Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “PRESCRIPTIONS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 271 records · Page 15Linked to original sources
PubMed2001

Non-steroidal anti-inflammatory and cytoprotective drug co-prescription in general practice. A general practitioner-based survey in France.

BACKGROUND AND AIM: Non-steroidal anti-inflammatory drugs (NSAIDs) represent one of the most frequently prescribed drugs. Gastrointestinal damage, the most common side effect of NSAIDs. can be limited by the prescription of cytoprotective agents. In order to assess determinants of NSAID-associated cytoprotective agent prescriptions in primary care practice, we performed a general practitioner (GP)-based study. METHODS: After a 2-month intensive information campaign, the participation of all GPs of the Côte d'Or (France) administrative area was requested. During a 2-month period, GPs had to return a mailed questionnaire on NSAID prescription for up to ten consecutive patients aged over 18 years who required NSAIDs. This 30-item questionnaire included questions about the patient, the type of NSAID and the GP. RESULTS: GP participation rate was 24%, and 791 prescriptions were provided. GPs who participated in the study were representative of GPs of the area in terms of sex, time elapsed since graduation and GP practice area. Around 80% of the patients included in the study were under the age of 65 years. The proportion of prescriptions combining NSAIDs and gastroprotective agents was 29.5%. Omeprazole accounted for 58% of the coprescriptions and misoprostol for 29%. Independent determinants associated with the co-prescription of a cytoprotective agent were age [odds ratio (OR) 4.1; confidence interval (CI) 95% 2.3 7.4], previous history of poor NSAID tolerance (OR 10.4; CI 95% 5.8-18.6), previous history of moderate to severe digestive disorders (OR 13.4; CI 95% 5.1 35.4) and indication for chronic illness (OR 1.8, CI 95% 1.1-3.1). Prescriptions of cytoprotective drugs were in conformity with official guidelines for 78.3% of the patients. Although around 60% of the patients with risk factors for poor tolerance received a gastroprotective drug, 50% of the patients over 65 years did not receive it. Conversely, nearly 12% of the patients with no risk factors were prescribed cytoprotective agents. Patient history was the main reason put forward by GPs for prescribing cytoprotective drugs. CONCLUSION: Although a large majority of GP prescriptions were in accordance with official recommendations, inadequate NSAID prescription practices remain relatively frequent especially with regard to the elderly.

Adult↗
PubMed2006

Clinical, social and relational determinants of paediatric ambulatory drug prescriptions due to respiratory tract infections in Italy.

OBJECTIVES: Collecting information on patterns of drug prescriptions and on factors influencing prescribing decisions is fundamental for supporting the rational use of drugs. This study was aimed at investigating patterns of drug prescription in paediatric outpatients and at evaluating determinants of prescriptions for respiratory tract infections (RTIs). METHODS: We conducted a national cross-sectional survey involving primary care paediatricians and parents. Diagnoses and prescriptions made at each consultation were described. Poisson regression models were used to analyse determinants of drug and antibiotic prescriptions for visits due to RTIs. RESULTS: A total of 4,302 physician and parent questionnaires were analysed. These corresponded to 2,151 visits, 792 of which were due to RTIs. Drugs were prescribed in 83.4% of RTI visits, while antibiotics were prescribed in 40.4%. According to paediatricians' perceptions, 84.2% of parents of children with a RTI expected to receive a drug prescription. Paediatricians' perception of parental expectations was the strongest determinant for prescription of drugs and specifically of antibiotics [adjusted relative risk (RR): 1.7 and 3.6, respectively; P < 0.001]. However, in 77.1% of RTI visits, paediatricians judged themselves as not being influenced at all by parents' expectations in their decision to prescribe. CONCLUSIONS: This study underscores that relational factors, in particular perceived parental expectations, are one of the leading factors of drug prescriptions in paediatric ambulatory care settings, reinforcing the opinion that communication between physicians and parents can affect prescription patterns.

Ambulatory Care↗
PubMed1997

Falsified or forged medical prescriptions as an indicator of pharmacodependence: a pilot study. Community pharmacists of the Midi-Pyrénées.

