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PubMed2003

Antibiotic prescribing patterns of French GPs for upper respiratory tract infections: impact of fusafungine on rates of prescription of systemic antibiotics.

INTRODUCTION: Despite attempts to limit their use, systemic antibiotics are extensively prescribed for respiratory infections in France. This survey analyzed data from the Thales database, which contains information from 1010 representative French general practitioners (GPs). The objective was to assess French GP prescribing patterns in upper respiratory tract infections (URTIs) including the rate of prescription of systemic antibiotics and anti-inflammatory drugs in the presence or absence of prescribing fusafungine (Locabiotal) an antibiotic with anti-inflammatory activity indicated for local use in URTIs. Drug costs to the French National Sickness Fund were also assessed. METHODS: This was a retrospective, longitudinal, case-control analysis. Prescribing patterns and costs were compared between patients who did and patients who did not receive fusafungine for a URTI (rhinopharyngitis, tonsillitis, or an influenza-like condition). The fusafungine group consisted of all patients in the database who were prescribed fusafungine at least once between 1 December 1999 and 30 November 2000. The control group was made up of randomly selected patients, matched for age and sex with the study group, who received at least one drug prescription (but not fusafungine) for a URTI during the same period. Patients were selected at the time of their first prescription, and their records for 1 year were analyzed. RESULTS: Each group contained 22 164 patients. For URTIs overall, systemic antibiotics were widely prescribed (at a rate of 54.6% and 67.8% in the fusafungine and control groups, respectively; p < 0.01). The rate of prescription of systemic antibiotics, NSAIDs and corticosteroids per prescription and per episode was significantly lower in the fusafungine group than in the control group. The mean cost per prescription for the French National Sickness Fund was significantly lower for the three URTIs overall when fusafungine was prescribed (9.21 euros [euro] vs euro9.67; p < 0.01). The mean cost to the National Sickness Fund per prescription of systemic antibiotics, NSAIDs, and corticosteroids was also significantly lower in the fusafungine group compared with the control group. The cost of nasal preparations was higher in the fusafungine group because Locabiotal is classified as a nasal preparation. The cost per prescription to the National Sickness Fund was increased by the presence of systemic antibiotics, NSAIDs, or corticosteroids among the prescribed drugs and decreased with the prescription of fusafungine. CONCLUSION: When fusafungine was prescribed for URTIs, fewer systemic antibiotics were prescribed, an important result in the current context of concern about emerging antibiotic resistance. The use of fusafungine was associated with a lower mean cost per prescription to the French National Sickness Fund.

Adolescent↗
PubMed2004

Prescription opioid abuse in patients presenting for methadone maintenance treatment.

To characterize prescription opioid dependent patients in a methadone maintenance treatment (MMT) program, a detailed retrospective chart review of new admissions (1997-1999, n=178, mean age=34.5+/-0.7 years, 65% male) was conducted. At admission most patients (83%) had been using prescription opioids (+/-heroin). Four groups were identified: 24% had used prescription opioids only; 24% used prescription opioids initially and heroin later; 35% used heroin first and prescription opioids subsequently; and 17% had used heroin only (this group was significantly younger: mean age 26+/-1 years, P=0.0001). Subjects reported regular use of prescription opioids at higher than therapeutic dosages. For example, in the 'prescription opioid only' group the reported mean (+/-S.E.) number of codeine or oxycodone-containing tablets consumed daily was 23 (+/-6) tablets and 21 (+/-3) tablets, respectively. There were no significant differences found amongst the groups in measures of social stability. Those dependent on prescription opioids alone were less likely to use illicit non-opioid drugs or to be associated with injection drug use. Those that used prescription opioids only or initially were more likely to have ongoing pain problems and to be involved in psychiatric treatment. Further research is required to better elucidate the complex relationships between pain, mental health and addiction in order to develop optimal prevention and treatment strategies for prescription opioid dependence.

Adult↗
PubMedDate not supplied

[Profile of prescription of psychotropic drugs in a National Fund of Social Foresight Organisation in Morocco].

