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PubMed2005

Pattern of drug prescription for children under the age of four years in a population in Greenland.

AIM: To provide knowledge of drug prescription patterns in general and of antibiotics in particular, and number of consultations and diagnoses leading to prescriptions among children aged 0-4 y in the Arctic. METHODS: A population-based cohort of children aged 0-4 y, living in Sisimiut, the second largest town in Greenland, was followed from August 1996 to December 1998. Information on consultations, diagnoses and drug prescriptions was obtained from medical files at the local health centre. RESULTS: Among 280 participating children, the mean number of consultations per child was 5.64 per year at risk (range 0-17), of prescriptions 4.02 per year at risk (range 0-17.2), and of prescribed systemic antibiotics per child 1.47 per year at risk (range 0-7.25). Systemic antibiotics formed the therapeutic subgroup most often issued for children, constituting 33.5% of all prescriptions. Of the systemic antibiotics, 50% were broad-spectrum penicillins, 34% penicillin V, 14% macrolides and 2% other antibiotics. The most frequent diagnoses leading to drug prescription in general as well as to prescription of systemic antibiotics were respiratory tract infections, accounting for 59% of all prescriptions and 81% of prescriptions of systemic antibiotics. Children aged 1/2-1 y of age had the highest prescription rates of drugs in general and of systemic antibiotics. CONCLUSIONS: Compared to other countries, prescription rates of drugs in general and of systemic antibiotics in particular were high. The use of broad-spectrum penicillins was higher than recommended in Greenlandic national guidelines, and might be reduced.

Age Distribution↗
PubMed2006

[Study of prescription-indication of proton pump inhibitors].

OBJECTIVES: To evaluate the adaptation of Proton Pump Inhibitors (PPI) prescriptions to the indications in the literature. To determine which doctors, patients and prescriptions characteristics are related to a correct prescription and to measure their relative importance. MATERIAL AND METHODS: Cross-sectional observational study of prescription indication in an Urban Primary Care Center. Simple Random Sampling was used from primary care center patients PPIs prescriptions between July and December of 2003. Non-electronic prescriptions (OMI-AP program) were excluded from the sample. 412 PPI prescriptions were necessary as sample size to obtain a 95% confidence with a 4.7% precision and a 50% expected proportion. Simple random sampling techniques were used. RESULTS: Prescription was correct under adequacy criteria in 36.4% of the cases. The effect of the "hiatal hernia" and "user activity status" variables showed the major impact on results with an OR: 0.361 and 1.672 respectively. NSAID treated patients PPIs prescriptions matched adequacy criteria in 79.5% of the cases. "Prescription source" and "User activity status" variables gave the highest impact with an OR: 2.5 and 4.52, respectively. CONCLUSIONS: The high percentage of non-adequate prescriptions together with the differences found between primary and specialized levels of attention, could suggest lack of knowledge of PPIs prophylactic indications and lack of coordination between different levels of attention that could be solved by creating common performing protocols.

Adult↗
PubMed2005

An electronic chart prompt to decrease proprietary antibiotic prescription to self-pay patients.

OBJECTIVES: Emergency physicians unaware of patients' insurance status may prescribe expensive proprietary antibiotics for patients who cannot afford them. The objective of this study was to develop a clinical decision support system to display patient insurance status before prescription writing for outpatient conditions. METHODS: This was a 26-week "before-and-after" trial at an urban emergency department (ED) with 78,000 visits/year treating a medically underserved population. Sixty-one prescribers, including attending physicians, residents, and physician assistants, participated. All patients older than 18 years of age discharged from the ED receiving antibiotic prescriptions were eligible. The electronic ED chart is linked to prescription-writing software, which includes a menu of 74 antibiotics. The system was programmed so that when an emergency physician accessed the prescription menu, a prompt appeared displaying insurance status. Prescribers also received educational interventions. The main outcome measure was the percentage of prescribers who reduced their prescription writing of proprietary antibiotics to self-pay patients. Data were analyzed with cluster techniques using SPSS 10.0 (SPSS Inc., Chicago, IL). RESULTS: Of 594 prescriptions written for self-pay patients before prompt insertion, 158 (26.6%) were for proprietary antibiotics. After the intervention, self-pay patients received 564 antibiotic prescriptions, of which 117 (20.7%) were for proprietary drugs. Analyzed by prescriber, the reduction in the prescription rate for proprietary antibiotics was statistically significant (p = 0.03, chi(2) test). Patients with respiratory or urinary infections also had a statistically significant reduction in proprietary antibiotic prescription (p = 0.03). CONCLUSIONS: A clinical decision support system, integrated into a prescription-writing program, can decrease the prescription of proprietary antibiotics for self-pay patients in the ED.

