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[Prescription, dispensation and sustitution of prescription forms of omeprazole].

OBJECTIVE: To verify and quantify, for a given active principle (omeprazole 20 mg) and for selected primary care physicians and pharmacies, the extent to which the drug prescribed on official national health system prescription forms coincides with the drug dispensed or whether the drug was dispensed following the pharmacist's criteria because the prescription was drafted in terms of the official Spanish denomination (OSD). In either case, the cost of the prescription is expressed in terms of the defined daily dose (DDD). METHOD: We reviewed 592 public health service prescriptions for omeprazole 20 mg, prescribed by 56 primary care physicians with a high prescription rate for this active principle, which were dispensed in 16 pharmacies. RESULTS: Prescriptions dispensed according to the physician's prescription (50% of the prescriptions) were cheaper than those expressed in OSD and dispensed as generic drugs by pharmacists using their own criteria (36% of the cases). In all cases of substitution of the prescribed drugs (14% of prescriptions), a generic drug was dispensed and 76% of these were more expensive than the prescribed drug. CONCLUSIONS: The results show that primary care physicians tend to take into account the cost of the drug and to choose cheaper drugs even when these are not generic. When pharmacists substitute the prescribed drug, they tend to dispense a generic drug that is more expensive.

Drug Prescriptions↗

How might the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 affect the financial viability of rural pharmacies? An analysis of preimplementation prescription volume and payment sources in rural and urban areas.

CONTEXT: Passage of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) has created interest in how the legislation will affect access to prescription drugs among rural beneficiaries. Policy attention has focused to a much lesser degree on the implications of the MMA for the financial viability of rural pharmacies. PURPOSE: This article presents descriptive information on mail-order prescriptions, volume, and payer type of retail prescriptions in rural vs urban areas. Together, these data provide a baseline for evaluating how implementation of the MMA may affect the financial viability of rural independent pharmacies. METHODS: Projections of prescriptions dispensed from retail and mail-order pharmacies in 2002 for the total US and a sample of 17 states were obtained from IMS Health. FINDINGS: The volume of mail-order prescriptions is small. Rural providers prescribed fewer retail and mail-order prescriptions per person, but more units per person. Rural areas have a higher percentage of prescriptions paid for by cash (18% vs 13%) and Medicaid (16% vs 10%) and a lower percentage of third-party payers than urban areas. Significant variation in volume and payer type exists between states. CONCLUSIONS: Rural, independent pharmacies may be negatively affected by MMA implementation as business shifts from cash to third-party reimbursement. The high degree of variation between states also has potentially important implications for the implementation of Prescription Drug Plan regions under MMA.

Community Pharmacy Services↗

The use of prescription claims databases in pharmacoepidemiological research: the accuracy and comprehensiveness of the prescription claims database in Québec.

Despite the potential benefits of using prescription claims databases for pharmacoepidemiological research, little work has been reported on the nature of available information or its accuracy. The purpose of this study was to describe information contained within the prescription claims database in Québec, and to assess the accuracy of drug information that might be used to monitor drug exposure and physician prescribing. The comprehensiveness of the prescriptions claims database was assessed by examining 1,917,214 records of dispensed prescriptions for a regionally stratified random sample of 65,349 Québec elderly in 1990. We found that values in key fields (individual identifiers, drug, quantity, date dispensed and duration) were missing or out of range in 0-0.4% of records. The accuracy of data were examined in 723 prescriptions filled by 306 elderly patients attending one internal medicine clinic. Of these prescriptions, 83% were filled by the patient and correctly identified the patient and drug and in 89% of these 599 records, the prescribing physician was correctly identified. The quantity and duration of the prescriptions were accurate in 69.1% and 72.1% of records, respectively. We conclude that the prescription claims database in Québec may represent one of the most accurate means of determining drugs dispensed to individuals. There may be limitations in using this database for dosing information.

Drug Prescriptions↗

Prescription and non-prescription drug use: a longitudinal study.

This study examines changes in the lifetime prevalence of prescription and non-prescription drug use in a national longitudinal sample of young adults. Cohort data used in this study are from the National Longitudinal Survey, Youth Cohort (NLSY) who responded to questions on use of prescription drugs for the years 1984 and 1992 (N = 8,771). Results reveal increases in the lifetime prevalence of prescription use of sedatives, transquilizers, and stimulants. Prescription use was higher among women while non-prescription use was higher among men. Non-prescription drug use in 1984 was significantly related to prescription use in 1992.

