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PubMedDate not supplied

[Evaluation of prescription practices and of the rational use of medicines in Niger].

With the aim of evaluating an essential drugs and costs recovery program in Niger, rational drug use and prescribing patterns were studied in 19 health centers in Tahoua region. Drug use indicators were measured by retrospective and prospective surveys, achieved before and after a training intervention for nurses in using national standard treatments guideline. In the first study period, 627 retrospective randomized prescriptions and 295 prospective prescriptions in successive consultations were collected, and in the second period, ten months later, 665 and 274 prescriptions, respectively. Findings were compared between the two periods, and discussed in regard to referentials and data from other studies. The average number of drugs per prescription increased from 2.96 to 3.14 (p < 0.01) between the two periods, and the percentage of prescriptions with injections from 29.9 to 36.6% (p < 0.02), whereas the percentage of prescriptions containing antibiotics decreased from 75.2 to 68% (p < 0.01). These values were higher than regional or international standards, which were 2 for the average of drugs 17% for the injections and 50% for the antibiotics. Prescribing in essential and generic names of the national drug list was very close to 100% for the two periods. The average cost of prescriptions increased from 437 to 553 francs CFA (p < 0.001), which was higher than the calculated reference cost of 400 francs, but lower than data in literature. Correct prescriptions according to standard treatment guideline were only around 50%, in the two retrospective surveys. The averages of consultation time were 5.4 and 6.1 minutes for the two prospective surveys respectively, and dispensing times were 3.1 and 3.4 minutes, longer than those noticed in most of other studies in developing countries. Prescribed drugs were actually dispensed in almost 100% of the cases during the two periods. Drugs were properly labeled in 92.8% of the cases in the first period survey, and in 89.7% of the cases in the second (p < 0.03), whereas the percentage of patients who knew the correct dosage for drugs delivered increased from 64.4% to 75.5% (p < 0.01). Drug formularies and treatment guidelines were available in all facilities except in one case. Key drug availability ratio at the time of visit were good, in spite of a regression from 97.6 to 85.6% between the two periods. Improving drug purchasing and communal management in the health centers, this program contributed to the availability of essentials generic drugs delivered in a satisfactory way to the patients, and to set up a favorable professional environment for the nurses. On the other hand, the training courses seemed to have a limited impact on prescribing patterns for the nurses. However, better availability of drugs, as well as dispatching courses on the two retrospective surveys periods, could have underestimated this impact. Increasing prescription cost, although remaining compatible with costs recovery of drugs, was probably caused by the negative evolution of some indicators: abusive use of injections, higher number of drugs prescribed, few prescriptions according to standard treatment. These bad habits, often the most dangerous, justify undertaking actions of adapted formation, but also of communication with the patients, which should be regularly evaluated. For that, it will be necessary to have more qualitative indicators, helpful for the assessment of most efficient therapeutic attitude, tempting to value the global impact of these actions on health populations in developing countries.

Adult↗
PubMed2001

[Off-label prescriptions in an adult surgical intensive care unit].

OBJECTIVE: The aim of the study was to document off label prescribing in an adult surgical intensive care unit setting and to determine explanatory factors. METHOD: Medical prescriptions of 20 adult patients consecutively admitted in surgical intensive care unit were recorded, from the time of admission to the second day of hospitalisation. Concordance of each prescription to the different sections listed on the approved labeling was checked on the Vidal 1999 dictionary. French guidelines promoted by the two major intensive care societies were looked for to explain the most frequent reason of unapproved use of the 10 main therapeutic classes concerned by off label prescription. RESULTS: In this study, 465 prescriptions were analysed, representing 80 drugs and 35 therapeutic classes. Prescriptions were considered off label in 25.6%. Antibiotics, stress ulcer prophylactic drugs, vitamins, antiepileptic drugs were the main therapeutic classes used off label. The main cause of off label prescription was unapproved indication (66%), dosing schedule (27%) and method of administration (17%). For 5 therapeutic classes, representing 45% of off label prescriptions, a guideline supporting these prescriptions was available or was published in the year following the study. CONCLUSION: Off label prescription is frequent in the setting of adult surgical intensive care unit. Seldom medical situations and the gap between official labeling and medical knowledge are explanatory factors of these off label prescriptions.