OBJECTIVE: While data on drug abuse liability have been determined for selected drugs in experimental studies, there is limited information available about drug abuse in real life. This study presents the results of a simple experimental epidemiologic survey of prescription forgeries in community pharmacies in the Midi-Pyrénées area (southwest France). During four periods (September-October 1991, January-June 1992, September-October 1992 and January-June 1993), resident pharmacy students in several volunteer pharmacies were asked to complete a specific report form for each suspect prescription request. The main criteria used to identify forgeries were: inadequate dosage, multiple use of the prescription form, drafting not in accordance with the rules of prescription or false prescription forms (stolen prescription forms, photocopies). RESULTS: A total of 165 falsified prescriptions were collected. The 305 drugs involved in these forged prescriptions were opiate analgesics, benzodiazepines, amphetamines and minor opiate analgesics. Medications were essentially buprenorphine, flunitrazepam (in 2 mg dosage), phenobarbitone+amphetamine and chlorazepate. CONCLUSION: These results suggest that forged prescriptions can be used as an indicator of potential abuse liability of marketed psychoactive drugs. Although this survey cannot describe the real prevalence of the misuse or abuse of drugs, it constitutes a useful warning epidemiologic system to elicit early observations regarding new misuses of drugs as they are requested at the pharmacy.

Drug Prescriptions↗
PubMed2006

[Evaluation of the antibiotic prescription in a paediatric intensive care unit].

UNLABELLED: The antibiotic prescription in intensive care units is frequent using often broad-spectrum antibiotics; its quality has never been evaluated in paediatric intensive care units. OBJECTIVES: To describe the modalities of antibiotic prescriptions in a paediatric intensive care unit and confront them to the literature guidelines and bacteriological data. METHODS: From January 1st to March 31st 2005, 52 consecutive prescriptions regarding 45 children, with a total of 47 hospitalisations were prospectively analysed. RESULTS: Confirmed diagnosis of bacterial infection was retained for 50 of the 52 patients: community acquired infection in 35 cases (70%) and a nosocomial infection in 15 cases. Ten children died during the antibiotic treatment (22%), with 5 deaths related to the infection (11%). Monotherapy represented 56% of the prescriptions of antibiotics. The initial antibiotic treatment was empirical in 42 of 52 cases (81%). The empirical prescriptions were documented afterward in 48% of cases. One or more microorganisms were isolated for 60% of the initial prescriptions. Misuses in antibiotic doses (in excess [10%] or by insufficiency [13%]), number of daily administration (4%), and way of administration and/or length of treatment were observed. Seventy-seven percent of the initial prescriptions seemed to be adapted to the identified or suspected bacteria, but only 63% adequate to recommendations. CONCLUSION: Almost 2/3rd of the antibiotic prescriptions were adequate to the recommendations. The implementation of standardized and specific protocols should contribute to improve the quality of these prescriptions.

Anti-Bacterial Agents↗
PubMed2005

Illicit use of prescription pain medication among college students.

This study identifies the prevalence, correlates, and sources associated with the illicit use of prescription pain medication among undergraduate college students. A cross-sectional, web-based survey was self-administered by a large random sample of 9,161 undergraduate students attending a large Midwestern university in the United States. Although undergraduate women were more likely to be prescribed pain medication, men were more likely to be approached to divert their prescription pain medication and report illicit use of prescription pain medication. Multivariate analyses indicated past year illicit use of prescription pain medication was higher among undergraduate students who were: previously prescribed pain medication, living in a house or apartment, and earning lower grade point averages. The majority of students obtained prescription pain medication for illicit use from peers and the second leading source was family members. There were several gender differences in the risk factors and sources of illicit use of prescription pain medication. Based on qualitative data, illicit use included recreational use for the purposes of intoxication and self-medication for pain episodes. Illicit users, who obtained prescription pain medication from peers, reported significantly higher rates of other substance use while those who obtained prescription medications from family members did not. These findings suggest that the illicit use of prescription pain medications may represent a problem among undergraduate students and effective prevention efforts are needed that account for gender differences.

