Evaluation of Medicine Prescription Pattern in Orthopedic Outpatient Clinics of Kerman Province, Iran

Document Type: Short Communication


1 Kerman Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran

2 Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran


Background: This study was aimed to evaluate the orthopedists’ prescription pattern for outpatients referred to private clinics in Kerman province, Iran.
Methods: In this study a total of 59,613 outpatients’ prescriptions issued by orthopedists contracting with Iran Health insurance organization and Iran Social Security Organization from the 1st May 2014 to the 1st May 2015 were analyzed for mean number of drugs per prescription, route of administration, drug category, drug names and the most common prescribed drugs.
Results: Mean number of drugs per prescription was 2.48. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most frequently prescribed drugs (60.34%) followed by vitamins & minerals (53.88%), skeletal muscle relaxants (33.18%) and corticosteroids (33.0 %). Naproxen 250mg (14.29%) and diclofenac 100mg (7.5%) were the most frequently prescribed NSAIDs. Vitamin D3 (injection & oral soft gelatin capsule) was the most frequently prescribed vitamin & mineral (24.72%). Gabapentin 300mg (12.73%) and methocarbamol 500 mg (10.59%) were the most frequently prescribed skeletal muscle relaxants. Methylprednisolone acetate (10.48%) and triamcinolone acetonide (7.45%) were the most frequently prescribed corticosteroids. Anti-ulcer drugs were prescribed only for 4.11% of outpatients.
Conclusion: NSAIDs, vitamins & minerals and corticosteroids were the most frequent prescribed drugs by orthopedists in Iran. The high rate of vitamin D3 and calcium prescription is a valuable finding for the prevention and treatment of osteoporosis; however, anti-ulcer drugs were prescribed lower than the requiered rate and this was a remarkable finding which increases the risk of NSAIDs /corticosteroids- induced gastropathies. Therefore, some interventions for improving drug prescription by orthopedists are suggested.