INTRODUCTION: Psychotropic drugs have undergone significant development in the last few years and their prescription is no longer limited to psychiatrists alone but also to other specialists and general practitioners. In Morocco, many topical questions arise regarding the profile of the prescription of psychotropic drugs. DESIGN: of the study. The present work is a transverse epidemiological study carried out by the CNOPS (National Fund of Social Foresight Organisations) consisting on the random selection of prescriptions drawn-up during the year 1997. The research work consisted at first in making the whole prescriptions including at least one psychotropic drug. Subsequently, we considered various parameters (age, gender, number and family of psychotropic drugs, prescriber, associations between psychotropic drugs...). RESULTS: Four percent of prescriptions included at least one psychotropic drug, 64.1% included one psychotropic drug and more than 33% included 2 to 3 psychotropic drugs. We have noticed a slight female predominance and half of the prescribed psychotropics was prescribed to patients aged between 40 and 60 years. General practitioners ranked first among doctors who prescribed psychotropic drugs (27.7%) followed by psychiatric-s (19%). Among psychotic-type drugs, anxiolytics dominated in the prescriptions (44.9%) followed by neuroleptics (25.2%), antidepressants (18.7%) and finally hypnotics (3%). Women consumed more anxiolytics and antidepressants than men. Among prescriptions drawn-up by general practitioners 52.4% were composed of anxiolytics. Psychiatrists prescribed neuroleptics in 35.3% of cases, then anxiolytics in 35.2%, and antidepressants in 28.7% of cases. Hypnotics concerned only 2.2% of their prescriptions. For the other specialists, the majority of prescriptions were for anxiolytics. Monotherapy was respected in 64.1% of cases. Antidepressants were combined associated with anxiolytics in more than 55% of cases. CONCLUSION: Psychotropic drugs are prescribed more by general practitioners than by psychiatric-s, and anxiolytics constitute the main component of the prescriptions, bearing in mind that women consume more anxiolytics and antidepressants than men.

Adult↗
PubMed2003

Prosthetic prescription in the Netherlands: an observational study.

Prosthetic prescription for lower limb amputees and the methodology used are primarily based on empirical knowledge. Clinical expertise plays an important role that can lead to an adequate prescription; however, a clear evidence based motivation for the choices made cannot be given. This can lead to local prescription variations with regard to overuse or underuse of prosthetic care and a lack of transparency for consumers and health insurance companies. Hence a clinical guideline may lead to a more consistent and efficient clinical practice and thus more uniformly high quality care. The purpose of this study was to get insight into potential similarities in prescription criteria in clinical practice in the Netherlands. Secondly, the authors were interested to know if prosthetic prescription was primarily based on the level of activity or intended use of the prosthesis. As part of the development of a consensus-based clinical guideline a multi-centred, cross-sectional study was carried out in order to observe the prosthetic prescription for a group of lower limb amputees. Therefore prescription data were collected from 151 amputees with trans-femoral amputation, knee disarticulation or trans-tibial amputation. Results of the multiple logistic regression show no relationship between the activity level and any of the variables included in the equation such as the hospital or medical doctor in Physical and Rehabilitation Medicine (MD in P&RM), prosthetic components, age of the amputee or reason of amputation. The criteria used are merely based on the clinical expertise and local experience whereas the actual prescriptions differ from location to location. In conclusion the development of a clinical guideline for prosthetic prescription in lower limb amputation is recommended. The information gained from this observational study will be used in a clinical guideline procedure for prosthetic prescription in the Netherlands.

Aged↗
PubMed2000

Improving the quality of the order-writing process for inpatient orders and outpatient prescriptions.

Because many preventable medication errors occur at the ordering stage, a program for improving the quality of writing inpatient orders and outpatient prescriptions at one institution was developed. To determine whether potential problems existed in the order-writing process for inpatients, all physician orders for a seven-day period in 1997 were reviewed (n = 3740). More than 10% of all orders had illegible handwriting or were written with a felt-tip pen, which makes NCR copies difficult to read. Other potential errors were also identified. Following educational programs for physicians and residents focusing on the importance of writing orders clearly, physician orders were reviewed for a 24-hour period (n = 654). The use of felt-tip pens decreased to 1.37% of all orders, and no orders had illegible handwriting. A similar quality improvement approach was used to evaluate the outpatient prescription-writing process. A review of all new prescriptions for a consecutive seven-day period at a local hospital-owned community pharmacy (n = 1425) revealed that about 15% of the prescriptions had illegible handwriting and roughly 10% were incomplete. Additional data were gathered through a survey sent to 71 outside provider pharmacies requesting information on problems related to prescriptions written by physicians from the institution; 66% responded. Failure to print prescriber name (96%), illegible signature (94%), failure to include DEA number (89%), and illegible handwriting other than signature (69%) were reported as the main problems. Each physician was given a self-inking name stamp to use when writing prescriptions. In addition, educational programs covering examples of poorly written prescriptions and the legal requirements of a prescription were held for physicians and residents. A follow-up survey showed that 72% of pharmacies saw stamps being used; when stamps were not used, however, illegible signatures continued to be a problem. Follow-up reviews of outpatient prescriptions indicate improvements in handwriting and completeness, but continuing educational efforts are needed. The quality of order writing for inpatients and outpatients continues to be monitored on a regular basis. Ongoing educational programs, follow-up reminders, and feedback to physicians have greatly improved the prescription-writing habits of physicians.

