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PubMed1992

Frequency response differences of four gain-equalized hearing aid prescription formulae.

The relative differences between the NAL, Berger, Lybarger und POGO hearing aid prescriptions were evaluated using 8 hypothetical audiograms and 81 actual hearing loss cases. The gains of the prescriptions were equalized, making the prescriptions maximally similar, as would presumably occur when the aids are worn. Statistically significant differences in the frequency responses of the prescriptions were found, with up to 17 dB gain difference observed; however, the gain differences at any given frequency were generally less than 8 dB. Sharply sloping hearing losses had the greatest differences between prescriptions. The NAL and Berger prescriptions were most disparate, while POGO and Lybarger were most similar. As large differences in prescribed gain are rare, research into the relevance of such small differences in frequency response is advocated as a precursor to study of the optimal prescription formula.

Ear↗
PubMed1997

Drug prescribing during direct and indirect contacts with patients in general practice. A report from the Møre & Romsdal Prescription Study.

OBJECTIVE: To describe general practitioners' (GPs) prescribing patterns during direct contacts (DC) vs. indirect contacts (IC) with respect to the patients (age and sex), diagnoses, and drugs. DESIGN: Descriptive study. SETTING: In the Norwegian county Møre & Romsdal, the GPs recorded all contacts with patients and prescriptions during two months. SUBJECTS: 69843 contacts with patients (42202 DC; 24983 IC) during which 56758 prescriptions were issued. MAIN OUTCOME MEASURES: Prescriptions (drugs, strength of tablets, amount prescribed, initial/repeat). Diagnoses for prescribing. RESULTS: 72 drugs were prescribed per 100 DC; 93 per 100 IC. The drugs prescribed most frequently during DC were CNS-drugs (19%), antibiotics (18%), and respiratory drugs (14%); and during IC, CNS-drugs (34%), cardiovascular (16%), and respiratory drugs (12%). More prescriptions during IC were repeat (IC, 79%; DC, 37%). 57% of all CNS-drugs were issued during IC (90% of which were repeat prescriptions). 25% of the antibiotics were issued during IC (70% of which were initial prescriptions). CONCLUSION: The GPs' prescribing patterns during DC and IC are different, which probably reflects that different health problems are handled during DC and IC. Prescription studies should address both settings. Our findings raise concern about the medical foundation for antibiotic and psychotropic prescribing during IC.

Adolescent↗
PubMed2006

Nonmedical use of prescription stimulants among students.

Despite the caveats discussed above, national epidemiologic surveys are useful in estimating the prevalence and historical trends of nonmedical use of prescription stimulants. Because it would be difficult and cost-prohibitive to ask several more in-depth questions on these national surveys, other smaller-scale research studies should be undertaken to understand more about the patterns and consequences of nonmedical use of prescription stimulants. The data from the few studies of college students suggest college students are more likely to use prescription stimulants than their noncollege-attending counterparts and suggest college students may experience a need to stay awake to study given the high level of demands in the college environment. More and more people are taking advantage of the opportunity to go to college, making the selection process more competitive. More data are needed regarding the availability of prescription stimulants on college campuses and, in particular, the availability and use of other types of prescription stimulants other than methylphenidate. Data from the college studies presented here also suggest that, in addition to using prescription stimulants as a study aid, students use prescription stimulants to stay awake longer to party or drink more. Because heavy drinking is known to be associated with a wide variety of negative consequences, it is important to learn more about this particular interaction so that appropriate prevention initiatives can be developed.

Adolescent↗
PubMed1999

The use of non-prescription sleep products in the elderly.