Adolescent↗
PubMedDate not supplied

[Prospective assessment of glycopeptides prescriptions in a general hospital].

OBJECTIVE: The authors had for aim to analyze the indications, quality, and volumes of glycopeptide (GP) prescriptions in all in-patient units of a general hospital. CLINICAL MATERIAL AND METHODOLOGY: A 4 month prospective study assessed the compliance of curative and prophylactic treatment prescriptions administered according to guidelines. The assessment criteria were as follows: prescription indicated or not, prescription modalities (administration of loading dose, performing of serum tests, dosage appropriateness, appropriateness with antibiogram data when available). RESULTS: Over the 46 assessed prescriptions, 84.7% were curative treatments (N = 39), whereas 15.2% (N = 7) were written out for surgical antibioprophylaxis. The prescription incidence and density were, respectively, 0.60 prescription/100 admissions and 20.8 DDJ/1000 hospitalization days, i.e. 24% of the total antibiotics budget. Prescriptions were always indicated for surgical antibioprophylaxis, but met standards in only 14% of cases. As for curative prescriptions, treatments were appropriate in 56.5% of cases, but only 18% met standards. GP use modalities proved incorrect at various levels: non existing load dose and lack of serum tests, subinhibiting daily doses, no dose lowering when possible, exaggerated duration of surgical antibioprophylaxis. Average GP serum levels were 16 mg/L and were higher than the target level in no more than 40% of properly prescribed treatments. CONCLUSION: Prescription modalities and treatment monitoring must be improved, given the development of bacterial resistance.

Anti-Bacterial Agents↗
PubMed2005

Moral hazard and prescription medicine use in Australia--the patient perspective.

All Australian citizens are provided affordable access to prescription medicines through the nation's system of universal pharmaceutical subsidies--the pharmaceutical benefits scheme. The rapid increase in pharmaceutical related expenditure has generated the concern that Australians are taking advantage of prescription subsidies and are using more medicines than are necessary, thereby creating a 'moral hazard'. This concern is predicated on a number of assumptions about patient behaviour rather than on empirical observation. These assumptions amount to a view that patients are consumers who treat prescription medicines as common goods subject to informed and rational calculation of the cost and benefits of their use. This paper reports the findings of an in-depth interview study undertaken to explore how prescription cost influences Australians' medicine use. Qualitative data were analysed to compare medicine users' descriptions of the role of prescription cost in medicine use against the assumptions that underlie the belief in moral hazard. Moral hazard did not appear to be significantly operating in the accounts of medicine use collected for this study. Interviewees' accounts of medicine use revealed an act characterised by ambivalence, a mix of desire and antipathy, faith and suspicion. Medicines appeared in interviewees' accounts as both pharmacologically and symbolically potent substances, which despite their familiarity as objects, are often mysterious to non-expert patients. Cost appeared as a secondary factor in patients' decision to access a prescription medicine. Using a prescription was predicated on the medicine being necessary, with necessity typically established by an expert doctor prescribing the medicine. Prescription medicines did not appear as 'common goods' where subsidised access motivates a 'consumer' to demand more or make the prospect of prescription use more attractive or necessary.

Australia↗
PubMed2003

An evaluation of the benefits of taking hormone replacement therapy with other prescription drugs.