Adolescent↗

Do rural consumers expect a prescription from their GP visit? Investigation of patients' expectations for a prescription and doctors' prescribing decisions in rural Australia.

OBJECTIVE: To assess patients' expectation for receiving a prescription and GPs' perceptions of patient expectation for a prescription. DESIGN: Matched questionnaire study completed by patients and GPs. SETTING: Seven general practices in rural Queensland, Australia. SUBJECTS: The subjects were 481 patients consulting 17 GPs. MAIN OUTCOME MEASURES: Patients' expectation for receiving a prescription and GPs' perceptions of patients' expectation. RESULTS: Ideal expectation (hope) for a prescription was expressed by 57% (274/481) of patients. Sixty-six per cent (313/481) thought it was likely that the doctor would actually give them a prescription. Doctors accurately predicted hope or lack of hope for a prescription in 65% (314/481) of consultations, but were inaccurate in 19% (93/481). A prescription was written in 55% of consultations. No increase in patients' expectation, doctors' perceptions of expectation, or decision to prescribe were detected for patients living a greater distance from the doctors. CONCLUSIONS: Rural patients demonstrated similar rates of hope for a prescription to those found in previous urban studies. Rural doctors seem to be similarly 'accurate' and 'inaccurate' in determining patients' expectations. Rates of prescribing were comparable to urban rates. Distance was not found to increase the level of patient expectation, affect the doctors' perception or to influence the decision to prescribe.

Adolescent↗

Impact of generosity level of outpatient prescription drug coverage on prescription drug events and expenditure among older persons.

OBJECTIVES: This study examined the impact of drug coverage generosity on older persons' prescription events (fills) and expenditures. METHODS: A cross-sectional study was conducted of 6237 older persons from the 1995 Medicare Current Beneficiary Survey. Dependent variables were per capita prescription events and expenditures. Independent variables were insurance type and drug coverage generosity. Control variables included sociodemographic and health status factors. RESULTS: Regardless of insurance type, per capita prescription events increased as drug coverage generosity improved and then decreased at the most generous level. Per capita prescription expenditures increased as generosity improved; with generous prescription coverage, prescription expenditures were approximately 3 times those with Medicare only. CONCLUSIONS: Even when factors that affect drug use and insurance selection are controlled, prescription coverage generosity influences prescription use.

Aged↗

The association between pharmacy closures and prescription drug use: a retrospective analysis of Medicaid prescription claims in Iowa.

OBJECTIVES: The objectives of this study were 2-fold: (1) to examine the association of pharmacy closures with prescription drug use by Medicaid recipients in Iowa; and (2) to evaluate how drug utilization patterns differ between patients whose pharmacies closed and patients whose pharmacies remained open. DESIGN: A 2-group pretest-posttest study of Medicaid enrollees who may have been affected by pharmacy closures. Prescription medication use during the periods preceding and after pharmacy closures was compared. A comparison group was used to account for extraneous factors. PATIENTS AND METHODS: Sixteen community pharmacies were selected from a pool of pharmacies that closed during 1994; 1092 patients were identified as the main users of these pharmacies, and a comparison group of 3491 patients whose main pharmacies had not closed also was identified. The average number of each patient's prescription claims for the 6 months preceding closing and the 6 months after closing was computed. Multiple regression analysis was conducted to determine whether any association existed between pharmacy closures and the use of prescription drugs. RESULTS: Patients whose pharmacies closed during 1994 had fewer prescription claims after the closings than before the closings. In contrast, patients whose pharmacies remained open had more prescription claims. This difference remains statistically significant after controlling for other factors, such as patient demographics and health status. CONCLUSIONS: A decrease in prescription drug use was associated with pharmacy closures. Attention should be directed to patient access to prescription medications in rural areas, as relatively more pharmacies close in rural areas.

Drug Prescriptions↗

[Drug policy in Slovakia and its reflection in prescriptions. 2. Prescriptions of individually prepared drugs based on the medical specialty].

The paper aims to analyze the frequency of medical prescriptions for the group of extemporaneously prepared drugs in relation to the specialization of physicians. The evaluation is based on the database of prescriptions dispensed by four pharmacies within 14.5 months in the years 1999-2000. The total number of prescriptions was 133,857, out of which 5615 (4.2%) were extemporaneous preparations. The share of specialists in the prescription of extemporaneous drugs was 7%, that of general practitioners, 1.4%. Out of the specialists, the largest share in the prescription of extemporaneously prepared drugs belonged to dermatologists, otorhinolaryngologists, and pediatricians. The economic aspect of prescription of the group of extemporaneous drugs was also evaluated. The average value of a medical prescription for an extemporaneously prepared drug was 68.40 SK, which represents 17.8% of the average value of a medical prescription for a mass-produced drug.

