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PubMed1996

[Long-term effects of prescription drugs in 174 patients treated for myocardial infarction, followed up from 4 to 5 years (the DEVENIR study)].

The aim of this study was to document changes in drug prescription after myocardial infarction. One hundred and seventy four men with typical myocardial infarction recensed by the Toulouse MONICA centre between 1989 and 1990 were followed up for 4.5 years. A copy of their drug prescription was obtained during the acute phase of infarction, at the time of discharge from hospital or clinic, after 6 months, and finally, after 4.5 years after infarction. During the acute phase, the majority of patients received nitrate derivatives, platelet antiaggregants, calcium antagonists, betablockers and antiarrhythmics. Between hospital discharge and the sixth month, the prescription of lipid lowering drugs quadrupled (from 8 to 33%; p < 0.00001) and those of platelet anti-aggregants decreased (from 82 to 70%; p < 0.01). The prescriptions of other drugs remained relatively stable. Between the 6th month and the 4th year of follow-up the only prescription to increase significantly was that of ACE inhibitors (from 14 to 23%; p < 0.03). The other prescriptions were maintained: platelet anti-aggregants (70% at 6 months vs 75% at 4.5 years), nitrate derivatives (59 vs 51%), betablockers (51 vs 52%), calcium antagonists (51 vs 48%), lipid lowering drugs (33 vs 42%), diuretics (3 vs 6%) and inotropic agents (2 vs 2%). Overall analysis showed an increase in the prescriptions of lipid-lowering agents (p < 0.00001) and ACE inhibitors (p < 0.002). On the other hand, the prescriptions of calcium antagonists and nitrate derivatives tended to decrease. These results show that the treatment of patients with coronary artery disease is based on drugs of proven efficacy, reflecting the impact of large scale therapeutic trials on everyday medical practice.

Adult↗
PubMed1997

The Danish prescription registries.

The extensive computerisation of Danish pharmacies has permitted the establishment of two large prescription registries: The Odense University Pharmacoepidemiological Database (OPED) and the Pharmacoepidemiological Prescription Database of North Jutland (PDNJ). The Danish prescription registries content, coverage, completeness and the quality of the data are discussed in this article. Furthermore, conditions for access to the data are presented. The two prescription registries cover a background population of approximately one million or 18% of the Danish population. The populations covered by the registries are stable and representative of the Danish population in general. The registries cover all reimbursed medicine at the level of the individual user. Registration of a unique and permanent personal identifier enables the compilation of longitudinal drug histories and allows the linking of prescription data to other population-based Danish registries. The degree of completeness of the Danish prescription registries is excellent for reimbursed prescription drugs. A small number of comparison studies also indicate high validity of the register information. The Danish prescription registries represent a useful new data source for pharmacoepidemiological studies.

Adverse Drug Reaction Reporting Systems↗
PubMed2003

Impact of an annual dollar limit or "cap" on prescription drug benefits for Medicare patients.

CONTEXT: Annual dollar limits, or "caps," on drug benefits are common in Medicare managed care (Medicare + Choice) and have been part of several proposals for a national Medicare drug benefit. OBJECTIVES: To determine how cap levels affect the percentage of patients exceeding the cap and their out-of-pocket drug costs and to identify the medications that contribute most to prescription costs. DESIGN AND SETTING: Cross-sectional analysis of 2001 pharmacy claims data from a large Medicare + Choice plan in a mature market with caps of 750 dollars to 2000 dollars per year applied to the plan's share of prescription costs. PARTICIPANTS: Patients who filled at least 1 prescription in 2001 (n = 438 802). MAIN OUTCOME MEASURES: Percentages of patients exceeding caps, identified from prescription claims; out-of-pocket patient costs before exceeding caps, calculated from patients' co-payments; and out-of-pocket patient costs after exceeding caps, estimated from total prescription costs before exceeding the cap. Each unique drug was ranked by total expenditures, which included spending by patients who exceeded caps and by the plan for that drug. RESULTS: A total of 22%, 14%, and 4% of Medicare patients exceeded caps of 750 dollars, 1000 dollars, and 2000 dollars, respectively. Across caps, patients faced a potential 2- to 3-fold increase in median out-of-pocket costs after exceeding caps (179 dollars-305/mo dollars) to continue the same prescription use as before exceeding caps (79-100/mo dollars). For patients who exceeded a cap of 750 dollars, yearly out-of-pocket drug costs ranged from 564 dollars to 4201 dollars (5th-95th percentiles). Fifteen of the 20 medications with the highest total prescription expenditures for patients who exceeded the cap were for chronic conditions. Seven had lower-cost generic versions or a generic medication available in the same treatment class. CONCLUSIONS: At lower caps, a substantial proportion of Medicare patients exceeded their annual drug benefit. To continue the same medication use as before exceeding caps, these patients faced potentially high increases in out-of-pocket costs for medications used primarily to treat chronic conditions. Generic options were not available for many of these drugs.

