in this study,over paracetamol could be due to its potent anti inflammatory activity.
Studies conducted in Scotland showed thatmost general dentists preferred to prescribe Amoxicillin, and a very high percentage of dentists also chose Metronidazole13. Similar results were found in studies done in Lahore. In this study majority of Final year Students and House Officersprescribed a combination of Metronidazole and Amoxicillin14.
Drugs used in dentistry have side effects. For example, Nsaids achieve their analgesic effect by inactivation of cyclooxygenase (COX) enzyme, that converts arachidonic acid into prostaglandins and leukotrienes 15,16,17. These COX inhibitors cause Gastro-Intestinal related side effects in patients. When giving such drugs it is effective to give supporting advice and medication, to patients, in order to counter such effects. Most Final Year students and House Officers had this habit as analyzed in this study.
Choices of Drugs, prescribed by House Officers and Final Year Students were dependent upon the Information provided by their Professors. It was encouraging to see a significant number of House Officers read literature for their choices. Same results were obtained by the study conducted by Asad Mahmood et al. However, it was alarming too see lots of students being misguided when making choices. Even though most were under guidance of their teacher a very high number was depending on Information from medical representatives. As commercialism is a dilemma in this stage it also poses a threat to the wellbeing of the patient. Many students were also depending on information from friends making their drug choices even more questionable.
The findings of this study showed slight discrepancies in the choices of Final Year Students and House Officers. This reinforces that even though both levels are supervised their standards are clearly not the same. Further focus needs to be done to uplift the level of training and study to produce better dentists in the field.
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