Drug Compounding↗

[Calcitonin prescriptions: an estimate of the expenditure due to inadequate prescription].

BACKGROUND: The use of calcitonin is very common in patients diagnosed with osteoporosis. The objective of this study was to determine the percentage of adequate prescriptions of calcitonin for patients with osteoporosis and to estimate the costs due to inadequate prescription. PATIENTS AND METHODS: Observational study. Four pharmacies in Osona County (Barcelona) were randomly selected. During two time periods, July-September and November-December of 1994, all women filling prescriptions for calcitonin in any of the eight pharmacies were invited to participate in the study. Adequate and inadequate prescription of calcitonin was determined based on the patient's clinical record. Justifiable and non-justifiable prescriptions were then determined after implementing a protocol and reviewing X-rays of the spine. RESULTS: Forty-eight women agreed to participate (participation rate: 68%). In the first analysis, 58.3% (95% CI: 43-72) of prescriptions were determined to be inadequate whereas in the second analysis 29.2% (95% CI: 17-44) were considered non-justifiable. Chronic back pain was associated with non-justifiable prescription of calcitonin (odds ratio: 5.2; 95% CI: 1.3-33.4). In the best of situations, the excess in annual spending due to inadequate prescription was estimated at 13 million pesetas for Osona County, 1,300 million for Catalonia, and 4,300 million for Spain. CONCLUSIONS: Between one-third and one-half of patients prescribed calcitonin in the study area apparently do not need it. Many cases of chronic back pain are being treated as osteoporosis without being properly studied. The costs derived from this incorrect practice are important. This study highlights the need for better practices in the diagnosis of osteoporosis.

Adult↗

Prescription and non-prescription medicine use in Denmark: association with socio-economic position.

OBJECTIVE: To analyse the association among different types of medicine use and different measures of socio-economic position (SEP) in one and the same general population. METHODS: Data from The Danish Health and Morbidity Survey 2000 were analysed. The survey was conducted by face-to-face interviews with a representative sample of the adult Danish population (n=16,690). The associations between prescription and over-the-counter (OTC) medicine use and education, occupation and income were assessed by logistic regression analyses. All analyses were adjusted for age, gender and two measures of health status. RESULTS: This cross-sectional analysis of medicine use in a large representative sample of the Danish population found greater use of prescription medicines among disability pensioners and "others" than in salaried employees. Disability pensioners and self-employed individuals used less OTC medicine than salaried employees. Individuals with low income used more prescription medicines but not more OTC medicines, than those with high income. No major differences were found in prescription medicine use with respect to education, but men within the two middle educational groups tended to use prescription medicine less frequently than both lower and higher educated men. A similar trend was not found for women. OTC medicine use was not associated with education for either gender. CONCLUSIONS: The prevalence of prescription medicine use increases with declining SEP, after adjusting for health status. Such an association does not exist for OTC medicine use. The results show that the least affluent have access to prescription medicine. The difference between prescription and OTC medicine use may be explained by a compensation mechanism.

Adolescent↗

A cluster-randomized educational intervention to reduce inappropriate prescription patterns for elderly patients in general practice--The Prescription Peer Academic Detailing (Rx-PAD) study [NCT00281450].

BACKGROUND: Age-related alterations in metabolism and excretion of medications increase the risk of adverse drug events in the elderly. Inappropriate polypharmacy and prescription practice entails increased burdens of impaired quality of life and drug related morbidity and mortality. The main objective of this trial is to evaluate effects of a tailored educational intervention towards general practitioners (GPs) aimed at supporting the implementation of a safer drug prescribing practice for elderly patients > or = 70 years. METHODS/DESIGN: Approximately 80 peer continuing medical education (CME) groups (about 600 GPs) in southern Norway will be recruited to a cluster randomized trial. Participating groups will be randomized either to an intervention- or a control group. The control group will not receive any intervention towards prescription patterns in elderly, but will be the target of an educational intervention for prescription of antibiotics for respiratory tract infections. A multifaceted intervention has been tailored, where key components are educational outreach visits to the CME-groups, work-shops, audit and feedback. Prescription Peer Academic Detailers (Rx-PADs), who are trained GPs, will conduct the educational outreach visits. During these visits, a set of quality indicators (QIs), i.e. explicit recommendations for safer prescribing for elderly patients, will be presented and discussed. Software will be handed out for installation in participants' practice computers to enable extraction of pre-defined prescription data. These data will subsequently be linked to corresponding data from the Norwegian Prescription Database (NorPD). Individual feedback reports will be sent all participating GPs during and one year after the intervention. Feedback reports will include QI-scores on individual- and group levels, before and after the intervention. The main outcome of this trial is the change in proportions of inappropriate prescriptions (QIs) for elderly patients > or = 70 years following intervention, compared to baseline levels. DISCUSSION: Improvement of prescription patterns in medical practice is a challenging task. Evidence suggests that a thorough evaluation of diagnostic indications for drug treatment in the elderly and/or a reduction of potentially inappropriate drugs may impose significant clinical benefits. Our hypothesis is that an educational intervention program will be effective in improving prescribing patterns for elderly patients in GP settings.