Ambulatory Care↗
PubMed2005

The effect of combination pharmacotherapy on the prescription trends of glaucoma medications.

PURPOSE: To describe prescription trends within a managed care setting for glaucoma medications and to examine the effect of introduction of Cosopt--a fixed combination of dorzolamide and timolol. PATIENTS AND METHODS: All prescriptions dispensed to any of the 470,350 members of an Israeli health maintenance organization were monthly scanned for patients treated for glaucoma, between January 2000 and May 2003. The monthly mean number of glaucoma patients was 3899 +/- 104 (mean +/- SD). All topical glaucoma prescriptions were documented, and the monthly prescription rate of each medication was calculated and plotted. The monitored glaucoma medications were: beta-adrenergic antagonists, dorzolamide, latanoprost, pilocarpine, brimonidine, Cosopt, and others. RESULTS: beta-adrenergic antagonists were the top prescribing drug (>35% of all glaucoma prescriptions). The prescription rates of pilocarpine and beta-adrenergic antagonists were in constant decline, while latanoprost and brimonidine increased steadily. The introduction of Cosopt changed the prescription trends of dorzolamide from increasing to rapidly decreasing, and accelerated the long-term decline of beta-adrenergic antagonists. Concomitant with the introduction of Cosopt the prescription rate of beta-adrenergic antagonists temporarily increased. This was due to a total increase in glaucoma prescriptions. When Cosopt was introduced, 37.5% of patients were prescribed Cosopt together with beta-adrenergic antagonists, and 16.5% also received dorzolamide. Thereafter the co-prescription decreased steadily. CONCLUSIONS: Introduction of a combination drug should be accompanied by physicians', pharmacists', and patients' education to prevent its inappropriate usage together with its components.

Antihypertensive Agents↗
PubMed2004

The insurance effect on prescription drug expenditures among the elderly: findings from the 1997 Medical Expenditure Panel Survey.

BACKGROUND: Despite continuing debate over a prescription drug benefit for the Medicare program, there has been relatively little research estimating the potential cost of providing such a benefit. OBJECTIVE: The objective of this study was to estimate the effect of prescription drug insurance on outpatient prescription drug expenditures among the elderly. RESEARCH DESIGN: We studied respondents aged > or =65 years to the 1997 Medical Expenditure Panel Survey, a representative survey of the U.S. noninstitutionalized population. Survey-weighted linear regression models were used to estimate the probability of any expenditures and total expenditures while controlling for sociodemographic characteristics, chronic conditions, and health status. MEASURES: We used prescription drug insurance status and outpatient prescription drug expenditures. RESULTS: An estimated 34 million elderly people filled 630 million prescriptions in 1997. Thirty-seven percent did not have prescription drug insurance. Total prescription drug expenditures exceeded $23 billion. Persons without prescription drug insurance spent slightly less than $7 billion; those with insurance spent more than $16 billion. After controlling for health status, comorbidity, and demographic characteristics, prescription drug insurance increased expenditures by $183 per person. The marginal increase in total expenditures of extending the average observed benefit to those currently uninsured is $2.3 billion (95% confidence interval, $1.2-3.5 billion). CONCLUSIONS: Proposals for a Medicare drug benefit provide high copayments to protect against insurance effects and to address uncertainty in cost estimates of the proposed benefit. By quantifying the insurance effect on expenditures among the elderly, the data reported here could reduce uncertainty in the budget estimation process.

