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PubMed2002

Patient variables associated with expectations for prescriptions and general practitioners' prescribing behaviour: an observational study.

OBJECTIVES: To determine patients' needs and expectations for prescriptions as a function of demographic and illness-associated variables versus outcome of consultation. DESIGN: Questionnaire study consisting of patient interview before and after consultation with general practitioner. SETTING: A total of 618 consecutive patients in the waiting room of nine general practices in Germany (Hesse). MAIN OUTCOME MEASURES: Patient needs and expectations for prescriptions and agreement between expected outcome and prescriptions received. RESULTS: As their top priority for consultation (33% of group), patients expected to receive information about their illness. Their needs for prescriptions (26%) and expectations of receiving them (41%) were clearly lower than physician prescribing (56%). Marked interpatient differences emerged with regard to need/expectation for medication according to age, minor versus chronic illness, duration of treatment, and first-time attendance, but this was not reflected in how often physicians prescribed. A total of 85% of patients expecting a prescription received one; 44% not expressing a need for medication were issued one. Although only 4% of patients would want a drug with questionable effectiveness, doctors wrote such prescriptions to no less than 21% of patients--and especially to those with minor, newly arisen ailments (33%). Nevertheless, patient satisfaction with their visit was very high (98%). CONCLUSIONS: In Germany, patient needs and expectations for medication are clearly lower than prescribing tendencies, and marked differences between patient groups in their needs or expectations for prescriptions are not reflected in the rates of prescriptions received. Above all, patients with minor illnesses wish to receive information about their illness, and they do not expect prescriptions of drugs with questionable effectiveness.

Adult↗
PubMed2006

Unintentional prescription drug overdose deaths in New Mexico, 1994-2003.

BACKGROUND: New Mexico has the highest rate of drug-induced mortality in the United States. The contribution of prescription drugs to the total overdose death rate has not been adequately described. METHODS: A total of 1,906 unintentional drug overdose deaths occurring in 1994 to 2003 in New Mexico were analyzed. Unintentional drug overdose death was defined as death caused by prescription, illicit, or a combination of drugs, as determined by a pathologist. Deaths were investigated annually by the medical examiner and data were analyzed in 2004-2005. Rates and trends of total and prescription drug overdose death were calculated, decedent characteristics were analyzed, and common drug combinations causing death were described. RESULTS: The rate of unintentional prescription drug overdose death increased by 179% (1.9 to 5.3/100,000) from 1994 to 2003. A high percentage of prescription drug overdose decedents were white non-Hispanic (63.2%) and female (43.9%). These decedents were older and less frequently had alcohol listed as an additional cause of death than decedents of other drug overdose categories. Of all deaths caused by prescription drug(s) (n =765), 590 (77.1%) were caused by opioid painkillers, 263 (34.4%) by tranquilizers, and 196 (25.6%) by antidepressants. CONCLUSIONS: The rate of prescription drug overdose death in New Mexico increased significantly over the 10-year study period. Comprehensive surveillance of drug overdose deaths is recommended to describe their occurrence in the context of both medical and diverted use of prescription drugs. Understanding decedent profiles and the potential risk factors for prescription drug overdose death is crucial for effective drug overdose prevention education among healthcare providers.

Adult↗
PubMed2004

Clinician identification of chronically ill patients who have problems paying for prescription medications.