Aged↗
PubMed1998

Why do some patients not cash their prescriptions?

BACKGROUND: A small number of studies have used different methodologies to measure primary non-compliance, but they have not established the reasons for patients not cashing their prescriptions. It has been suggested that the number of uncashed prescriptions is a measure of the quality of doctor-patient communication, but this hypothesis remains untested. AIM: To establish the feasibility of obtaining data on a sensitive subject from patients by interview and to seek patients' reasons for not cashing prescriptions using qualitative data. METHOD: Questionnaire administered to 1000 consecutive patients attending surgery, followed by interview with those patients who indicated that they had not cashed the index prescription. RESULTS: The response rate was 93.5%. Twenty-two patients were included in the study. There was wide variation in the number of uncashed prescriptions issued by each doctor (1-13). A total of nine out of 22 patients reported that their medication was cheaper over the counter and obtained it in this way; 13 out of 22 did not obtain their medication. Five patients indicated that cost was a factor in not obtaining their medication. Other factors included the doctor's permission not to cash the prescription, poor understanding of the illness, and the wish to maintain control. CONCLUSION: It is feasible to ask patients about aspects of their behaviour that may indicate, or cause, difficulties in the doctor-patient relationship. Prescribing behaviour varies widely between doctors and, although cost is a factor in determining whether a prescription will be cashed, other variables, such as the patient's desire to maintain control over the illness, may be more important.

Adolescent↗
PubMed2004

Characterizations of long-term oxycodone/acetaminophen prescriptions in veteran patients.

BACKGROUND: Long-term management of chronic pain with opioids may be stable over time or may be complicated by problematic dose increases, drug dependencies, and toxic effects. To determine clinical contexts in which stability or problems may occur, we examined the pharmacologic and clinical correlates of long-term prescriptions of oxycodone/acetaminophen, a commonly prescribed short-acting opioid formulation. METHODS: We analyzed linked, archival outpatient pharmacy and clinical databases from the New England Veterans Integrated Service Network between January 1, 1998, and June 30, 2001. Durations, doses, and dose changes of oxycodone/acetaminophen prescriptions and concurrent use of long-acting opioids, benzodiazepines, tricyclic antidepressants, and anticonvulsants were determined. RESULTS: In aggregate, 2195 patients (31% with cancer diagnoses per the International Classification of Diseases, Ninth Revision, Clinical Modification) received oxycodone/acetaminophen for more than 9 months at a mean prescribed daily dose of 3.9 tablets per day (range, 0.5-13.0 tablets per day) with minimal changes in daily prescribed mean dose over time. Patients with cancer were more likely than other patients to receive concurrent long-acting opioids. For patients without cancer, a higher mean daily dose was associated with duration, older age, human immunodeficiency virus (HIV) and/or AIDS, and with prescribed benzodiazepines and long-acting opioids; concurrent benzodiazepine prescriptions were associated with anticonvulsant prescriptions and with psychogenic pain and alcohol abuse and/or dependence diagnoses. CONCLUSIONS: In veteran patients who received long-term oxycodone/acetaminophen prescriptions, mean daily doses were typically modest and stable, likely reflecting a selection of patients with successful, long-term management. Among patients without cancer, however, associations of higher oxycodone/acetaminophen doses with benzodiazepine prescriptions, psychogenic pain, alcohol abuse, and HIV/AIDS may portend opioid prescription management problems.

Acetaminophen↗
PubMed2005

Patterns of prescription of four major antipsychotics: a retrospective study based on medical records of psychiatric inpatients.