  1. Onder G, Landi F, Cesari M, Gambassi G, Carbonin P, Bernabei R, et al. Inappropriate medication use among hospitalized older adults in Italy: results from the Italian Group of Pharmacoepidemiology in the Elderly. Eur J Clin Pharmacol 2003; 59(2):157-62.
  2. Wettermark B, Hammar N, Fored CM, Leimanis A, Otterblad Olausson P, Bergman U, et al. The new Swedish Prescribed Drug Register-opportunities for pharmacoepidemiological research and experience from the first six months. Pharmacoepidemiol Drug Saf 2007; 16(7):726-35.
  3. Amann U, Schmedt N, Garbe E. Prescribing of potentially inappropriate medications for the elderly an analysis based on the PRISCUS list. Dtsch Arztebl Int 2012; 109(5):69-75.
  4. Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int 2010; 107(31-32):543-51.
  5. Kaufmann CP, Tremp R, Hersberger KE, Lampert ML. Inappropriate prescribing: a systematic overview of published assessment tools. Eur J Clin Pharmacol 2014; 70(1):1-11.
  6. Hanlon JT, Schmader KE, Boult C, Artz MB, Gross CR, Fillenbaum GG, et al. Use of inappropriate prescription drugs by older people. J Am Geriatr Soc 2002; 50(1):26-34.
  7. Miquel MD, Cuervo MS, Silveira ED, Machuca IS, González-Blazquez S, Errasquin BM, et al. Potentially inappropriate drug prescription in older subjects across health care settings. Eur Geriatr Med 2010; 1(1):9-14.
  8. Harmon KG, Hawley C. Physician prescribing patterns of oral corticosteroids for musculoskeletal injuries. J Am Board Fam Pract 2003; 16(3):209-12.
  9. Lee SH, Han CD, Yang IH, Ha CW. Prescription pattern of NSAIDs and the prevalence of NSAID-induced gastrointestinal risk factors of orthopaedic patients in clinical practice in Korea. J Korean Med Sci 2011; 26(4):561-7.
  10. Mesko JW, Brand RA, Iorio R, Gradisar I, Heekin R, Leighton R, et al. Venous thromboembolic disease management patterns in total hip arthroplasty and total knee arthroplasty patients: a survey of the AAHKS membership. J Arthroplasty 2001; 16(6):679-88.
  11. Kalichman L, Li L, Kim DH, Guermazi A, Berkin V, O’Donnell CJ, et al. Facet joint osteoarthritis and low back pain in the community-based population. Spine (Phila Pa 1976) 2008; 33(23):2560-5.
  12. Ahmadizar F, Soleymani F, Abdollahi M. Study of drug-drug interactions in prescriptions of general practitioners and specialists in Iran 2007-2009. Iran J Pharm Res 2011; 10(4):921-31.
  13. Leopold SS, Redd BB, Warme WJ, Wehrle PA, Pettis PD, Shott S. Corticosteroid compared with hyaluronic acid injections for the treatment of osteoarthritis of the knee. A prospective, randomized trial. J Bone Joint Surg Am 2003; 85(7):1197-203.
  14. Das BP, Adhikari N, Garg M, Rauniar GP, Naga Rani MA. Utilization pattern of nonsteroidal anti-inflammatory drugs (NSAIDs) in orthopaedic practice at a tertiary care hospital in eastern Nepal. JNMA J Nepal Med Assoc 2000; 39:315-18.
  15. Gupta M, Malhotra S, Jain S, Aggarwal A, Pandhi P. Pattern of prescription of non-steroidal antiinflammatory drugs in orthopaedic outpatient clinic of a north Indian tertiary care hospital. Indian J Pharmacol 2005; 37(6):404-5.
  16. Sadeghian GH, Safaeian L, Mahdanian AR, Salami S, Kebriaee-Zadeh J. Prescribing quality in medical specialists in isfahan, iran. Iran J Pharm Res 2013; 12(1):235-41.
  17. Karimi A, Haerizadeh M, Soleymani F, Haerizadeh M, Taheri F. Evaluation of medicine prescription pattern using World Health Organization prescribing indicators in Iran: a cross-sectional study. J Res Pharm Pract 2014; 3(2):39-45.
  18. World Health Organization. How to Investigate Drug Use in Health Facilities: Selected drug use indicators.[cited ????????] Available from: http://apps.who.int/medicinedocs/en/d/Js2289e/
  19. Hogerzeil HV. Promoting rational prescribing: an international perspective. Br J Clin Pharmacol 1995; 39(1):1-6.
  20. Banerjee I, Bhadury T, Agarwal M. Prescribing pattern in orthopedics outpatient department of a medical college in India. Int J Basic Clin Pharmacol 2015; 4(6):1175-7.
  21. Shankar P, Pai R, Dubey Ak, Upadhyay Dk. Prescribing patterns in the orthopaedics outpatient department in a teaching hospital in Pokhara, western Nepal. Kathmandu Univ Med J (KUMJ) 2006; 5(1):16-21.
  22. Tsumura H, Tamura I, Tanaka H, Chinzei R, Ishida T, Masuda A, et al. Prescription of nonsteroidal anti-inflammatory drugs and co-prescribed drugs for mucosal protection: analysis of the present status based on questionnaires obtained from orthopedists in Japan. Intern Med J 2007; 46(13):927-31.
  23. Pearse EO, Redfern DJ, Sinha M, Edge AJ. Outcome following a second hip fracture. Injury 2003; 34(7):518-21.
  24. Crilly RG, Speechley M, Overend TJ, Mackenzie R, Simon S, Cremer S. Evaluation of a care pathway in the initiation of calcium and vitamin D treatment of patients after hip fracture. Can J Aging 2009; 28(01):21-6.
  25. Solomon DH, Johnston SS, Boytsov NN, McMorrow D, Lane JM, Krohn KD. Osteoporosis medication use after hip fracture in US patients between 2002 and 2011. J Bone Miner Res 2014; 29(9):1929-37.
  26. Cranney A, Adachi JD. Corticosteroid-induced osteoporosis: a guide to optimum management. Treat Endocrinol 2002; 1(5):271-9.
  27. Nash JJ, Nash AG, Leach ME, Poetker DM. Medical malpractice and corticosteroid use. Otolaryngol Head Neck Surg 2011; 144(1):10-5.
  28. Moghadam‐Kia S, Werth VP. Prevention and treatment of systemic glucocorticoid side effects. Int J Dermatol 2010; 49(3):239-48.
  29. Scarpa R, Sarzi-Puttini P, Cimmino MA, Caporali R, Parazzini F, Zaninelli A, et al. Analysis of pharmacologic and nonpharmacologic prescription patterns of general practitioners and specialists in the AMICA study. Semin Arthritis Rheum 2005; 35(1 Suppl 1):24-30.
  30. McCabe PS, Maricar N, Parkes MJ, Felson DT, O’Neill TW. The efficacy of intra-articular steroids in hip osteoarthritis: a systematic review. Osteoarthritis Cartilage 2016; 24(9):1509-17.
  31. Kegel G, Marshall A, Barron OA, Catalano LW, Glickel SZ, Kuhn M. Steroid injections in the upper extremity: experienced clinical opinion versus evidence-based practices. Orthopedics 2013; 36(9):e1141-8.
  32. Nair KP, Marsden J. The management of spasticity in adults. BMJ 2014; 349:g4737.
  33. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol 2015; 14(2):162-73.
  34. Chou R, Peterson K, Helfand M. Comparative efficacy and safety of skeletal muscle relaxants for spasticity and musculoskeletal conditions: a systematic review. J Pain Symptom Manage 2004; 28(2):140-75.
  35. Schlansky B, Hwang JH. Prevention of nonsteroidal anti-inflammatory drug-induced gastropathy. J Gastroenterol 2009; 44(Suppl 19):44-52.
  36. Richardus JH, Withington SG, Anderson AM, Croft RP, Nicholls PG, Van Brakel WH, et al. Adverse events of standardized regimens of corticosteroids for prophylaxis and treatment of nerve function impairment in leprosy: results from theTRIPOD'trials. Lepr Rev 2003; 74(4):319-27.
  37. Lanas A, Polo-Tomás M, Roncales P, Gonzalez MA, Zapardiel J. Prescription of and adherence to non-steroidal anti-inflammatory drugs and gastroprotective agents in at-risk gastrointestinal patients. Am J Gastroenterol 2012; 107(5):707-14.