PURPOSE: Little is known about whether health care providers are effectively identifying patients who have difficulty covering the costs of out-of-pocket prescription medications. We examined whether and how providers are identifying chronically ill adults who have potential problems paying for prescription medications. METHODS: We conducted a cross-sectional survey of a national sample of 4050 adults aged 50 years or older who use prescription medications for at least one of five chronic health conditions. The primary outcome measure was patient report of being asked by a doctor or nurse in the prior 12 months whether the patient could afford the prescribed medication. The measures of prescription cost burden were cost-related underuse of medications, cutting back on other necessities to pay for medications, and worries about medication costs. We adjusted for patient income, education, race/ethnicity, age, sex, health status, number of prescribed medications, pharmacy benefits, frequency of outpatient visits, having a regular health care provider, and sampling weights. RESULTS: In the weighted analyses, 16% (547/4050) of respondents reported that they had been asked about potential problems paying for a prescribed medication. Only 360 (24%) of the 1499 respondents who reported one or more burdens from out-of-pocket medication costs reported being asked this question. After adjusting for potential confounders, patients who had cut back on medication use or other necessities to cover payments were no more likely than other patients to be asked about the ability to pay for prescription medications. Concerns about medication costs, being a racial/ethnic minority, taking seven or more prescription medications, and having no prescription coverage were independently associated with a greater likelihood of being asked about possible problems with prescription costs. CONCLUSION: Few chronically ill patients who are at risk of or experiencing problems related to prescription medication costs report that their clinicians had asked them about possible medication payment difficulties.

Aged↗
PubMed2006

Factors associated with early opioid prescription among workers with low back injuries.

UNLABELLED: Prescription of opioids for nonmalignant musculoskeletal pain has increased substantially in recent years, but there is little information on the incidence of, or factors associated with, such prescription for work-related back pain. In a prospective cohort study (N = 1,067), we examined associations between worker sociodemographic and other characteristics and opioid prescription within six weeks of the first medical visit for workers' compensation claims for work loss due to back injury. We examined administrative, pharmacy, and worker-reported data. In bivariate logistic regression models, Hispanics were less likely than non-Hispanic whites to receive opioid prescriptions, and very high body mass index, daily tobacco use, greater pain and physical disability, pain radiating below the knee, injury severity categorizations (from medical records) of major sprain and radiculopathy, and worse mental health were associated with opioid prescription. Adjusting for demographics, pain intensity, and physical disability, opiate prescription was significantly associated with daily tobacco use, pain radiating below the knee, and injury severity categories (major sprain and radiculopathy). Knowledge of worker characteristics associated with early opioid prescription may be useful in future studies of the role of early pain treatment in influencing subsequent course of pain and disability among workers with back injuries. PERSPECTIVE: Little is known about patient characteristics that may influence physicians' decisions concerning prescription of opioids for acute back pain. Not surprisingly, workers with more severe back injuries are more likely to be prescribed opioids, but reasons for prescription disparities based on ethnicity and tobacco use warrant further study.

Adult↗
PubMed1999

Prescription attitudes among gynecologists towards two particular risk factors of osteoporosis: the patient's age and her bone mineral density.

OBJECTIVE: The present report assesses, among Belgian gynecologists, the effect of age and bone mineral density on osteoporosis prescription strategy in postmenopausal women. METHODS: Charts of postmenopausal women were summarized. We constructed cases by modifying some parameters. Ten years of age were added or subtracted to the real age of the patient. The bone mineral density (BMD) result was also modified (three levels: normal BMD, osteopenia, osteoporosis). A total of 612 cases were constructed. Twelve cases were sent out of these 612 files to every Belgian gynecologist (n = 1010). For each chart the gynecologists were asked whether they would treat the patient with HRT. They were also asked whether they would prescribe other therapies than HRT and if so, which ones. RESULTS: The chance to have an osteoporosis prevention or treatment prescribed increased when BMD decreased (respectively 57.4% for normal BMD, 73.1% for osteopenia cases and 89.4% for osteoporosis cases; P < 0.001). HRT was the most frequently prescribed medication (67% of the cases), but its prescription rate does not reflect only osteoporosis prevention. Nevertheless, for similar cases with osteopenia, the HRT prescription rate increased by a factor 1.25 and for similar cases with osteoporosis, HRT prescription rate increased by a factor 1.39. Calcium was the 2nd most frequent prescribed regimen. It was prescribed in 17% of the cases. A 3.4-fold increase for osteopenia cases and 7.6-fold increase for osteoporosis cases was observed, compared to women with normal BMD. When calcium was prescribed, it was in association with HRT in 64% of the osteopenia cases and in 76% of osteoporosis cases. Other drugs were less often prescribed. For the "younger age group", that is, with a mean age of 55 years, a prescription rate of 82.9% for any osteoporosis regimen was reached, whereas in the age group that was 10 years older a 20% lower prescription rate was reached (62.6%, P < 0.001). This was mostly due to a decrease in HRT prescription. CONCLUSIONS: Prescription of medication known to reduce osteoporosis occurred more often in cases with low BMD. In the older patients with osteoporosis, gynecologists prescribed HRT less frequently. This was not compensated by a higher prescription rate of other medication.