Adult↗
PubMedDate not supplied

Mail-order prescriptions requiring clarification contact with the prescriber: prevalence, reasons, and implications.

BACKGROUND: Prescription review by pharmacists prior to dispensing is an important step in an overall strategy for preventing medication errors. Contacts with prescribers may be required to clarify missing, unclear, or inconsistent information. While essential to reduce the likelihood of potential patient harm, clarification contacts are time-consuming for pharmacists and prescribers. The scope of the issue and the factors that contribute to it are not well understood. OBJECTIVE: To quantify the frequency of contacts with prescribers that were necessary to obtain clarification of prescriptions and to identify the factors that made these prescriber contacts necessary. METHODS: An analysis was conducted involving new prescriptions received by a national mail-order pharmacy that required clarification contacts with prescribers for quality reasons (i.e., those potentially impacting the accuracy of dispensing). Excluding refills and renewals, the percentage of new prescriptions requiring clarification contacts was calculated and categorized by incoming delivery channel (mail, fax, telephone, etc.). The quality problems that prompted these contacts were categorized according to the problem identified. RESULTS: Among the total of 295378 new prescription orders received during the 1-week study period (from April 7 to April 13, 2002), 8.7% contained quality problems that necessitated clarification contact with prescribers. Prescriptions received by fax transmission and mail were most likely to require clarification as compared with direct telephone conversation and miscellaneous (including electronic) channels. Among prescriptions that required a clarification contact for quality problems, an average of 2.4 problems per prescription was observed. The most common problems were: directions unclear or missing (24.3%); refill quantity unclear, missing, or incorrect (24.3%); dosage unclear (20.2%); drug name or strength unclear (13.2%); missing physician or patient data (11.4%); and missing prescriber signature (3.2%). CONCLUSION: Prescriber clarification contacts are frequently needed to reduce the potential for medication error in the current prescription fulfillment process. While these contacts are necessary to clarify data elements essential to accurate medication dispensing, they are time- and resource-intensive. These study results suggest that alternate prescription order channels, including electronic, could reduce the sizable burden of prescription order clarification in mail-order pharmacy.

Communication↗
PubMed2001

Self-restriction of medications due to cost in seniors without prescription coverage.

OBJECTIVE: Little is known about patients who skip doses or otherwise avoid using their medications because of cost. We sought to identify which elderly patients are at highest risk of restricting their medications because of cost, and how prescription coverage modifies this risk. DESIGN AND PARTICIPANTS: Cross-sectional study from the 1995-1996 wave of the Survey of Asset and Health Dynamics Among the Oldest Old, a population-based survey of Americans age 70 years and older. MEASUREMENTS: Subjects were asked the extent of their prescription coverage, and whether they had taken less medicine than prescribed for them because of cost over the prior 2 years. We used bivariate and multivariate analyses to identify risk factors for medication restriction in subjects who lacked prescription coverage. Among these high-risk groups, we then examined the effect of prescription coverage on rates of medication restriction. MAIN RESULTS: Of 4,896 seniors who regularly used prescription medications, medication restriction because of cost was reported by 8% of subjects with no prescription coverage, 3% with partial coverage, and 2% with full coverage (P <.01 for trend). Among subjects with no prescription coverage, the strongest independent predictors of medication restriction were minority ethnicity (odds ratio [OR], 2.9 compared with white ethnicity; 95% confidence interval [95% CI], 2.0 to 4.2), annual income <$10,000 (OR, 3.8 compared with income > or =$20,000; 95% CI, 2.4 to 6.1), and out-of-pocket prescription drug costs >$100 per month (OR, 3.3 compared to costs < or =$20; 95% CI, 1.5 to 7.2). The prevalence of medication restriction in members of these 3 risk groups was 21%, 16%, and 13%, respectively. Almost half (43%) of subjects with all 3 risk factors and no prescription coverage reported restricting their use of medications. After multivariable adjustment, high-risk subjects with no coverage had 3 to 15 times higher odds of medication restriction than subjects with partial or full coverage (P <.01). CONCLUSIONS: Medication restriction is common in seniors who lack prescription coverage, particularly among certain vulnerable groups. Seniors in these high-risk groups who have prescription coverage are much less likely to restrict their use of medications.

