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PubMed2005

Potential limitations of electronic database studies of prescription non-aspirin non-steroidal anti-inflammatory drugs (NANSAIDs) and risk of myocardial infarction (MI).

PURPOSE: To determine whether specific limitations in electronic database studies may lead to biased estimates of the association between prescription, non-selective non-aspirin non-steroidal anti-inflammatory drugs (NANSAIDs) and myocardial infarction (MI) METHODS: Using our case-control study of NANSAIDs and first, non-fatal MI, we determined the odds ratio (OR) for prescription NANSAIDs and MI. In the 'Replicating Electronic Database Analysis,' we considered non-prescription NANSAID users to be 'non-users,' did not stratify by aspirin use, and did not adjust for confounders typically unavailable or incomplete in existing databases. In the 'Misclassification Assessment Analysis,' we removed non-prescription NANSAIDs from the 'non-user' category. In the 'Confounding Assessment Analysis #1,' we additionally adjusted for smoking, family history, and years of education. In the 'Confounding Assessment Analysis #2,' we also adjusted for body mass index (BMI) and physical activity. In the 'Interaction Assessment Analysis,' we stratified on aspirin use and repeated the latter analysis. RESULTS: The prevalence of current NANSAID and aspirin use was higher in our controls than in electronic database studies, consistent with the fact that non-prescription NANSAIDs accounted for 81% of all NANSAID use. Education, physical activity, and BMI also were associated with prescription NANSAID use. When each potential source of bias was removed, the OR for NANSAIDs moved further from 1.0 (i.e., toward a protective association with MI): 'Replicating Electronic Database' analysis (OR 1.00, 95% confidence interval [CI]: 0.78--1.28); 'Misclassification Assessment Analysis' (OR 0.89, 95%CI: 0.70--1.14); 'Confounding Assessment Analysis #1' (OR 0.85, 95%CI: 0.66--1.10); 'Confounding Assessment Analysis #2' (OR 0.78, 95%CI: 0.60--1.01); 'Interaction Assessment Analysis' (OR 0.69, 95%CI: 0.51--0.95). CONCLUSIONS: Limitations in electronic databases may be responsible for the lack of association of NANSAIDs on lower MI risk noted in these studies. Further studies-preferably randomized trials-are needed to address the risk-benefit ratio of NANSAID use.

Adult↗

PubMed2007

Use of albumin in three French university hospitals: is prescription monitoring still useful in 2004?

PURPOSE: Use of albumin (indications and quantities involved) has not been assessed in France since major changes occurred after the publication of Cochrane group meta-analysis. The objectives of this study were to measure the repartition of albumin indications in three French university hospitals in 2004 and to assess the feasibility and usefulness to implement a prescription-monitoring program. METHODS: Exhaustive record of albumin prescription during 2 months in three French university hospitals of Marseille. Inclusion of all patients with a first prescription of albumin between 15 March 2004 and 15 May 2004. Indication, formulation and quantity prescribed were recorded for each prescription. RESULTS: One hundred and eighty-seven patients received a total of 426 prescriptions for a total quantity of 21 094 g of albumin during the study. The first indications were hypoalbuminemia (33% of total quantity), plasmapheresis (30.2%) and ascites or hepatorenal syndrome (13.7%). Fifty per cent of total quantity was used by 14 patients (7.5% of included patients). CONCLUSIONS: Most of albumin consumption in our study is concentrated on recognized indications or indications without alternative to albumin. The different levels of analysis (number of patient treated, number of prescription and quantities used) must be taken into account when analyzing medications such as albumin. Only a marginal proportion of consumption is expected to be saved with close monitoring of indications.

Adolescent↗

PubMedDate not supplied

Increased US prescription trends associated with the CDC Bacillus anthracis antimicrobial postexposure prophylaxis campaign.