Adolescent↗
PubMed2002

Prescription patterns analysis--variations among Bulgaria, Romania, Macedonia and Bosnia Herzegovina.

The objective of the study is analysis of the prescription patterns in Bulgaria, Romania, Macedonia and Bosnia Herzegovina (BiH). The study discusses the relevance between prescription and morbidity and the rationality of the drug prescription in terms of Essential Drug Concept (EDC). For the assessment of the morbidity influence on the prescription official statistical information was reviewed and prevailing causes of diseases in the observed countries were calculated. To study the patterns geographically selected regions from the countries under consideration were observed during 1998-2000. In all the countries under consideration respiratory tract, nervous system and cardiovascular diseases are playing the leading role. The prescription of cardiovascular drugs, anti-infectious nervous and respiratory system drugs also predominate. Comparison between prescription and morbidity patterns shows a significant relationship between the morbidity and prescription patterns. Prescription matches the morbidity requirements for the prevailing diseases. The proportion of the essential drug prescribing is higher in countries with officially adopted national EDL as Romania and BiH. No policy promoting rational drug prescription exists and countries use different indicators for the combinations, injections and drugs prescribed per prescription.

Bosnia and Herzegovina↗
PubMed2002

Non-steroidal anti-inflammatory drug and antacid co-prescription in Taiwan: analysis of national insurance claims.

BACKGROUND: Antacids were usually co-prescribed with non-steroidal anti-inflammatory drugs (NSAIDs), although no broad evidences were available as to the effects of antacids in preventing NSAID-associated gastropathy. We performed a survey of national insurance claims for outpatient services in Taiwan to determine the extent of this co-therapy nationwide. METHODS: The National Health Insurance Research Database supplied the sampling datasets for analysis. They represented 0.2% of the entire claims for outpatient medical services in 1999. Co-prescribing was assessed as NSAIDs and antacids on the same prescription. The selection and grouping of NSAIDs followed the guidelines of the Anatomical Therapeutic Chemical (ATC) Classification System recommended by the World Health Organization. Only the oral drugs prescribed on regular visits were taken into account. RESULTS: In totally 425,442 prescriptions with 1,825,604 items of drugs, non-aspirin NSAIDs were present in 108,818 (25.6%) prescriptions and antacids in 235,252 (55.3%) prescriptions respectively. Furthermore, antacids were present in 71.3% of prescriptions that contained NSAIDs and in 49.8% of prescriptions that did not contain NSAIDs (p < 0.001). Significant association of NSAIDs and antacids existed in different specialties of prescribing physicians, but the co-prescription rate (antacids in NSAIDs prescriptions) varied from the highest of 92.8% in the neurosurgery to the lowest of 49.8% in the pediatrics. Significant association of NSAIDs and antacids also existed at different levels of health care facilities, where the co-prescription rates were 80.9% at medical centers, 83.5% at regional hospitals, 87.4% at local hospitals, and 66.6% at primary care units. The subgroup of oxicams was more frequently co-prescribed with antacids than other subgroups (odds ratio = 1.51, p = 0.001). CONCLUSIONS: Concomitant prescription of oral non-aspirin NSAIDs and antacids was indeed a popular practice in Taiwan. Beside their effects in alleviating the NSAID-associated dyspepsia, the role of antacids in preventing NSAID-associated peptic ulcers or in masking the warning symptoms of these ulcers demands further evaluation.

Adult↗
PubMed2006

The economic burden of prescription drug use among elderly patients in Ponce, Puerto Rico.