PURPOSE: (1) To identify factors associated with the choice among the three atypical antipsychotics available in France (amisulpride, olanzapine, risperidone) and the typical antipsychotic of reference: (haloperidol), (2) to compare psychotropic co-prescription rates according to antipsychotic. METHODS: All antipsychotic prescriptions including at least one of the four antipsychotics (n=421) for all inpatients (n=372) hospitalized 24 hours or more in the 6 months previous to the start of the study were included (2003). Data were obtained from medical records and psychiatrist interviews. Of the prescriptions, 13.3% included amisulpride, 39.4% olanzapine, 27.3% risperidone, and 20.0% haloperidol. Mean dosages were 142 mg (amisulpride), 15 mg (olanzapine), 4.5 mg (risperidone), and 19.5 mg (haloperidol). RESULTS: Differences between antipsychotics were observed in relation to patients' age (younger patients prescribed amisulpride and olanzapine, p=0.04), diagnoses (affective disorders more frequently prescribed olanzapine and risperidone, p=0.005), and mode of hospitalization (admissions under constraint more frequently prescribed haloperidol, p<0.001). Antidepressant and anxiolytic-hypnotic co-prescription rates were lower with haloperidol than with atypicals. Mood-stabilizer co-prescription rates were higher for olanzapine and risperidone than for haloperidol and amisulpride. Anticholinergic co-prescription was higher with haloperidol than with atypicals (p<0.001). CONCLUSIONS: Haloperidol was prescribed to a minority and targeted male patients hospitalized under constraint, using high dosages. Type and rate of co-prescriptions varied considerably between haloperidol and atypicals.

Adult↗
PubMed2003

[Cost reduction with project based prescription of generic ACE inhibitors].

BACKGROUND: Increasing drug costs are an economic burden for the health insurance system. AIM: The regional drug prescription pattern for ACE inhibitors in the Austrian county Burgenland was compared for patients discharged from hospital and those in primary care. Furthermore, the potential cost reduction by voluntary prescription of cheaper generic drugs was estimated in the project "Bessere Therapie zum besseren Preis". METHODS: Following consensual analysis of the regional cross-sectional study, a cheaper generic of the most cost-intensive class of ACE-inhibitor drugs should be prescribed at internal medicine wards and in primary care. The number of prescriptions for patients from the largest health insurance company BGKK was studied and the costs were calculated. RESULTS: Of the 1347 patients discharged during October 1999 from internal medicine departments of four different hospitals 879 patients received a total of 1440 cardiovascular drugs. The regional prescription pattern at hospitals matched that of physicians in primary care. Between the second quarter of 2000 and 2001, the prescription of ACE inhibitor drugs increased by project advertising from 23,627 packages by 13.1%, and drug costs in this group were reduced by [symbol: see text] 29,778 in this quarter (7.3% of costs). The number of Enalapril prescriptions increased by 33.4% with a percentual portion of generic Enalapril of 57.3%, and in the rest of Austria by 16.9% with 45.0% generics. CONCLUSION: Consensus based projects are appropriate pharmacoeconomic interventions to change prescription patterns, increase the use of drugs and reduce the increasing cost requirements.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1998

Prescription changes and drug costs at the interface between primary and specialist care.

OBJECTIVE: To explore the relevance of prescription changes and related drug costs when patients are referred from primary to secondary care. PATIENTS AND METHODS: Secondary analysis of data derived from a study on the quality of referrals, which was performed in 1989-1990. New and non-acute referrals of ambulatory patients were studied for internal medicine, neurology, and dermatology. Diagnoses were coded according to the ICPC, and drug names were coded according to the ATC. Prescription data were collected from referral letters and questionnaires. Drugs were also coded as generic or brand name products. Cost of treatment was calculated on the basis of information in the 1989 edition of the Dutch Public Health Care Drug Compendium taking into account the price of the drug and the duration of the prescription. Potential savings were calculated for those brand name products for which substitution by a similar drug was possible. RESULTS: Data on 289 referrals, representing 289 patients, were available for analysis. In 126 out of the 289 patients (43.6%), specialists added to or changed prescriptions initiated by the general practitioner (GP). Specialist prescribing tended to shift to more chronic use. The costs of specialist prescribing are on average 23% higher than for GP prescriptions. Although specialists had fewer opportunities for generic substitution, the potential for savings was greater than for GPs. In many cases, the specialists changed the diagnosis. Only in neurology was the relative risk of receiving a prescription increased when the diagnosis changed. CONCLUSION: Specialists have considerable influence on prescribing to outpatients. The number of prescriptions and the related costs increased greatly when patients were referred from primary to secondary care. The opportunities for generic substitution, and therefore for possible savings, are not fully exploited by GPs or specialists.

