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PubMed1998

[Variability of prescriptions in prevailing indications in primary care: a multicenter study. Study of Prescriptions in Primary Care (GEPAP)].

OBJECTIVES: It seems convenient to have information on how drugs are used in everyday's practice in order to be able to make drug selection proposals. The aim of this study was to describe the prescription profile in a number of prevalent indications and its variability among the participating centres. DESIGN: Cross-sectional descriptive study. SETTING: Four Primary care centres. PARTICIPANTS: Each of the 32 participating physicians collected information on 200 consecutive patients who received a prescription between October 1994 and January 1995. MEASUREMENTS AND MAIN RESULTS: 5932 patients, with a mean age of 56 years (SD = 18 years) were included. We analysed the prescriptions they received for hypertension (988 patients), hyperlipidaemia (254), peptic ulcer (PU) (136), nonulcer dyspepsia (271), chronic obstructive lung disease (COLD) (293), asthma (134) and depression (261). We describe the number of different drugs used (range: 14 for PU-63 for hypertension), the number of drugs that accounted for 90% of the prescriptions (range: 5 for PU-20 for depression), the number of recently marketed drugs (range: 0 for PU-9 for hypertension) and the proportion of prescribed drugs they accounted for (range: 0% for PU-12.4% for depression). We found an important variability among the participating centres in all the considered indications; for instance, statins for hyperlipidaemia. CONCLUSION: A rather high variability in prescription habits among participating centres was found. Prescription was highly concentrated in a few number of drugs, and the use of recently marketed drugs accounted for less than 10% of all prescriptions, although data show variability according to the considered indications.

Cross-Over Studies↗
PubMed2006

The Medicare Prescription Drug Improvement and Modernization Act: prescription drugs and academic medicine.

The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) provides universally available prescription drug benefits to elderly and disabled Medicare beneficiaries for the first time. This paper first discusses three controversial features of this legislation: (1) the form of the prescription drug benefit package; (2) the use of competing private plans; and (3) the uncertainty about the future cost of the new prescription drug benefit. The paper then evaluates the implications for academic medicine of the prescription drug benefit and other MMA legislative provisions aimed at improving the quality of medical practice and shifting away from acute care. Ultimately, the health of seniors and the efficient use of public funds in the new prescription drug benefit depend centrally on the prescribing practices of physicians. Academic medicine should turn its attention to training the next generation of physicians to be more effective agents and advocates for their patients in their use of pharmaceuticals.

Academic Medical Centers↗
PubMed2004

Senior citizens and the burden of prescription drug outlays: what lessons for the Medicare prescription drug benefit?

This article uses data from a cohort of elderly and retired persons over the 1996-2001 period in the US to (i) determine the extent to which changes in socioeconomic or demographic characteristics, particularly age, income and education, impact the total amount that is spent on prescription drugs and (ii) to analyse the predictors of individual out-of-pocket (OOP) prescription drug outlays among the same cohort and determine whether age, race, sex, income, education, marital status and health status have an influence on these. The analysis considers the implications for elderly individuals who choose to participate in the new Medicare Part D drug benefit, labelled the Medicare Prescription Drug, Improvement, and Modernisation Act of 2003. The results highlight the necessity for the Medicare prescription drug benefit to carefully target the eldest among the elderly, who are most in need and are in danger of becoming trapped in the so-called Medicare 'doughnut hole', i.e. incur high prescription drug outlays, without adequate coverage. The study also finds evidence that women, those who are not married, middle income elderly and those in poor health, who purchase drugs more intensively, are at risk of incurring significant prescription OOP drug outlays.

Age Factors↗
PubMed2000

[Evolution of polyvalent intravenous immunoglobulins (IVIg) prescription, at the Assistance Publique - Hopitaux de Paris between 1988 and 1997. Results of the plan of action set up in order to regulate the prescription].

