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At least 343 records · Page 19Linked to original sources
PubMed1999

[Incomplete prescription: a potential medication error].

OBJECTIVE: According to the American Society of Health System Pharmacists, an incomplete or imprecise medial order comprises a prescription error. Such errors have potential consequences in terms of mortality, morbidity, prolonged hospital stay and, finally, in health care expenditure. The aim of this study was to determine the rate of incomplete prescriptions observed in a university hospital setting and identify the causes of such imprecisions. METHODS: A prospective analysis of prescriptions for oral medicines ordered by an internal medicine unit of a university hospital was conducted on a daily basis by a pharmaceutical team immediately after the orders were written. A complete prescription was defined as one with the following information: unit dose, formulation, number of doses per day, hour of administration, particular instructions for use. RESULTS: Among the 241 prescription lines analyzed during a 20 day period, 131 (54.2%) were incomplete. The number of doses per day was missing for 7.9%, unit dose for 6.2%, particular instructions for 4.9% and the formulation for 2.9%. DISCUSSION: These findings demonstrated the lack of quality of the prescriptions studied. A treatment scheme totally incompatible with quality prescriptions and a poor understanding of prescription quality were the most probable causes. These two elements reflect the gap between the outdated organizational scheme currently in use and appropriate implementation of the hospital drug distribution circuit.

Drug Prescriptions↗
PubMed1999

[Factors influencing the prescription of insulin and oral antidiabetics in primary care].

OBJECTIVES: To analyse the prescription of insulin and oral diabetic medication (ODM) in primary health care, and to evaluate which variables, depending on the prescribing doctor, work-place or population attended, explain quality and/or quantity variations in prescription. DESIGN: Crossover, observational study. SETTING: Málaga-Este Health District, Málaga. PARTICIPANTS: 21,166 prescriptions issued by 144 doctors in the Málaga-Este Health District during the first quarter of 1997 were analysed. MEASUREMENTS AND MAIN RESULTS: Insulin consumption of 10.63 defined daily doses per 1,000 inhabitants and day (DID) and ODM of 18.51 DID were calculated. No significant differences were observed in insulin or ODM prescription for sex, and few for age, job or doctors' specialty via MIR (intern) training. Working in a centre with MIR teaching and in a reformed centre were significantly associated with a greater use of insulin (p < 0.0001 and p < 0.02, respectively). Having a higher allocation of patients drawing pensions meant a greater consumption of insulin (p < 0.01) and even more of ODM (p < 0.0001). The population allocated being older was associated with greater consumption of ODM without any changes in insulin prescription. CONCLUSIONS: The personal features of doctors working in primary care affect very little the quantity and quality of insulin and ODM prescription. The characteristics of the work-place (reformed centre and centre entitled to teach) and the population attended (older and drawing a pension) are the main factors conditioning the amount of prescription of insulin and ODM, respectively. Nevertheless, in all cases ODM prescription quality is low.

Administration, Oral↗
PubMed1999

Trends in the prescription of psychotropic drugs and hormone substitutes in Austria.

INTRODUCTION: Psychological instability as a result of changing hormone levels are commonly observed during menopause. We examined the question whether the prescription of psychotropic drugs is related to age or gender and whether the increase in the prescription rate of hormone substitutes has an impact on this phenomenon. METHODS: Age and gender-specific prescription rates of psychotropic drugs and hormone substitutes were examined in a retrospective study using data of the European Pharmaceutical Market Research Association of Austria. The relevant Austrian figures were established on the basis of representative samples. RESULTS: There are no gender-specific differences in terms of prescription frequency up to the age of 45 years. After the age of 45, there is a significant increase in the prescription of psychotropic drugs for women. When comparing the years 1991 and 1996, we find a reduction in the number of prescriptions of psychotropic drugs and an increase in the prescription rate of hormone replacement drugs. DISCUSSION: An increase in the prescription rate of hormone substitutes may contribute to the psychological stabilisation of menopausal women and thereby reduce the need for psychotropic drugs.