Costs and Cost Analysis↗
PubMed2006

Motives, diversion and routes of administration associated with nonmedical use of prescription opioids.

OBJECTIVES: The main objectives of this study were to assess the motives, diversion sources and routes of administration associated with the nonmedical use of prescription opioids as well as to examine substance use related problems associated with the nonmedical use of prescription opioids. METHOD: A self-administered, cross-sectional Web survey was conducted in 2005 at a large public Midwestern 4-year university in the U.S. using a probability-based sampling approach. The final sample included 4580 full-time undergraduate students. RESULTS: The three most common motives associated with the nonmedical use of prescription opioids were to relieve pain, get high, and experiment. The leading sources of prescription opioids were friends and parents although there were gender differences in reports of primary sources. More than 1 in every 10 nonmedical users reported intranasal administration. Multivariate analyses indicated nonmedical users of prescription opioids who used for motives other than to relieve pain, obtained these drugs from non-parental sources, or used these drugs via non-oral routes of administration were significantly more likely to experience substance use related problems. CONCLUSIONS: These results indicate that nonmedical use of prescription opioids represents a considerable problem for particular subgroups of college students. While additional research is needed, the present study offers important new directions for policy and research regarding prescription opioid misuse.

Administration, Intranasal↗
PubMed2005

Prescription of teratogenic medications in United States ambulatory practices.

PURPOSE: The purpose of this study was to identify the potentially teratogenic medications most frequently prescribed to women of childbearing age and the specialty of physicians who provide ambulatory care to women who use such medications. In addition, we evaluated rates of contraceptive counseling to explore awareness of the risks associated with teratogenic medication use. SUBJECTS AND METHODS: The prescription of teratogenic medications and provision of contraceptive counseling on 12,681 visits made by nonpregnant women, 14 to 44 years of age, to 1880 physicians in US ambulatory practice (National Ambulatory Medical Care Survey) between 1998 and 2000 was analyzed. RESULTS: Use of a potentially teratogenic, class D or X, medication by a woman of childbearing age is documented on 1 of every 13 visits made to US ambulatory practices. These include anxiolytics (4.1 million annual prescriptions), anticonvulsant medications (1.4 million annual prescriptions), antibiotics like doxycycline (1.4 million annual prescriptions), and statins (0.8 million annual prescriptions). Isotretinoin accounts for less than 5% of potentially teratogenic prescriptions (0.5 million annual prescriptions). Internists and family/general practitioners provide ambulatory care to 45% of women prescribed potentially teratogenic medications, psychiatrists provide ambulatory care to 20% of women prescribed potentially teratogenic medications, and dermatologists provide ambulatory care to 20% of women prescribed potentially teratogenic medications. Contraceptive counseling was provided on less than 20% of visits that documented use of a potential teratogen by a woman of childbearing age. Women using low-risk (class A or B) drugs received contraceptive counseling as frequently as women using potential teratogens (P = .24). CONCLUSION: Potentially teratogenic medications are prescribed to millions of women of childbearing age each year. Physician awareness of the teratogenic risk associated with class D or X medications seems low.

Abnormalities, Drug-Induced↗
PubMed2005

The association of consumer cost-sharing and direct-to-consumer advertising with prescription drug use.