OBJECTIVES: Clinical trials of hormone replacement therapy (HRT) exclude women who have other health problems. The aim of our community survey was to investigate the impact of HRT on women with a variety of other health problems. METHOD: Questionnaire sample of 935 women aged 45-58 years. The questionnaire assessed menopausal quality of life (QOL); self reported health status, prescription drug use and history of hormone supplement use. RESULTS: Thirty five percent of the total sample had taken a variety of prescription drugs in the last 2 months. Prescription drug use was significantly higher in current and former users of HRT/ERT than in non-HRT/ERT users. Current and former HRT users who also took prescription drugs had a significantly lower mean length of HRT/ERT use when compared to women who took HRT/ERT with no prescription drugs. Peri and postmenopausal women currently taking HRT/ERT reported significantly higher MQOL than both former and non-HRT users, which suggest that the benefits of taking hormone supplements during the menopausal transition for some women. There was a significant interaction between hormone use, level of prescription drug use and QOL. Among women who have high levels of prescription drug use, those who take hormone supplements report significantly fewer deficits in QOL when compared to non or former users of HRT/ERT. Additionally, women taking selective serotonin re-uptake inhibitors (SSRI) plus HRT report significantly higher levels of QOL compared to women taking SSRI alone. CONCLUSIONS: The advantages of taking HRT among who take prescription drugs could be attributed to the mood enhancing effects of estrogens. HRT should be considered for some peri and postmenopausal women who are taking SSRIs or who are taking at least three different types of prescription drugs.

Comorbidity↗
PubMedDate not supplied

Survey on unclaimed prescriptions in a community pharmacy.

OBJECTIVE: To quantify the number of unclaimed prescriptions, document the reasons patients did not claim prescriptions, investigate the effect of telephone contact on the pickup rate, and document the types of medications involved and the frequency of this type of non-compliance. DESIGN: A total of 549 unclaimed prescriptions were evaluated during a nine-month study. Pharmacy students contacted patients whose prescription orders had been dispensed but not claimed. Patients contacted by telephone were asked why they had not claimed their prescriptions. The types of medications involved were documented, and a follow-up check was made of the patient's profile on the pharmacy computer system to determine whether the telephone contact affected the pickup rate. RESULTS: Reasons given for not claiming the prescriptions included: transfer to another pharmacy, prescription was forgotten, the patient no longer wanted or needed the prescription because they had medication left over, or patient decided they did not need the medication. Telephone contact had minimal impact on the compliance rate of this patient group. The most common unclaimed medication categories were anti-infectives, cough and cold/allergy medications, and birth control/hormones. CONCLUSIONS: Patients cited many reasons for not picking up their medication. Follow-up telephone calls did not increase the number of prescriptions picked up by patients in this study.

Drug Prescriptions↗
PubMedDate not supplied

Effect of a change in third party reimbursement rate on prescription gross margin.

OBJECTIVE: To measure the effect of a change in an insurance company's reimbursement formula on prescription department gross margins for all prescriptions and subgroups of prescriptions. DESIGN: Retrospective descriptive analysis. SETTING: Wisconsin. PARTICIPANTS: Two units of a chain pharmacy. INTERVENTION: Reimbursement changed from usual and customary price to average wholesale price less 10% plus a $2.00 dispensing fee for single-source products, and maximum allowable cost plus a $2.00 dispensing fee for multisource products. MAIN OUTCOME MEASURE: Gross margins for prescriptions dispensed in the month before and after the reimbursement change. RESULTS: The average estimated gross margin decreased 26.9% after the change in reimbursement, and the effect on the average gross margin for generic prescriptions was nearly twice that of the effect on the average gross margin for brand name prescriptions. The effect of the reimbursement change on different therapeutic classes ranged from an increase of 0.7% in the cardiovascular class to a decrease of 68.2% in the eyes, ears, nose, and throat class. The effect of the reimbursement change was greater for low-cost prescriptions than for high-cost prescriptions. CONCLUSION: The large effect of the reimbursement change, combined with continued growth in third party prescriptions, raises concerns about whether pharmacies can accept third party contracts with low reimbursement rates and still maintain current profitability and service levels.

Data Collection↗
PubMedDate not supplied

Case study using descriptive analysis to estimate hidden costs in processing third party prescriptions.