Aged↗
PubMed2005

Racial disparities in prescription drug use for mental illness among population in US.

BACKGROUND: Racial minorities are a rapidly growing portion of the US population. Research suggests that racial minorities are more vulnerable to mental illness due to risk factors, such as higher rates of poverty. Given that the burden of mental illnesses is significant, equal likelihood of mental health services utilization is important to reduce such burden. Racial minorities have been known to use mental health services less than Whites. However, it is unclear whether racial disparity in prescription drug use for mental illnesses exists in a nationally representative sample. For a valid estimation of prescription drug use patterns, the characteristic in the distribution of prescription drug use should be accounted for in the estimation model. AIMS OF THE STUDY: This study is intended to document whether there was a disparity in psychiatric drug use in both extensive and intensive margins between Whites and three racial minorities: Blacks, Hispanics, and Asian-Indians. The study looked at several specified mental illnesses, controlling for underlying health status and other confounding factors. METHODS: Secondary data analysis was conducted using the multiyear Medical Expenditure Panel Survey (MEPS), a nationally representative panel sample from 1996 through 2000. This analysis provides estimates of the actual expenditure on prescription drug use for people with specified mental illnesses for this study, based on comparison of Whites and other racial minorities. We derived the estimates from the two-part model, a framework that adjusts the likelihood of using prescription drugs for the specified mental illnesses while estimating the total actual expenditures on prescription drugs among the users. RESULTS: This study found that Blacks, Hispanics, and Asian-Indians were less likely than Whites to use prescription drugs by 8.3, 6.1 and 23.6 percentage points, respectively, holding other factors constant in the sample, with at least one of the specified mental illnesses. The expenditure on prescription drugs for the specified mental illnesses differs between each of racial minorities (Blacks, Hispanics, and Asian-Indians) and Whites even after adjusting for the different likelihood of using those prescription drugs. Blacks, Hispanics, and Asian-Indians with the specified mental illnesses were estimated to spend 606.53 US dollars, 9.83 US dollars and 179.60 US dollars less per year, respectively, on their actual prescription drugs than Whites. DISCUSSION: This study concludes that three racial minorities: Blacks, Hispanics, and Asian-Indians, with the specified mental illnesses are less likely to use psychiatric drugs than Whites. Among users, racial minorities use less psychiatric drugs than Whites in terms of actual spending on those drugs. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: There is a need to focus on a program to reach out to racial minorities with a diagnosis of mental illnesses, and this program should consider the cultural specificity of each minority group regarding mental illnesses. IMPLICATIONS FOR HEALTH POLICIES: In the development of mental health policy, it is crucial to understand the underlying non-socioeconomic factors which may significantly determine the access to mental health service. Also, education programs or other outreach programs for racial minorities are necessary to understand the different distribution of mental health services for racial minorities. IMPLICATIONS FOR FURTHER RESEARCH: Future research should examine the causes for racial disparity in the use of prescription drugs for mental illness both in the extensive and intensive margins. An in-depth analysis is needed to map out the attributes for the observed disparity between Whites and racial minorities in mental health service use.