BACKGROUND: Previous research on the impact of various cost-sharing strategies on prescription drug use has not considered the impact of direct-to-consumer (DTC) advertising. OBJECTIVE: To explore the association of cost-containment strategies with prescription drug use and to determine if the association is moderated by DTC prescription drug advertising. METHODS: The study population included 288 280 employees and dependents aged 18 to 65 years with employer-sponsored health insurance contributing to the MEDSTAT MarketScan administrative data set. Person-level enrollment and claims data were obtained for beneficiaries enrolled continuously during July 1997 through December 1998. Direct-to-consumer advertising data were obtained from Competitive Media Reporting and linked to the MEDSTAT enrollment files. Localized DTC advertising expenditures for one class of medication were evaluated and matched with prescription claims for eligible MEDSTAT contributors. The association of various types and levels of cost-sharing incentives with incident product use was evaluated, controlling for the level of DTC advertising, health status, and other demographic covariates. RESULTS: The relationship of cost-sharing amounts with drug use was modified by the level of DTC advertising in a geographic market. This relationship was dependent on the type of cost-sharing, distinguishing between co-payments for provider visits and co-payments for prescription drugs. Compared with low-advertising markets, individuals residing in markets with high levels of advertising and paying provider co-payments of $10.00 or more were more likely to use the advertised product. In the same markets, higher prescription drug co-payments were associated with a decreased likelihood of using the advertised product. A similar relationship was not observed for the nonadvertised competitor. CONCLUSIONS: Among insured individuals, response to cost-sharing strategies is moderated by DTC prescription drug advertising. The relative ability of cost-sharing strategies to influence drug use should be interpreted with caution in the presence of DTC advertising.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2005

Distinguishing characteristics of patients who seek more information or request a prescription in response to direct-to-consumer advertisements.

OBJECTIVE: The objective of this study was to examine demographic and psychographic profiles of individuals who sought additional information or requested a prescription drug based on a direct-to-consumer advertisement. METHODS: A cross-sectional descriptive survey was used for collecting data from a random sample of 200 Minnesotans during Fall 2002. Chi-square and Mann-Whitney U tests were used as nonparametric tests for assessing differences in distributions between our categories of study subjects. RESULTS: Out of 177 deliverable surveys, 81 (46%) were returned. Of these, 80 surveys were usable for analysis. The results showed that the distinguishing characteristics of individuals who sought additional information based on an advertisement were associated with demographic variables such as number of drugs taken daily and monthly out-of-pocket expenditures for prescription drugs. In contrast, distinguishing characteristics of individuals who requested prescription drugs (in addition to seeking information) based on an advertisement were psychographic in nature such as (1) viewing themselves as having greater influence on their physician, (2) having a stronger relationship with their physician, (3) expressing greater satisfaction with their current therapy, (4) viewing prescriptions as less of a burden, and (5) having higher outcome expectations for prescription drugs compared to the respondents who did not ask for a prescription drug based on a direct-to-consumer advertisement. CONCLUSIONS: Distinguishing characteristics of information seekers were demographic in nature, whereas those characteristics of prescription requesters were psychographic in nature.

Advertising↗
PubMed2005

Trend and area variation in amphetamine prescription usage among children and adolescents in Michigan.

The increased use of stimulant medications for children and teenagers is an ongoing issue of professional and public concern. Unlike methylphenidate, the growth of prescriptions and patterns of utilization of amphetamines for pediatric populations have not been well documented. The study objectives were to describe the trends of amphetamine prescription utilization among pediatric age groups in Michigan and to compare area variations. A population-based computerized data set from the state of Michigan was used to extract all outpatient prescriptions for Schedule II amphetamines dispensed from 1990 to 1997. The prescribing rates by age groups and by counties were computed with the projected population size of corresponding years, and mapped and analyzed with spatial statistical methods. Counties that did not conform to the global spatial dependence pattern in the prescription rate were identified using Moran scatter plot. A total of 236,661 outpatient prescriptions for amphetamines were dispensed in Michigan during the time frame, including less than 1% for methamphetamine, 24.5% for amphetamine, and 74.8% for dextroamphetamine. The prescribing rate was highest among children 10-14 years old (380 prescriptions per 10,000 people) in 1997, followed by children 5-9 years old (253 prescriptions per 10,000). Over the 8-year period, the prescribing rates of amphetamines increased significantly, ranging from 380% for children 2-4 years to 817% for teenagers older than 14 years. The rates among counties ranged from 60 to 1648 per 10,000 children 5-14 years old, with the highest prescribing rates in the northwestern regions of Michigan. Although spatial dependence explained 36% of the variance, the area variations that are unaccounted for are still considerable. In conclusion, there were substantial increases and unexplained area variations in amphetamine usage in Michigan during the study period. Both phenomena require awareness and evaluation from researchers, policy makers, clinicians, and the public.

Adolescent↗
PubMed2003

Prescription of QT-prolonging drugs in a cohort of about 5 million outpatients.