Adult↗
PubMed2000

[Limited changes in prescription of third-generation oral contraceptives after reports on elevated thrombosis risk and subsequent professional guidelines].

OBJECTIVE: To compare the prescription behaviour of general practitioners (GP) and gynaecologists regarding 2nd and 3rd generation oral contraceptives (OC) in the period before and after the warning of increased thrombosis risk of 3rd generation pills. DESIGN: Retrospective, descriptive. METHOD: With the aid of data on OC prescriptions collected by the Institute for Medical Statistics, the numbers of prescriptions from Dutch GPs and gynaecologists in the year before the warning by the British Committee on Safety of Medicines that 3rd-generation OC increased the risk of thrombosis, were compared with the numbers in the year after publication of the guideline of the Dutch General Practitioners Society (NHG), which stated a preference for the 2nd-generation OC, and of the guideline of the Dutch Society for Gynaecology and Obstetrics, which stated no preference. RESULTS: In neither the GP nor the gynaecologist groups did the proportion of 3rd-generation pills in the OC prescriptions decrease significantly. However, in the GP group the proportion of new 3rd generation OC prescriptions decreased significantly from 56 to 40%. However, after a few trimesters it rose again. CONCLUSION: The changes in prescription behaviour of the GP group were in accordance with the NHG guidelines. However, the proportion of the 3rd-generation OC prescriptions remained relatively large and the effect was of short duration. The only conclusion that could be drawn regarding the gynaecologists, was that the proportion of 3rd-generation OC prescriptions did not change significantly.

Contraceptives, Oral↗
PubMedDate not supplied

[Pharmaceutical intervention for the optimisation of outpatient drug prescription in a hospital Emergency Department].

OBJECTIVE: To discuss various aspects of drug prescription for first-year resident physicians (MIR-1) working in Emergency Departments in order to promote a rational use of drugs, and to assess the impact of such pharmaceutical intervention. METHOD: During personal interviews MIR-1s were briefed (both orally and in written form) on prescription characteristics of their department. Both qualitative (compliance with the Pharmaco-therapeutic Guide, prescription of drugs with low intrinsic value) and quantitative (prescription profile for medicines with the same active principle but different price) parameters were discussed. Then the impact of these interviews was analysed by comparing outpatient prescriptions by MIR-1s during August-November 2000 versus those filled by their colleagues during this same period in 1998 and 1999. RESULTS: Outpatient prescriptions by the MIR-1 group conformed better to the qualitative and quantitative parameters studied. Despite such better results, greater savings may still be obtained by improving quinolone/macrolide, anti-ulcer drug, ACE inhibitor and NSAID prescriptions, since these amount to 93% of total potential savings. DISCUSSION: By conducting personal interviews with a pharmacist new MIR-1s encounter an additional information source contributing to more sensible drug prescriptions.

Drug Prescriptions↗
PubMed2003

Do delayed prescriptions reduce antibiotic use in respiratory tract infections? A systematic review.

BACKGROUND: There is concern about the increasing resistance of antibiotics to common bacteria. Delayed prescribing for respiratory tract infections is a strategy that may reduce the use of antibiotics. AIM: To systematically review controlled trials of delayed prescriptions to establish their capacity to reduce antibiotic intake. DESIGN OF STUDY: A systematic review of the literature. SETTING: Four studies were conducted in the United Kingdom and one in New Zealand. METHODS: We searched MEDLINE from 1966 to April 2003, EMBASE, and the Cochrane Controlled Trials Register using the following terms: 'delayed', 'antibiotics', 'prescriptions', and 'back-up' (as in back-up prescription). We included controlled trials of studies in which the intervention was a delayed prescription compared to an immediate prescription for patients with upper respiratory tract infections. The studies were selected independently and the results compared. Disagreements were resolved by discussion. The data and quality of the studies were extracted and assessed independently by two of the authors. RESULTS: Four randomised controlled trials and one before-after controlled trial contributed to the review. The relative risk in the randomised trials for lower antibiotic usage when a delayed prescription was given ranged from 0.54 for the common cold to 0.25 for otitis media. CONCLUSION: The consistent reduction in antibiotic usage in the five controlled trials included in this review suggests that delayed prescription is an effective means of reducing antibiotic usage for acute respiratory infections. The duration of delay for prescriptions ranged widely, from 1 to 7 days.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Implementation of an assisted electronic prescription system applied to parenteral nutrition in a general hospital].