OBJECTIVE: To identify and quantify additional hidden costs associated with processing third party prescriptions. DESIGN/SETTING: Using time and motion techniques, the frequency of rejected third party prescriptions and the time involved to resolve those rejections were measured in one supermarket chain pharmacy and one independent pharmacy. From this information, additional costs attributed to processing third party prescriptions were calculated. RESULTS: In a market where almost 95% of all prescriptions are third party reimbursed, payers rejected 18.7% and 22.3% of the prescriptions submitted by the supermarket chain and independent pharmacies, respectively. Additional or hidden costs for rejected prescriptions averaged $1.10 at the supermarket chain pharmacy and $1.54 at the independent pharmacy, with the difference attributable to the higher level of pharmacy staff involvement in resolving rejections at the independent pharmacy. When additional costs for all third party prescriptions were calculated, the average additional cost per third party prescription dropped to $0.44 for the supermarket chain pharmacy and $0.61 for the independent pharmacy. CONCLUSION: Increasing pharmacist availability for pharmaceutical care requires decreasing time spent in the dispensing process, especially resolving third party problems. Systems analysis and time and motion techniques were effectively used to more accurately measure the time and costs associated with processing third party prescriptions. Actual costs found in this study were considerable, but significantly less than those reported previously in studies using estimates and surveys.

Costs and Cost Analysis↗
PubMedDate not supplied

[Pilot study on prescription of benzodiazepines in Switzerland: does cognitive availability of legal rules affect medical prescribing behavior].

All 481 prescriptions of benzodiazepines from five Zurich pharmacies during a 6 week period were evaluated with respect to their compliance with the Swiss Law on Narcotics, which was formulated to prevent benzodiazepine dependence. Three weeks into the study, all 17 physicians with prescriptions of benzodiazepines practising in the catchment areas of two of the five pharmacies randomly selected were faxed an information sheet explaining formal juridical requirements for benzodiazepine prescription stipulated by the law. 28 % of all prescriptions were not compliant with the law. The older a patient, the greater his/her risk of receiving a non-compliant prescription. Neither sex of patients nor professional specialization of the prescribing doctor did impact prescription compliance. The preventive intervention, i. e. information on legal requirements, also had no significant impact on the compliance of prescriptions with the law. As other studies with soft interventions and educational measures directed to the prescribing physician also failed to reduce inappropriate prescription of benzodiazepines, it is concluded that sanctions against incompliant prescription behaviour should be considered as a preventive alternative.

Awareness↗
PubMed2006

Changes in drug prescription over a decade in an Arctic child population.

AIM: To describe the changes in drug prescription to 0-14-y-old outpatient children from 1991 to 2001. METHODS: ATC codes on prescriptions were compared. MAIN RESULTS: Prescriptions rose from 2.00 to 2.18 drugs/child/year, and the proportion of prescribed drugs rose from 60.7% to 70.4% of the child population (p<0.001). The 10 most prescribed subgroups accounted for 92.7% of all drugs in 0-1-y-olds and 75.9% in the schoolchildren. The individual prescription of anti-asthmatics increased by 155% (p<0.001), the use of nasal preparations and drugs against cough decreased, and more of the antibiotics were penicillin V. In 0-1-y-olds, prescriptions halved, while they nearly doubled in schoolchildren (p<0.001). CONCLUSION: In Nuuk, a unique possibility exists: to be able to study changes in drug use and prescriptions to individual children over time from one health clinic. In the last decade, major changes have occurred regarding the number of drugs, the distribution of therapeutic subgroups, and prescriptions to all age groups. If interpreting from the magnitude of prescriptions, the prevalence of asthma doubled in this period. In summary, this study has revealed changes in prescription that can hardly be explained by changes in disease patterns. Even if unrecognized, this might also be found elsewhere.

Adolescent↗
PubMed1998

Barriers to prescriptive practice for psychiatric/mental health clinical nurse specialists.

Prescriptive authority for advanced practice psychiatric nurses (APPNs) has recently been legislated in many states. APPNs in Minnesota were granted prescriptive authority in 1995, but from 1995 to 1996 only 17 of 80 qualified APPNs in that state had received prescriptive authority. A survey on the barriers encountered in obtaining prescriptive authority was mailed to the 80 APPNs who completed a psychopharmacology course required for prescriptive authority. Of the 54 (67.5%) APPNs who returned the questionnaire, 43 registered for the course for the purpose of prescriptive authority but only 17 of these respondents had received prescriptive authority. The major barriers to obtaining prescriptive authority reported by these APPNs were work setting limitations, personal comfort with prescribing, and ability to develop a collaborative agreement with a psychiatrist. Based on these APPNs' responses, suggestions are given for: increasing the acceptance of the prescriber role, developing support for the prescriber role, obtaining equitable reimbursement, and simplifying the process of obtaining prescriptive authority.