Many drugs prolong the QT interval and increase the risk of torsade de pointes. Concurrent use of two or more of these drugs can further increase the risk, but the prevalence of concurrent prescription of QT-prolonging drugs is not known. Using the administrative claims database of a national pharmaceutical benefit manager, we conducted a retrospective cohort study in 4,825,345 subjects aged 18 years or older. After identifying 50 drugs with QT-prolonging potential, and an additional 26 drugs that inhibit the metabolic clearance of QT-prolonging drugs, we measured the frequency of overlapping prescriptions for two or more of these drugs in the outpatient setting in 1999. Nearly 1.1 million subjects (22.8%) filled 4.4 million prescriptions for QT-prolonging drugs. Of these, 103,119 subjects (9.4%) filled overlapping prescriptions for two or more of the drugs or for a QT-prolonging drug and another drug that inhibits its clearance; 7249 subjects (0.7%) filled overlapping prescriptions for three or more of these drugs. Twenty-two percent of subjects who filled overlapping prescriptions were aged 65 or older; 74% were women. Antidepressants were involved in nearly 50% of the cases. Concurrent prescription of QT-prolonging drugs is common in the outpatient setting, and antidepressants are involved in half of these cases. Large pharmaceutical claims databases are useful for detecting potentially harmful prescribing behaviors, but better clinical evidence on medication safety is needed before such a system can be implemented fully.

Adult↗
PubMed2003

[Generic drug prescription at discharge from a hospital emergency service].

BACKGROUND AND OBJECTIVE: Drug prescription at hospital discharge often implies continuation of the treatment in primary health care. The aim of this study was to assess prescription of generics at discharge from a hospital emergency service. MATERIAL AND METHOD: Longitudinal and retrospective study, on a random sample of medical reports in a hospital emergency service during one year (August 2000 to July 2001). Information on the medical specialty, prescribed generic drugs and marked availability of the corresponding generic drugs pharmaceutical specialties was collected. Factors associated with generic prescription were analyzed by means of logistic regression analysis. RESULTS: A sample of 1,245 medical reports was selected in which 2,315 drugs were prescribed. Although generic drugs were available for 33.3% (CI 95%, 31.4-35.2) of prescriptions, 9.5% (95% CI, 8.3-10.7) of prescribed drugs were generics. The average price of trademark prescribed medicines, for which there was a generic equivalent, was 7.09 Euros (95% CI, 6.54-7.63 Euros), and that of the corresponding generic versions was 5.08 Euros (95% CI, 4.68-5.48 Euros). Variables associated with generic drug prescription included the particular study period (OR=1.35; 95% CI, 0.99-1.84), the medical specialty of the prescriber (OR=1.40; 95% CI, 1.05-1.86), availability of generic drugs (OR=1.76; 95% CI, 1.30-2.39) and low price of prescribed drugs (OR=2.67; 95% CI, 1.80-3.98). CONCLUSION: In spite of the availability of generic drugs, prescription of generic drugs at discharge of this hospital emergency service was low. Prescription and use of generic drugs should be promoted in hospitals.

Costs and Cost Analysis↗
PubMed2002

[Induced prescription in primary health care in area Bilbao].

OBJECTIVES MAIN OBJECTIVES: to know the proportion of induced prescription (IP) in Area Bilbao and its source, the proportion of cost IP accounts for, the proportion of IP in the main therapeutic groups, the attitude of GP when requested for prescription and its influence on cost, the proportion of disagreement with requested prescription, the reasons for disagreement, and the proportion with letter from specialist. SECONDARY OBJECTIVES: to know the proportion of IP in the remaining therapeutic groups, in drugs of low clinical value, in generic drugs and in new drugs with low or no therapeutic improvement. DESIGN: A descriptive cross-sectional study.Setting. Primary health care. PARTICIPANTS: Drugs prescribable under National Health Service prescribed by and/or requested to GPs. Main results. 7.922 drugs were analysed. Type of prescription: IP, 48.3% (95% CI, 47.2-49.4); GP prescription (GPP), 50.6% (95% CI, 49.5-51.7); unknown source, 1,1% (95% CI, 0.9-1.3). Main source, public specialist (72.2%), private specialist (16.6%). IP accounted for 62.5% of cost. In the most prescribed therapeutic group, central nervous system (24.2%), IP, 39.8%; GPP, 58.9%; in cardiovascular system (19.1%), IP, 56.2%; GPP, 43.1%. 98.4% of requested prescription was actually prescribed, 1.2% was changed and 0.4%, suppressed. Proportion of disagreement, 11%; reasons for disagreement, no need for medical treatment (23.9%), therapeutic group (34.4%), active ingredient (13.2%), brand name (28.5%). There was a 62.4% with letter from specialist. CONCLUSIONS: Primary care is not accountable for a substantial proportion of prescription. GP prescribes a considerable proportion of drugs without agreement. It would be necessary a system that allows to separate the cost by care levels and also improve their communication.