PURPOSE: We evaluated national outpatient antimicrobial prescription trends in relation to the first United States case of inhalational anthrax due to the intentional delivery of Bacillus anthracis (B. anthracis) spores. METHODS: We queried IMS HEALTH's National Prescription Audit Plus7 database for two 6-month periods (July-December) in 2001 and 2000 to describe outpatient prescription trends of antimicrobials recommended during the Centers for Disease Control and Prevention's (CDC) postexposure prophylaxis campaign. RESULTS: Overall, antimicrobial utilization for the referent 6-month time frame was greater in 2000 compared to 2001. In contrast, ciprofloxacin utilization was greater in 2001 during October, the month following the index case, increasing by more than 40% over utilization in October 2000. Similarly, doxycycline utilization increased by 30% during October/November. This corresponded to relative increases in US utilization for ciprofloxacin of approximately 160,000 prescriptions for the month of October and for doxycycline of approximately 96,000 prescriptions during October and 120,000 prescriptions for November. CONCLUSIONS: We conclude more widespread prescribing of ciprofloxacin and doxycycline occurred in response to the first US bioterrorist-associated anthrax attacks than was warranted based upon confirmed or suspected B. anthracis exposure alone.

Anthrax↗

PubMedDate not supplied

Pattern of prescriptions issued by nursing home-based physicians versus office-based physicians for frail elderly patients in German nursing homes.

PURPOSE: The purpose of this study was to describe the physician prescription pattern for frail elderly patients in German nursing homes and to identify differences, if any, between that of physicians based in the nursing homes (A) and those with office-based practices (B). METHODS: Retrospective, longitudinal study of medication prescriptions on the basis of the database of a health insurance (Betriebskrankenkasse) in Berlin, Germany. We assessed the medication prescriptions for all 996 unselected insured individuals aged > or = 60 years who were insured throughout 1999 and lived in nursing homes. We analyzed selected patient characteristics and prescription data. Drugs were classified according to the WHO ATC code and were assigned a mean daily defined dose (DDD). RESULTS: 816 individuals were women and 180 were men. A total of 78% of women and 43% of men were aged 80 years or older. Two hundred sixty three patients were seen by nursing home-based physicians (A) and 733 by office-based physicians (B). The median of prescriptions per patient and year was 31 (A) and 37 (B) (p between groups < 0.001). Patients in Group A also received a lower number of DDDs in comparison to Group B (1109 vs 1250; p < 0.01). Costs were substantially higher in group B, and in both groups higher in the 60-69 years old in comparison to the more senior patients. The prescription pattern suggested a considerable frequency of inappropriate drug use in both groups in the following classes: psychopharmacological agents (neuroleptics, antidepressants, hypnotics), pain medication, digitalis glycosides, laxants and loop diuretics. On an average, office-based physicians (B) prescribed relatively more medications in all major classes with the exception of non-opiate analgesics, laxants and anxiolytics. CONCLUSIONS: These data are indicative of a considerable use of inappropriate medication for frail geriatric patients. Differences between the prescribing pattern among nursing home-based and office-based physicians were not substantial, however, the latter group prescribed relatively more drugs.

Aged↗

PubMed2005

Impact of mailed warning to prescribers on the co-prescription of tramadol and antidepressants.

PURPOSE: An evaluation was made of the effectiveness in changing prescribing behavior of 'Dear Health Professional (DHP)' letters mailed by the manufacturer to physicians and other health professionals advising them of safety information on co-prescribing of tramadol and antidepressants. METHODS: A retrospective cohort analysis of prescription claims of all plan members from 12 UnitedHealth Group-affiliated health plans who received a first prescription for tramadol between 1 April 1995 and 31 December 1996. The prevalence of co-prescribing of antidepressants and tramadol relative to the date of the 'DHP' communication was determined. RESULTS: 9218 plan members received an initial prescription for tramadol within the observation period. Prior to the date of the 'DHP' communication 1061/4774 (22.2%) members received a prescription for an antidepressant within 30 days of their first prescription for tramadol. Following the date of the communication 844/4444 (19.0%) of members received an antidepressant within 30 days of their first prescription for tramadol. An overall decreasing linear trend in antidepressant co-prescribing was evident over the observation period, but there was no statistically significant acceleration in the decrease following this communication. CONCLUSIONS: The mailed 'DHP' advisory letter did not affect the rate of co-prescribing of tramadol with antidepressants.

Adult↗

PubMed2005

Three complementary definitions of polypharmacy: methods, application and comparison of findings in a large prescription database.