Drug Prescriptions↗
PubMed2000

Trends in prescriptions for highly active antiretroviral therapy in four New York City HIV clinics.

OBJECTIVE: To describe trends in prescriptions for antiretroviral therapies and factors associated with prescriptions for highly active antiretroviral therapy (HAART). METHODS: Medical records of patients at four HIV clinics in New York City were reviewed every 6 months. For the four 6-month periods 1997 to 1998, we identified patients with a CD4+ nadir <500 cells/microl; sample sizes were 434, 432, 503, and 643, respectively. Trends in HAART prescriptions were tested by logistic regression using robust variance estimates because some patients contributed more than one time period. Associations between HAART prescriptions and patient characteristics were tested by chi2 and multiple logistic regression analysis. RESULTS: Patients were predominantly black or Hispanic (89%-90%) and male (66%-68%), and injection drug use was the most prevalent HIV risk (38%-49%). From 1997 to 1998, HAART prescriptions increased from 54% to 89% of antiretroviral prescriptions, and the proportion that included an nonnucleoside reverse transcriptase inhibitors (NNRTI) increased from 3% to 10%. HAART prescriptions were inversely associated with CD4+ nadir group during all time periods, and in the second half of 1998, patients with CD4+ nadir between 50 and 199 cells/microl were as likely to be prescribed HAART as the most immunosuppressed patients (CD4+ nadir <50 cells/microl; 91% versus 92%). HAART prescriptions were associated with clinic, HIV risk, and other patient characteristics in some time periods but not consistently. CONCLUSIONS: In these four HIV clinics, prescriptions for HAART increased significantly from 1997 to 1998, leveling off at 89% in the second half of 1998. Increasingly, HAART was prescribed for healthier patients and included an NNRTI.

Adult↗
PubMed1991

Improving prescription-writing skills in a family practice residency.

The objective of this study was to evaluate a novel method of physician education that uses copies of prescriptions written by study participants to provide feedback on their prescription-writing skills. A prospective, blind, completely random before-after design was used, with observation, intervention, and postintervention periods, each lasting four months. The study group comprised 20 family practice residents, stratified by year of training and randomly assigned to treatment or control groups. Copies of all prescriptions written by participating residents were evaluated for prescription-writing errors. During the intervention phase, prescription copies with errors were returned to the treatment group residents with a tactful comment pointing out the error and suggesting changes. Over the three time periods, there was a continuous decline in the rate of prescription-writing errors in the treatment group, but not in the control group. A significant number of physicians who received the feedback improved their prescription writing (p less than 0.01), but logistic regression failed to show a difference attributable to the intervention. In conclusion, written feedback on copies of prescriptions produced a small decrease in the number of prescription-writing errors. Further, long-term study may show a magnified effect of this teaching method.

Double-Blind Method↗
PubMedDate not supplied

Medicaid managed care prescription use and cost savings.

OBJECTIVE: To evaluate the impact of Medicaid managed care (MC) enrollment on prescription use and costs. DESIGN: Retrospective, cross-sectional analysis of claims submitted over a 6-month period. SETTING: Ohio Medicaid. PATIENTS AND OTHER PARTICIPANTS: Stratified, random selection of 2,932 MC and 1,335 fee-for-service (FFS) recipients. MAIN OUTCOME MEASURES: Dependent variables were the probability of any prescription use and 6-month prescription counts and costs. Independent variables included age, plan enrollment (MC or FFS), county enrollment status (mandatory or voluntary), presence of a chronic comorbidity, and any outpatient medical visit. RESULTS: After adjusting for comorbidities and outpatient medical visits, plan enrollment effects depended on age. FFS enrollees 8 to 12 and 12 to 18 years old were less likely (adjusted odds ratios 0.56 and 0.58, respectively) to receive a prescription, while enrollees over 30 years of age were 2.98 times more likely to receive a prescription. Among prescription users, level of use and costs were consistent across all ages for MC enrollees. FFS enrollees had 25% to 218% higher levels of prescription use than MC enrollees, depending on age. Prescription costs were 8% lower for FFS enrollees ages 4 to 8 but higher for all enrollees in other age groups (range, 22% to 311% higher). CONCLUSION: Prescription use and costs were lower for Medicaid MC enrollees than they were for patients in traditional FFS plans. Further research is needed to examine the quality of care for both FFS and MC enrollees.