Aged↗
PubMed2006

Drug prescription patterns before, during and after pregnancy for chronic, occasional and pregnancy-related drugs in the Netherlands.

OBJECTIVE: To compare the prescription of drugs in women over a period from 2 years before until 3 months after pregnancy, regarding the type of drugs used and the fetal risk. DESIGN: A cohort study based on pharmacy records of women giving birth to a child between 1994 and 2003. SETTING: The study was performed with data from the InterAction database, containing prescription-drug-dispensing data from community pharmacies. POPULATION: The study population included 5412 women for whom complete pharmacy records were available. METHODS: Drugs were classified into three categories: (1) drugs for chronic conditions, (2) drugs for occasional use and (3) drugs for pregnancy-related symptoms and also classified according to the Australian classification system. MAIN OUTCOME MEASURES: The prescription rate was calculated as the number of women per 100 women who received one or more prescriptions for a given drug within a specified time period. RESULTS: About 79.1% of the women received at least one prescription during pregnancy. The prescription rate for most drugs for chronic diseases and for occasional use decreased during pregnancy, whereas, as expected, the prescription rate for pregnancy-related drugs increased. During the first trimester of pregnancy, 1.7% of all drugs prescribed for chronic conditions and 2.3% of the occasional drugs were classified as harmful. CONCLUSIONS: The increase in prescription rate during pregnancy is caused by an increase in prescription rate of drugs for pregnancy-related symptoms. The prescription of harmful drugs is more commonly associated with drugs for occasional use rather than with drugs for chronic conditions. Therefore, a more cautious prescribing of drugs to healthy women in the fertile age is necessary.

Abnormalities, Drug-Induced↗
PubMed2006

[Demand for dispensing of medicines without medical prescription].

OBJECTIVES: To study the request for drugs and their dispensing without the necessary prescription form. DESIGN: Cross-sectional, observational study. SETTING: Volunteer community pharmacies in Spain. MAIN MEASUREMENTS: Percentages of request and dispensation of drugs without prescription. Reasons given by people requesting the medicines and pharmacists' reasons for dispensing them. RESULTS: 11.1% of prescription drugs were requested without a prescription form: 69.7% of these requests were for chronic medication or acute treatment and 20% were for self-medication. The drugs without prescription form were dispensed in 10.8% and refused in 0.3% of cases. The reasons given by pharmacists for dispensing without the compulsory prescription form were: "drugs recommended by a doctor" (33.3%), "advance on prescriptions" (24.1%), and "the pharmacist knew the patient's pharmaco-therapeutic record" (17.5%). CONCLUSIONS: Dispensing drugs without the necessary prescription form is a very frequent practice (10.8%) and is not restricted to any particular drug therapy group. Doctors, dentists, nurses, pharmacists, patients and health service management must all assume their share of responsibility if this problem is to be solved. The system of prescription and dispensing of chronic medicine (repeat prescription in long-term treatment) needs to be improved and strengthened.

Adult↗
PubMed2006

Racial differences in medication switching and concomitant prescriptions in the treatment of bipolar disorder.

OBJECTIVE: This study examined whether the practices of switching between classes of medications and prescription of concomitant medications differed between black and non-black patients with bipolar disorders. METHODS: In a retrospective cohort design, data from 1998 to 2004 for patients with diagnoses of bipolar disorders were obtained from a large claims database. Information was obtained on the number of prescriptions for four classes of medications (anticonvulsants, mood stabilizers, and first- and second-generation antipsychotics) as well as on medication switching (between drug classes), concomitant prescriptions, resource use, and outcomes (an emergency department visit or a hospitalization). Logistic models assessed the relationship between outcomes and switching or concomitant prescriptions. RESULTS: The study population consisted of 1,113 adults who received at least one prescription from the four drug classes. Medication switching or concomitant prescriptions were documented for more than one-third of patients (36.6 percent). A significantly greater proportion of black patients received two or more medications from different drug classes (41.1 compared with 34.7 percent). The number of prescriptions was lower for black patients than for non-black patients. Patients for whom switching or concomitant prescriptions were documented were significantly more likely to have an emergency department visit or a hospitalization, and race was a significant predictor of these outcomes. CONCLUSIONS: The prevalence of polypharmacy-medication switching and concomitant prescriptions-was high among patients with bipolar disorder, with a higher prevalence among black patients. Patients who experienced switching or concomitant prescriptions were more likely to visit the emergency department or to be hospitalized.