In 1991 the public hospitals in Paris set up a plan to regulate the prescription of IVIg. The plan includes an expert committee and reliable data collection. The expert committee has a threefold mission: i) perform an annual up-date of IVIg classification using three categories: accepted indications (group I), currently deabated indications (group II), and unwarranted indications (group III); ii) develop guidelines for improved therapeutic strategies; iii) stimulate research. Data on use of IVIg are collected in 16 pilot hospitals. These data designate IVIg prescriptions by indication. Data are centralized by the CEDIT which publishes an annual report. Between 1988 and 1991, prescription of IVIg increased at an average annual rate of 33%. Between 1991 and 1996, the amount of IVIg used leveled off: approximately 330 kilograms/year, excluding research protocols. In 1997 there was a decline to 299 kilograms accounting for a total expenditure of 44 million French francs (US$ 6.7M). In 1997, group I prescriptions represented 80% of all IVIg prescriptions, group II 9.8% and group III 9.1%. Comparison of medical practice with a scientificaly recognised reference made it possible for AP-HP to set up an effective regulation of IVIg prescriptions. The longevity of this evaluation work is by itself a success.

Data Collection↗
PubMed1999

Prescription Drug Marketing Act of 1987; Prescription Drug Amendments of 1992; policies, requirements, and administrative procedures. Food and Drug Administration, HHS. Final rule.

The Food and Drug Administration (FDA) is issuing a final rule to set forth procedures and requirements implementing the Prescription Drug Marketing Act of 1987 (PDMA), as modified by the Prescription Drug Amendments of 1992 (PDA) and the FDA Modernization Act of 1997 (the Modernization Act). The final rule sets forth requirements for the reimportation and wholesale distribution of prescription drugs; the sale, purchase, or trade of, or the offer to sell, purchase, or trade, prescription drugs that were purchased by hospitals or health care entities, or donated to charitable organizations; and the distribution of prescription drug samples. FDA is also amending certain sections of the regulations entitled "Guidelines for State Licensing of Wholesale Prescription Drug Distributors" to make them consistent with this final regulation.

Drug Industry↗
PubMed1979

[Prescription profile in French speaking Switzerland and in the Tessin. Analysis of 2006 medical prescriptions].

Analysis of 2006 prescriptions given to 641 unselected patients by 360 doctors in the French- and Italian-speaking parts of Switzerland provides a wealth of information on prescription trends and the cost of medicine. The patients ordinarily received medication belonging to several therapeutic groups, usually 2 or 3 but up to 9 different groups. Each prescription averaged 2.08 drugs with a mean cost of 18.90 Swiss francs. The price varied considerably according to the group of drugs. Those related to the cardiovascular system were the most expensive closely followed by antibiotics, while the ophthalmological prescriptions were the least expensive. Hydergine is the most-sold drug in Switzerland, followed by Bactrim; however, if the various benzodiazepines were grouped together their sale would exceed the others. There are 62 different drugs for rheumatic conditions and 47 penicillins in Switzerland. The abundance of drugs and the prescription of medication with dubious action contribute to the inflationary cost of illness. For any given drug there is a striking parallelism between the number of pages publicizing it in 4 medical journals and total sales. This clearly demonstrates the influence of advertising on prescription trends. Doctors should be aware of this fact and rely on more objective sources of their information about drugs.

Drug Prescriptions↗
PubMed2001

Ask the doctor. A few years ago, I had a heart attack. My doctor treated me with angioplasty, and I haven't had any symptoms of heart disease since. I do carry a bottle nitroglycerin with me, but haven't taken any in years. I renew my prescription every six months because I know the pills go bad. My problem is that I also need Viagra to have sexual intercourse. Whenever I refill my prescription for Viagra, the pharmacist gives me a hard time because he knows I also have a prescription for nitroglycerin. Just how dangerous is Viagra?

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3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2003

Treatment planning for lung cancer: traditional homogeneous point-dose prescription compared with heterogeneity-corrected dose-volume prescription.