PURPOSE: To develop and compare three operational definitions of polypharmacy using a large prescription database. METHODS: We defined Cumulative polypharmacy as all prescriptions filled during a 178 day window--which captured 95% of eventual refills as calculated from Kaplan-Meier and cumulative incidence curves. Continuous polypharmacy was all prescriptions filled in two such windows 6 months apart. Simultaneous polypharmacy was the number of prescriptions active on a particular day, as determined by fill dates and amount of medication given. We applied these definitions to the outpatient prescription files of New England veterans and compared the resulting estimates of polypharmacy using descriptive statistics. RESULTS: 118,013 patients received at least one prescription between January 1998 and July 1999. Cumulative polypharmacy averaged 3.54 (SD = 4.95) medications and continuous polypharmacy averaged 1.96 (SD = 3.23). Examination of simultaneous polypharmacy over 40 2-week intervals revealed an average of 2.63 (CI 2.61-2.65), a minimum of 1.09 (CI 1.08-1.10) and maximum of 4.94 (CI 4.92-4.96). One arbitrarily selected observation point had an average of 3.87 (SD = 3.17). CONCLUSIONS: Our definitions of cumulative and continuous polypharmacy serve to set upper and lower bounds for the estimate of polypharmacy. Our method for simultaneous polypharmacy gives numbers that diverge in some respects, but it is better at showing transient changes in medications. The methods are complementary and allow exploration of various aspects of medication use, such as cumulative medication exposure over time, the influence of chronic medical problems, and the causes of rapid changes in medications.

Databases, Factual↗

PubMed2004

Drug prescription in pregnancy: analysis of a large statutory sickness fund population.

OBJECTIVE: To examine the prescription of drugs in Germany prior to, during and after pregnancy. METHODS: For the first time, prescription data of a large cohort of pregnant women, from a German statutory sickness fund, were available for scientific analysis. For each woman who gave birth between June 2000 and May 2001 reimbursed prescriptions for two periods (90 days each) before pregnancy, three during and two after delivery were considered. The drugs were classified according to the ATC code. RESULTS: Of the 41,293 women, 96.4% received at least one drug during pregnancy. A median of 7 drugs per women was prescribed. Excluding vitamins, minerals, iodide and iron, 85.2% received at least one drug and the median was 3. Magnesium, which was seldom prescribed outside of pregnancy, was by far the most frequently prescribed substance (20% of all prescriptions, 61% of the women). Iron (54% of the women) and iodide (31%) were also prescribed often. The prescription rates of gynaecological antiinfectives (maximum in third trimester: 23% of the women), antacids (max. in third trim.: 11%), as well as antiemetics and antinauseants (max. in first trim.: 8%) during pregnancy considerably increased. A decrease was seen for analgesics, antiinflammatory and antirheumatic drugs, muscle relaxants, ophtalmologicals and anti-acne preparations, for example. Potential teratogenic drugs were prescribed to 1.3% of the women. CONCLUSION: This analysis of a large nation-wide cohort of pregnant women showed that during pregnancy drugs were prescribed to most women, even when vitamins, minerals, iodide and iron were omitted. Magnesium and iron seemed to have been over-prescribed. On the other hand, the official recommendation for iodide substitution, to prevent thyroid diseases in mother and child, was insufficiently implemented. In our opinion, regular analysis of prescription data can identify potential harmful therapies and focal points where guidelines are needed and can check their implementation.

Adult↗

PubMed2004

[Psychopharmaceutical prescriptions to older people. A comparison between patients in aged- and nursing homes, outpatient treatment with nursing care and outpatients without nursing care].

To determine, whether age, sex, grade of need of care and living in nursing homes can influence prescribing behavior in elderly. In a retrospective and longitudinal study, the pattern of psychoactive drug prescriptions of nursing home residents was compared with non-institutionalized people with and without need of care. During 1999, the computerized files of 3592 people (> 60 years), insured by a health insurance fund (BKK) in Berlin, Germany, were obtained. Nursing home residents received significantly more prescriptions of psychoactive drugs than the others, especially more neuroleptics (40.1% versus 12.4% and 7.4%). Quality of prescriptions seemed to be higher in nursing homes (use of drugs with fewer side effects and less possible interactions), psychoactive drug prescriptions were given more frequently by psychiatrists and neurologists (37%). Non-institutionalized patients received them most from general practitioners (45%). Women received more prescriptions of psychoactive drugs than male patients. With rising grade of need of care, proportionately more patients received psychoactive drugs. The results of this study show some evidence of the lacking quality in the prescriptions of psychopharmaceuticals to the elderly.