Integrated and shared information systems allow obtaining a high degree of information about processes, costs and outcomes, and considerably reducing prescription errors. Assisted electronic prescription, in the setting of total parenteral nutrition, integrated with other hospital databases and with the hospital drugs management system, is a tool that allows increasing patient' safety (by reducing prescription errors), improving quality assistance, improving information systems and information management and the efficiency of used resources. In this work, implementation of an assisted electronic prescription system applied to parenteral nutrition in a hospital and processes reengineering performed in the nutrition setting are described. This implementation was performed by medical staff from the Nutrition and Diet Department and pharmacists from the Pharmacy Department of Ramón y Cajal Hospital using "Nutriwin" computer software. For two months prior and after its implementation, a follow-up of time consumed in the circuit prescription-validation-elaboration-dispensation of parenteral nutrition formulas has been performed. After implementation, treatment orders reach on average 1 h and 15 minutes sooner the Pharmacy Department; by avoiding transcription, a saving of 3 min per nutrition formula calculations is achieved, besides reducing potential errors; elaboration of nutrition formulas can be started on average 1 h and 20 minutes sooner as compared to manual prescription. Besides, the staff that writes down the prescription may know in real time the nutritional profile for each patient in the current episode and the patient's historic. Electronic prescription of treatment orders in this area has represented for our hospital an optimization of the employed resources, a reduction of potential errors that may occur, an improvement in consumption management, and an increase in the whole process quality.

Drug Prescriptions↗
PubMed2006

How many antibiotic prescriptions are unsubsidised in New Zealand?

AIMS: To determine the proportion of prescriptions for antibiotics which were unsubsidised, in one town in one year, and to use this to develop a model which could be used to estimate the number of unsubsidised prescriptions. METHODS: Data on all prescriptions for antibiotics during 2002 were extracted from pharmacy computers in one town. Data were obtained from PharmHouse database on all subsidised prescriptions from the town pharmacies during 2002. (The PharmHouse database is a subset of the New Zealand Health Information System database and contains records of all the claims for medicines dispensed within New Zealand.) These were compared and the proportion of unsubsidised prescriptions for each antibiotic calculated. Weighted linear regression was used to develop a model of the relationship between the percentage of each drug subsidised, and patient and prescription characteristics obtainable in PharmHouse. RESULTS: 64.4% of antibiotic dispensings in the study town were subsidised, and therefore captured by the PharmHouse database. The proportion varied substantially between different antibiotics. For particular drugs, the proportion of drugs unsubsidised could be predicted by the price of the drug, the number of days it was prescribed for, and the number of patients aged under six who received subsidised prescriptions. CONCLUSIONS: Previous studies using PharmHouse data are likely to have significantly underestimated the extent of drug use. Further research is needed on whether this model can help to estimate the extent of unsubsidised prescriptions.

Anti-Bacterial Agents↗
PubMed2006

[Prescription and drug expenditure in gynecology and obstetrics in Northwest medical units from IMSS].

BACKGROUND: Drug prescription is the most frequent medical intervention in Gynecology and Obstetrics; however, studies of prescription profile are limited. In this study, we analyzed differences of expense by drug prescription for gynecologic and obstetrics health problems. PATIENTS AND METHOD: It was performed a cross sectional study for one year analysis in each medical area that shape IMSS western district. We calculated spending and consumption coefficients for each drug and therapeutic groups. User coefficients were ordered to compare consumption differences. Besides the statistical ratio of consumption between drugs groups, we described the differences found and analyzed the prescription profile among medical regions. RESULTS: Data related to the expenses in each one of the regions show important differences in each one of the drugs and therapeutic groups. The most common expense for drugs is related to the treatment of osteoporosis, menopause and fertility problems. We also found differences in prescription drug preferences in each therapeutic subgroup. DISCUSSION: Drug prescription studies are useful as a basis for further specific studies in each pharmacologic subgroup. There are few studies that analyze the drug prescription profile on Gynecology and Obstetrics. In this study it is possible to suppose that medical prescription was not based on known medical evidences; therefore, we must reconsider the need of a permanent actualization and systematic medical evaluation.