PURPOSE: To quantify the differences in doses to target volumes and critical thoracic structures calculated by traditional homogeneous point-dose prescription and heterogeneity-corrected volume-dose prescription. METHODS AND MATERIALS: Between 1998 and 2001, 30 patients with inoperable Stage I/II non-small-cell lung cancer underwent radiation treatment planning at our institution. A commercially available convolution/superposition- based algorithm was used. Three treatment plans were calculated for each patient using identical beam geometries: one plan was generated by traditional homogeneous point-dose prescription, a second by the traditional method with heterogeneity correction, and a third by heterogeneity-corrected volume-dose prescription that would cover 95% of the planned target volume (PTV). Target volume coverage, isocenter dose, and dose uniformity in the second and third plans were compared. RESULTS: The PTV, clinical target volume (CTV), and isocenter calculated by the heterogeneity-corrected volume-dose method were equivalent to those calculated by the traditional homogeneous point-dose method with heterogeneity correction. The fraction of the PTV covered by heterogeneity-corrected volume-dose prescription was significantly greater than the fraction covered by traditional homogeneous point-dose prescription with heterogeneity correction (p = 0.05). The dose prescribed using the traditional method would have been delivered to less than 90% of the PTV in 14 of 30 patients. There was no significant difference in the maximum and minimum doses to the PTV, the CTV, or the isocenter calculated by the traditional homogeneous method with heterogeneity correction and the heterogeneity-corrected volume-dose method. There was also no significant difference in the planned volume of lung receiving greater than 20 Gy as calculated by these two methods. CONCLUSION: When compared with traditional homogeneous radiation treatment planning, heterogeneity-corrected methods produce equivalent PTV, CTV, and isocenter doses while providing superior PTV coverage.

Carcinoma, Non-Small-Cell Lung↗
PubMed2000

An office-based instrument for exercise counseling and prescription in primary care. The Step Test Exercise Prescription (STEP).

BACKGROUND: Available evidence suggests that despite physicians' positive attitudes toward exercise as an important part of promoting a healthy lifestyle, few physicians actually prescribe exercise for their patients. One barrier may be lack of a standard office instrument. OBJECTIVES: To determine the (1) exercise counseling habits among a large group of Canadian family physicians and (2) acceptance and utilization of an exercise counseling instrument geared to primary care practice. DESIGN: Randomized control trial. SETTING: Primary care practice. PARTICIPANTS: Family physicians (N = 400) from 3 regions of Canada, representing both rural and urban practice (ratio of 1:3). Patients (10 per practice) were healthy community dwellers older than 65 years obtained as a convenience sample in their family practice. INTERVENTIONS: In phase 1, 400 physicians listed as being in general or family practice by their provincial registries were randomly selected from a larger group listed by these registries and contacted by telephone. A total of 362 completed a 10-minute questionnaire that detailed practice demographics, preventive practice, and exercise counseling habits. In phase 2, 293 agreed to further participate in the administration of an exercise prescription randomly assigned to them by the study team. Two methods of exercise prescription were compared: counseling using the American College of Sports Medicine guidelines (control) and counseling using guidelines and an office-based step test (Step Test Exercise Prescription [STEP]) to determine fitness level and prescribe an exercise training heart rate. Physicians were asked to deliver their assigned exercise prescription to a convenience sample of the next 10 healthy patients older than 65 years who presented to the office. MAIN OUTCOME MEASURES: Primary outcome measures were physician exercise counseling confidence and knowledge before and after the study. Secondary outcomes included details of the exercise counseling sessions (e.g., time required). RESULTS: In phase 1, more than 90% of the 362 physicians claimed to practice preventive health counseling, and 70% claimed to include exercise counseling. Only 67.4% felt confident regarding their exercise prescribing, and most (93.8%) were interested in improving their exercise prescribing skills. The leading barriers to exercise prescription were described in order as inadequate time, lack of necessary skills and tools, and lack of reimbursement. In phase 2, no difference in physician profile, patient profile, or indications for exercise counseling were observed between control (n = 145) and STEP (n = 148) groups. STEP was significantly longer (16.4 vs 12.9 min; P = .001) to administer; however, improvement in physician confidence (P = .01) and knowledge (P = .009) were significantly greater compared with controls. CONCLUSIONS: Most family physicians practiced preventive exercise counseling but reported lack of time and skills as barriers to this practice. Physicians randomized to the STEP group took longer to deliver exercise advice but felt more confident and knowledgeable compared with controls.

Aged↗
PubMed1997

[Prescriptions, prescription-writing errors and patient safety].