Adult↗
PubMed2006

Incremental prescription and drug costs during the years preceding diabetes diagnosis in primary care practices in Germany.

INTRODUCTION: To evaluate incremental drug prescription costs before diabetes diagnosis in primary care patients in Germany. MATERIAL AND METHODS: Based on 400 primary care practices throughout Germany (Disease Analyzer, IMS Health, Frankfurt, Germany), we selected only patients receiving continuous treatment (age >or= 40 years) and ascertained drug prescriptions and costs up to 6 years before diabetes was diagnosed. For control, we selected age- and sex-matched nondiabetics (n = 6,294 pairs, age 65.5 +/- 10.5 years, 44 % male). We evaluated incremental prescriptions and costs by calculating differences and ratios between patients with and without a diabetes diagnosis. We also evaluated predictors of cost differences using multivariate regression models. The data used for the evaluation was taken from the period 1993 to 2002. RESULTS: The mean number of prescriptions in the year preceding diagnosis in men and women increased 15 % and 19 %, respectively (p < 0.001). Prescription costs were 21 % (men) and 28 % (women) higher in subjects who were destined to receive a diabetes diagnosis (269 and 264 Euros per person) compared to controls (p < 0.001). Incremental prescriptions and costs were already present six years preceding diagnosis. Cardiovascular drugs had the largest impact, accounting for about two-thirds of incremental prescriptions and costs. Women had higher numbers of prescriptions and costs, however, differences and ratios were comparable to men. Incremental costs were higher in patients with private compared to statutory health insurance, and in Western compared to Eastern Germany. DISCUSSION: Numbers of prescriptions and costs in primary care patients with future diabetes diagnosis in Germany were already increased six years before clinical detection, reflecting increased cardiovascular risk even before clinical diabetes diagnosis.

Cost of Illness↗
PubMed2001

Antibiotic prescription in italian children: a population-based study in Friuli Venezia Giulia, north-east Italy.

UNLABELLED: Comprehensive information on prescription patterns of antibiotics in Italy is scarce. This study describes the use of systemic antibiotics in children according to age and sex in Friuli Venezia Giulia, north-east Italy. A pharmacological prescription database was used to identify individual prescriptions provided to all 0-15-y-old resident children (n = 140,630) during 1998. Overall, 124,383 prescriptions were identified. The prescription rate was highest in the 3-6 y olds, with 1491 antibiotic prescriptions per 1,000 children per year. Antibiotics were prescribed for 52% of infants, 57.2% of toddlers and 62% of preschool children. Twenty-nine percent of the prescriptions were for cephalosporins, 27% for macrolides and 24% for broad-spectrum penicillins. Prescription rates were much higher than in other countries such as Denmark, with more antibiotic courses prescribed for more children at all ages. Prescriptions from general practitioners and family paediatricians often included second-line antibiotics (e.g. cephalosporins and macrolides) or antibiotics that have not been approved for community-acquired paediatric infections (e.g. quinolones). CONCLUSION: The development of regional guidelines for antibiotic use in children should be urgently recommended.

Adolescent↗
PubMedDate not supplied

Promotion of prescription drugs to consumers: case study results.