Cross-Sectional Studies↗
PubMed2006

Prescription drug abuse: what is being done to address this new drug epidemic? Testimony before the Subcommittee on Criminal Justice, Drug Policy and Human Resources.

This comprehensive health policy review of the prescription drug abuse epidemic is based on the written and oral testimony of witnesses at a July 26, 2006 Congressional Hearing, including that of Laxmaiah Manchikanti, MD, the chief executive officer of the American Society of Interventional Pain Physicians and additions from review of the literature. Honorable Mark E. Souder, chairman of the Subcommittee on Criminal Justice, Drug Policy, and Human Resources, introduced the issue as follows: "Prescription drug abuse today is second only to marijuana abuse. In the most recent household survey, initiates to drug abuse started with prescription drugs (especially pain medications) more often than with marijuana. The abuse of prescription drugs is facilitated by easy access (via physicians, the Internet, and the medicine cabinet) and a perception of safety (since the drugs are FDA approved). In addition to the personal toll of drug abuse using prescription drugs, indirect costs associated with prescription drug abuse and diversion include product theft, commission of other crimes to support addiction, law enforcement costs, and encouraging the practice of defensive medicine." The Administration witnesses, Bertha Madras, Nora D. Volkow, MD, Sandra Kweder, MD, and Joe Rannazzisi reviewed the problem of drug abuse and discussed what is being done at the present time as well as future strategies to combat drug abuse, including prescription drug monitoring programs, reducing malprescriptions, public education, eliminating Internet drug pharmacies, and the development of future drugs which are not only tamper-resistant but also non-addictive. The second panel, consisting of consumers and advocates, included Misty Fetco, Linda Surks, and Barbara van Rooyan, all of whom lost their children to drugs, presented their stories and strategies to prevent drug abuse, focusing on education at all levels, development of resistant drugs, and non-opioid treatment of chronic pain. Mathea Falco, JD, and Stephen E. Johnson presented issues related to drug abuse and measures to curb drug abuse by various means. Stephen J. Pasierb presented startling statistics on teen drug abuse and various educational programs to deter abuse. Laxmaiah Manchikanti, MD presented an overview of prescription drug abuse, strategies to prevent drug abuse, including immediate funding and rapid implementation of NASPER, education at all levels and improving relations with the DEA and the provider community.

Analgesics, Opioid↗
PubMed1989

Prescription-writing patterns and errors in a family medicine residency program.

Copies of 1814 prescriptions written by 20 residents were reviewed to determine prescribing patterns and the incidence of prescription-writing errors. An average of 0.69 prescriptions were written per patient visit at an average cost (to the pharmacist) of $13.35. Over one third of all prescriptions were written using the generic name, and "dispense as written" was specified on only 3.25%. On average, 21% (n = 373) of all prescriptions collected contained at least one prescription-writing error. Errors were characterized as omissions (6%), unfulfilled legal requirements (1%), incomplete directions (1%), dose or direction errors (3%), unclear quantity to be dispensed (3%), or prescriptions written for nonprescription products (5%). A correct diagnosis and treatment plan can be undermined by a written prescription that is incorrect or miscommunicates the intention of the prescriber.

Adolescent↗
PubMed1983

Association between appropriateness of prescribing and prescription documentation.

