Evaluation of medical prescriptions and off-label use on board ships to improve healthcare quality

OBJECTIVE: This study analyzed the appropriateness of drug therapies prescribed for a particular category of patients: the seafarers. We investigated an important problem of this area: the off-label use of drugs, which resulted to be a consequence of major shortcomings in the on-board pharmacies of ships. The off-label use of drugs is allowed, but can lead to some not negligible ethical and health problems, compromising the quality of provided healthcare. MATERIALS AND METHODS: The analysis was performed on electronic health records of patients onboard ships without physicians, and assisted by the CIRM from 2011 to 2015. This work is divided into two phases: in the first one, we classified the diagnoses registered onboard on the basis of the ICD-10 classification proposed by the WHO. In the second phase, we evaluated the congruence of the pharmacological therapies prescribed by CIRM physicians, according to the MICROMEDEX Database, which provides comprehensive information about drugs and their use. RESULTS: From the analysis emerged that prescribed drugs were not always corresponded to their primary indication of use. In particular, in 2011 off-label drug use was widely spread (more than 30%) in some ICD-10 classes. In the following years (2012-2015) a decrease of off-label use of drugs was noticed. CONCLUSIONS: The results suggest that a standardization of onboard pharmacies is crucial, in order to have a complete on-board pharmacy that will allow preventing and counteracting any situation of health danger, which may occur onboard, ensuring high quality healthcare to seafarers all over the world.