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PubMed1995

Prescription drug and healthcare use among Swedish patients treated with antidepressants.

OBJECTIVE: To analyze healthcare and prescription drug use among patients taking and those not taking antidepressant drugs in a Swedish community. DESIGN: Cross-sectional study. SETTING: General population of the rural Swedish municipality Tierp of approximately 20,000 inhabitants. PARTICIPANTS: All residents of Tierp aged 25 years or older during 1988. MAIN OUTCOME MEASURES: Mean number of ambulatory care visits, hospital bed days, and prescriptions per person; proportion of those taking prescription drugs in different pharmacologic classes. RESULTS: Patients treated with antidepressant drugs had a significantly (p < 0.05) greater use of ambulatory care, hospital care, and prescription drugs than those who did not take antidepressants in the study population. They also had an increased frequency of use of prescription drugs from virtually all pharmacologic classes. Furthermore, the risk for polypharmacy was high in patients treated with antidepressant medications. CONCLUSIONS: Those who took antidepressant drugs consumed more health services and prescription drugs than did those not taking an antidepressant. Patients receiving antidepressant treatment may be at serious risk for iatrogenic disease and should be evaluated carefully with respect to concomitant drug use.

Adult↗
PubMed2001

International approaches to the prescription of long-term oxygen therapy.

While there is broad agreement about who should receive long-term oxygen therapy (LTOT), there is little information available on how clinicians should decide on the oxygen prescription itself, at rest, during sleep and during exercise. The authors describe the results of an international survey that was undertaken to compare how respirologists prescribed oxygen. A questionnaire was sent to 100 respirologists in each of seven countries. The questionnaire identified whether resting flow rates were derived in a standard manner or by individualized patient testing. Test targets were ascertained for rest, exercise and sleep, as was the percentage of time that each test target had to reach for the test to be accepted. The majority of respondents individualized the oxygen prescription at rest (81%). Resting arterial oxygen saturation (Sa,O2) was most commonly targeted at 90-91%. The approach to night prescription varied (p<0.001). Respirologists in Canada and the USA increased the resting Sa,O2 by 1-2 L x min(-1) during sleep, while those in Spain used the resting (awake) flow for the night prescription (62%). Respirologists in the Netherlands, France, and Italy individualized the night prescription more frequently. Although oxygen during exercise was individualized in most countries (74%), significant differences remained among countries (p<0.001). The majority of respirologists (62%) aimed to achieve an Sa,O2 of 90-91% during exercise, while 70% of all respirologists tried to achieve the desired Sa,O2 for 90% of the test. There were substantial differences among countries as to how the oxygen prescription was written. This survey highlights the need for multicentre studies that improve the effectiveness of long-term oxygen therapy utilization.

Adult↗
PubMed2004

Unlicensed and off-label prescription of respiratory drugs to children.

Many respiratory drugs are not available in formulations suitable for infants and toddlers. Efficacy and safety research is mostly restricted to older children. However, respiratory drugs are frequently used in children for common diseases like asthma, upper and lower respiratory tract infections, rhinitis and sinusitis. The unlicensed and off-label use of respiratory drugs in children were studied. A population-based cohort study was conducted by using the computerised medical records in the Integrated Primary Care Information project. The study population comprised a random sample from all children aged 0-16 yrs who were registered with a general practitioner in 1998. All prescriptions for respiratory drugs during the study period were classified according to their licensing and off-label status. The study population comprised 13,426 patients (51.7% male, median age 8.7 yrs), of whom 2,502 (19%) received 5,253 prescriptions for respiratory drugs in 1998. A total of 3,306 (62.9%) prescriptions concerned licensed drugs. Of the remaining 1,947 prescriptions (37.1%), 882 (16.8%) were unlicensed for use in children, and 1,065 (20.3%) were prescribed off-label. The 1-yr cumulative risk of receiving an unlicensed or off-label prescription was 45% among children with at least one prescription for a respiratory drug. This population-based study showed that a large proportion of respiratory drugs prescribed by the general practitioner are unlicensed for use in children, or licensed but prescribed in an off-label manner. Results have to be interpreted with caution because they may unjustly suggest inaccurate prescribing, whereas it may be difficult to treat children with respiratory symptoms and diseases, because for many respiratory drugs paediatric data on safety and efficacy are insufficient. These findings underline the importance of research on suitable formulations, dosages and efficacy of respiratory drugs in children.

Adolescent↗
PubMed2001

[A checking system for contraindications using a prescription, injection and disease name ordering system and its evaluation].