Adult↗
PubMed1998

Medical opinions, beliefs and prescription of orthopaedic footwear: a survey of Dutch orthopaedists and rehabilitation practitioners.

OBJECTIVES: To get insight into medical opinions about the use of orthopaedic footwear and the medical and social factors related to the prescription of orthopaedic footwear by orthopaedists and rehabilitation practitioners. METHODS: In this study 85 orthopaedists and 96 rehabilitation practitioners filled out a questionnaire measuring perceived desirability of prescribing orthopaedic footwear in specific medical conditions, the perceived advantages of orthopaedic footwear, the perceived disadvantages of orthopaedic footwear, the attitude to orthopaedic footwear and satisfaction with the co-operation with the pedorthist. Clinicians were asked to estimate their referral rate of orthopaedic footwear. RESULTS: Orthopaedists and rehabilitation practitioners agree that the prescription of orthopaedic footwear should be considered in the case of rheumatoid arthritis, amputation of the foot and diabetic foot and not be considered in the case of sprain and back pain. In the case of hallux valgi, dermatological problems and clavus (severe corn) a reticent prescription policy seems to be the optimal choice. In the other medical conditions studied no unequivocal prescription policy could be derived. Respondents who prescribed orthopaedic footwear more than the median (more than 50 prescriptions per year) were more often rehabilitation practitioner, perceived more advantages of prescription footwear, perceived less disadvantages of prescription footwear and were more satisfied about the co-operation with the pedorthist. CONCLUSION: In some medical conditions orthopaedists and rehabilitation practitioners agree about the optimal use of orthopaedic footwear. In some other medical conditions orthopaedists and rehabilitation practitioners are divided about the use of orthopaedic footwear. Reported rate of prescription was not related to desirability of prescription, but was related to beliefs such as perceived advantages, perceived disadvantages and satisfaction with co-operation with the pedorthist, underlining the importance of cognitive factors in prescription style.

Adult↗
PubMed1998

Prescription and nonprescription analgesic use in Sweden.

OBJECTIVE: To analyze patterns of prescription and nonprescription analgesic use in the general Swedish population, in association with predisposing factors, enabling factors, need, and health behavior. DESIGN: Cross-sectional interview survey. SETTING: The Swedish Surveys of Living Conditions for the 2-year period 1988-1989. PARTICIPANTS: A probability sample of all inhabitants of Sweden aged 18-84 years (n = 11996). MAIN OUTCOME MEASURES: Prescription and nonprescription analgesic use during a 2-week period. RESULTS: Women reported use of analgesics both with and without prescriptions to a greater extent than did men. Among women, 12.2% reported prescription analgesic use and 30.4% reported nonprescription analgesic use. The corresponding proportions among men were 7.2% and 20.0%, respectively. In the descriptive analyses, prescription analgesic use was most common among persons aged 45 years and older, while use of nonprescription analgesics was most common in people aged 18-44 years. The polychotomous logistic regression analyses showed that headache and musculoskeletal pain were strongly associated with prescription analgesic use to a similar extent among men and women. Headache was associated with nonprescription analgesic use among men and women, but a gender difference was found in the association between musculoskeletal pain and nonprescription analgesic use. Women with musculoskeletal pain used nonprescription analgesics to a greater extent than did men with musculoskeletal pain. Poor health--measured as self-perceived health status and physical function--and high use of health care were related only to prescription analgesic use. Smoking and being overweight were associated with prescription analgesic use among men and with nonprescription analgesic use among women; alcohol consumption was associated with both types of analgesic use only among women. CONCLUSIONS: This study shows that men and women differ in their choice between prescription and nonprescription analgesics and that the choice between prescription and nonprescription analgesics is influenced by an individual's pain, self-perceived health, and lifestyle.

Adolescent↗
PubMed2005

Short-acting beta-agonist prescription fills as a marker for asthma morbidity.

