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PubMed2001

[Validity of an indicator of the quality of pharmacological prescription in patients with hyperlipemia].

OBJECTIVES: The computer system for billing prescriptions (SIFAR in Spanish) enables indicators to be extracted for the study and follow-up of the use of medicines in the INSALUD primary care areas. Concretely, we studied the indicator referring to pensioners consumption of lipid-lowering drugs (PCLL), not validated, and whose value is expected to drop as quality increases. The objective was to calculate the correlation of the indicator of prescription of lipid-lowering drugs on the SIFAR with the proportion of lipid-lowerers prescribed correctly for pensioners (PCP). DESIGN: A descriptive study of correlation between two indicators of drug prescription. SETTING: Four health districts in Madrid. PARTICIPANTS: The prescriptions of 49 general practitioners, chosen at random on the basis of three strata defined by the value of the indicator, were studied. Each doctor filled out a protocol of data for each pensioner patient to whom he/she prescribed a lipid-lowerer during the study period. MEASUREMENTS AND MAIN RESULTS: The PCLL and PCP indicators were compared through the correlation of Spearman. 6,779 prescriptions for 1,125 patients were collected from the 49 participating doctors. The mean percentage of lipid-lowerers correctly prescribed was 31.9%, figure that rose to 77.5% when the LDL value was not specified. The correlation between the PCLL and the PCP was near zero. CONCLUSIONS: The PCLL indicator of the SIFAR does not discriminate quality in lipid-lowering drug prescription to people over 64.

Aged↗
PubMed2002

[Evaluating, improving and monitoring generic drug prescription].

OBJECTIVE: To evaluate and improve generic drug prescription by family physicians in a regional primary care district with a specially-designed intervention. DESIGN: Uncontrolled study of an intervention, based quality evaluation and improvement methods. We selected an indicator that could be constructed with the available data (monthly reports of prescriptions dispensed through the public national health system) and determined the proportion of prescriptions for generic drugs to the total number of prescriptions dispensed, for those medications that had a generic alternative (percentage of generic prescriptions, PGP). After these data were evaluated, an intervention was implemented to increase generic prescriptions. Prescribing behavior was again evaluated and monitored at the end of the intervention period. Setting. Forty-five primary care teams in the Murcia (Southeast Spain) regional primary care district. PARTICIPANTS: A total of 339 family physicians. Interventions. During 15 months, individual reports of prescribing practices, in which changes over time were graphed, were sent to each participating prescriber. Each semester the physicians received a personal letter and a specially-printed, updated card showing the generic medications available and their pharmaceutical forms. One to three face-to-face clinical outreach sessions were held with each primary care team. Specific prescribing goals for the PGP were set and incentives to attain the goals were included in the terms of the contract for clinical services signed between the regional office of primary care management and each primary care team. MAIN OUTCOME MEASURES: The PGP increased from a pre-intervention rate of 2.7% to a post-intervention rate of 17.63%. Absolute improvement was therefore 14.84%, and relative improvement was 15.27%. Variability was monitored and analyzed with control charts. There was no significant variability within the pre- and post-intervention phases, whereas variability increased significantly (indicating improvement) during the intervention phase. CONCLUSIONS: The increase in PGP showed that prescribing for generic preparations improved. Statistical quality control tests were useful in evaluating and tracking the results of the intervention, and were indispensable for monitoring and promptly detecting opportunities to improve prescribing behavior and take appropriate measures.

Drug Prescriptions↗
PubMed2002

[Geriatric drug therapy guide: evaluation of the effect on prescription at old people's homes in Gipuzkoa].

OBJECTIVE: To analyse the impact of the composition, publication and dissemination of the Geriatric Drug-therapy Guide of Gipuzkoa (GDGG) and monitoring of adherence to it, as an intervention in the community to improve medical prescription in old people s homes (OPH) in Gipuzkoa. DESIGN: Descriptive evaluation < > the intervention. SAMPLE: billed prescriptions for pharmaceutical products (PP) from Osakidetza in 1996 (pre-intervention) and 1997-1999 (post-intervention). SOURCE: the prescription data base of the Basque Government. SETTING: 35 OPH in Gipuzkoa (2963 residents). MEASUREMENTS AND RESULTS: Indicators: Adherence percentage=(No. units prescribed of PP with selected active principles)x100/total No. PP prescribed); Mean price per unit (MPU)=(total RSP of units/total No. PP units). Overall adherence rose from 44% in 1996 to 62% in 1999; the groups accounting for 84% of prescription and the sub-groups accounting for 65% of prescription went up in these years from 43% to 64% and from 50% to 67%, respectively. A deceleration of the increase in MPU in OPH was detected, when compared with the figure for primary care. CONCLUSIONS: Overall adherence to the GDGG is high, with an upwards tendency that lasts about three years after the initial intervention. Similarly, the evolution of the MPU for the PP prescribed in OPH is better than the primary care average, with a steady deceleration in the indirect indicator analysed. The community intervention undertaken is an effective tool for improving medical prescription in the old people s homes examined.