UNLABELLED: While sleep disorders are common in the elderly, the use of non-prescription products for sleep in this population has not been fully evaluated. The objectives of this project were to assess the use, perceived effectiveness and toxicity of non-prescription sleep products in an ambulatory elderly population. METHODS: A self-administered 20-question survey was distributed to seniors, aged 60 years or more, during hospital or pharmacy visits. RESULTS: Of the total respondents (N=176, mean age 74+/-7 years, 59% female), 84 (48%) indicated that they had used one or more therapies for sleep within the past year. These included non-prescription products (50% of therapies), prescription products (17%) and non-drug activities such as walking or drinking milk (34%). For those individuals who had used a non-prescription product in the past year (N=47, 27% of total respondents), the most frequently used products were: dimenhydrinate (21%), acetaminophen (19%), diphenhydramine (15%), alcohol (13%) and herbal products (11%). Most took them at least 1 day per week (79%) and 32% took them daily. These products subjectively improved sleep latency (mean 32 vs 61 minutes, p<0.001), number of nocturnal awakenings (mean 2 vs 3 awakenings, p<0.001) and total hours of sleep (mean 6.6 vs 5.4 hours, p<0.001). Mild side-effects were reported by 35 respondents (75%), the most common being dry mouth (N=22) and daytime drowsiness (N=13). Respondents were taking an average of four (SD+/-3, range 0-10) other medications currently. CONCLUSIONS: Non-prescription products are widely used by this population of ambulatory elderly for sleep disturbances. Most of the products were not marketed for sleep; however, they were perceived to be efficacious with low toxicity. The potential for drug interaction is high. Further research is warranted to evaluate the safety and effectiveness of non-prescription sleep products in the elderly.

Aged↗
PubMed2000

The early experience of general practitioners using Green Prescription.

AIM: Sedentary lifestyle is a significant risk factor for increased morbidity and mortality in many medical conditions. A Hillary Commission initiative, Green Prescription is a written exercise prescription given by general practitioners (GPs) to sedentary patients to encourage physical activity. Our aim was to establish the extent to which GPs in the North Health region in 1997 issued with Green Prescription packages had used them, the circumstances under which they were used, and barriers to their use. METHODS: 433 GPs issued with packs were faxed a one-page questionnaire for immediate completion, with follow-up of non-responders. RESULTS: The response rate was 73%, with 65% of respondents having written Green Prescriptions. Their main reasons for use were patient need for more exercise and presence of high-risk medical conditions such as hypertension, cardiovascular disease, obesity and diabetes. Reasons for non-use were: GP already giving advice about physical activity; concern that Green Prescription was patronising and simplistic; compliance issues and time restraints. Some requested a computerised version. CONCLUSION: Non-responders may be non-users, hence we estimate that 48-65% of targeted GPs used Green Prescription. Barriers identified by GPs have assisted in Green Prescription development, which is now nationwide and assessed by independent researchers tri-annually.

Adult↗
PubMed2001

Discharge prescriptions following admission for acute myocardial infarction at tertiary care and community hospitals in Quebec.

BACKGROUND: Many physicians are not adhering to the recommendations found in evidence-based guidelines for the treatment of acute myocardial infarction (AMI). Physicians who practise in tertiary care settings may show better adherence to guideline recommendations than physicians who practise in other settings. OBJECTIVE: To determine whether there is an association between the practice setting of admission for AMI and discharge prescriptions for cardiac drugs recommended in evidence-based guidelines. PATIENTS AND METHODS: Discharge prescription data from a prospective cohort of patients with AMI admitted at five tertiary care (n=250) and five community hospitals (n=331) in Quebec from December 1996 to November 1998 were examined. RESULTS: The proportions of patients who were prescribed recommended drugs at tertiary care hospitals compared with those at community hospitals were as follows: beta-blockers (78% versus 74%, respectively; 95% CI around the difference - 4% to 11%), lipid-lowering drugs (45% versus 39%, respectively; 95% CI - 2% to 15%) and angiotensin-converting enzyme (ACE) inhibitors (44% versus 57%, respectively; 95% CI - 22% to - 5%). In adjusted analyses, practice setting was not associated with the prescription of beta-blockers (odds ratio [OR] for tertiary care 1.36; 95% CI 0.82 to 2.24) or lipid-lowering drugs (OR for tertiary care 1.06; 95% CI 0.67 to 1.68). However, tertiary care admission reduced the likelihood of ACE inhibitor prescription (OR 0.50; 95% CI 0.32 to 0.77). This association may have been due to the increased likelihood of ACE inhibitor prescription for patients with hypertension at community hospitals (OR 2.13; 95% CI 1.23 to 3.67). The results also showed that older patients were less likely to be prescribed beta-blockers or lipid-lowering drugs, women were less likely to be prescribed beta-blockers and patients with diabetes mellitus were less likely to be prescribed lipid-lowering drugs (OR 0.45; 95% CI 0.23 to 0.89). CONCLUSION: No strong association was found between the practice setting of admission for AMI and discharge prescriptions for cardiac drugs recommended in evidence-based guidelines. Prescription rates for recommended drugs were high, yet results suggest that there is room for improvement with regard to patients with diabetes, women and older patients.