OBJECTIVES: Hospital admissions and emergency department (ED) visits have traditionally been used to assess the strength of association between environmental exposures, such as air pollution, and asthma morbidity. In the current study, we evaluate the use of short-acting beta-agonist (SABA) prescriptions as a surrogate marker for asthma exacerbation with respect to these more traditional markers. METHODS: Claims data for recipients covered by Illinois Medicaid with a diagnosis of asthma were obtained for fiscal-years 1996 through June 1998. Claims for short-acting bronchodilators and asthma-related ED visits and hospital admissions for 31,140 adults were identified. The odds ratio for the association of either an ED visit or hospital admission and an SABA prescription was calculated for time lags ranging from -28 to +28 days. Individual-subject heterogeneity and seasonal effects were corrected for using the Mantel-Haenszel method. RESULTS: After adjustment for individual and seasonal effects, there was a significant positive association between SABA prescriptions and ED visits or hospital admissions for asthma on any single day. In addition, a significant positive association was also found between the ED visits or hospital admissions occurring on the few days prior to an SABA prescription. No significant relation was found (after adjusting for subject and seasonal effects) between prescriptions and admissions when an SABA prescription date preceded that of a hospital admission or an ED visit. CONCLUSIONS: A very strong and significant association between ED visits or hospital admissions for asthma and SABA prescriptions was observed, which suggests that SABA prescription fills can be used as a marker for asthma morbidity. In addition, a temporal association exists between claims for ED visits or hospital admissions for asthma and SABA prescription claims when an ED visit or hospital admission precedes the SABA prescription.

Adolescent↗
PubMed2006

The effect of direct-to-consumer advertising on prescription drug use by older adults.

BACKGROUND AND OBJECTIVE: Although older adults are frequent consumers of prescription drugs and increasingly the intended audience of direct-to-consumer advertising (DTCA) marketing efforts, little is known about the effect of DTCA on older adults' prescription drug-seeking behaviour. In response, the objective of this study is to examine factors associated with requesting a prescription drug from a physician following exposure to DTCA among older adults, and whether the drug or other medical treatment was prescribed during the encounter. METHODS: A secondary data analysis of the "Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs", a data set publicly available through the Inter-university Consortium for Political and Social Research (ICPSR 3687), was conducted. For the purposes of this study, only those respondents who indicated that they had been exposed to DTCA (n = 2601) were included in the study sample. Using a two-step weighted logistic regression approach, separate models were estimated to examine first, whether a request for the advertised drug was made following exposure to DTCA and secondly, the outcomes of any patient-physician encounters that occurred following exposure to DTCA. RESULTS: Descriptive analysis of the outcome variables revealed that, among respondents exposed to DTCA, 31% (n = 801) requested a prescription drug from their physician. Approximately 5% of those who made a request were > or =75 years of age. Among respondents requesting a prescription drug, 69% (n = 556) received a prescription in response to their request, of whom, approximately 5% were > or =75 years of age. Multivariate findings suggest that although adults > or =75 years of age are less likely to request a prescription drug following exposure to DTCA (odds ratio [OR] = 0.58; p = 0.032), when they do approach their physicians, they are more likely to receive recommendations for further treatment, with ORs indicating a 250% (OR = 3.507; p = 0.002) increase in the odds of further referral among adults > or =75 years of age. CONCLUSION: Overall, results from the study suggest that DTCA influences the patient-doctor relationship and prescription drug acquisition behaviour of patients; however, the nature of the effect of DTCA on older adults is complex. Because future cohorts of older adults may be more comfortable about requesting prescription drugs and the consumer-driven approach to obtaining medical care, understanding the impact of DTCA on older consumers represents an important area for further inquiry.

Advertising↗
PubMed2001

The cost of inadequate prescriptions for hypolipidaemic drugs. VICAF Group.