Aged↗
PubMed2003

[A system, developed by prescribing doctors, of indicators of the quality of pharmaceutical prescription in primary care].

OBJECTIVE: To work out a system of indicators and standards, designed by means of a consensus group of general practitioners, that enables evaluation of the quality of Primary Care prescription to be improved. Design. Informal consensus method. SETTING: A PC area in Asturias with 156 614 inhabitants and 9 health centres.Participants. Nine PC doctors accepted voluntarily to take part in the project. METHOD: A consensus group of nine PC doctors was formed. At a first meeting they worked out some potential indicators of quality of prescription. After applying these indicators to the prescription data, a second meeting was held, at which the results of applying the indicators along with criteria of excellence were used to establish the definitive indicators and their numerical values of optimum compliance. RESULTS: It was possible to agree by consensus 11 indicators of quality of prescription and their values of optimum compliance. Eight of the indicators referred to choice of a medicine within a pharmaco-therapeutic group; and three, to groups in which the volume of prescription may suggest improper usage. CONCLUSIONS: It is feasible for PC doctors to reach a consensus on a group of criteria that is perceived as valid for measuring quality of prescription and which includes certain impalpable values for determining quality.

Adult↗
PubMed2002

Buprenorphine prescription by general practitioners in a French region.

Since 1996 French general practitioners (GPs) may prescribe sublingual buprenorphine tablets as maintenance treatment for opiate dependence. The computerised data management of the main French health reimbursement system now allows surveillance of the use of this drug, and how it is prescribed. The purpose of this study is to determine the profile of maintained patients, prescribed doses, associated psychotropic treatments and how practitioners prescribe these treatments. This study analyses the 11186 buprenorphine prescriptions electronically transmitted for reimbursement between September and December 1999 in a specific French region. It was found that the 2078 treated patients consumed a mean of 11.5 mg of buprenorphine per day and 12% of them procured prescriptions from more than two prescribers. 43% of maintained patients had an associated benzodiazepine prescription, mainly flunitrazepam, often on the same prescription form. 61% of patients had regular follow-up, others had occasional consultations (21%) and another 18% had deviant maintenance treatment (more than two prescribers or more than 20 mg per day of daily buprenorphine dose). Benzodiazepine consumption was much higher in the 'deviant group' (71.4%). 85% of buprenorphine prescriptions were made by GPs. 21% of GPs prescribed buprenorphine and 61% of those had only one or two maintained patients. Buprenorphine prescription by French GPs is a procedure with no particular requirements, allowing many patients to easily access maintenance treatments. However, a high risk of abuse exists, which demands extensive investigation and evaluation of these practices.

Administration, Sublingual↗
PubMedDate not supplied

Consumer perceptions of risk and required cost savings for generic prescription drugs.

OBJECTIVE: To examine consumer risk perceptions for generic prescription drugs used to treat different types of medical conditions, and to explore the relationship between risk perceptions and the amount of cost savings required before consumers would purchase the generic version of a prescription drug. DESIGN: Cross-sectional mail survey. SETTING: Metropolitan area in central Wisconsin. PARTICIPANTS: Random sample of 500 consumers age 18 and older. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Responses to 16 items on 8-page questionnaire. None. RESULTS: The response rate was 71.4%. The percentage of respondents who perceived that generic prescription drugs were riskier than brand name products varied from 14.2% to 53.8%, depending on the medical condition being treated. Significantly larger cost savings were required for consumers to purchase generic prescription drugs with higher perceived risk. CONCLUSION: Financial incentives to use generic prescription drugs may be successful, even for consumers who perceive generic drugs to be riskier than brand name prescription drugs. As the perceived level of risk increases, larger cost savings are required.

Adult↗
PubMed2005

[Assessing quality in the process of using hazardous drugs-prescription and preparation].

