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PubMed2005

Dental prescribing.

Explore the source record for details and available documents.

Antibiotic Prophylaxis↗
PubMed2001

Managing the entry of new medicines in the National Health Service: health authority experiences and prospects for primary care groups and trusts.

For the most part, the management of new medicines in the NHS has hitherto been a matter for local discretion. The result is that access to medicines is often determined by where a patient lives, as opposed to some nationally agreed clinical criteria. This "postcode prescribing" has led to widespread variations in access to medicines and concerns about the resulting inequalities. Primary care groups and trusts are expected to reduce variations in access to care, whilst at the same time balancing their finances, since any overspends on prescribing must be covered by disinvestment in hospital and community services. We interviewed 21 health authority (HA) prescribing advisers to ascertain how they viewed the managed entry of new medicines in order to identify lessons for PCGs. In addition, we report the views of local prescribing managers on the potential impact of recent government policy changes on the process and speculate on the likely implications of these for primary care groups and trusts. What is clear from the study is that HAs often have no explicit objective in relation to new medicines, but that their desire to act is prompted by fears of overspending on prescribing budgets. The danger of this approach is that patients may be denied cost-effective treatments since all new medicines are seen as a problem. It seems likely that PCG/Ts will face the same dilemmas with which the HA advisers in our study have been wrestling for some time. Recent policy changes in relation to prescribing budgets and new medicines are likely to exacerbate these problems. The tensions between local priority setting, which may mean saying no to new medicines, whilst at the same time eradicating postcode prescribing and balancing budgets means that PCG/Ts face difficult policy choices.

Budgets↗
PubMed1999

Drug and Therapeutics (D & T) committees in Dutch hospitals: a nation-wide survey of structure, activities, and drug selection procedures.

AIMS: To determine structure, activities and drug selection processes used by Dutch hospital drug and therapeutics (D & T) committees. METHODS: A pretested structured survey questionnaire based on the Australian process and impact indicators, previous research, and consultation of professionals was developed. Subsequently, D & T committees that met predefined selection criteria were asked to participate. RESULTS: The overall response rate was 70% (38/54). D & T committees varied considerably in size and representation of clinical expertise. Although responsibilities were theoretically alike, actual responsibilities were frequently passed on to other authorities, such as pharmacy staff. Few committees used detailed guidelines or decision supportive matrices to establish transparency in drug selection. With respect to drug selection, the value scores on the information resources used, the factors involved, and the selection criteria used varied. Hospital pharmacists were likely to be most involved and to have the greatest impact. A consensus was most difficult to achieve for drugs used in cardiology, oncology, and psychiatry. Interference of industrial marketing strategies on drug selection was recognized and identified. CONCLUSIONS: Our results indicate that Dutch hospital D & T committees differ with respect to their clinical expertise and their activities, a situation comparable with that observed in other countries. Furthermore, the lack of transparency in drug selection was considerable. These findings clarify the differences previously found between Dutch hospital drug formularies.

Data Collection↗
PubMed1993

The knowledge base of health visitors and district nurses regarding products in the proposed formulary for nurse prescription.

The background to the legalization of nurse prescribing is reviewed and a small questionnaire survey of health visitors and district nurses described. Significantly more district nurses than health visitors wanted to become nurse prescribers. Health visitor knowledge of some parasiticidal lotions and antifungal agents was found to be variable and the recommended dose of paracetamol for post-immunization pyrexia was recognized by less than two-thirds of the sample. District nurse knowledge of lactulose was limited in comparison to their knowledge of alginate and hydrocolloid dressings; however, their knowledge of factors other than dressing type which enhance or delay healing was variable. The mean knowledge scores of both the health visitors and district nurses were unacceptably low for prescribing purposes. The majority of the total sample stated that they would like further training, with a preference for such provision in the form of study days.

Clinical Competence↗
PubMedDate not supplied

The use of conventional antipsychotic medications for patients with schizophrenia in a medicaid population: therapeutic and cost outcomes over 2 years.