It is important to administer appropriate agents to inpatients and outpatients with various conditions. In addition to the preparation and guidance for taking drugs, we should always consider the patient's basic information including age, history of allergy, name of disease, and history of examination. In particular, information on contraindications may have serious effects on patients, and must be checked most strictly. However, it is impossible to do routine work after obtaining all information such as the patient's basic information that are serially changing, drug history frequently revised, and a large volume of information on medication. In this study, we developed a prescription surveillance system. This system facilitates real-time checking of the names of diseases that correspond to contraindications as a rule, drug interactions, and administration to elderly patients and pregnant women on attached documents for medicines, utilizing prescription orders, injection orders, and disease name orders. This system facilitates efficient and accurate checking even in the following cases: when a prescription involves another department; when several prescriptions on different prescription dates occur; when a combination of an oral agent and an injection is contraindicated; or when an agent that can not be administered due to the patient's disease is prescribed. Therefore, all pharmacists can detect prescriptions involving agents that are contraindicated regardless of job skill. Pharmacists may contribute to higher quality medical practice.

Adolescent↗
PubMed2002

[The construction and evaluation of the preventing method for the input mischoice in a prescription order entry system--usefulness of a three-character input and a warning screen display system].

In the computerized prescription order entry system, it has been pointed out that a physician's input mischoice for medicine is one of the causes of medication errors. We therefore investigated the input mischoices by physicians at the time of writing prescriptions. Subsequently, the number of input characters in a prescription order was changed to three characters from two characters. Furthermore, 105 items of high-alert medications, which are likely to result in injury if errors occur, were established. A warning screen display system that requests reconfirmation of the effect, name, usage, and dosage of those medicines was also built. It was found that 70% of input mistakes were caused by choosing the medicine displayed immediately above or below the desired drug. By changing the number of input characters of a prescription order to three characters from two characters, the rate of specification of a trademark improved sharply from 36% to 85%. Consequently, the rate of choice of a drug with another trademark decreased significantly from 0.028% to 0.0047%. In 5% of cases when the warning screen was displayed for a high-alert medicine, the prescription was stopped, and 25% were changed to other medicines. The above results show that the system that requires the input of three or more characters for the physician order entry and displays a warning screen for high-alert medicines is useful in preventing mischoices at the time of prescription input.

Artificial Intelligence↗
PubMed2004

Using a computerized drug prescription screening system to trace drug interactions in an outpatient setting.

BACKGROUND: Drug-drug interactions are one of the main causes of adverse effects. These events have been studied most often in hospital settings; however, investigations on prescribing based on community practice have shown a high prevalence rate of potential drug interactions. OBJECTIVE: To develop a computerized system able to trace drug interactions quickly through the identification of clinicians issuing potentially unsafe prescriptions. METHODS: We retrospectively evaluated hazardous concomitant prescriptions of hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) and azole antifungals, which were invoiced through 9 months of 2001 within an outpatient setting. The study was conducted in Badajoz, a southern Spanish province, and was divided in three 3-month periods according to the release of 2 warning notes on this drug combination by the Spanish Drug Agency. Prescriptions written during this period were optically scanned each month, and the resulting information, including data from patients, physicians, and drugs involved, was converted to a database and searched for potentially unsafe coprescriptions. RESULTS: A total of 8342711 prescriptions were invoiced in the period of study, 174 of which were for a statin-azole combination. The number of these prescriptions remained fairly constant during periods I and II (63 and 71, respectively), decreasing to 40 in period III. Some clinicians (12.6%) repeatedly prescribed a hazardous drug combination at some point in this study, whereas 18 of 171 patients who received the hazardous coprescription at any time did so repeatedly within a given period. The impact of drug alerts was remarkably deeper in urban rather than rural care centers. CONCLUSIONS: The computerized drug prescription handling system described here is able to readily identify physicians and patients who issue/consume hazardous drug combinations, thus allowing both the possibility of individually informing the healthcare professionals involved and early detection of adverse effects.

Antifungal Agents↗
PubMed2006

Impact of residence on prevalence and intensity of prescription drug use among older adults.