Adolescent↗
PubMed1989

[Prescription habits. Illustrated by a random sample].

With the object of illustrating prescribing habits and errors in prescriptions, a randomized sample of 1,000 prescriptions was employed from the prescriptions from a single day. The main result of the investigation is that, in general, a great proportion of errors occur as 61.7% of the prescriptions were incorrect. Errors concerning limiting of issue and indications of reasons for use are particularly noticeable. Only 48% of the drugs prescribed for which limitation of issue is compulsory and 32.4% of all preparations do not show the indication for use. The alterations in the circular on dispensing issued by the Danish Board of Health with the object of prompting doctors to write multiple prescriptions and always to give the indication for employment of the preparation concerned are thus far from fulfilled. Employment of telephonic prescriptions is still extensively employed as nearly 50% of all prescriptions are given by telephone and the intention of the circular that telephone prescriptions should only be employed in special circumstances is thus far from fulfilled. The present authors find the the doctors' duty to provide the indications for use should be emphasized on account of control of prescriptions in the pharmacies and ensuring correct medication for the patients concerned. Similarly is should be deliberated whether the requirement of endorsing prescriptions for reissue of B preparations should be maintained and measures for limitation of the use of telephonic prescriptions should be limited with due respect to the advantages and disadvantages of these.

Denmark↗
PubMed1983

Effect of a call-in prescription refill system on workload in an outpatient pharmacy.

The effect of a computer-assisted call-in prescription refill system on the workload of an outpatient pharmacy was investigated. After installation of a telephone-answering device and a dedicated telephone line in the pharmacy, patients were able to call 24 hours a day and request a prescription refill. A computer system was used to screen the patient's record for drug interactions, print a new label, and update the patient's profile. Data were collected on the number of prescriptions processed per hour and per day before (period 1) and after (period 2) the system was implemented. The workload was assessed by the number of new prescriptions, refills, call-in refills, and total prescriptions processed. The mean number of prescriptions processed per hour ranged from approximately 10 to 178 during both periods. During period 2, the pharmacists processed a mean of 172 and 161 prescriptions per hour for the first and second hours of the day, respectively; for period 1, these means were 112 and 135 prescriptions, respectively. The numbers of refill prescriptions and total prescriptions dispensed during period 2 were significantly greater than those of period 1. Overall, there was a 16.9% increase in prescription volume. The computer-assisted call-in refill system had an effect on the workload and gave pharmacy management some control over the hourly work flow.

Drug Prescriptions↗
PubMed1983

Physician noncompliance with prescription-writing requirements.

Prescriptions processed in an outpatient pharmacy department (OPD) were audited retrospectively for physician noncompliance with prescription-writing requirements, and the estimated cost in pharmacist and patient time attributable to the errors made was assessed. During a 14-day period, 7858 prescriptions written by 451 physicians and taken to the OPD of a large teaching hospital were examined. When the patient's name, physician's signature, drug quantity, or directions for use were omitted, patients were asked to return the prescription in person for correction. In a follow-up study, the time spent at the clinic for this purpose was recorded for 50 patients. For another sample of 52 prescriptions corrected by a pharmacist's telephone call to the physician, pharmacist time spent was recorded. Errors were found in 1070 prescriptions. The total number of errors was 1130, for a noncompliance rate of 14.38%. The most frequent errors were ordering of nonformulary drugs and erroneous or unspecified dosage strength. There was no difference in noncompliance among physicians with various levels of training. An average of 25 patients per day were asked to return to the clinic for correction of their prescriptions; more than half did not return to the OPD. For the 50 patients whose return visits were monitored, time spent in the clinic area was 15.0 +/- 9.1 minutes. For the 52 prescriptions corrected by telephone calls to physicians, the pharmacist spent 10.3 +/- 11.0 minutes. Under these study conditions, pharmacists spent 16.3 hours per day correcting prescription errors; if asked to return all unfillable prescriptions, patients would have spent 23.7 hours per day. Pharmacy departments might reduce these time expenditures by conducting periodic reviews of prescription errors and apprising physicians of frequent areas of noncompliance.