Aged↗

Prescription drug abuse in Canada and the diversion of prescription drugs into the illicit drug market.

Prescription drug abuse has received considerable attention in media reports in recent years. The purpose of this article is to describe the Canadian situation and context with regards to prescription drug abuse and the diversion of psychotropic prescription drugs into the illicit drug market, with a focus on the need for more data and interventions. Canada ranks within the top 10% of countries in the use of benzodiazepines, opioid prescriptions and stimulants. There are many ways that prescription drugs are diverted into the illicit market and varied reasons for use and abuse. Prescription drug abuse is further related to a number of negative consequences, including overdose. While seniors and women have been the primary focus for research in Canada on prescription drug abuse, adolescents and young adults have received less attention. Systematic epidemiological data specifically on prescription drug abuse in the Canada context are lacking and are needed in order to more clearly understand the reasons for the phenomenon and to develop and implement appropriate interventions.

Adolescent↗

Prescription drug use and self-prescription among resident physicians.

CONTEXT: Self-prescription is common among practicing physicians, but little is known about the practice among resident physicians. OBJECTIVE: To determine prescription drug use and self-prescription among US resident physicians. DESIGN AND SETTING: Anonymous mail survey of all resident physicians in 4 US categorical internal medicine training programs in February 1997. MAIN OUTCOME MEASURES: Self-reported use of health care services and prescription medications and how they were obtained. RESULTS: A total of 316 (83%) of 381 residents responded; 244 residents (78%) reported using at least 1 prescription medicine and 162 residents (52%) reported self-prescribing medications. Twenty-five percent of all medications and 42% of self-prescribed medications were obtained from a sample cabinet; 7% of all medications and 11% of self-prescribed medications were obtained directly from a pharmaceutical company representative. CONCLUSIONS: Self-prescription is common among resident physicians. Although self-prescription is difficult to evaluate, the source of these medications and the lack of oversight of medication use raise questions about the practice.

Drug Prescriptions↗

Usefulness of traditionally defined herbal properties for distinguishing prescriptions of traditional Chinese medicine from non-prescription recipes.

Traditional Chinese medicine (TCM) has been widely practiced and is considered as an attractive to conventional medicine. Multi-herb recipes have been routinely used in TCM. These have been formulated by using TCM-defined herbal properties (TCM-HPs), the scientific basis of which is unclear. The usefulness of TCM-HPs was evaluated by analyzing the distribution pattern of TCM-HPs of the constituent herbs in 1161 classical TCM prescriptions, which shows patterns of multi-herb correlation. Two artificial intelligence (AI) methods were used to examine whether TCM-HPs are capable of distinguishing TCM prescriptions from non-TCM recipes. Two AI systems were trained and tested by using 1161 TCM prescriptions, 11,202 non-TCM recipes, and two separate evaluation methods. These systems correctly classified 83.1-97.3% of the TCM prescriptions, 90.8-92.3% of the non-TCM recipes. These results suggest that TCM-HPs are capable of separating TCM prescriptions from non-TCM recipes, which are useful for formulating TCM prescriptions and consistent with the expected correlation between TCM-HPs and the physicochemical properties of herbal ingredients responsible for producing the collective pharmacological and other effects of specific TCM prescriptions.

Algorithms↗

Elderly patients in general practice: diagnoses, drugs and inappropriate prescriptions. A report from the Møre & Romsdal Prescription Study.