OBJECTIVE: To examine the economic impact of prescription drug use on the personal income of elderly individuals in Ponce, Puerto Rico. METHODS: One-hundred elderly individuals who attend five care centers were interviewed using a four-page structured questionnaire. The interview collected information about the source and amount of income of participants, the type of insurance coverage for prescription drugs, the amount of expenditures for prescription drugs that are paid out-of-pocket and the barriers they face to use or obtain prescription drugs. RESULTS: Participants were mostly female (69%) and the average age was 77 years. The average monthly income reported was 476 dollars, 79% of which was derived from Social Security. The average monthly expenditure was 364.00 dollars of which 117.00 dollars (32%) was spent on health related expenditures: 70.00 dollars (19%) on prescription drugs, 31.00 dollars (8%) on health insurance premiums, 10.00 dollars (3%) on medical expenditures not related to prescription drugs, and 6.00 dollars (2%) on over-the-counter drugs. The great majority reported having health insurance but one-third pay out-of-pocket for their prescription drugs. Nearly two-thirds expressed they have experienced problems to obtain or use medications in the past six months. Thirty-eight percent reported that the problem was that the cost of medications was too high. CONCLUSION: In spite of insurance coverage, the cost of prescription drugs places a substantial economic burden on elderly individuals. On average, prescription drug expenditures comprise nearly 20% of the personal expenditures of respondents, second only to groceries. This accounts for 15% of their personal income. The economic burden of prescription drugs on the elderly may affect access to needed drugs and may adversely impact health outcomes.

Age Factors↗
PubMed1998

[Improvement of prescriptions for serum tumor markers in a general hospital].

OBJECTIVES: Using a standardized prescription sheet we attempted to improve requests for serum tumor markers in a general hospital. METHODS: Over two 35-day periods before and one year after defining a local prescription consensus and introducing a new prescription sheet, we counted the number of orders for five tumor markers (CEA, CA 19-9, CA 15-3, CA 125, alpha FP) and determined their compliance to the defined prescription protocol. RESULTS: Between the two study periods, the number of prescriptions for the designated tumor markers fell by 24%, from 153 requests in 94 patients to 123 requests in 99 patients, despite a 6% increase in the number of admissions. There was a significant reduction in the number of serum markers orders per prescription (from 1.6 to 1.2) although the distribution by tumor marker remained unchanged. Compliance to the prescription protocol improved, rising from 65 to 87% in units where the pre-protocol compliance rate was below 80%. The rate of compliance was not correlated with correct completion of the new prescription sheet (91% vs 86% respectively). The 6-month cost-savings was estimated at 31,104 FF using the general French nomenclature for laboratory tests. Direct cost reduction was estimated at 5,688 FF. CONCLUSION: Long-lasting improvement of serum tumor marker prescriptions can be achieved in a general hospital. Obtaining a local consensus implicating all prescribing units seems more important than a change in the presentation of the prescription sheet.

Biomarkers, Tumor↗
PubMed2001

Pediatric stimulant and selective serotonin reuptake inhibitor prescription trends: 1992 to 1998.

BACKGROUND: Presciption trends have key implications for costs, outcomes, and research, yet few data exist on pediatric selective serotonin reuptake inhibitor (SSRI) trends and associations with stimulant trends. OBJECTIVE: To describe prescription trends for stimulants, SSRIs, and combination prescriptions by age, sex, and race. METHODS: Retrospective population-based analysis of North Carolina Medicaid prescription claims files. PARTICIPANTS: North Carolina Medicaid recipients, 1992 through 1998, aged 1 to 19 years. The population ranged from 342 333 children in 1992 to 581 088 in 1998. MAIN OUTCOME MEASURES: Annual number of prescriptions, patients filling a prescription claim, and prescription prevalence for stimulants and SSRIs. RESULTS: The number of children and adolescents who received stimulants increased from 6407 (24 584 claims) in 1992 to 27 951 (135 057 claims) in 1998. The number of SSRI recipients increased from 510 children (1326 claims) in 1992 to 6984 children (25 392 claims) in 1998. Prescription prevalence in school-aged children 6 to 14 years increased from 4.4% to 9.5% for stimulants during the study period, and from 0.2% to 1.5% for SSRIs. In 1998, stimulant prescription prevalence was highest for white school-aged males (18.3%) vs black females (3.4%) and SSRI prescription prevalence was highest for white school-aged males (2.8%) vs black females (0.6%). Combination pharmacotherapy also increased during 1992 through 1998. CONCLUSIONS: Prevalence of stimulant and SSRI medications has increased during the 1990s, with prescription prevalence in North Carolina Medicaid youth higher than previously reported. Age, sex, and racial differences are apparent and call for further attention. Combination pharmacotherapy also has growing importance.