OBJECTIVE: To evaluate the association between drug therapy patterns achieved with conventional antipsychotics and direct healthcare costs over 2 years. METHODS: Paid claims data from the California Medicaid (Medi-Cal) program were used to identify 2476 patients with schizophrenia for whom 2 years of data were available. Ordinary least squares (OLS) regression models were used to estimate the association between lack of antipsychotic drug therapy, delayed therapy, changes in medications, and continuous therapy on healthcare costs over a 2-year period. RESULTS: Nearly 99% of Medi-Cal patients with schizophrenia were treated with conventional antipsychotics. Patients with schizophrenia consumed nearly $48,000 in direct costs over 2 years. Over 16% of patients did not use any antipsychotic medication for 2 years. Untreated patients used more healthcare resources than treated patients did ($10,833, P = .0422), especially psychiatric hospital care ($8,027, P = .0004). However, treated patients frequently experienced suboptimal drug use patterns. Nearly 33% of treated patients delayed antipsychotic therapy for up to 2 years. Delayed therapy was associated with increased costs of $12,285 (P = .070). Over 56% of patients experienced changes in therapy that were associated with higher total direct costs ($17,644, P < .0001). Finally, only 3.2% of treated patients used an antipsychotic medication consistently for 2 years. However, continuous drug therapy was not associated with lower costs. CONCLUSION: Suboptimal drug use patterns are common and costly in Medi-Cal patients with schizophrenia who initiated therapy with conventional antipsychotics.

Adult↗
PubMed2001

Suboptimal prescribing in older inpatients and outpatients.

Investigators searched Medline and HealthSTAR databases from January 1, 1985 through June 30, 1999 to identify articles on suboptimal prescribing in those age 65 years and older. A manual search of the reference lists from identified articles and the authors' article files, book chapters, and recent reviews was conducted to identify additional articles. The definitions for various types of suboptimal prescribing (polypharmacy, inappropriate, and underutilization) are numerous, and measurement varies from study to study. The literature suggests that suboptimal prescribing is common in older outpatients and inpatients. Moreover, there is significant morbidity and mortality associated with suboptimal prescribing for these older patients. Evidence from well-controlled studies suggests that multidisciplinary teams and clinical pharmacy interventions can modify suboptimal drug use in older people. Future research is necessary to measure and test other methods for tackling this major public health problem facing older people.

Aged↗
PubMed2001

Understanding medicines: conceptual analysis of nurses' needs for knowledge and understanding of pharmacology (Part I).

The advent of nurse prescribing in the United Kingdom (UK), albeit from a very limited formulary at first, provides a timely prompt for careful reflection on the extents and depths of understanding of medicines required by nurses for a variety of different purposes. This paper, which is the first of a two-part work, presents a conceptual analysis of what is required for patient care and support, pro re nata (as required) administration of medicines, protocol-directed administration of medicines (dependent prescribing), independent prescribing from the current Nurse Prescribers' Formulary or independent prescribing from extended formularies or the entire British National Formulary. It includes review, with common examples, of presentational issues distinguishing between approved, generic names of medicines and trade or brand names, and some discussion of combination medicines; and of recent research that has demonstrated that patient care was improved when the bioscience knowledge of nurses increased.

Drug Prescriptions↗
PubMed2000

[Dangers and risks of black market anabolic steroid abuse in sports --gas chromatography-mass spectrometry analyses].

Anabolic steroids have become increasingly popular among athletes even at subcompetitive or recreational level instead of extensive doping tests, educational campaigns and lethal incidents. Nowadays, the fitness boom has also produced a population of steroid users at high school level and also under non-sports practicing children. After opening the borders to East Europe an explosion of the black-market for anabolic steroids occurred. Beside the well-known side effects of anabolic steroids new problems and risks occurred due to fake drugs from the black market. This review ist subdivided into two parts: We provide a detailed review of the literature an anabolic steroids to the reader the information needed to make an informed decision an the relative risks and benefits of anabolic steroids. Secondly, we evaluated 40 "anabolic steroids" obtained from the black market using mass spectrometry or gas chromatography analysis to evaluate the real pharmacological compounds. As the results of this analysis, we found that 15 (37.5%) these drugs contained different or any pharmacological compounds as labeled. From the external packing, a differentiation between original and the fake drugs was impossible. Therefore, a large information and credibility gap concerning anabolic steroids particular those from the black market exists between the athletes and the medical and scientific communities. We believe that this gap can only be closed if both groups are be better informed about anabolic steroids.

Anabolic Agents↗
PubMed1999

Inadequate prescription-drug coverage for Medicare enrollees--a call to action.

In summary, most low-income elderly and disabled persons lack coverage for important medications, resulting in avoidable deterioration of health among those with chronic illnesses and use of expensive institutional services. Rapidly escalating drug costs, more restrictive drug-coverage policies, and a dramatic increase in the population of elderly and disabled persons will exacerbate these problems. With the current budget surplus, as well as bipartisan concern about health care needs and public concern about drug costs and coverage, it is time to act responsibly and aggressively. We recommend a national replication of the best features of state pharmacy-assistance programs in a federal-state insurance program for low-income Medicare enrollees, either alone or in combination with expanded Medicare coverage. Such a program will reduce the current inequitable situation in which the most vulnerable patients have the least access to medications, with serious medical and economic consequences.

Aged↗