Adrenergic Antagonists↗
PubMed2001

Effect of prescription benefit changes on medical care utilization in a Medicare HMO population.

OBJECTIVE: To examine the impact of 2 cost-containment efforts in prescription benefits in successive years that included changes in copayment and coverage levels, expanded generic coverage, and brand name prescription drug limit-of-coverage in a Medicare health maintenance organization (HMO). The benefit changes included moving to a drug benefit with increased total coverage and higher copayments in the first year (1998) and to one with brand name limit-of-coverage and unlimited generic availability in the second year (1999). STUDY DESIGN: A repeated-measures analytical design with enrollee follow-up before and after introduction of the 2 policies. PATIENTS AND METHODS: A cohort of 2411 older adults continuously enrolled in a Medicare HMO since 1998 was followed up for 1 year pre-post for healthcare service utilization and costs; 259 patients enrolled since 1997 were available to test the effects of the first policy change. RESULTS: Bivariate and multivariate analyses found a significant decrease of 27% in prescription costs, a 4% decrease in physician visits, and a 6% decrease in total costs associated with the change in prescription benefit in the second year (1999). The policy change in the first year (1998) resulted in a 29% increase in prescription costs and 38% increased total costs for the HMO. CONCLUSIONS: Introduction of a prescription benefit that included substantial brand name limit-of-coverage and generic drug coverage expansion was associated with significantly reduced prescription costs. In addition, this change did not seem to increase nonprescription-related healthcare service use in the population.

Aged↗
PubMed2002

Do delayed prescriptions reduce the use of antibiotics for the common cold? A single-blind controlled trial.

OBJECTIVE: To test the use of a delayed prescription compared with instructions to take antibiotics immediately in patients presenting to family physicians with upper respiratory tract infections (common colds). STUDY DESIGN: Randomized controlled single-blind study. POPULATION: Subjects were 129 patients presenting with the common cold who requested antibiotics or whose physicians thought they wanted them. All patients were in a family practice in Auckland, New Zealand, consisting of 15 physicians (9 male, 6 female) who had completed medical school between 1973 and 1992. OUTCOMES MEASURED: Outcomes were antibiotic use (taking at least 1 dose of the antibiotic), symptom scores, and responses to the satisfaction questions asked at the end of the study. RESULTS: Patients in the delayed-prescription group were less likely to use antibiotics (48%, 95% CI, 35%-60%) than were those instructed to take antibiotics immediately (89%, 95% CI, 76%-94%). Daily body temperature was higher in the immediate-prescription group. The lack of difference in the symptom score between the 2 groups suggests that there is no danger in delaying antibiotic prescriptions for the common cold. CONCLUSIONS: Delayed prescriptions are a safe and effective means of reducing antibiotic consumption in patients with the common cold. Clarification of patient expectations for antibiotics may result in a lower prescription rate. When the patient demands a prescription, delaying its delivery has the potential to provide gentle education.

Adult↗
PubMed2003

[Effects of "Qiang Gu Kang Wei" compound prescription on bone metabolism in rats under simulated weightlessness].