Adolescent↗
PubMed2004

Changes in drug utilization following the outpatient prescription drug cost-sharing program--evidence from Taiwan's elderly.

This paper examines changes in drug utilization following Taiwan's newly implemented National Health Insurance (NHI) outpatient prescription drug cost-sharing program for persons over 65 years old. The study is a hospital outpatient prescription level analysis that adopts a pretest-posttest control group experiment design. Selected measures of outpatient prescription drug utilization are examined for cost-sharing and non cost-sharing groups in cost-sharing periods and pre cost-sharing periods. Additional analyses were conducted comparing older patients with and without chronic diseases and differences for essential and non-essential drugs. Patients over age 65 were drawn from 21 hospitals in the Taipei area using a stratified random sampling method. This paper yields several interesting findings. First, average prescription cost and prescription period increased for both the cost-sharing and non cost-sharing groups. However, the rate of increase was significantly less in the cost-sharing group when compared with the non cost-sharing group. Second, the elderly with non-chronic diseases were more sensitive (i.e., reducing drug utilization) to the drug cost-sharing program when compared with those with chronic diseases. Third, for the elderly with non-chronic diseases average drug cost per prescription experienced a smaller decrease in essential drugs but a moderate increase in non-essential drugs for the cost-sharing group. By contrast, for the non cost-sharing group, average drug cost per prescription increased sharply in non-essential drugs as well as essential drugs. Finally, there was a significant increase in the number of prescriptions as well as drug costs above the upper bound of the cost-sharing schedule. The outpatient drug cost-sharing program implemented by the NHI in Taiwan did not reverse the trend of prescription drug cost increases in hospitals. The significant increase in the number of prescriptions above the upper bound of the cost-sharing schedule implies that the NHI should increase the upper bound. Further analysis needs to evaluate any adverse clinical impact for older patients resulting from policy changes.

Aged↗
PubMed1997

Patterns of dose variability in radiation prescription of breast cancer.

PURPOSE: Comparison of radiation outcome of various treatment protocols is difficult due to the variability of dose prescription. A retrospective analysis of the pattern and intercomparison of dose prescriptions is presented for the treatment of breast cancer. MATERIALS AND METHODS: To represent the clinical practice for breast irradiation with tangential fields, commonly used prescription points were chosen that lie on the perpendicular bisector of the chest wall separation (s) that represents the breast apex height (h). These points are located at 1.5 cm from the posterior beam edge, at the chest wall-lung interface (2-3 cm), at distances of h/3 and h/2, and at the isocenter. One hundred consecutive patients treated with intact breast following excisional biopsy were used in this study. For analysis, treatment planning was carried out without lung correction with a 6 MV beam for all patients, even though some of the patients were treated with high energy beams for dose uniformity. Dose distributions were optimized with wedges and beam weights to provide a symmetrical dose distribution on the central axis plane. The statistical analyses of the different parameters, s, h, maximum dose, and doses at various prescription points were carried out. RESULTS: The maximum dose (hot spot) in breast varied from +5% to +27% above the prescribed dose among the patient population. The hot spot was directly related to s, and appeared to be independent of h and the ratio h/s. Among 55%, 40%, and 5% of the patients, the magnitude of the hot spot was 5-10%, 10-15%, and >15%, respectively. Except for the magnitude of the hot spot, the doses at various prescription points were independent of the breast size. For a prescription point at h/3 or at the lung-chest wall interface, the dose variation within +/- 1% is observed for 90% of the patient population. On the other hand, the average dose variation is about +/- 3% among other protocols with dose prescription point varying up to the h/2 point. With the prescription point at the isocenter, an average and maximum variation of 4-5% and 11% were observed, respectively. The maximum dose inhomogeneity for some patients was significantly higher, i.e. up to +27% even without the lung correction. CONCLUSIONS: A wide variation in prescription dose is observed among the different treatment protocols commonly used in breast treatment. For a total dose of 46-50 Gy delivered at 2 Gy/fraction to the breast, the prescribed dose may vary between 50 and 55 Gy and the hot spot dose per fraction may range between 2.3 and 2.5 Gy depending on the protocol and breast size. Thus dose normalization at hot spot and the isocenter should be discouraged unless the total dose to the breast is modified. A uniform definition of dose prescription for breast treatment is greatly required for intercomparison of clinical data.