Adult↗
PubMed2002

Increased risk of serious injury following an initial prescription for diphenhydramine.

BACKGROUND: Diphenhydramine may be associated with excess risk of injury relative to nonsedating H1-receptor antagonists. OBJECTIVE: This study sought to compare the risk of injury in patients exposed to diphenhydramine with the risk of injury in patients exposed to loratadine. METHODS: A retrospective cohort study of injury was carried out in 12,106 patients whose initial antihistamine prescription was for diphenhydramine and in 24,968 patients whose initial antihistamine prescription was for loratadine. Data were taken from a health care claims database that included employees, dependents, and retirees who filed claims from January 1991 through December 1998. Rates of six serious injuries in the diphenhydramine cohort after and before the first prescription were compared with rates in the loratadine cohort after and before the first prescription. RESULTS: In the 30 days after the first antihistamine prescription, the rate of all injuries was 308 per 1,000 person-years in the diphenhydramine cohort versus 137 per 1,000 person-years in the loratadine cohort. The rate ratio estimate adjusted for age and gender using Poisson regression was 2.27 (95% confidence limits [CL] 1.93, 2.66). In the corresponding 30 days of the preceding year, the injury rates in the diphenhydramine and loratadine cohorts were 128 and 125 per 1,000 person-years, and the adjusted rate ratio was 1.02 (CL 0.83, 1.26). Thus, the cohorts appeared to have similar preprescription injury rates. The differences between the cohorts declined with time from prescription: For all injuries, the estimated percentage decline in the rate ratio was 4.1% per day (CL 3.3, 4.9), and the estimated time from the initial prescription until the diphenhydramine cohort returned to baseline risk was 32.3 days (CL 26.9, 37.6). CONCLUSIONS: If these associations are causal, the percentage of the injuries attributable to diphenhydramine was 55% (CL 41, 65), implying a substantial number of excess injuries and costs incurred as the result of diphenhydramine use. The high use rates of this drug and the high incidence of injury suggest that further study of the association between injury and type of antihistamine is needed.

Adolescent↗
PubMed1998

Antacid (A02A) and antiulcer (A02B) drug prescription patterns: predicting factors, dosage and treatment duration.

BACKGROUND: A study is made of the pharmaco-epidemiology of antacid (ATC class A02A) and antiulcer (A02B) drug prescriptions during the year 1992. METHODS: Prescription data were extracted from 1941 case histories of patients over 15 years old from four health care centers in the Valencian Community (Spain). Dosage and treatment duration were evaluated, along with the way in which morbidity, self-evaluated health, the demographic pattern and life-style characteristics influence drug prescription. RESULTS: The proportion of drug prescriptions increased with age in both sexes (p < 0.01). Drug use depended mainly on chronic diseases. In prescribing antacids, the most influential diagnosis was gastritis (ICD 534, OR: 157), followed by duodenal ulcer (ICD 532, OR: 152) and gastric ulcer (ICD 531, OR: 122), other gastrointestinal disorders (ICD 66, OR: 54) and undefined diagnoses (OR: 15). In the prescription of antiulcer drugs, the most influential diagnoses were gastric and duodenal ulcer (OR: 380 and 342, respectively), and a significant relation was observed with the diagnosis of osteomuscular diseases (OR: 6). Lifestyle and demographic pattern were of marginal importance. The estimated duration of treatment was 85 days. No significant differences were observed in either treatment duration or administered doses of almagate, ranitidine and omeprazole with respect to sex, age or diagnosis. CONCLUSIONS: Prolonged treatment is common for acid suppression. The widespread use of peptic ulcer drugs is mostly due to excessive prescription for non-ulcer dyspepsia. At the same time, many patients consume these drugs on a long-term basis in the absence of a clear diagnosis. This observation supports the need for appropriate diagnostic and prescription protocols to secure increased economical savings and management results.

Adolescent↗