Drug Prescriptions↗
PubMed1994

[Study of prescriptions referred back to a health center].

OBJECTIVE: To study referred-back prescriptions, in the areas of source, consumption, cost and information supplied to the family doctor. DESIGN: Descriptive study of a prospective type. SETTING: "La Merced" Health Centre, Cádiz. PATIENTS AND OTHER PARTICIPANTS: All the reports sent over a two-month period from referral specialists (emergency, second level and hospital) to four consulting rooms at the Health Centre. MEASUREMENTS AND MAIN RESULTS: Out of the 6,499 on-demand consultations, 241 attended in order to obtain a referred-back prescription (3.74%). Of the total of 241 reports sent back by specialists, 12%, 7.9% and 69.7% did not report on diagnosis, recommended dosage and length of treatment, respectively. 44.8% were short-term treatments. In 47.7% of the referred-back prescription notes, only one prescription was required. Referred-back prescriptions supposed 9% of the prescriptions issued during the period under observation. CONCLUSIONS: The study only measured incidence, therefore underestimating referred-back prescriptions. In 48% of prescriptions, administrative time could have been saved by dispatching the prescription at its place of origin. There was a notable lack of information supplied in the reports, which we interpret as an indirect indicator of poor coordination between different levels of care. When prescription studies are carried out in Primary Care, the prescription profile of the referral specialists must be taken into consideration.

Community Health Centers↗
PubMed1997

[Legal format and costs of prescriptions at the Central Hospital in Yaounde, Cameroon].

Prescribing treatment is the last act of a medical visit. A prescription is a written document that engages the medical and legal responsibility not only of the physician but of all those subsequently involved in its execution. In countries with weaker economies and more limited health care insurance the costs of filling a prescription can place a heavy financial burden on the families. In the present study we analyzed 285 prescriptions written in the Emergency Room and Outpatient Clinic of Central Hospital in Yaounde, Cameroon. In most cases prescribers were in compliance with legal requirements regarding their identity, but in 20 to 30% of cases neither the name nor function of the prescriber was mentioned. Most prescriptions were written legibly and coherently for both paramedical personnel and the patient. The number of products prescribed ranged from 2 to 5 depending on the issuing department. Practitioners in the outpatient clinic prescribed few brand-name products from the public outlet of the hospital pharmacy (16% of the prescriptions). In 68% of the cases a generic replacement was available. Practitioners in the emergency room were more apt to prescribe brand-name products (73% of the prescriptions). Five classes of drugs accounted for two thirds of prescriptions, i.e. analgesics-antipyretics, usual antibiotics, antimalarials, non-steroid anti-inflammatory drugs, and vitamins. Lawfully required information (drug presentation, route of administration, dose unit, directions and duration of treatment) was stated on 85% of prescriptions from the outpatient clinic and 50% from the emergency room. Although there were large variations, the mean cost of filling a prescription at the town pharmacy was identical in the two groups, i.e. 9500 CFA francs. The cost was 50% lower at the hospital pharmacy. All prescribers and in particular medical students should receive instruction in prescription writing. Careful selection of brand and non-brand-name drugs in agreement with practitioners should achieve further reductions in the cost of filling a prescription in hospital pharmacy.

Analgesics↗
PubMed2005

How and why are non-prescription analgesics used in Scotland?