Breast Neoplasms↗
PubMed2003

Lower respiratory tract infections in adults: non-antibiotic prescriptions by GPs.

BACKGROUND: The AIR II study is a prospective multicentre assessing management of lower respiratory tract infections (LRTIs) in adults by general practitioners (GPs). Epidemiological studies generally address the prescriptions of antibiotics. To our knowledge, little is known about the real impact of non-antibiotic therapeutic prescriptions (defined here as co-prescriptions) in LRTI. Therefore, the aim of the study was to evaluate non-antibiotic prescriptions in LRTIs. METHODS: Two thousand general practitioners (GPs) were randomly selected and asked to participate in each of 30 predefined areas covering mainland France. The patient's sociomedical record was completed by the GP during the consultation and sent to the data processing centre at the same time as an anonymous copy of his prescription. The GP also had to report the inclusion by telephone and agree to a telephone appointment with an interviewer. RESULTS: GPs (n = 3144) reported 5469 evaluable cases. Pneumonia accounted for 9.6% of diagnoses, acute exacerbations of chronic bronchitis 14.9% and acute bronchitis 72.5%. Antibiotics were prescribed to 96.5% of patients. In addition to the 5270 prescriptions of antibiotics, co-prescriptions proved to be twice as numerous as prescriptions of antibiotics (10,027 prescriptions for 5115 patients). Mucomodifiers, steroidal anti-inflammatory drugs and bronchodilators were significantly more prescribed in AECB than others. Non-steroidal anti-inflammatory drugs and antitussives were significantly more prescribed in acute bronchitis than AECB or CAP. CONCLUSIONS: Our results suggest that recommendations of management in LRTIs need to take into account co-prescriptions.

Adolescent↗
PubMedDate not supplied

Postcard and telephone reminders for unclaimed prescriptions: a comparative evaluation using survival analysis.

OBJECTIVE: This study investigated unclaimed prescription reminders with the goal of developing practical and useful recommendations for pharmacies interested in reminding patients to pick up unclaimed prescriptions. Based on the recipient and mode of the reminder notification, this study measured differences in unclaimed prescription pickup time. DESIGN: This study was conducted using a convenience sample of three independent pharmacies in a large Midwestern city. A total of 120 subjects with prescriptions remaining unclaimed after 3 or 4 working days were included in the study. Once identified as unclaimed, these prescriptions were randomly assigned into a control group or one of the following four intervention groups: (1) a telephone reminder to the patient, (2) telephone notification to the prescribing physician, (3) a postcard reminder to the patient, and (4) postcard notification to the prescribing physician. RESULTS: The results suggest that different methods of pharmacist-initiated reminder systems may affect time to prescription pickup in community pharmacy practice. Marginally significant differences were found among the five study groups and the time to prescription pickup (P = .09). Compared with the control group, neither telephone nor postcard reminders--to patients or physicians--significantly decreased the mean number of days to pickup of potentially abandoned prescriptions. CONCLUSION: The actual value of an unclaimed prescription reminder program may reside in improved relationships with customers and with the medical community. The effort and expense of implementing and maintaining an unclaimed prescription reminder system should be balanced against the opportunity to establish and improve pharmacist-patient and pharmacist-physician relationships. Further research in different pharmacy settings should investigate the effectiveness of (1) postcard versus telephone reminders, (2) physician versus patient notification, and (3) the effects of reminders on patient outcomes.