OBJECTIVE: To investigate the effect of "Qiang Gu Kang Wei" prescription on bone metabolism in simulated weightless rats. METHOD: Male SD rats were randomly divided into five groups: 1) free active control (FAC); 2) tail-suspended control (TS); 3) tail-suspended and treated with large dose of the prescription (TS + L) (30 g/kg); 4) tail-suspended and treated with middle dose of the prescription (TS + M) (20 g/kg); 5) tail suspended and treated with small dose of the prescription (TS + S) (10 g/kg). The experiment lasted 3 weeks. The effect of the prescription on bone biomechanical properties, bone density, bone mineral contents, and bone biochemical markers of bone metabolism were examined. RESULT: Bone biomechanical properties, bone density, total and bound bone gla protein (BGP) of serum all increased significantly in three groups treated with the prescription. CONCLUSION: "Qiang Gu Kang Wei" prescription prevents bone loss, hence maintains bone density and bone biomechanical properties under simulated weightlessness.

Animals↗
PubMed2003

Prescription drug access disparities among working-age Americans.

Working-age African Americans and Latinos are much more likely than white Americans to report they cannot afford all of their prescription drugs, according to a new study by the Center for Studying Health System Change (HSC). In 2001, nearly one in five blacks and one in six Latinos 18 to 64 years old did not purchase all of their prescriptions because of cost, compared with slightly more than one in 10 whites. Cost-related prescription drug access problems are considerably higher for people with chronic conditions, particularly African Americans. Regardless of race or ethnicity, uninsured working-age people with chronic conditions are at particular risk for not being able to afford all of their prescriptions, with about half reporting cost-related prescription access problems. Increased patient cost sharing for prescription drugs will likely increase prescription drug access disparities for insured African Americans and Latinos, especially those with chronic conditions.

Adult↗
PubMed2002

National All Schedules Prescription Electronic Reporting Act (NASPER): balancing substance abuse and medical necessity.

The National All Schedules Prescription Electronic Reporting Act, or NASPER, is a bill proposed by the American Society of Interventional Pain Physicians to provide and improve patient access with quality care, and protect patients and physicians from deleterious effects of controlled substance misuse, abuse and trafficking. Controlled prescription drugs, including narcotic analgesics, anxiolytics, anti-depressants, stimulants, and sedative-hypnotics play a significant and legitimate role in interventional pain management practices in managing chronic pain and related disorders. Based on the 1997 household survey on drug abuse it is estimated that 76.9 million Americans had used an illicit drug at least once in their life. In 1997, 4.2 million people used analgesics, 2.1 million used tranquillizers, and an additional 2.3 million people used various other drugs, including sedatives, tranquillizers, etc. The non-medical use of prescription drugs exceeds that of all illicit substances except for marijuana and hashish. The report on epidemiology trends in drug abuse, based on community epidemiology work group analysis showed continued increase of abuse of prescription drugs in urban, suburban, and rural areas. The most commonly abused drugs include oxycodone, hydrocodone, hydromorphone, morphine, codeine, clonazepam, alprazolam, lorazepam, diazepam and carisoprodol. The diversion of prescription controlled substances to illicit channels is a public health and safety issue. This review describes the role of controlled substances in chronic pain management, prevalence and economic impact of controlled substance abuse, prescription accountability, effectiveness of prescription monitoring programs, and rationale for national controlled substance electronic reporting system.

Journal Article↗
PubMed1989

[Prescription of psychopharmaceuticals in general practice. 1. A registry study in the county of Arhus].

Prescription of psychotropic drugs by general practitioners was registered by means of a multicenter-questionnaire investigation in the County of Arhus. A total of 227 doctors registered 4,180 prescriptions to 3,756 patients during one week. The sex ratio (m/f) was 0.5, calculated not only from the number of prescriptions but also from the defined daily doses (DDD). The frequencies of prescribing increased markedly with age so that for men and women in the age group 70+, these were 188 and 322 DDD/1,000 of the population per 24 hours, respectively. Benzodiazepines constituted 67.3% of all of the prescriptions and 76.9% of the prescribed DDD while neuroleptics constituted 13.6% and 3.9% and antidepressives 9.5% and 7.0%, respectively. Neuroleptics were prescribed in doses of about 1/5 DDD. About 50% of the first prescriptions but only 17% of the renewed prescriptions were undertaken by direct doctor-patient contact in connection with consultations or visits in the home. Prescription of psychotropic drug by general practitioners is estimated to constitute just under 90% of the psychotropic drug in the County of Arhus.