BACKGROUND: The high consumption of hypolipidaemic agents warrants the study of the costs caused by these medicines being inadequately prescribed. OBJECTIVE: To quantify the economic cost generated in 1 year in primary care by inadequate (or unnecessary) prescriptions for hypolipidaemic drugs. METHODS: A cross-sectional study based on hypolipidaemic drug prescriptions for a population of pensioners ordered during 1 year by 49 family physicians from 4 health areas in Madrid, Spain. Each doctor completed a data collection sheet for each patient for whom a hypolipidaemic agent was prescribed. The adequacy of each prescription was evaluated according to 2 quality levels: for level 1, it was necessary to have knowledge of the following parameters: total cholesterol level at the start of treatment, low density lipoprotein cholesterol (LDL-C) level, whether dietary intervention preceded pharmacological treatment, patient age and risk factors; for level 2, it was not necessary to have knowledge of either diet before pharmacological treatment or LDL-C levels. Inadequate expenditure was quantified by physician, by type of doctor who initiated the pharmacological treatment (the family physician, specialist, other doctor), therapeutic group and agent. STUDY PERSPECTIVE: Primary healthcare management of 4 public health areas. RESULTS: The cost of inadequate prescriptions for hypolipidaemic drugs reached 116,480.60 US dollars ($US; 1997 values) for quality level 1 and $US37,893.37 for level 2. 12.3% of the health professionals ordered all their prescriptions inadequately (level 1). Of the total inadequate prescription expenditure, 20.4% represented treatments initiated by family physicians and 35.3% by specialists (level 1). Statins made up 78.2% of the total cost; the inadequate expenditure for this therapeutic group reached $US88,797 (level 1). Of the prescriptions for fibrates, 88% were inadequate (level 1). CONCLUSIONS: In this study, 67% of prescriptions for hypolipidaemic medicines were ordered inadequately in the pensioner population, which represents a considerable pharmacological expenditure. This percentage and the mean cost per inadequate prescription was higher if a specialist was the professional initiating the treatment. Therefore, it is necessary to run pharmaceutical prescription quality programmes with both primary care physicians and specialists involved.

Aged↗
PubMed1998

Attitudes to and use of a modified prescription form by general practitioners and pharmacists.

OBJECTIVE: To evaluate the rate of use and acceptance of a new prescription form designed to provide more information to pharmacists and patients. DESIGN: Prospective descriptive study. SETTING: A semi-rural community outside Melbourne, Victoria, in November 1994. PARTICIPANTS: GPs and pharmacists working three or more sessions per week in the locality, and 21 consumers who formed two consumer focus groups. INTERVENTION: An education session for GPs and pharmacists, followed by a one-month trial of new prescription forms which included notations to facilitate interprofessional communication. MAIN OUTCOME MEASURES: Rate of use and acceptability of the new prescription notations. RESULTS: Eighteen GPs and 10 pharmacists participated; 3600 forms were issued and 2521 prescriptions, including 3464 prescription items, were analysed. GPs and pharmacists used at least one of the new prescription notations in 45% (1559) of prescription items; 35% of prescription items (1222) were notated with the general purpose of the medication. Qualitative findings suggested that GPs, pharmacists and consumers considered the new prescription form to be beneficial and useful. CONCLUSIONS: A modified prescription form to increase communication between GPs and pharmacists is acceptable in clinical practice.

Abbreviations as Topic↗
PubMed1999

[Correct documentation of drug prescriptions].

The present study was undertaken to investigate and minimize possible differences in doctors' and nurses' documentation of drug prescriptions. A retrospective medical audit including 100 patients receiving medication revealed 69% correct prescriptions in doctors' case records. Only 44% of prescriptions in nurses' drug lists were correct. Based on the exposed problems a prescription sheet and clinical guidelines for medication were developed and implemented in the department. This resulted in 91% correct prescriptions in a comparable group of 100 patients receiving medication, a highly significant improvement. Among prescriptions signed by a doctor as legally requested, 98% were correct. The prescription sheet also served as an updated survey of medication. No health-threatening prescription errors were disclosed in either group. In conclusion, a common prescription sheet significantly improved the quality of drug prescriptions.

Denmark↗
PubMed2000

[Drug prescriptions for Danish children].

We used a prescription database to identify all reimbursed prescriptions for children aged 0-15 years living in North Jutland County (population 95,134), Denmark, during 1997. We identified 154,189 prescriptions for 48,091 child users. The mean prescription rate was 1621/1000 children/year. Overall, half of the child population purchased > or = 1 prescription. In children younger than three years, 75.3% purchased prescriptions, and 17.5% received > or = 5 prescriptions. Systemic antibiotics, anti-asthmatics, ophthalmologicals, and dermatological corticosteroids accounted for 82% of the prescriptions. One-third of the 0-2 year old children purchased prescriptions for anti-asthmatics, mainly systemic beta 2-agonists, and almost half purchased antibiotics, mainly broad-spectrum penicillins. In the 7-15 year olds, 39.1% redeemed at least one prescription. The study stresses the need for epidemiological studies on the reasons for drug use and evaluation of pharmacological effects in children.

Adolescent↗