Community Pharmacy Services↗
PubMed2003

Differences in prescription of antiretroviral therapy in a large cohort of HIV-infected patients.

The objective of this study was to determine factors associated with prescription of highly active antiretroviral therapy (HAART). The authors observed 9530 patients eligible for antiretroviral therapy (ART) in more than 100 hospitals and clinics in 10 US cities. Multiple logistic regression analysis was used to assess factors associated with HAART prescription, stratifying patients by no history versus history of ART to assess the association between prescription and CD4, viral load, and outpatient visits. Overall, female gender (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.60-0.76) and alcoholism (OR, 0.85; 95% CI, 0.74-0.99) were associated with decreased likelihood of HAART prescription. Enrollment at a private facility (OR, 1.33; 95% CI, 1.14-1.56), heterosexual exposure (OR, 1.34; 95% CI, 1.13-1.58), and Hispanic ethnicity (OR, 1.19; 95% CI, 1.04-1.37) were associated with prescription. For patients with no history of prescribed ART, CD4 <500 cells/microL (OR, 3.94; 95% CI, 2.02-7.66), and high viral load were associated with increased likelihood of prescription; for patients with history of ART prescription, those whose outpatient visits averaged > or =2 per 6-month interval (OR, 1.30; 95% CI, 1.10-1.54) were more likely and those with high viral load were less likely to be prescribed HAART (OR, 0.50; 95% CI, 0.44-0.56). The authors found differences in HAART prescription by gender, race, exposure mode, alcoholism, and provider type for all patients, by CD4 and viral load for patients with no history of ART prescription, and by average number of outpatient visits and viral load for patients with history of ART prescription.

Adult↗
PubMedDate not supplied

Changing prescribing patterns and increasing prescription expenditures in Medicaid.

PURPOSE: Prescription drug expenditures are the most rapidly growing component of total health care expenditures and particularly affect state Medicaid programs. We determined the extent to which increasing prescription price and changing prescribing patterns contribute to rising prescription expenditures in Medicaid. METHODS: We conducted a claims-based analysis comparing annual prescription drug expenditures and prescribing patterns. Prescription drug and outpatient visit claims for all North Carolina Medicaid enrollees from 1998 through 2000 were included. We analyzed drugs individually by combining all prescriptions and expenditures for the same drug formulation, and we calculated the number of units dispensed per person-year of enrollment. RESULTS: Prescription drug coverage for 1 person-year cost 503 dollars in 1998 and 759 dollars in 2000, for an annual increase of 22.8%. The average number of prescriptions filled per person-year increased from 13.0 in 1998 to 15.5 in 2000. Increased prescribing for 6 drugs accounted for more than 25% of the total increase in expenditures. The price for the 15 most expensive drugs increased an average of 4.1% annually. CONCLUSIONS: Prices for existing drugs increased slightly during the study period, but the major cause of the increase in drug costs was an increase in the number of prescriptions for new and more expensive medications. Prescribing patterns in Medicaid differ somewhat from those in the private sector and partly reflect the population with low socioeconomic status and high health care needs that it serves. To help control rising prescription drug expenditures, efforts should be undertaken to improve appropriate and cost-effective prescribing.

Adult↗
PubMedDate not supplied

Selected characteristics of senior citizens prescription drug payment and procurement in 1998 and 2001.