Adolescent↗
PubMed1989

[An analysis of massive prescription of tranquilizers and hypnotics].

Investigation of the prescriptions for tranquilizers and hypnotics issued in a provincial Danish town with approximately 30,000 inhabitants, revealed that 12% of all users over 40 years had received massive quantities of tranquilizers and hypnotics within one month, viz more than 100 defined daily doses/user. Only four recipients of massive prescriptions were found in the age group 16-39 years. In the group of recipients of massive prescriptions over the age of 60 years, it was found that persons entitled to medicine free-of-charge comprised every third or forth user. Recipients of massive prescriptions over the age of 40 years did not differ as regards age and sex from recipients of ordinary quantities, viz less than or equal to 100 defined daily doses/user/month. Differences in the frequencies of prescription of massive quantities could be demonstrated between the various general practices. These differences could not be correlated with differences in the ages of the general practitioners, types of practice or sizes of practice. A series of prescribing habits on the part of the practitioner appear to be of particular significance for prescription of massive quantities of tranquillizers and hypnotics. These include; the decision to prescribe hypnotics, choice of hypnotic and prescription of several tranquillizers and/or hypnotics simultaneously.

Adolescent↗
PubMed1994

Prescription of nonsteroidal anti-inflammatory drugs for elderly people in Alberta.

OBJECTIVE: To examine the extent prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) are used by elderly people in Alberta as well as the degree of concurrent use of multiple NSAIDs, of peptic ulcer medications and of certain medications known to have clinically significant adverse interactions with NSAIDs. DESIGN: Retrospective analysis of the Alberta Blue Cross database. SETTING: Alberta. PATIENTS: All people 65 years of age and older using the subsidized drug benefit plan for whom prescription claims were submitted for reimbursement between Jan. 1 and June 30, 1991. OUTCOME MEASURES: Number of people who received one or more prescriptions for NSAIDs, rates of prescribing peptic ulcer medications and drugs with the potential for clinically significant interactions with NSAIDs among NSAID users and non-NSAID users, and rate of prescribing more than one NSAID concurrently. RESULTS: Of the Albertan population 65 years of age and over 61,601 (26.7%) received at least one prescription for an NSAID during the study period. In decreasing order, the five most commonly prescribed NSAIDs were acetylsalicylic acid, diclofenac, naproxen, indomethacin and ibuprofen. The total cost of NSAID therapy was $5,415,974. Of the people prescribed an NSAID 25.8% were also prescribed a peptic ulcer medication, as compared with 10.5% of the non-NSAID users. There was a significant relation between the increasing number of NSAID prescriptions and the likelihood of receiving a peptic ulcer medication. Those who received a prescription for an NSAID were more likely than non-NSAID users to have been prescribed coumarin anticoagulants, diuretics, angiotensin-converting-enzyme inhibitors, beta-blockers, oral corticosteroids, methotrexate and lithium, all of which are known to have possible adverse interactions with NSAIDs. A total of 2,631 people had two or more prescriptions for NSAIDs filled on the same day. CONCLUSIONS: NSAIDs are prescribed frequently for elderly people and are associated with an increased likelihood of concurrent prescription of peptic ulcer medication and medications that could have adverse drug interactions with NSAIDs. Additional study is required to evaluate the appropriateness of NSAID use in elderly patients, to determine the degree of actual patient consumption of these medications, to document the true prevalence of clinically significant drug interactions and to formulate educational strategies to reach physicians with this information.

Aged↗
PubMed1999

Factors contributing to trends in prescription drug expenditures.