OBJECTIVE: To evaluate the quality of cytotoxic drug prescription based on the results of an interventional pharmaceutical program and the quality of the final product based on quality-control prior to preparation. METHODS STUDY PERIOD: July 2002-March 2003. Hazardous drug prescription was evaluated through an analysis of pharmaceutical interventions during therapeutical monitoring. Depending on repercussion in patients, they were classified in three categories (treatment optimization, resource optimization or criteria unification). Data obtained from manual quality control programs prior to hazardous drug preparation were evaluated. RESULTS: Sixty-four interventions were made (9 interventions per 100 prescriptions): 55% were classified as treatment optimization, 28% as resource optimization and 17% as criteria unification. A total of 66% of the interventions focused on treatment optimization were caused by prescription errors. Ninety-seven per cent were accepted. Out of 2,074 preparations, 1,951 were evaluated (94.9%). A 5.1% of non-evaluated preparations were due to a lack of registration and 0.8% to violations in the established protocol. CONCLUSIONS: Results of the interventional Pharmaceutical program show that an assisted prescription system is necessary, not only to detect prescription errors but also to prevent them. Manual controls in different stages of the process are useful and they should be complementary to other more reliable dosification controls.

Antineoplastic Agents↗
PubMedDate not supplied

[Comparative study of errors in electronic versus manual prescription].

OBJECTIVE: Electronic prescribing is considered a basic measure for the prevention and reduction of medications errors. The goal of this survey was to assess the incidence of errors occurring with electronic versus standard prescription. METHOD: A prospective, sequential, open-label study to assess errors with electronic prescribing as compared to traditional manual prescribing in two public hospitals in Balearic Islands. Errors regarding medication, diet and/or nursing orders were assesses along four process stages: medical prescription, pharmacy transcription/validation, nursing transcription, and dispensation. RESULTS: With manual prescription 1,576 errors/18,539 therapy orders (8.50%) were identified, whereas with electronic prescription 827 errors/18,885 therapy orders (4.38%) were detected, which represents a relative risk reduction by 48% and an absolute risk reduction by 4.12% (p < 0.0001). Pharmacy transcription/validation errors decreased (1.73 vs. 0.13%, p < 0.0001), as did nursing transcription errors (2.54 vs. 0.81%, p < 0.0001) and dispensation errors (2.13 vs. 0.96%, p < 0.0001); however, the number of prescription errors increased (2.10 vs. 2.40%, p = 0.0401). CONCLUSIONS: Electronic prescription is a powerful tool, and one that in this work was shown to decrease medication-, diet-, and nursing care-related errors in a highly significant way; however, it should be developed and maintained in order to achieve safety and effectiveness as required by drug usage.

Drug Prescriptions↗
PubMed2001

Patterns of prescription and drug use in ophthalmology in a tertiary hospital in Delhi.

AIMS: The present study was carried out to describe the patterns of prescription and drug use in Ophthalmology in out-patients at Dr Rajendra Prasad (R.P.) Centre for Ophthalmic Sciences of All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi. METHODS: Prescriptions of 1017 out-patients were audited through a specially designed form and analysed for the following: average number of drugs per prescription, duration of treatment (recorded or not), dosage forms prescribed, frequency of administration (recorded or not), number of encounters with antibiotics and percentage of drugs prescribed by generic name. RESULTS: Prescription analysis showed that the average number of drugs per prescription was 3.03. Duration of treatment was recorded for only 26.4% of the drugs prescribed. The maximum number of drugs prescribed were in the form of eye drops (76%), followed by tablets (10.9%), ointments (6.4%), syrups (1%), capsules (0.7%), lotions (0.3%) and injections (0.1%). No dosage form was recorded for 4.6% of the drugs prescribed. The frequency of administration was recorded for only 77.9% of the drugs prescribed. The number of antibiotics prescribed was 1059 which constitutes 34.2% of the total number of drugs prescribed. The percentage of drugs prescribed by generic name was only 35%. CONCLUSIONS: The results obtained in this study indicated an awareness of polypharmacy but a high incidence of common prescription writing errors such as not recording the duration of therapy, frequency of administration and dosage form. Moreover prescribing by generic name was also low.

Drug Prescriptions↗
PubMed2002

Prescription drug costs for dually eligible people in a medicaid home- and community-based services program.