Age Distribution↗

PubMed2003

Prospective survey of antibiotic utilization in pediatric hospitalized patients to identify targets for improvement of prescription.

BACKGROUND: The rise in the use of antibiotics has resulted in increasing health care costs and the emergence of resistant bacteria. Little is known about the general misuse of antibiotics in hospitalized children. We evaluated the utilization of antibiotics in a pediatric teaching hospital aiming to identify targets for improvement of prescription. PATIENTS AND METHODS: Clinical, radiological, laboratory and treatment data of patients hospitalized in a pediatric medical and a pediatric surgery ward were prospectively collected during a 6-week period. A subsequent review of the collected data by a pediatric infectious diseases specialist, taking into consideration existing in-house treatment guidelines, was carried out. RESULTS: A total of 125 (36%) of 349 patients was prescribed 246 antibiotics. The median length of hospital stay for children prescribed antibiotics was 5 days (range, 2-30 days) and for those not prescribed 3 days (1-32 days; p < 0.001). Of 154 patients in the medical ward, 64 (42%) received antibiotics, compared to 61 (31%) of 195 patients in the surgical ward (p < 0.05). Empirical prescriptions were more frequent than prophylactic ones, which were more frequent than therapeutic prescriptions (136 [55%] vs 94 [38%] vs 16 [7%]; p < 0.001). Overall, 85% of the prescriptions were considered justified. The rates of inappropriate prescriptions were similar in the medical and surgical ward, and higher for therapeutic (19%) or prophylactic treatment (18%) than for empirical treatment (12%). Higher inappropriate prescription rates were noted for macrolides than for co-trimoxazole and beta-lactams (50% vs 18% and 15%, respectively; p < 0.05). CONCLUSION: Efforts need to be undertaken towards continuous education of medical staff on judicious antibiotic use, as well as ensuring compliance with existing guidelines. Improvement in the availability of rapid diagnostic methods to discern viral from bacterial infections may help reduce the numbers of empiric therapies in favor of pathogen-targeted therapeutic treatments.

Anti-Bacterial Agents↗

PubMed1986

Computerized prescription checking system.

This is a report on a validation system which was developed by utilizing medication history profiles of drugs prescribed to patients. Upon entering the current prescription data of a patient, the system will automatically retrieve the patient's history of past medication and the previous prescription, and print out the contents of both the current and previous prescriptions in order to validate the treatment. As a result of the Prescription Validation System, the safety of dispensing drugs by the pharmacists has been greatly improved compared to the past by checking on operator's errors of input of data, by identifying transcription error and by matching the spelling in the prescription. Medication instruction to the patients become more accurate since it is easier to monitor any changes on the prescription.

Computer Systems↗

PubMed1989

The effect of patient charges on the utilisation of prescription medicines.

This study is a time-series regression analysis of National Health Service (NHS) prescription drug utilisation. The monthly volume of items dispensed with and without charge in England (1969-1986) form the dependent variables for model estimation. The main finding is that, for items that incur a charge, increases in the real value of the prescription charge are associated with reductions in prescription drug utilisation. The charge-volume elasticity (1969-1986) is estimated at -0.33, rising to -0.64 in the later sub-period (1978-1986). OTC products display a positive cross-price elasticity (+0.22) with chargeable items, but they are less clearly substitutes for prescriptions exempt from charge. One of the main predictors for exempt prescriptions is the number of elderly in the population. The study concludes that the evaluation of the prescription charge policy requires more detailed study of both the incidence of the charge effect and the possible costs and health consequences of reduced utilisation due to the charge.

Demography↗

PubMed1992

Epidemiology of diabetes mellitus in southern Italy: a case-finding method based on drug prescriptions.

