Evaluation of prescribing rationality for rheumatoid arthritis patients at a regional hospital in Indonesia

Abstract

Rheumatoid arthritis requires long-term pharmacotherapy with disease-modifying antirheumatic drugs, corticosteroids, and non-steroidal anti-inflammatory drugs. Irrational prescribing can lead to treatment failure, adverse effects, and increased healthcare costs. This study evaluated prescribing rationality for rheumatoid arthritis patients at RSUD Al Ihsan, Bandung, Indonesia, during 2023. A retrospective cross-sectional design was employed, analyzing medical records of 81 outpatients using five rationality criteria: appropriate indication, appropriate drug, appropriate dose, appropriate patient, and appropriate dosing interval. Results showed complete compliance for appropriate indication (100%) and appropriate drug selection (100%). However, deficiencies were identified in dose appropriateness (81.82%), patient appropriateness (97%), and dosing interval appropriateness (81.82%). Dose-related errors involved diclofenac sodium prescribed below therapeutic range and etoricoxib exceeding recommended doses. Patient-related inappropriateness included diclofenac sodium use in four elderly patients over 65 years without documented gastroprotection. Interval-related errors involved etoricoxib and meloxicam prescribed more frequently than recommended. Overall prescribing rationality was 92.1%, indicating generally appropriate practices with specific areas requiring improvement through clinical decision support systems, prescriber education, and regular prescribing audits.