OBJECTIVE: Identify key factors related to patients. medication adherence and health outcomes after they received a prescription that they requested based on a prescription drug advertisement. METHODS: During January 2002, 6 individuals who requested advertised prescription medications and received a prescription from their physician were interviewed. Qualitative analysis was employed to allow for preservation of individual findings and variances in effects for each subject. RESULTS: In all, the 6 patients received 10 prescriptions. For 8 of the 10 requests (80%), the patients were given a prescription for the specific products requested. Of the 10 prescriptions granted to the patients, only one (10%) of the medications was discontinued by the patient due to lack of efficacy. In addition, one patient discontinued one of the products because it was withdrawn from the market. The results showed that individuals (a) may be willing to.just try. new therapies to see if they work better than their existing therapies, (b) appear to make decisions about the usefulness or value of the drug product after a short-term trial, (c) compare the value of the product with the out-of-pocket cost of the product after a short trial, (d) value and seek the advice of their physician about information they see in advertisements, (e) become extremely pleased when they find that the new product actually helps them, and (f) may develop favorable views about advertised prescription drug products, in general, if they had a favorable experience with the first product they requested. Some patients experienced disappointment, side effects, new challenges about how to fit the newly prescribed therapy into their lifestyle and existing drug regimen, the need for follow-up appointments with their physician, and the unwelcome challenge of how to pay for their newly prescribed therapy. CONCLUSIONS: Each study subject had unique experiences and outcomes after asking his or her physician for an advertised prescription drug product. Both positive and negative experiences were noted. Asking for an advertised drug appears to be viewed by patients as an opportunity for a short-term trial of a new therapy. Such short-term trials could introduce the need for follow-up physician visits and may result in higher drug expenditures for patients.

Journal Article↗
PubMed2003

Epidemiology of bacterial diseases in Norwegian aquaculture--a description based on antibiotic prescription data for the ten-year period 1991 to 2000.

In Norway, antibacterial drugs for use in farmed fishes have to be prescribed by a veterinarian. Moreover, a national surveillance programme requires that copies of all prescriptions be sent to the Directorate of Fisheries. The prescriptions give information regarding fish farm and locality, weight and species of fish to be medicated, diagnosis, type and amount of drug prescribed, and date. These prescription data for the 10 yr period 1991 to 2000 have been recorded and systematised. A total of 6322 prescriptions issued for 11 fish species were registered; Atlantic salmon represented 87% of the prescriptions, rainbow trout 4.5%, arctic char 0.3%, turbot 3.8%, halibut 2.1%, Atlantic cod 1.2%, and European eel 0.3%. European sea-bass, wolf-fish, coalfish and wrasse represented a total of 0.4% of the prescriptions. Furunculosis was the most frequently given diagnosis in Atlantic salmon, accounting for 79% of all prescriptions for this species. Furunculosis was more frequent during the summer and early autumn, and in the western parts of Norway. Fish weighing more than 1 kg seemed to be the most susceptible. However, furunculosis has almost disappeared in Norwegian aquaculture since 1993. Vibriosis gave cause for antibiotic treatments in almost all fish species, and was the most common diagnosis in rainbow trout, halibut, turbot, cod and European eel. In Atlantic salmon, fish of small and medium size (up to 1 kg) seemed to be more at risk from vibriosis, and outbreaks were more frequent during summer, and in the western counties. Cold-water vibriosis was the second most frequently treated disease in Atlantic salmon, creating severe problems mainly in larger fish, in the northern parts of the country, and during winter and spring. The seasonal distribution was similar for winter ulcer disease, the only disease which seemed to be of increasing importance in Atlantic salmon. Non-specific diagnoses, such as 'bacterial infection' and 'fry disease', were given in a much higher proportion of prescriptions for marine fish species than in prescriptions for salmonids.

Animals↗
PubMed2001

Prescription of analgesics in general medical practice.

The aim of this study was to examine the frequency of prescription of analgesic drugs by General Practitioners in Austria, the reasons for which they are prescribed, as well as relevant organizational details. A questionnaire was designed to prospectively collect data from 14 participating General Practitioners over a period of at least 20 days each. The type of analgesic drugs prescribed during direct (doctor) or indirect (receptionist) consultations was recorded, coded according to the ATC classification and separated into first and repeat consultations. Furthermore, the diagnostic terms and the individual intensity of pain perception by the patients were noted. During 7248 consultations recorded, 1083 prescriptions of analgesics were issued. The majority of first prescriptions are issued during direct consultations, whereas a large number of repeat prescriptions are prepared for the doctor's supervision by the receptionists via indirect consultations. Almost half of the patients receive repeat prescriptions. In both, direct and indirect consultations with patients, approximately every 7th contact results in the prescription of an analgesic drug. The antirheumatic drug group is the most frequently prescribed group of painkillers whereas opioids are rarely prescribed. Selection of drugs is not clearly related to the degree of pain experienced by individual patients. Problems of the musculo-skeletal system rank first among the classifications leading to prescription of an analgesic. Pain needs quick and efficient therapy. Prescriptions of analgesics in General Practice ought to be issued in such a way as to serve this large group of patients without, however, taking extensive risks: repeat and first prescriptions issued during indirect consultations have to be precisely recorded and need the doctor's personal supervision.