The study evaluates whether data concerning drug prescriptions available from the National Health System (NHS) can be used to provide an estimate of the prevalence and pattern of treatment of diabetes in a well defined health district in southern Italy. In Italy virtually all drug prescriptions are obtained through the NHS. For a period of three consecutive months all prescriptions of insulin, hypoglycemic agents and strips for blood and urine testing were monitored in a well defined area near Naples. 2958 cases were thus identified giving a prevalence of drug treated diabetes mellitus of 2.01%; prevalence was higher in females than in males (2.68 vs 1.35%) and increased with age from 0.05% in the age group below 9 years to 13.67 in the age group over 70 years. This case-finding procedure was validated by cross-check with independent sources of cases. To evaluate the sensitivity of the method a list of 820 "known" cases of drug treated diabetes mellitus was obtained from a random sample of local general practitioners (GPs) and diabetic clinics: 73.5% of these cases were also detected through the analysis of drug prescriptions. To evaluate the probability of misclassification a random subsample of 602 cases identified through prescriptions was submitted to the GPs working in the study area, for 517 the diagnosis of diabetes was confirmed, thus yielding a positive predictive value of 85.9%. After correction for sensitivity and probability of misclassification the prevalence of drug treated diabetes in our population was 2.52%. The pattern of prescriptions in this population is also given.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2005

Pediatric prescription pick-up rates after ED visits.

OBJECTIVE: To determine the compliance rate in filling outpatient medication prescriptions written upon discharge from the emergency department (ED). METHODS: Emergency department records of children during a 3-month period were examined along with pharmacy claim data obtained in cooperation with the largest insurance carrier in the community (private and Medicaid). Pharmacy claim data were used to validate the prescription pick-up date. RESULTS: Overall, 65% of high-urgency prescriptions were filled. The prescription pick-up rate in the 0-to 3-year age group (75%) was significantly higher than in the rest of the cohort (55%) ( P < .001). Children with private insurance were more likely to fill their prescriptions (68%) compared to children with Medicaid insurance (57%) ( P = .03). CONCLUSION: This study demonstrates that filling a prescription after discharge from an ED represents a substantial barrier to medication compliance.

Adolescent↗

PubMed2005

Correlates of nonmedical use of prescription benzodiazepine anxiolytics: results from a national survey of U.S. college students.

This study examined the prevalence and correlates associated with the nonmedical use of prescription benzodiazepine anxiolytics among U.S. college students. This study analyzed data from a nationally representative sample of 10,904 randomly selected students attending 119, 4-year U.S. colleges in 2001. The lifetime prevalence of nonmedical prescription benzodiazepine anxiolytic use was 7.8%, past year prevalence was 4.5% and past month was 1.6%. Past year rates of nonmedical use of prescription anxiolytics ranged from zero percent at the lowest use schools to 20% at the highest use school. Multivariate regression analyses indicated nonmedical use was more likely to occur among college students who were White, had both male and female sex partners and reported higher rates of substance use and other risky behaviors. In addition, nonmedical use of prescription benzodiazepine anxiolytics was less likely to occur among college students who attended college in the North Central region of the U.S. or historically black colleges and universities (HBCUs). This study provides evidence that the nonmedical use of prescription benzodiazepine anxiolytics represents a problem on some college campuses and among certain subgroups of U.S. college students. These findings have important implications for developing prevention efforts aimed at reducing the nonmedical use of prescription benzodiazepine anxiolytics among college students while not hindering the effective clinical treatment for various anxiety disorders.

Adult↗

PubMed2006

The impact of cost sharing of prescription drug expenditures on health care utilization by the elderly: own- and cross-price elasticities.

PURPOSE: To estimate healthcare demand elasticity and evaluate the impact of deductible/co-payment policy changes for prescription drugs on the use of drugs and physician visits among seniors with rheumatoid arthritis (RA) in British Columbia (BC), Canada. METHODS: According to the BC drug insurance program, prior to 2002, seniors co-paid the dispensing fee of each prescription to an annual maximum of CAN$ 200 (plan A). Starting in 2002, this plan was split into plan A and plan A1 (Premium Assistance) such that the co-payment amount equaled a maximum of CAN$ 25 and CAN$ 10 per prescription to an annual maximum of CAN$ 275 and CAN$ 200, respectively. Because of the endogeneity of the beneficiary price in the presence of a non-linear price schedule resulting from the cost-sharing policy, we implemented the method of instrumental variables to estimate price elasticities. The instrument was based on the price an individual would face under the new cost-sharing policy if their consumption remained at the pre-policy level. RESULTS: A total of 8017 patients were included. The estimated own-price elasticity of demand for prescription drugs and the cross-price elasticity of demand for physician visits were found to be negative and positive, respectively. The implications of our findings were that when cost sharing for prescription drugs increased, the demand for prescription drugs decreased and the demand for physician visits increased. CONCLUSIONS: In a predominantly publicly funded health care system, the selective introduction of market driven cost containment concepts such as patient cost-sharing might have the unintended impact of increasing overall health utilization for seniors with RA.