BACKGROUND: Elderly patients are particularly vulnerable and most at risk of suffering adverse drug reactions, which are often caused by inappropriate prescribing practice. Gaining insight into physicians' drug prescribing patterns in order to identify prescribing problems is the fundamental first step in trying to improve the quality of prescribing. OBJECTIVES: We aimed to describe drug prescribing in general practice for elderly patients, using patients' age and sex, encounters, indications for prescribing and the occurrence of some predefined inappropriate drug prescriptions. METHODS: A cross-sectional, descriptive study was conducted in the Norwegian county of More & Romsdal. All patient contacts (n = 16 874) and prescriptions (n = 16 774) issued during two months in general practice were recorded. In defining inappropriate prescriptions, explicit criteria were used. RESULTS: Prescriptions (of which 72% were repeat) were issued during two-thirds of all contacts, and 63% were for females. Seventy per cent of all prescriptions were made up by the ten most commonly prescribed therapeutic groups, for which the three most frequent diagnostic indications for prescribing comprised between 47 and 89% of all diagnoses for prescribing each of them. About one in six patients who received a benzodiazepine tranquillizer was concurrently prescribed another benzodiazepine for sleeping problems. In total, 13.5% of all prescriptions met at least one of the criteria listed for pharmacological inappropriateness. CONCLUSION: Inappropriate drug prescriptions for elderly patients are common in general practice. Since the majority of the prescribing practice is made up by rather few diagnoses and drugs, improved practice for only a few may nevertheless have a large impact on the total profile.

Age Distribution↗

[Theories of medicine in the newly discovered medical book "Hon'po Kagen Hishu" by San'ki Tashiro: basic prescriptions and modified prescriptions].

While investigating the formation of the Gosei-ha school in Japan by Tashiro San'ki and Manase Dosan, we discovered "Hon'po Kagen Hishu", a heretofore unknown medical book by San'ki Tashiro. A comparison of this work with Sanki's "Wakyokushu" revealed the following points. (1) "Hon'po Kagen Hishu" is a medical book compiled by San'ki Tashiro, and is believed to have been put together after the newly-compiled "Wakyokushu" (1525). (2) The book is roughly divided into two parts: basic prescriptions and modified prescriptions. "Hon'po Kagen Hishu" reveals clearly that San'ki's medical theories form the key theories of these two parts. (3) Many of the basic prescriptions contained in "Hon'po Kagen Hishu" were existing prescriptions used by the Kyokuho-ha School which was popular in Japan at the time. The modified prescriptions conform to the bian zheng pei ji (selection of drug based on the differential diagnosis) theories of the Li-Zhu medical school. (4) Among the 15 prescriptions described in the 'Shobyou Tsuyo no Yakuho' chapter of "Hon'po Kagen Hisku" secret prescriptions from schools of thought including the Nakarai school were discovered, pointing to a connection between San'ki and the Nakarai school.

Books↗

Purchasing prescription medication in Mexico without a prescription. The experience at the border.

Prescription medication can often be purchased in Mexico without a physician's prescription. United States residents living along the border may have access to dangerous medications by crossing the border and purchasing them in Mexican pharmacies. We sought to determine the extent and frequency of this behavior in a sample of our ambulatory clinic population. Patients from the Texas Tech University Internal Medicine Clinic were surveyed to collect information about their use of medications, use of alternative sources of health care in Mexico, and purchasing of prescription medication in Juarez, Mexico. More than 80% of patients stated they had purchased prescription-type medication at a pharmacy without a physician's prescription. The most common reasons for buying prescription medication in Mexico were because it was less expensive or because a prescription was not necessary. These data indicate a potential for US residents along the border to take medications in an unregulated manner, a practice that could pose problems for health care providers on both sides of the border.

Adult↗

[Prescription of psychopharmaceuticals in general practice. 3. Prescription of hypnotics].

In a multicentre-questionnaire investigation in general practice in the County of Arhus with participation of 66% of the general practitioners in the county, 1,516 prescriptions for hypnotics were registered during one week. 68% of the prescriptions were for women and 32% for men. The average ages of the patients were 65 and 64 years, respectively. The frequency of prescription increased markedly with age. 83% of the prescriptions and 85% of the hypnotics calculated in defined daily doses were benzodiazepines. The majority of the benzodiazepine hypnotics and sedatives prescribed had long half-lives. At the time of the first prescription of hypnotic, 31% of the patients were in a state of mental crisis while only 7% were so after medication for at least six years. In about 30% of the patients, a co-existing somatic disease contributed to a considerable extent to the prescription of the hypnotic while under 1/5 of the patients suffered from genuine mental illness. Approximately 20% of the patients were considered to be potential or genuine addicts. More than 80% of the renewed prescriptions occurred by indirect doctor-patient contact.

Adolescent↗