Analgesics↗
PubMed2003

[Audit on antibiotic prescriptions in a department of infectious diseases].

OBJECTIVES: France is one of the countries that prescribe the most antibiotics. The inappropriate use of antibiotics participates in the emergence of multi-resistant bacteria. This study was aimed at assessing the adequation of antibiotic prescriptions in a hospital department of internal medicine-infectious diseases. METHODS: Over a two-month period, all the antibiotics treatments were analysed prospectively. The adequation of the treatments was analysed at first with regard to the various consensus conferences of the French-speaking Society of infectious diseases (Société de pathologie infectieuse de langue française (Spilf)) and then with regard to the bacteriological results. RESULTS: One hundred and five prescriptions were analysed during the study period. Thirty-five percent of prescriptions were inadequate with regard to the criteria used. In 22 cases the prescription was excessive, in 8 cases it was unjustified and in 5 cases it was inappropriate. Moreover, in univariate analysis, 3 factors were correlated with inadequation: prescriptions drawn-up by a non-infectious disease practitioner (OR =3.45, IC 95% 1.34-9.09, p=0.008), prescriptions drawn-up by junior in the department (OR =4.10, IC 95% 1.54-11.08, p=0.003) and prescriptions pour respiratory infections (OR=2.58, IC 95% 1.03-6.48, p =0.04). CONCLUSION: This study conducted in a department of infectious diseases reveals the persisting high rate of inappropriate prescriptions, confirming the need to develop control and retro-control strategies regarding the prescription of antibiotics in order to control the diffusion of multi-resistant bacteria.

Adolescent↗
PubMedDate not supplied

[Evaluation of the understanding level of pediatric prescription].

OBJECTIVE: This study intends to establish the relation between the understanding level of pediatric prescription by the mother, or other adult, accompanying the child to a doctors visit and the probable causes of noncompliance with the treatment, in order to improve the quality of pediatric health care. METHODS: We randomly interviewed one hundred adults who accompanied children to the pediatric outpatient clinic of Hospital Universitário. They received medical orientation and/or prescriptions. The interviews were made from April to October 2000 and we used a questionnaire to evaluate social, economic and cultural status. We also evaluated aspects related to the appointment and treatment, and the understanding of doctors handwriting and prescription. RESULTS: Eighty-three percent of them received a prescription and 17% received only orientation; 88% were the mothers and 63% had not finished elementary school. Concerning the appointment, 80% felt satisfied. Seventy-one percent among those who received prescriptions could understand the doctor's handwriting and 29% had some or none understanding of it. Forty-seven percent of the prescriptions had symbols and/or abbreviations that could not be understood by 59% of the adults. Seventy-one percent could remember all the prescribed drugs without looking at the prescription; 15.7% needed to read it in order to remember the drugs; 7.2% could not remember the drugs and said that a pharmacist had to help them and 6% could not remember or read the prescription. CONCLUSION: Aspects related to the poor understanding of pediatric prescriptions are caused by the low social, economic and cultural status of the adult accompanying the child; as well as aspects regarding physicians such as the use of symbols and abbreviations, illegible handwriting and verbal orientation only.

English Abstract↗
PubMedDate not supplied

Comparison of prescription reimbursement methodologies in Japan and the United States.