Aged↗

PubMed2005

Outpatient prescription of oral antibiotics in a training hospital in Turkey: trends in the last decade.

AIM: The aim was to evaluate the changing trends in outpatient prescription of oral antibiotic forms at a Training Hospital in the last decade. MATERIAL AND METHOD: All the outpatient prescriptions during April and May 2004 were evaluated. The diagnosis, the department of the prescriber, the count and generic name of each prescribed antibiotic were all noted. RESULTS: Of the 33,491 outpatient prescripitions, 14.9% included antibiotic (n=5004). The pediatric clinics (26.4%), Ear, Nose and Throat department (13.7%), and the department of Gyneacology and Obstetrics (10.8%) were the leading departments in antibiotic prescriptions. Upper respiratory tract infections (45.4%), urinary tract infection (11.4%) and lower respiratory tract infections (4.2%) shared the first lines of diagnosis stated. Of the antibiotic prescriptions, 96.3% included oral forms. Co-amoxiclav (26.4%), quinolones (11.7%) and cephalosporins (16.5%) were the most frequently prescribed antibiotics. Percent of antibiotic prescriptions based on microbial sensitivity test results was 7.1%. CONCLUSION: Compared with the results of the study carried out 11 years ago; though co-amoxiclav is still the most frequently prescribed antibiotic, many other changes have been observed in antibiotic prescription attitudes.

Anti-Bacterial Agents↗

PubMed1994

Pharmacists' use of safety caps on refilled prescriptions.

Investigations have shown that pharmacists' use of child-resistant containers for dispensing prescriptions has been inconsistent. Use of new child-resistant containers when refilling prescription orders, however, has not been studied. For this study, an investigator presented a prescription order for 30 amitriptyline 50-mg tablets to 50 randomly selected pharmacies in Memphis. Approximately three weeks later, the investigator returned the empty prescription vials to the pharmacies for refills. Of the 44 pharmacies that completed the study, 39 (89%) dispensed the original drug in child-resistant containers, and 38 (86%) dispensed the refill in child-resistant containers. Only 29 (66%) refilled prescriptions were placed in new prescription vials, as specified by federal regulation. Chain pharmacies were twice as likely (p < 0.005) to dispense the refills in new containers as were independent pharmacies.

Drug Packaging↗

PubMed2000

[Benzodiazepine prescription at a health center: prevalence, its use and user characteristics].

OBJECTIVES: To find the prevalence of prescription of benzodiazepines (BDZ) in 1997 at a health centre (HC), and the characteristics of both their consumption and the takers. DESIGN: Crossover, observational study. SETTING: Primary care urban centre. PATIENTS: From a total of 7356 patients over 14 with clinical records and belonging to four lists, a random sample stratified by lists was selected. INTERVENTION: A form was used to gather social and demographic data, educational level, family context, linked pathologies, number of visits to HC per year, BDZ prescription and variables defining the kind of consumption. MAIN RESULTS: The prevalence of BDZ prescription was 7.7% (CI, 6-10%). Consumption profile: 33% long BDZ, 31% intermediate and 33% short. 44% consumed BDZ occasionally or for less than 2 weeks, and 42% had been taking it for over a year. For 56% (95% CI, 40-70) their G.P. was the origin of the prescription. The reason for the prescription was not specified in 42% of cases. The variables which defined the profile of the consumers, included in the logistic regression, were: sex, number of visits and linked pathologies, whose OR were: 1.57 (CI, 1.08-2.03), 1.11 (CI, 1.06-1.17) and 1.61 (CI, 1.04-2.05). CONCLUSIONS: The prevalence of BDZ prescription during 1997 in the population seen at our clinics was very similar to the figures found in other studies, with higher annual consumption averages and without the reason for taking it being specified in half the cases. The profile of BDZ takers was: mainly women, people with linked pathologies, and as a function of the number of attendances.

Adult↗