BACKGROUND: UK Government policy increasingly encourages self-care of minor illnesses, including self-medication. Analgesics constitute a quarter of UK over-the-counter medicines sales, but concerns have been expressed about their potential for inappropriate use. OBJECTIVES: To estimate the prevalence of recent use of non-prescription analgesics in Scotland, to describe by whom they are used, and to estimate inappropriate use. METHOD: A cross-sectional postal survey consisting of a self-completed questionnaire that collected data on respondents' use of non-prescription and prescription medicines, as well as demographic and lifestyle data. The sample comprised 2708 subjects of 18 years and over, randomly selected from the Scottish electoral roll. RESULTS: The response rate was 55% (n=1501). Some 37% (555/1501) of respondents had used a non-prescription analgesic in the previous two weeks. Analgesics accounted for 59% (636/1081) of all non-prescription medicines used in that period. After controlling for all other variables, age, sex, level of education, self-reported health status, prescription exemption status, and use of prescription analgesics, remained significant predictors of non-prescription analgesic use. There was evidence of possible inappropriate use of non-prescription analgesics including use of multiple analgesics (n=67), use by individuals self-reporting conditions associated with cautious use of certain analgesics (n=51), and potential drug-drug interactions (n=15). A few respondents appeared to be using non-prescription analgesics to supplement medical treatment of chronic conditions (n=4). CONCLUSIONS: Our findings have demonstrated a high level of use of non-prescription analgesics amongst the general public, with significant potential for inappropriate use. As we move towards a culture of increased self-management of minor illness, this demonstrated need for improved pharmacovigilance of non-prescribed medicines must be addressed.

Adult↗
PubMed2003

Temporal trends in antihypertensive drug prescriptions in Canada before and after introduction of the Canadian Hypertension Education Program.

OBJECTIVE: Poor control of hypertension is a world-wide health issue. In 1999, the Canadian Hypertension Education Program (CHEP) was launched to annually develop and implement evidence-based hypertension guidelines in an effort to improve hypertension control rates. This study was designed to examine temporal trends in antihypertensive drug prescribing and to explore whether drug prescriptions changed after initiation of the new CHEP guideline process. DESIGN AND METHODS: We used longitudinal Canadian dispensing data (from the IMS CompuScript database; IMS Health, Pointe-Claire, Quebec) to examine antihypertensive prescriptions in the 3 years prior to and the 3 years following introduction of the new CHEP process. To control for temporal changes in the incidence of other cardiovascular conditions for which antihypertensive agents may be prescribed for their non-blood pressure-lowering effects (for example, angiotensin-converting enzyme (ACE) inhibitors for heart failure or coronary artery disease), prescription rates for digoxin, loop diuretics, and nitrates were also examined. RESULTS: Prescriptions for all antihypertensive agents increased significantly between 1996 and 2001 [11% for thiazides, 45% for beta-blockers, 68% for ACE inhibitors, 19% for calcium channel blockers, and 4332% for angiotensin receptor blockers (ARBs)]. Loop diuretic prescriptions increased 27%, but prescriptions for digoxin (-19%) and nitrates (-8%) declined over this time frame. Time series analyses demonstrated increases in the prescription growth rate for all four antihypertensive drug classes recommended in CHEP for the period 1999-2001 compared with 1996-1998, which were statistically significantly and of substantial magnitude (absolute annual increase in prescription growth rate of 4.6% (95% confidence interval 3.5-5.9%) for thiazides, 3.0% (1.8-4.2%) for beta-blockers, 8.2% (6.7-9.7%) for ACE inhibitors, and 6.1% (4.4-7.8%) for calcium channel blockers). The growth rate in nitrate prescriptions did not significantly change [1.1% (-0.6 to +3.0%)] and, although the changes in growth rate for loop diuretics [4.7% (3.2-6.3%)] and digoxin [2.1% (0.6-3.5%)] were statistically significant, they were of smaller magnitude than the changes in the four recommended antihypertensive agents. Similar results were observed when analysis was restricted to new prescriptions only. CONCLUSIONS: Prescriptions for all antihypertensive drugs increased substantially in Canada between 1996 and 2001; the rate of increase was significantly greater after 1999 for all four drugs recommended as first-line therapy in the annual CHEP guidelines. This preliminary data is encouraging, but a national survey of blood pressure control is needed to fully evaluate the impact of the new Canadian guideline process.

Antihypertensive Agents↗
PubMed2006

Do coxibs reduce prescription of gastroprotective agents? Results of a record linkage study.