BACKGROUND: People without prescription drug coverage face greater financial burdens and may sometimes be unable to follow the courses of treatment prescribed by their physicians. The U.S. legislature is considering Medicare coverage for prescription drugs and the use of managed care approaches for containing costs associated with senior citizens. prescription drug therapy. OBJECTIVE: The purpose of this study was to describe selected characteristics of senior citizens. prescription drug payment and procurement. METHODS: Data were obtained via mailed survey from national random samples of senior citizens in 1998 and in 2001. Descriptive statistics and regression analyses were used to describe relationships among study variables. RESULTS: Of 2,434 deliverable surveys, 946 (39%) were returned. Of these, 700 (29%) respondents provided usable data for analysis. Results showed that in 2001, compared with 1998, the proportion of senior citizens without any prescription insurance coverage did not change significantly, 29% and 32%, respectively. However, the proportion of respondents with prescription drug coverage who had to share costs of prescriptions through copayments and coinsurance rose significantly, from 69% in 1998 to 89% in 2001. Between 1998 and 2001, the proportion of senior citizens using mail-order pharmacies rose significantly, from 17% to 27%, and the proportion who reported financial hardship also rose, from 19% in 1998 to 31% in 2001. Controlling for year, prescription drug use, and income, logistic regression analysis showed that respondents without any prescription insurance coverage were about 5 times more likely to report financial hardship compared with those having coverage. CONCLUSIONS: The proportion of senior citizens without any prescription drug insurance coverage did not change significantly between 1998 and 2001, but cost sharing in terms of the proportion that had cost-sharing requirements and the amount of the cost sharing through copayments and coinsurance rose significantly. Self-reported financial hardship and the use of mail-order pharmacies among seniors increased between 1998 and 2001.

Aged↗
PubMedDate not supplied

Consumer understanding and satisfaction associated with a 3-tier prescription drug benefit.

OBJECTIVE: The purpose of this research was to investigate consumer understanding and satisfaction associated with a 3-tier prescription drug benefit among users of the prescription drug benefit. METHODS: This study involved a self-administered postal questionnaire and the use of prescription drug claims to evaluate utilization of prescription medications. Fifteen hundred subjects were randomly selected based on the following inclusion criteria. Each subject had to (1) be enrolled in a 3-tier copayment ($10 generic, $20 formulary brand, $35 nonformulary brand) prescription drug benefit; (2) be the primary beneficiary (cardholder); (3) be >18 years of age; (4) have received at least 1 prescription medication using his or her prescription drug insurance; and (5) have a mailing address on file. RESULTS: A total of 479 usable responses were returned (35% response rate). The mean (SD) understanding score was 2.22 (1.54) (range: 0 to 6). Fewer than 1% of respondents correctly answered all 6 items used to measure the level of understanding. The mean (SD) satisfaction score was 54.32 (19.69) (range: 0 to 100). Experience with purchasing a medication within a particular copayment tier was predictive of correctly answering the item related to that tier.s copayment amount. Multiple regression analysis revealed a relationship between the amount of use of the drug benefit and the degree of satisfaction with the drug benefit. There was no significant relationship between the level of understanding and the degree of satisfaction with prescription drug insurance. CONCLUSION: The average level of beneficiary understanding of the 3-tier copayment prescription drug benefit was very low, and the average degree of respondent satisfaction appeared to be near neutral. There was no significant relationship between the level of understanding and the degree of satisfaction with prescription drug benefits. The level of understanding was proportional to the amount of drug benefit use, but the degree of satisfaction was not related to the amount of drug benefit use.

Adolescent↗
PubMed1989

Influence of age, sex, and race on prescription drug use among Georgia Medicaid recipients.

Interactions among patients' age, sex, and race that influence prescription drug use in a state Medicaid population are described. A database containing information about all 574,762 Medicaid prescriptions dispensed in Georgia during December 1985 was sorted and summarized so that each record represented one Medicaid recipient. The following data were included for each recipient: the total number of Medicaid prescriptions received by that patient during that month, the total payments made by the state for those prescriptions, and the patient's age, sex, and race. Analyses were conducted on a 10% random sample representing 17,128 patients. The age variable was broken down as follows: Child, 0-5 years; Youth, 6-23 years; Adult, 24-64 years; and Old, 65 years of age or older. Race was recorded as white or nonwhite, and sex as male or female. The average white patient received significantly more prescriptions than did the average nonwhite patient. The largest percentage (41.6%) of the patients in the sample were classified as Old, and this group received the greatest mean number of prescriptions. The differences between mean numbers of prescriptions for white and nonwhite patients increased as the age of the patients increased. Gender influenced drug use only through its interaction with age and race. Patients in the white female Old category had the greatest mean number of prescriptions per patient, and patients in the nonwhite male Youth category had the fewest. The peak period of prescription drug use occurred between the ages of 70 and 80 years, and thereafter use decreased. In this Medicaid population a patient's age and race significantly influenced the number of prescription drugs that he or she used.