The association between the quality of physician prescribing and the degree of prescription documentation in the medical record was studied in four family-practice offices. Carbon-copy prescriptions were collected for five months at each office, and 438 were randomly selected for evaluation. For each prescription, a case abstract was prepared from the medical record. The abstract summarized the patient's previous care related to the problem for which the prescription was issued. The abstracts were blinded and randomly assigned for review by a panel of physicians and pharmacists working in family practice, resulting in a total of 1866 evaluations. Each panelist evaluated appropriateness of drug choice, potential benefit, and degree of prescription documentation. Actual prescription documentation of drug name, strength, quantity, directions, and refills was determined by comparing the carbon-copy prescription with the medical record. Multiple regression analysis revealed a significant correlation between panel evaluations for drug choice and actual documentation of drug name, strength, and directions. Likewise, the mean rating of potential benefit was significantly associated with actual documentation of drug name, strength, directions, and refills. The mean rating of appropriateness of documentation was significantly associated with all five independent documentation variables. Drug name, strength, and directions were recorded in 94%, 60%, and 75% of the medical records, respectively. These data demonstrate a positive association between the quality of prescribing and actual prescription documentation in the medical record.

Analysis of Variance↗
PubMed1995

A general model of drug prescription.

Currently, there is no widely accepted structured representation of drug prescription. Nevertheless, a structured representation is required for entering and storing drug prescriptions avoiding free text in computerized systems, and for drug prescription reviews. Derived from part of the work of the European OPADE project, we describe an object-oriented model of drug prescription which incorporates important concepts such as the phase and triggering event concepts. This model can be used to record all drug prescriptions, including infusions, in a structured way avoiding free text. The phase concept allows the storage of sequentially ordered dosage regimens for a drug within the same prescription. The prescription triggering event concept allows recording of the administration of a drug conditional to dates, symptoms and clinical signs, medical procedures, and everyday life events. This model has been implemented within the OPADE project; the corresponding aspects of the user interface are presented to show how this model can be used in practice. Even if other new attributes may be added to the described objects, the structure of this model is suitable for general use in software which requires the entry, storage and processing of drug prescriptions.

Drug Administration Schedule↗
PubMed1994

[Survey on antibiotic prescriptions in general medicine].

The objectives of the survey are to describe the use of antibiotics in general practice, in order to identify inappropriate use and to estimate the exposure to different antibiotic categories in the population. The data refer to the overall drug prescriptions issued in general practice during 1991 in Rome. Four million of antibiotic prescriptions were issued, corresponding to 9% of the overall drug prescriptions and to 11% of the drug expenditure in Rome. When considering all anti-infective drugs (antibiotics plus antivirals and immunostimulating agents) the prescriptions and the expenditure increase up to 13% and 18% respectively. Three therapeutic categories (penicillins, cephalosporins and macrolides) represent more than 50% of the antibiotic prescriptions. Among the general population, 34% received at least one anti-infective drug and each patient received on average 2.7 prescriptions during the year. More than 20% of the prescriptions refers to antibiotic categories (such as aminoglycosides and chloramphenicols) which are not considered as a first choice in general practice. The analysis shows that a considerable proportion of antibiotic prescriptions refers to therapeutic categories with negative benefit/risk profile. More appropriate use of antibiotics might reduce both adverse events and drug expenditure.

Anti-Bacterial Agents↗
PubMedDate not supplied

A study of the quality of prescriptions issued in a busy pediatric emergency room.

An analysis of 2,213 prescriptions written by physicians in a busy, urban pediatric emergency room revealed that only 110 or 5 percent had no errors or omissions of specifications. The quality of the prescriptions was evaluated according to the standards of acceptable prescribing for the following specifications: quantity, dosage, time interval between doses or specific hours to be given, and specific instructions. The hospital pharmacists, also under pressure, generally failed to monitor the prescriptions adequately--either they did not rectify the physicians' errors or at times they made incorrect changes. To improve the quality of prescriptions issued under pressure in an emergency room, several courses of action are recommended: Pharmacology departments of medical schools should place more emphasis on teaching students the art of writing explicit, comprehensible prescriptions. The physician and pharmacist should work as a team in the interest of providing patients with accurate and detailed prescriptions; or both the physician and the pharmacist should delegate the composition of prescriptions to an automated computer system, thereby reducing human error in writing and monitoring prescriptions and allowing both professionals more time for direct contact with patients.