This study examined the prescription drug costs of Medicare beneficiaries participating in a Medicaid home- and community-based services (HCBS) program and discussed possible implications of providing a prescription drug benefit under Medicare. The study examined Medicaid pharmaceutical claims data using two random samples (n=766) of dually eligible Medicare beneficiaries in a HCBS program from four regions in Georgia. The average total monthly Medicaid prescription drug expenditure was determined. Annual prescription expenditures for this group averaged more than 1,500 dollars per person. Prescription drugs intended for the treatment of cancer and circulatory disorders combined to account for 61% of total program drug expenditures. Multivariate analysis found that drug expenditures were higher for those who died during the observation period, the young-old, Caucasians, and those who self-selected into the program. Higher drug expenditures for the self-selected group, even after frailty adjustments, suggest the presence of adverse selection. Medicare prescription drug benefit proposals that rely on voluntary enrollment may also experience adverse selection from frail, low-income beneficiaries.

Aged↗
PubMed2001

Epidemiology of prescriptions for neuroleptic drugs: tranquilizers rather than antipsychotics.

BACKGROUND: The pharmacology of neuroleptics as well as epidemiological and clinical observations of prescriptions of these drugs give the impression that they are and can be used for indications other than schizophrenia to a considerable degree. METHOD: We analyzed pharmacoepidemiological data on neuroleptic prescriptions in Germany. We used the following criteria: numbers of defined daily doses (DDDs) per annum, diagnoses for which they were prescribed, patient age, specialist medical training of the prescribing physician, and indicators that neuroleptics were used instead of other psychotropic drugs such as minor tranquilizers. RESULTS: Only 14% of the prescriptions for neuroleptic drugs were for schizophrenic psychoses, 18% for other paranoid psychoses and 5% for affective disorders. 63% were prescribed for neurotic disorders, sleep disorders, or dementia. Almost half of the neuroleptic prescriptions were given for patients aged 65 years or over. Only 40% were prescribed by psychiatrists or neurologists. Throughout the period from 1986 to 1995, neuroleptic prescriptions increased steadily, which was paralleled by a decrease in the prescription rates for benzodiazepines. CONCLUSIONS: Evaluation is urgently needed for those uses of neuroleptic drugs that, from a pharmacoepidemiological perspective, must be seen as their primary indication.

Adult↗
PubMed1999

Psychotropic drug prescription in a psychiatric university hospital.

A retrospective survey on drug prescription over a one-year period (1989) in 1083 patients (48.3% of whom were male) hospitalized in a psychiatric university hospital in Switzerland and a 35-day prospective study (1992) on the prescription of "as needed" (prn) medication in a closed and an open ward were carried out. Their aim was to establish a basis for a monitoring of prescription habits and for pharmacoeconomic considerations. In the retrospective study, 48.3% of the patients were male. The mean duration of hospitalization of the patients was 47.0 +/- 68.1 days (mean +/- s.d.). Only 11 out of the 1083 patients (1%) were without psychotropic medication. The mean (+/- SD) number of drugs/day the patients were prescribed was 4.6 +/- 2.8, including 3.2 +/- 1.7 psychotropic drugs. Patients suffering from schizophrenia (67 d) or from unipolar depression (67.4 d) were hospitalized for the longest periods. Antipsychotics (67.5% of the patients) were the most frequently prescribed psychotropic drugs, followed by anxiolytics (42.2%), antidepressants (28.3%), hypnotics (31.4%) and mood stabilizers (7.1%). Antiparkinsonian agents accounted for 4.6% of all prescriptions. Levomepromazine, haloperidol (30.9% of all patients) and clotiapine were the most often prescribed neuroleptics, and clozapine was administered to only 6.4% of all patients. Among the antidepressants, maprotiline (11.9% of all patients) was more frequently prescribed than the classical tricyclic antidepressant amitriptyline, while the only available SSRI fluvoxamine and MAO inhibitors were rarely used. The most frequently prescribed anxiolytics were clorazepate (28.2% of all patients), lorazepam, bromazepam, and prazepam. Among the hypnotic drugs, chloral hydrate (11.5%) was more frequently administered than the first-ranking benzodiazepine flunitrazepam (7.8%). In the prospective study, 97% and 77% of the patients (n = 55) of the closed (n = 29) and of the open ward, respectively, were prescribed "as needed" (prn) drugs. However, only 71 and 80%, respectively, of these patients finally received the drug. The frequency of prescription was 34.9% for neuroleptics, 15.1% for anxiolytic drugs, 8.2% for non-benzodiazepine hypnotics and only 2.1% for benzodiazepine hypnotics. The most frequently prescribed neuroleptic drug was clotiapine (18% of all patients), but finally, only 29% of the prescribed doses were administered. Studies of this type are biased by the fact that local habits of prescription do not allow generalisation of the findings. Such surveys should be carried out more frequently and simultaneously in different centers. Critical comparisons could help to optimize treatment.