Adolescent↗
PubMed2007

Concordance between discharge prescriptions and insurance claims in post-myocardial infarction patients.

PURPOSE: To assess the degree of concordance between the information (drug quantity, days' supply, and daily dose) recorded on hospital discharge prescriptions and what appears in a public drug insurance electronic claims database. METHODS: A retrospective chart audit of hospital discharge prescriptions with linkage to a prescription claims database was conducted. Three hundred and forty-five post-myocardial infarction patients discharged from an Ontario university-affiliated teaching hospital were included. The percentage of linkable records with perfect agreement between the written prescription and the insurance claim was our measure of concordance. RESULTS: Seventy-seven per cent and 82% of discharge prescriptions were filled within 7 days, and 120 days post-discharge, respectively. Of those dispensed and that contained adequate information, concordance was perfect for days' supply, quantity, and daily dose for 70.7% (95%CI 67.9-73.4%), 65.9% (95%CI 63.2-68.7%), and 75.9% (95%CI 73.2-78.6%) of prescriptions, respectively. For cardiac drugs, which comprised the majority of filled prescriptions, concordance was greater for daily dose and days' supply than for quantity (75.7% [95%CI 72.7-78.6%] and 75.5% [95%CI 72.6-78.4%] vs. 65.3% [95%CI 62.3-68.4%]). Concordance varied by medication type. CONCLUSION: Most hospital discharge prescriptions were filled within 1 week. Among the data elements studied, concordance between written prescriptions and insurance claims was greatest for daily dose. Concordance was greater for scheduled cardiac medications than for other medications.

Aged↗
PubMed1993

The effect of prescription size on acquisition of maintenance medications.

OBJECTIVE: To determine whether large prescriptions (> or = 90 days' supplies) enhance the acquisition of maintenance medications by patients. DESIGN: Study 1: multisite, retrospective cohort study evaluating outpatient digoxin use. Study 2: single-site, retrospective cohort study to confirm Study 1. SETTING: Study 1: Ten Veterans Affairs Medical Centers in the Rocky Mountain region. Study 2: The only facility from Study 1 (site C) that dispensed large prescriptions of maintenance medications. PATIENTS: Randomly selected outpatients receiving two or more digoxin prescriptions (n = 176 in Study 1, n = 114 in Study 2). INTERVENTION: None. RESULTS: The main outcome measure was the proportion of prescribed doses of maintenance medications obtained. In Study 1, patients who received at least one large digoxin prescription obtained a mean of 137.2% of their prescribed digoxin doses over a mean of nine months, compared with 91.3% for patients who received only small prescriptions of < 90 days' supplies (p = 0.02). Patients receiving large prescriptions were more likely to obtain at least 100% of their prescribed amounts of digoxin (adjusted OR = 11.4, 95% CI = 1.3-96.8, p = 0.03). At site C, patients in Study 1 obtained a mean of 129.0% of all maintenance drugs given in large supplies, compared with 95.2% of drugs prescribed only in small supplies (p = 0.006). In Study 2, acquisition of digoxin increased progressively from 89.7% among individuals who received only small digoxin prescriptions to 113.0% for those who received only large supplies (p = 0.002), over a mean of 14 months. CONCLUSIONS: Large prescriptions facilitate the acquisition of maintenance medications but may lead to oversupplies, while small prescriptions impose a barrier to obtaining these drugs.

Aged↗