Child↗
PubMed1993

Dynamic aspects of prescription drug use in an elderly population.

OBJECTIVE: This study explores longitudinal patterns in outpatient prescription drug use in an elderly population. DATA SOURCES/STUDY SETTING: Enrollment records and prescription drug claims were obtained for a sample of elderly Pennsylvanians (N = 27,301) who had enrolled in the Pharmaceutical Assistance Contract for the Elderly (PACE) program at any time between July 1984 and June 1987. Study Design. The study tracks monthly prescription fill rates for sampled PACE beneficiaries from their initial enrollment month through disenrollment, death, or the end of the study (whichever occurred first). We specify two-part multivariate models to assess the effect of calendar time, length of time in the PACE program, and progression to disenrollment or death both on the probability of any prescription use and on the level of use among those who filled at least one prescription claim per month. Control variables include age, gender, race, income, residence, and marital status. DATA COLLECTION/EXTRACTION METHODS: Data were extracted from administrative files maintained by the PACE program, checked for errors, and then formatted as person-month records. PRINCIPAL FINDINGS/CONCLUSIONS: We find a strong positive relationship between drug use and the length of time persons are PACE-enrolled. Persons whose death occurs within a year have much higher prescription utilization rates than do persons whose death is at least a year away, and the differential increases as death nears. Persons who fail to renew PACE coverage use significantly fewer prescription drugs in the year prior to disenrollment. Holding age and other factors constant, we find that average levels of prescription use actually declined over the study period.

Aged↗
PubMed1996

Release of spectacle prescriptions: an update.

BACKGROUND: Due to the provisions of the Federal Trade Commission's prescription release rule, the patients of optometrists are entitled to a copy of the spectacle prescription following the examination. METHODS: The FTC rule and provisions of various state laws that regulate the release of information from medical records have been reviewed to determine the specific legal requirements that govern the release of spectacle prescriptions. RESULTS: Although the FTC rule does not require specific information to be included in a spectacle prescription, in 19 states specific information is required, and optometrists in all states should include such additional information as they believe will be necessary to ensure that patients receive the appropriate spectacles from a third-party dispenser. In addition, the laws of 29 states require optometrists to release copies or information from patient records on request from the patient, and in 3 states optometry practice acts or board rules require the release of copies of the spectacle prescription, thereby expanding the duty to patients beyond that required by the FTC rule. In states that do not have statutory provisions, court rulings must be consulted to determine the extent of an optometrist's obligation to provide prescription information from records to patients. CONCLUSIONS: These legal obligations should be observed when providing spectacle prescriptions or responding to requests for prescription information.

Eyeglasses↗
PubMed1997

Intervention to reduce telephone prescription requests.

OBJECTIVE: To evaluate a systematic effort to reduce telephone orders for prescription medications in a community family practice. DESIGN: Three-year intervention project. SETTING: Solo family practice in Ottawa. PARTICIPANTS: All patients requesting telephone orders for prescription medications. INTERVENTIONS: A retrospective analysis of phone requests and orders was conducted on 1 continuous year's records. A new office policy was instituted on October 9, 1992, discouraging telephone orders for prescription medication. Prescription telephone requests and orders were then monitored continuously for the next 3 years. MAIN OUTCOME MEASURES: Number of telephone prescription requests and orders per half-day 1 year before the intervention compared with the number for the 3 years after the intervention. RESULTS: One year before the intervention, there were 4.96 telephone prescription requests per half-day: 3 years after the intervention this number fell to 0.85. One year before the intervention, the number of telephone prescription orders per half-day was 4.80; this number fell continuously to 0.67 during the 3 years following the intervention. CONCLUSIONS: We observed a reduction in the number of telephone prescription requests and orders following the introduction of an office policy that encouraged prescribing and renewing medication in person.

Drug Prescriptions↗