OBJECTIVES: To compare methods of prescription reimbursement in Japan and the United States. DATA SOURCES: Data were obtained through interviews and a search of the pharmacy literature using MEDLINE, International Pharmaceutical Abstracts, the Iowa Drug Information Service, and the Internet. Search terms were pharmacy, dispensing fee, reimbursement, prescriptions, Japan, United States, and average wholesale price (AWP). A comprehensive search was done (i.e., no year limits were observed). STUDY SELECTION AND DATA EXTRACTION: Performed manually by the authors. DATA SYNTHESIS: The reimbursement systems for prescriptions differ widely between Japan and the United States. The reimbursement system in the United States is fairly straightforward and easy to understand; it is generally based on product cost (e.g., AWP minus a percentage) plus a small dispensing fee. The system in Japan is extremely complex. Reimbursement formulae have four components, including fees for professional dispensing, drug cost, counseling and administration, and medication supplies and devices. Additionally, various adjustments to the final amount are made based on dosage form, length of therapy, number of prescriptions dispensed by the pharmacy per month, and when the prescription is filled (e.g., after hours, on Sundays or holidays). In Japan, each pharmacist is limited to filling 40 prescriptions per day, but each "prescription" can involve several medication orders, making it difficult to compare Japanese pharmacists' workloads with those of their counterparts in the United States. In addition, Japanese pharmacists are provided remuneration for providing various cognitive services, such as taking a patient history, counseling a patient, consulting with a physician, and identifying drug-related problems. CONCLUSION: Japan and the United States have very different methods of reimbursing pharmacists for dispensing prescriptions, each with positive and negative features. Based on the features of pharmacy reimbursement systems in each country, perhaps the optimal pharmacy practice system would have workload limits that reflect safety standards and amount of support staff available, provide a fair and standardized method for determining drug cost, are relatively straightforward, pay for cognitive services, and provide care for all of citizens through of some type of national health care system.

Costs and Cost Analysis↗
PubMed1998

Differences in prescription drug utilization and expenditures between Blacks and Whites in the Georgia Medicaid population.

To address policy concerns regarding prescription drug access by vulnerable minority groups, we analyzed prescription drug use and spending among black and white enrollees in the Georgia Medicaid program. Using a two-part model estimating use and level of use of any prescription drugs, the study examined black/white differences controlling for age, sex, and Medicaid eligibility characteristics. Results showed black enrollees were significantly less likely to use any prescription drugs and received significantly fewer prescriptions than white enrollees. After adjustment, the black/white difference for children was 43%, with black children using 2.7 fewer prescriptions relative to white children. Patterns of use were similar for adults and the elderly, with black adults using 4.9 fewer prescriptions, and black elders using 6.3 fewer prescriptions, than their white peers. Spending rates per full-year enrollee were similar to utilization patterns and maintained the black/white differential. White Medicaid enrollees had higher use and spending than black enrollees across most high-volume therapeutic drug categories. The study explores several possible explanations for these differences.

Adolescent↗
PubMed1979

A survey of psychotropic drug prescriptions in an oncology population.

The present study examined the prescription practices concerning psychotropic drugs in 5 major oncology centers over a 6 month period. During the survey period 1579 patients were admitted to the collaborating institutions, and 51% of them were prescribed at least one psychotropic medication. Hypnotics were the most frequently prescribed drugs, accounting for 48% of total prescriptions, followed by anti-psychotics at 26% and anti-anxiety agents at 25%. Anti-depressant drugs accounted for only 1% of psychotropic prescriptions. Analysis of prescription rationales revealed that 44% of the psychotropic prescriptions were written for sleep, while 25% were given for nausea and vomiting; approximately 17% were attributed to psychological distress, and 12% were associated with diagnostic medical procedures. The overall rate of prescription was approximately 2 psychotropic drugs per patient per admission, with only 2% of prescriptions resulting in chart-documented side effects. At the level of individual compounds, 3 distinct drugs accounted for 72% of total prescriptions--flurazepam (33%), prochlorperazine (21%), and diazepam (17%).

Anti-Anxiety Agents↗
PubMed2004

Factors related with prescription requirement to dispense in Spain.