BACKGROUND: Coxibs are claimed to be cost-effective drugs and reduced prescription of gastroprotective agents is assumed to be one of their major benefits. Real life prescription of these drugs may be substantially different than that considered in pharmacoeconomic analyses or claimed by drug companies, yet. Our objective was to evaluate whether coxibs were associated with reduced prescription of gastro-protective agents (GPAs, specifically proton pump inhibitors, H2 blockers and misoprostol) compared to non selective NSAIDs. METHODS: A record-linkage study was performed using 2001 outpatient prescription data from the province of Modena (about 632,000 inhabitants, in Northern Italy). Logistic regression was used to calculate the odds ratio of GPA prescription for coxib and non-selective NSAID adult users (> 14 years). Three categories of users were further investigated: "acute", "chronic and "incident or new". Main outcome measures were same-day co-prescription and 30 days prescription of GPAs in coxibs and non selective NSAIDs users. To limit selection bias, data were adjusted for age, sex, DDD of coxibs and non selective NSAIDs received during 2001, DDD of GPAs and (for non-incident users) DDD of NSAIDs received during the previous 4 years RESULTS: Same day co-prescription rates were similar considering the overall population and "acute" users. Chronic coxibs users instead showed higher co-prescription rates than chronic NSAIDs users (OR = 1.2, p < 0.05). GPA prescription within thirty days was also higher among all subgroups of coxibs users (OR ranging from 1.6 to 2.0, p < 0.001). CONCLUSION: Assumptions made in pharmacoeconomic analyses on coxibs (lower GPA prescription associated with coxibs use) may be overly optimistic. Claims made through cost-effectiveness data should be carefully interpreted, and mechanisms for attributing drug prices revised accordingly.

Journal Article↗
PubMed2000

Back-up antibiotic prescriptions for common respiratory symptoms. Patient satisfaction and fill rates.

BACKGROUND: In recent years much has been written about the overuse of antibiotics, especially for common respiratory illnesses. One approach to this issue is the use of a back-up prescription, only to be filled if a patient's condition deteriorates or fails to improve. The purpose of our study was to determine patient satisfaction, prescription fill rates, and correlates of these outcomes among patients receiving back-up antibiotic prescriptions. METHODS: In our observational study we obtained survey data from 28 physicians and 2 physician extenders in 3 family practice clinics and their patients presenting with complaints of common respiratory symptoms. We computed patient satisfaction and fill rates of back-up antibiotic prescriptions. Agreement between the perceived need of patients for antibiotics before the office visit and the subjective rating of their physicians of the clinical necessity to prescribe antibiotics for these patients was assessed using the kappa statistic. Finally, we determined correlates of satisfaction and the rate of filling back-up prescriptions. RESULTS: Of the 947 patients enrolled in the study, 46.6% received no antibiotic prescriptions, 30.2% received back-up antibiotic prescriptions, and 23.2% were given immediate-fill prescriptions for an antibiotic. Patients' self-reported satisfaction and fill rates for back-up antibiotic prescriptions were 96.1% and 50.2%, respectively. CONCLUSIONS: Our findings indicate that patients were very satisfied with a back-up antibiotic prescription. The fact that half of the patients chose not to fill these prescriptions suggests a potential health care cost savings.

Anti-Bacterial Agents↗
PubMed1992

A population-wide profile of prescription drug use in Saskatchewan, 1989.