Adolescent↗
PubMed2000

Pediatrician and family physician prescription of selective serotonin reuptake inhibitors.

OBJECTIVES: Selective serotonin reuptake inhibitor (SSRI) prescriptions for children and adolescents have increased greatly in recent years despite a paucity of demonstrated safety and efficacy data and a lack of clear guidelines for use. Our study sought to describe family physician and pediatrician SSRI prescribing patterns for children and adolescents, identify influences on SSRI prescription variations, and describe the use of SSRI within the overall management of depression and other mental disorders in primary care. DESIGN: A survey was mailed to all 596 active North Carolina general pediatricians and a random sample of 557 family physicians in primary care practice. Family physicians who did not see children in their practice were excluded. The survey instrument consisted of a 4-page questionnaire. Survey items included physician demographics, practice characteristics, general management, volume of pediatric patients with depressive symptoms, prescription of SSRIs for depression and other diagnoses, and potential influences on SSRI prescribing practices. The main outcomes were self-reported physician prescription of SSRIs for children and adolescents. Results were analyzed using chi(2) comparisons and logistic regression. RESULTS: The overall response rate was 66% (55% family physicians and 76% pediatricians). Of the physicians, 72% had prescribed an SSRI for a child or adolescent. Depression was the most common reason for prescribing an SSRI; over two thirds of respondents had prescribed an SSRI for depression in a child 18 years of age or younger. Over half of the physicians reported they had prescribed an SSRI for a diagnosis other than depression in a child 18 years of age or younger. Attention-deficit/hyperactivity disorder was the most frequent use cited other than depression, followed by obsessive-compulsive disorder, aggression, eating disorders, and enuresis. Primary care physicians prescribed SSRIs for adolescents more commonly than for younger children. Only 6% of the respondents had ever prescribed an SSRI for a child younger than 6 years of age. In terms of SSRI prescriptions written for depression in the last 6 months, 32% of the physicians had recently prescribed SSRIs for adolescent patients and 6% for patients younger than 12 years of age. Family physicians were more likely than pediatricians to have recently prescribed SSRIs for adolescent patients (41% vs 26%), but there was no difference in recent SSRI prescriptions for children <12 years of age by physician specialty (4% vs 6%). Prescription of SSRIs was not associated with decreased use of counseling for treatment of depression, but prescription of SSRIs was associated with decreased use of referrals (63% vs 74%). There was no difference in the use of counseling between family physicians and pediatricians (61% vs 59%). However, pediatricians were more likely to use referrals in their usual approach to depression (77% vs 48%) compared with family physicians. More family physicians had prescribed SSRIs for pediatric patients compared with pediatricians (91% vs 58%), and more family physicians had prescribed SSRIs in combination with other psychotropic medications (54% vs 31%). For the majority of respondents, SSRI prescriptions constituted most of the medications used to treat childhood depression (75% of family physicians vs 61% of pediatricians). Family physicians were more likely to report a belief in the safety (63% vs 48%) and effectiveness (40% vs 32%) of SSRIs. Only 8% of physicians reported adequate training in the treatment of childhood depression and just 16% were comfortable with the treatment of depression. There were no specialty differences in training for the treatment of childhood depression; however, more family physicians than pediatricians agreed that they were comfortable with the management of childhood depression (22% vs 11%). (ABSTRACT TRUNCATED)

Adolescent↗