PURPOSE: To identify factors associated with prescription requirement to dispense. METHODS: We carried out a cross-sectional study on a sample of 166 pharmacists in North-West Spain. The following independent variables were collected through a personal interview: pharmacist's education and speciality, characteristics of the pharmacy, and its socio-economic environment. We constructed multiple regression models using as dependent variables: requirement of prescription to dispense five drugs which have to be dispensed with a prescription; and opinion on whether a prescription should be required to dispense these drugs. RESULTS: The response rate was 98.8%. A proportion of 65.9% of pharmacists dispense antibiotics without any prescription. This proportion is 83.5% for nonsteroidal anti-inflammatory drugs, 46.3% for ACE inhibitors, 13.4% for benzodiazepines and 84.8% for oral contraceptives. A higher requirement prescription was found to be associated with the antecedent of a speciality training of the pharmacist (p = 0.028) and his or her age (p < 0.001). A low prescription requirement is associated with the condition of being owner of the pharmacy (p = 0.032), with a high economic level of the population attended (p = 0.016) and with the size of the pharmacy (p = 0.045). CONCLUSIONS: The proportion of pharmacists who dispense drugs without a prescription is extremely high. Our results suggest that in order to increase quality of dispensing, it is necessary to increase pharmacist education and direct efforts of awareness primarily at pharmacists in charge, who are young and work in large pharmacies.

Adult↗
PubMed2003

Error reduction: academic detailing as a method to reduce incorrect prescriptions.

OBJECTIVES: Clinical decision making can be influenced by academic detailing, and it was hypothesised that this technique may be used to reduce simple errors when prescribing drugs of addiction. These prescriptions require specific details to be included, otherwise the prescription has to be returned to the prescriber and re-written, wasting the time of the dispenser and prescriber alike. METHODS: The legal requirements for the prescription of addictive drugs were used to define prescription errors. Prescription error rates at six hospitals were assessed, including a control and an intervention hospital where academic detailing was carried out. Prescription error rates were documented before and after an academic detailing visit to junior doctors, including the provision of a bookmark containing the requirements for these drugs. These errors were expressed as a percentage of the total written for a 4-week period. RESULTS: At the intervention hospital, there was a significant decrease in error rate (from 41% to 24%, P<0.0001) with an improvement in all the requirements stated on the bookmark. At this hospital, the confidence of the junior doctors on a self-rating 5-point scale in writing prescriptions for these drugs increased from a mean of 3.25 (95% CI 2.92-3.58) to 4.14 (95%CI 3.90-4.38) after the intervention (P=0.03). The baseline error rates at the other hospitals ranged from 25% to 46%, but the control hospital did not show a significant change in error rate over the same study period ( P=0.66). A post-hoc review suggested that liquid preparations were more difficult to prescribe correctly, which in part accounted for the differences in error rate between hospitals. CONCLUSIONS: Academic detailing appears to be a useful method of reducing erroneous hospital prescriptions; and, to our knowledge, this is a novel finding.

Analgesics, Opioid↗
PubMed1994

The effect of a patient charge and a prescription regulation on the use of antihypertension drugs in Limburg, The Netherlands.

On 1 February 1983 a patient charge was introduced for prescription drugs for persons insured under the Dutch Sickness Funds Insurance Act. The charge consisted of a co-payment of NLG 2.50 per prescription item up to a maximum of NLG 125 for each family per calendar year. In the period before the introduction of the charge a prescription regulation was in force. For the majority of drugs this rule directed that each prescription item should be for a dosage of not more than 30 days. The prescription regulation was officially introduced on 1 January 1981 and ceased with the introduction of the charge. The effect of both measures on the use of antihypertension drugs in Limburg was investigated in an interrupted time-series analysis. Both the prescription regulation and the charge appeared to have an effect on the number of prescription items per insurant and the number of units delivered per prescription item. However, neither measure resulted in a reduction in the number of units delivered per insurant or the number of 'defined daily doses' (DDDs) per insurant. These findings suggest that neither measure resulted in a decrease in the inappropriate or appropriate use of antihypertension drugs.

Antihypertensive Agents↗