Between 1970 and 1995, national prescription drug expenditures and Medicaid drug expenditures increased proportionately less than did total health care expenditures and total Medicaid expenditures, respectively, although they increased to a greater extent than did expenditures in other sectors of the economy. General inflation, which cannot be controlled by health care policy, has been the major factor contributing to the growth in national prescription drug expenditures. Other contributors were population growth, increases in per capita prescription use, increases in per-prescription intensity (ie, real drug expenditures), and the fact that prescription drug prices exceeded general inflation. Medicaid drug expenditures have increased mainly because of growth in the number of drug recipients, increases in prescription drug prices, and economy-wide inflation.

Data Collection↗
PubMed1975

A comparison of maintenance and nonmaintenance outpatient prescription directions, durations of coverage, and costs per day.

The purpose of this paper is to present the results of a study on maintenance and nonmaintenance drugs written for outpatients not covered by prescription insurance. The average cost to the patient for a day's supply of drugs, as well as the average dosage, frequency of administration, and length of duration for maintenance and nonmaintenance drugs were examined. The objective of the study was to present the economics and prescribing patterns for the two groups of drugs in order to provide data on the costs involved and the prescribing patterns of physicians. The results of comparing the various components of maintenance and nonmaintenance drugs revealed that significant differences exist in the dosage direction, frequency of administration, units prescribed per day, lengths of duration, costs per day, prescription prices, and quantities prescribed and dispensed. Maintenance drug prescriptions tend to have lower dosage directions, costs per day, and frequencies of administration and higher quantities prescribed and dispensed, prescription prices, and lengths of duration. Two variables, frequency of administration and quantity prescribed, were found to have the greatest influence on the cost per day and length of duration for maintenance drug prescriptions. It is the conclusion of this study that further examination into the factors which influence the physician when he specifies the frequency of administration and quantity to prescribe on maintenance drug prescriptions be conducted.

Analysis of Variance↗
PubMed1975

Savings from generic prescriptions. A study of 33 pharmacies in Rochester, New York.

Brand name and gereric prescriptions for 12 drugs were surveyed at 33 pharmacies in the Rochester, New York, area to determine how frequently generic prescriptions were filled with a product other than the major brand, and at a savings to the consumer. Generic prescriptions for ampicillin, erythromycin, propoxyphene, and dioctyl sodium sulfosuccinate were often filled at prices lower than comparable brand name prescriptions. Occasional, but often substantial, savings were obtained for papaverine, pentaerythritol tetranitrate, and conjugated estrogens. No savings were obtained for penicillin V, chlorpheniramine, diphenylhydantoin, sulfisoxazole, or methenamine mandelate. The pharmacists included in the survey identified correctly a mean of 18.5 out of 22 drugs as to whether products other than the major brand were available. A sample of physicians identified correctly a mean of 14.1 drugs. Pharmacists who were better informed as to which drugs were available generically were more likely to stock alternative products and more likely to charge lower prices on generic prescriptions than on brand name prescriptions.

Alkanesulfonates↗
PubMedDate not supplied

Sources of prescription contraceptives and subsequent pregnancy among young women.

For more than four in 10 teenage women who first obtained a prescription contraceptive from a private doctor or family planning clinic prior to pregnancy, marriage or interview in 1979, that method was the first they had ever used. Whites were over two times more likely to have previously used a nonprescription method than were blacks. Blacks, on the other hand, were two times more likely than whites to have been virgins before first using a prescription method. Slightly more than half of all young women who used a prescription method first obtained it from a family planning clinic, and the remainder got it from a private physician. Blacks were much more likely to have gone to a clinic than were whites. Nine in 10 of those who obtained a prescription method chose the pill. Among blacks, there was no appreciable difference between those who got the method from a clinic and those whose source was a private doctor. Whites who obtained their method from a private doctor, however, were somewhat more likely to choose the pill than were those who got it from a clinic. Of all who had been sexually active before ever using a prescription method, about eight out of 10 whites, but only about five in 10 blacks, had previously used a nonprescription method. Overall, there was an interval of about one year between first intercourse and the time the young women first got a prescription method. Among whites, there was no difference in parental education or family stability between clinic and private physician patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