OBJECTIVE: To measure the prevalence of prescription drug use in Saskatchewan in 1989. DESIGN: Retrospective study. PARTICIPANTS: A total of 961,203 Saskatchewan residents (including those who died or were born during the study year) who were eligible for coverage under the Saskatchewan Prescription Drug Plan. The study population represented 94% of the province's total population; those excluded were mostly status Indians (for whom a federal plan is available). MAIN RESULTS: At least one prescription was received by 66.0% of the study population in 1989. The mean number of prescriptions per patient was 8.2, and the mean cost of drug material per prescription was $13.95. Females received substantially more prescriptions than males; the difference was particularly notable for cardiovascular agents, antidepressants and benzodiazepines. In the senior population 80.8% received at least one prescription; the mean number of prescriptions per patient was 18.4. The most commonly dispensed drug for the entire study population was amoxicillin (290 prescriptions per 1000 people); triazolam was the most frequently dispensed central nervous system drug (74 prescriptions per 1000 people). Regional variation in overall drug use was remarkably small, although it increased at the drug-class level, especially for tranquillizers. The use of cardiovascular drugs was 27% to 32% higher (depending on how use was measured) per Regina resident than per Saskatoon resident. Benzodiazepines were commonly used on a long-term basis, despite recommendations to the contrary. CONCLUSIONS: The results quantify the prevalence of prescription drug use, underscore the importance of careful management of drug therapy by physicians and pharmacists (especially for seniors), illustrate substantial variation in drug therapy strategies and raise questions about utilization of benzodiazepines and cardiovascular drugs.

Age Factors↗
PubMed2005

Medicare-approved drug discount cards and renal transplant patients: how much can these cards reduce prescription costs?

BACKGROUND: Post-transplant prescription medications are expensive, often costing over 12,000 dollars annually. Many solid-organ transplant patients have Medicare coverage and patients enrolled in Medicare-approved drug discount card (MADDC) programs may be able to receive prescription medications at a reduced price. However, many transplant healthcare practitioners are unaware of the utility of MADDCs. The purpose of this study was to determine whether enrolling renal transplant patients (RTPs) into a MADDC produces significant savings in prescription costs. METHODS: Two Medicare RTPs, with prescription medication profiles representative of an RTP within 3 months post-transplant and an RTP greater than 5 yr post-transplant, were randomly selected from the Medication Access Program's database. Cost benefit analyses were from the patients' perspective and were performed using the: (i) prescription cost from the Medicare website of MADDCs that listed the greatest and least prescription costs compared with the retail cash price of the same prescription without using the MADDCs; and (ii) MADDCs' annual enrollment fee. The potential cost difference of using MADDCs and not using MADDCs to purchase the prescription medications were calculated. RESULTS: RTPs' monthly out-of-pocket cost for prescription medications ranged from 162 dollars to 340 dollars, and MADDCs offered discounts of 20-37% from retail prices; thus outweighing the MADDC enrollment cost. CONCLUSION: MADDCs, when selected and used appropriately, can reduce prescription medication cost for RTPs. Card selection is of great importance as discount rates vary greatly among cards, and only under restricted circumstances is a patient allowed to switch to another card. It is imperative that practitioners are aware of these programs and utilize cost-effective prescribing practices.

Cost Savings↗
PubMed2000

Compliance with prescription filling in the pediatric emergency department.

OBJECTIVES: To determine the rate of compliance with filling of prescriptions written in a pediatric emergency department and to examine the reasons for not filling the prescriptions. DESIGN: Compliance with filling prescriptions was determined using a follow-up standardized telephone questionnaire, designed so that it was not obvious that assessing prescription filling was the major reason for the study. Compliance herein was defined as having the prescription filled on the same or next day of the pediatric emergency department visit. SETTING: Pediatric emergency department of a tertiary care hospital. SUBJECTS: Pediatric patients discharged home with a drug prescription. MAIN OUTCOME MEASURE: The proportion of prescriptions written in the pediatric emergency department that were filled on either the same or next day as determined by telephone follow-up. This outcome is expressed as a proportion with 95% confidence interval. RESULTS: Follow-up was completed in 1014 (83%) of the 1222 children, aged 4.5 +/- 4.2 (mean +/- SD) years. Compliance with prescription filling was 92.7% (940/1014). Parental reasons for not filling the prescription included medication unnecessary (27%), financial (6.8%), and not enough time (6.8%). Dissatisfaction with the explanation of the medical problem, instructions for treatment, and instructions for follow-up treatment were significantly associated with noncompliance by univariable logistic regression (P<.05). CONCLUSION: The rate of prescription nonfilling in children seen in a pediatric emergency department is at least 7%, although lower than that in adults in a similar setting.

Child, Preschool↗