The aim of the study is to contribute to knowledge about prescribing-writing errors on prescriptions from hospitals. One hundred and seventy prescriptions, prescribed from Copenhagen University Hospital, were evaluated in a project at Copenhagen University Hospital Pharmacy. Prescriptions were collected at two private pharmacies in Copenhagen during a two-week period in October 1995. The prescriptions contained an average of 1.5 errors and only 11% of the prescriptions were faultless. The three most frequent errors of omission were code of department, inadequate identification of the physician and indications of use. It is often difficult to reach the physician at the hospital, but the first step is to ease the identification of physician and ward. This project confirms that indication of use is a frequent error of omission.

Denmark↗
PubMed1998

[Prescription habits in a primary health care district: approach to an indication-prescription study].

OBJECTIVE: To analyse the profile of medical prescription and prescription habits in the most common illnesses in a Primary Health Care district. DESIGN: Descriptive crossover study. SETTING: Algeciras-La Línea (Cádiz) Primary Care district. MEASUREMENTS AND MAIN RESULTS: A randomised sample of clinical histories stratified by months was selected. This included 338 Paediatrics cases (< 8 years old) and 665 general medical cases (> 8). The therapeutic groups most commonly prescribed for the children were R (45.7%) and J (27.1%) The therapeutic groups most used among the > 8 group were C (17.9%), R (14.8%), N (14.7%) and A (14.3%). Hypertension was the most common chronic pathology in this group (8.9%), treated most often by ACEIs (44.9%). CONCLUSIONS: 1) In our ambit, the most widespread pathology signified the greatest consumption of therapeutic groups. 2) The indication-prescription analysis detected prescription habits that need to be watched: the use of antibiotics and expectorants/mucolytics in ARI and the use of fixed-dose combinations which are hard to justify. Prescription habits in Hypertension treatment and Hyperlipidaemia also merit a consensus analysis.

Adolescent↗
PubMed1998

[Antabus treatment in general practice. A pharmaco-epidemiological study of prescription patterns based on a prescription database].

Denmark has a long tradition for the use of alcohol-aversive drugs in the treatment of alcoholism, most commonly disulfiram (Antabuse). The purpose of this study was to examine the prescription patterns for disulfiram in Danish general practice on an individual level. By means of a prescription database we analysed 150,787 prescriptions on reimbursed medicine to persons who had redeemed prescriptions for alcohol-aversive drugs during the period 1.1.1993 to 31.12.1995 in the County of Funen. Prevalence of disulfiram treatment was 12 per 10,000 inhabitants, three-year prevalence 75 per 10,000 inhabitants and incidence 21 per 10,000 inhabitants per year. Eighty-seven percent of treatments were stopped at (or before) the expiration of one prescription, and relapse was frequent (46%).

Adult↗
PubMed1990

[The study of Chinese herbal medicinal prescription with enzyme inhibitory activity. IV. The study of the prescription containing mineral drug with adenosine 3',5'-cyclic monophosphate phosphodiesterase].

Twenty five Chinese herbal medicinal prescriptions containing gypsum, kaolin, longgu, oyster shell and sodium sulfate were studied for the inhibitory activity of adenosine 3',5'-cyclic monophosphate phosphodiesterase. The inhibitory activity of 15 prescriptions without mineral drug was higher than that of each original prescription. On the contrary, four were lower and six were not recognized to be different. All 11 prescriptions containing gypsum with an exception increased the inhibitory activity by removing gypsum. The half prescriptions containing kaolin or sodium sulfate also increased the inhibitory activity by removing the drug.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed1993

The effects of user charges on the dispensing of prescription medicines: a survey of prescription charge payment in the Wellington region.