Adult↗
PubMed1983

The effects of competition on prescription-drug-product substitution.

Almost all states have enacted legislation, that allows pharmacists to substitute drug products when filling prescriptions. We studied the effects of competition in the drugstore service area on the use of less costly drug products and the pricing of prescriptions under the drug-product-selection law in Minnesota. In 38 drugstores in the Minneapolis-St. Paul area, rates of substitution of generic or less-costly brands and prescription prices were analyzed according to the degree of competition in the drugstore's service area, as measured by the pharmacists' perceptions and the number of competing drugstores within a 1-mile radius. Although higher levels of competition were associated with increased use of generic drugs for prescriptions written generically, competition did not appear to affect either dispensing patterns for prescriptions written for brand-name products or the retail prices of brand-name or generic products. These findings do not support the hypothesis that competition reduces prescription-drug prices through improved selection of drug products at the retail pharmacy level.

Drug Prescriptions↗
PubMedDate not supplied

Characterizing the emerging population of prescription opioid abusers.

Despite an alarming recent increase in prescription opioid abuse, the characteristics of prescription opioid abusers remain largely unknown. In this study, the demographic and drug use characteristics of 75 methadone patients (36 prescription opioid and 39 heroin users) were compared using a retrospective chart review. Prescription opioid abusers exhibited a profile of characteristics that may predict favorable treatment response, including less severe opioid use and IV drug use, and greater social stability compared to primary heroin abusers. Despite the limitations inherent in this retrospective chart review, this study provides initial evidence that prescription opioid abusers may have a number of characteristics that predict favorable treatment response. This new information may inform and assist current efforts to develop efficacious treatments for prescription opioid abuse.

Adult↗
PubMed1997

Prescription of antimicrobial agents to elderly people in relation to the type of infection.

OBJECTIVE: to describe how frequently antimicrobial agents are prescribed for elderly people and to examine the prescribing practice of treating physicians. DESIGN: for each of the 1196 subjects examined, a review of the medical records was carried out for the year preceding the examination and data on antimicrobial prescriptions, including types of infections, were recorded. The sales statistics of antimicrobial agents in this population were compared with the nation-wide ones, collected by the National Agency for Medicines. SETTING: a health centre in Lieto, a rural district in southwestern Finland; 1990-91. SUBJECTS: 1196 subjects, aged 64-97 years, 488 men and 708 women. MAIN OUTCOME MEASURES: frequencies of prescriptions of specified antimicrobial agents, including types of infection in relation to gender and form of care over a 1-year period. RESULTS: more women (36%) than men (28%) had received antimicrobial agents. The proportion who had received such agents increased with increasing age, the trend being more marked in men. The mean number of prescriptions per user per year was slightly lower in men than women (0.6 and 0.7 respectively). In both sexes, 54% of the users of antimicrobial agents had received only one prescription. Cephalosporins and penicillins were the most commonly prescribed agents. Among those who had received three or more antimicrobial prescriptions, cephalosporins had been used most frequently. Elderly people living in long-term institutional care were treated with antimicrobial agents more frequently than those living outside institutions. Of all antimicrobial prescriptions given to women, 60% were prescribed for urinary tract infections, 21% for respiratory infections and 8% for skin infections. The figures for men were 18, 45 and 10%. CONCLUSIONS: multiple use of antimicrobial agents is common in old age, especially in those in institutions. More attention should be to the provision of appropriate antimicrobial treatment.

Aged↗
PubMed1994

Antibiotics prescription in primary care: a 5-year follow-up of an educational programme.