OBJECTIVE: The study aimed to examine the impact of user charges on the dispensing of prescription medicines. The effect of social class, customer type and number of items on the incidence of payment problems was examined. METHOD: The study employed a two week survey of 26 pharmacies randomly selected from Wellington Pharmacy Guild. Pharmacists completed a questionnaire on each occasion user charges led to a problem dispensing a prescribed medicine. Data collected included: type of problem encountered and its outcome, customer information (including the customer's pharmaceutical benefit category), and prescription information (including the number of items prescribed). RESULTS: The overall incidence of payment problems was 1.5% or 1 in every 66 prescription forms processed by the pharmacists. User charges resulted in medicine dispensing failure on 56% of the problem occasions. Customers incurred debt or were funded by a social agency on the remaining 44% of problem occasions. Fifty-three percent of dispensing failures resulted in non-collection of items at the end of the survey period. Thirty-four percent of debts were outstanding at the end of the survey. The incidence of all payment problems correlated with the social "need" score of the pharmacy area and was significantly higher for children's and student's prescriptions. CONCLUSION: User charges may provide a greater barrier to children, students and people living in areas of high social need. Ongoing evaluation of the impact of user charges is required to ensure improved prescribing is achieved equitably [corrected].

Adult↗
PubMed2000

Interventions for helping patients to follow prescriptions for medications.

BACKGROUND BACKGROUND: Efforts to assist patients with adherence to prescribed, self-administered medications might improve the benefits and efficiency of health care. OBJECTIVES OBJECTIVE: To update an ongoing review summarising the results of randomised controlled trials (RCTs) of interventions to help patients follow prescriptions for medications, focusing on trials that measured both adherence and clinical outcomes. SEARCH STRATEGY: Computerised searches to July 1998 in MEDLINE, CINAHL, The Cochrane Library, International Pharmaceutical Abstracts (IPA), PsychInfo, Sociofile, and HSTAR; bibliographies in articles on patient adherence; articles in the reviewers' personal collections; and contact with authors. SELECTION CRITERIA: Articles were selected if they reported an unconfounded RCT of an intervention to improve adherence with prescribed medications, measuring both medication adherence and treatment outcome, with at least 80% follow-up of each group studied and, for long-term treatments, at least six months follow-up for studies with positive initial findings. DATA COLLECTION AND ANALYSIS: Information on study design features, interventions and controls, and findings were extracted by one reviewer (PM) and a research assistant and confirmed by two of the other reviewers. The studies were too disparate to warrant meta-analysis. MAIN RESULTS: For short-term treatments, one study, of counselling and written information, showed an effect on adherence and clinical outcome. Ten of 19 interventions for long-term treatments reported in 17 RCTs were associated with improvements in adherence, but only nine interventions led to improvements in treatment outcomes. Almost all of the interventions that were effective for long-term care were complex, including combinations of more convenient care, information, counselling, reminders, self-monitoring, reinforcement, family therapy, and other forms of additional supervision or attention. Even the most effective interventions did not lead to large improvements in adherence and treatment outcomes. Two studies showed that telling patients about adverse effects of treatment did not affect their adherence. REVIEWER'S CONCLUSIONS: The full benefits of medications cannot be realised at currently achievable levels of adherence. Current methods of improving adherence for chronic health problems are mostly complex and not very effective. More studies of innovative approaches to assist patients to follow medication prescriptions are needed.

Drug Prescriptions↗
PubMedDate not supplied

[Impact of Opposable Medical References (RMO) prescription guidelines for antibiotic prescriptions in ambulatory medicine].

The French RMO (Références Médicales Opposables) are prescription guidelines based on a critical assessment of antibiotic drug prescription. The RMO 2, which concerns the prescription of commonly used antibiotics for otorhinolaryngological/respiratory infections, provides an example of the advantages and drawbacks of such an approach. Its effect on prescription behaviour is probably significant. The economic impact in terms of health cost has remained within acceptable limits.

Anti-Bacterial Agents↗
PubMed1996

[The prescription as an aid for communication between physicians and pharmacists. A study of errors and insufficient information on prescriptions].

Traditionally the pharmacist and the physician have played separate roles in the delivery of prescription drugs to patients. One reason for this is the potential for errors during this complex process. The prescription is the key instrument in the communication between the two professions. By screening a large number of prescriptions we found several errors involving potential harm to the patient. We also found that the prescription often contains insufficient information, thereby making it difficult for the pharmacist to evaluate the medication. Quality assurance is of vital importance in both the prescribing and the dispensing process. Professional cooperation between pharmacist and physician should combine the unique knowledge of both professions and thereby achieve optimal drug therapy for the patient.

Drug Prescriptions↗