An educational programme on the use of antibiotics for respiratory tract infections (RTIs) in primary care, initiated among district physicians at the Community Health Centre of Höör, Sweden in 1985, resulted in an overall reduction in prescriptions for antibiotics, particularly broad-spectrum antibiotics. The aim of the present study was to evaluate the long-term effects of the programme on antibiotic prescription patterns at the centre. Since 1985, computerized records have been kept of every consultation at the centre, including details of the attending physician, the patient, diagnosis and type of antibiotic prescribed. Moreover, during a 3-month period in 1991, each pharmacy in the region recorded details of all prescriptions for antibiotics dispensed. Estimated immediately after the programme, the proportion of RTI patients prescribed antibiotics had fallen to 44%, a figure virtually unchanged 5 years later. During the subsequent five-year period, antibiotics dispensed at the pharmacy in Höör were further reduced from 14.1 to 13.2 defined daily doses 1000 inhabitants-1 day-1. As compared with district physicians at other community health centres in the region, those at Höör prescribed more penicillin V (80% of all antibiotic prescriptions) and less broad-spectrum antibiotics. The educational programme, combined with an active interest among district physicians at Höör in current research into antibiotic usage, has thus wrought enduring changes in the pattern of antibiotic prescription. A probable contributory factor was the district physicians' awareness that the computerized registration of diagnosis and treatment enables prescription patterns to be audited at an individual level.

Anti-Bacterial Agents↗
PubMed2002

Prevalence of dementia in users of hormone replacement therapy as defined by prescription data.

BACKGROUND: Studies of hormone replacement therapy (HRT) and dementia and cognitive impairment show mixed results. This study assessed the prevalence of dementia and cognitive impairment in users and nonusers of HRT defined using computer-stored prescription information. METHODS: The study involved 3924 women 75 years of age and older who were members of the Southern California Kaiser Permanente Medical Care Program in 1998. HRT use was determined based on prescription data for 1992-1998. Cognitive function and dementia were assessed using the Telephone Interview of Cognitive Status supplemented by the Telephone Dementia Questionnaire and medical record review. RESULTS: Odds ratios (ORs) for cognitive impairment/dementia showed expected associations with age, education, ethnicity, and a history of stroke or Parkinson's disease. After adjustment, the OR for cognitive impairment or dementia in HRT users compared with HRT nonusers was 0.91 (95% confidence interval 0.75-1.10). The adjusted ORs for all dementia and dementia without cause in HRT users compared with nonusers were 0.77 (95% confidence interval 0.59- 1.00) and 0.78 (0.58-1.05), respectively. Twenty percent of women with cognitive impairment or dementia who had been classified as HRT users by prescription (one prescription each year from 1992-1998) denied hormone use compared with 8.8% of women without impairment. Medical record review validated prescription information for the impaired women. CONCLUSIONS: The study identified an important methodologic problem in studies of HRT and cognitive impairment and dementia that depend on recalled information about drug exposure. A protective effect of HRT for cognitive impairment and dementia was neither established nor ruled out based on the prescription data.

Age Distribution↗
PubMed2003

Outpatient antibiotic prescriptions from 1992 to 2001 in the Netherlands.

OBJECTIVES: Although Dutch outpatient antibiotic prescription rates are low compared with other European countries, continuing to scrutinize trends in outpatient antibiotic use is important in order to identify possible increases in antibiotic use or inappropriate increases in the use of particular classes of antibiotics. METHODS: We assessed the volume of Dutch outpatient antibiotic prescriptions from 1992 to 2001 by calculating the mean number of outpatient antibiotic prescriptions (indicating the number of times physicians decide to prescribe an antibiotic agent) per 1000 patients insured by the Dutch Sickness Fund per year, according to subgroups (narrow-spectrum penicillins, broad-spectrum penicillins, tetracyclines, macrolides, sulphonamides and trimethoprim, and quinolones). Data were obtained from the Dutch Drug Information Project/Health Care Insurance Board. RESULTS: The total volume of outpatient antibiotic prescriptions in 2001 was 394 prescriptions per 1000 patients insured by the Dutch Sickness Fund. Overall, the rates were stable between 1992 and 2001, with small variations across years, but with marked differences in volumes within antibiotic groups across these years: a decrease in prescribing of narrow-spectrum penicillins (-29%), amoxicillin (-23%), tetracycline (-24%), doxycycline (-19%) and trimethoprim and derivatives (-45%) was accompanied by an increase in prescribing of co-amoxiclav (+85%), macrolides (+110%) and quinolones (+86%). CONCLUSIONS: The international trend of a decline in the use of narrow-spectrum and older penicillins and prescribing more broad-spectrum and new chemotherapeutics was shown to exist in a low prescribing country, The Netherlands. Therefore, inappropriate antibiotic prescribing should remain prominent on the research agenda in intervention studies in order to improve the appropriate selection of antibiotic class and to reduce the prescription of antibiotics.

Ambulatory Care↗