BACKGROUND: Higher levels of morbidity among older adults result in greater need for pharmaceutical products and pharmacy services compared with the need in the general population. Rural residents reportedly have reduced access to healthcare services secondary to transportation difficulties, a limited supply of healthcare workers and facilities, and financial constraints. OBJECTIVE: To examine differences in the prevalence and intensity of prescription pharmaceutical use among urban and rural older adults in Manitoba, Canada. METHODS: Participant data from the 1996/1997 Manitoba Study of Health and Aging were linked to pharmaceutical claims data recorded in Manitoba Health's Drug Program Information Network. The effect of residence on the prevalence and intensity of drug use was determined, in addition to the effects of other sociodemographic characteristics, measures of health, and health service utilization. RESULTS: The prevalence of prescription pharmaceutical use did not differ between urban and rural residents (90.6% vs 89.5%, respectively; p = 0.60). Users of home-care services (OR 1.93; 95% CI 1.09 to 3.39), those who perceived their income as adequate (2.38; 95% CI 1.09 to 5.17), and those with a higher number of chronic health problems (1.42; 95% CI 1.26 to 1.62) were significantly more likely to access prescription medications. Rural and urban residents were equally likely to be high users of prescription drugs (21.3% vs 20.0%, respectively; p = 0.64). CONCLUSIONS: Poor health status is associated with a higher prevalence and intensity of use of prescription drugs among older Manitobans. Rural residence is not a barrier to receipt of prescription pharmaceuticals.

Aged↗
PubMed2005

Effects of making emergency contraception available without a physician's prescription: a population-based study.

BACKGROUND: Timely access to emergency contraception has the potential to reduce the number of unwanted pregnancies and subsequent abortions. A public health policy initiative in British Columbia beginning in December 2000 allowed pharmacists to provide emergency contraceptives (ECs) without a prescription. We sought to determine changes in EC use after the policy was introduced and to analyze EC use with data generated by the policy. METHODS: All Ovral, Preven and Plan B EC prescriptions from Jan. 1, 1996, to Dec. 31, 2003, were identified through the BC PharmaNet and Medical Services Plan administrative databases and the data analyzed to determine changes between 1996 and 2002. Changes over time were determined in the frequency of EC provision, choice of EC agent, frequency of EC use by age group, repeat use and geographic distribution of EC prescription for the pre- and post-policy periods. Anonymized patient-specific data from treatment consent forms were used to describe the reason for EC use, interval between unprotected intercourse and EC prescription, proportion prescribed for immediate or future use, referrals for regular birth control and STD screening and concomitant antiemetic use. Consent data also provided the time in the menstrual cycle that the EC was requested. RESULTS: The number of EC prescriptions increased from a pre-policy mean of 8805 (99% confidence interval 7823-9787) in the years 1996 to 2000 to a post-policy total in 2002 of 17 794. Physicians prescribed the levonorgestrel regimen (Plan B) less frequently than did pharmacists. The frequency of EC use was highest among women aged 20-24 years across all study years, and all age groups demonstrated a post-policy increase in use. On average, 2.1% of the women received an EC 3 or more times a year over the period of the study. More women in urban regions received ECs than women in more rural areas of the province. Analysis of pharmacist treatment consent forms used in 2001 and 2002 showed that 56.2% of women receiving an EC reported using a method of birth control that had failed, 55.7% of pharmacist-provided ECs were obtained within 24 hours after unprotected intercourse, 1.1% of ECs were obtained for future use, antiemetics were provided to 57.7% of women receiving the Yuzpe regimen (Ovral, Preven) and to 20.5% of women receiving levonorgestrel, and women tended to seek ECs when unprotected intercourse occurred at the time of highest risk of pregnancy in their menstrual cycle. Women in greatest financial need obtained ECs more frequently from physicians than from pharmacists. INTERPRETATION: The policy change that granted pharmacists authority to provide ECs to women without a physician's prescription did not simply expand EC availability but was associated with an overall increase in EC use in the province.

Adolescent↗
PubMed2006

Simultaneous and concurrent polydrug use of alcohol and prescription drugs: prevalence, correlates, and consequences.

OBJECTIVE: In this study, we sought to examine the prevalence, correlates, and consequences associated with simultaneous polydrug use and concurrent polydrug use of alcohol and prescription drugs. For purposes of this investigation, simultaneous polydrug use referred to the co-ingestion of different drugs at the same time, and concurrent polydrug use referred to the use of different drugs on separate occasions within the past 12 months. METHOD: Undergraduate students attending a large public midwestern university in the United States were randomly selected to self-administer a Web survey. The sample consisted of 4,580 undergraduate students, with a mean (SD) age of 19.9 (2.0) years; the sample consisted of 50% women, and the racial breakdown was 65% white, 13% Asian, 7% black, 5% Hispanic, and 10% other race/ethnicity. The survey assessed simultaneous polydrug use and concurrent polydrug use of alcohol and four classes of prescription drugs: (1) pain medication, (2) stimulant medication, (3) sedative medication, and (4) sleeping medication. RESULTS: The 12-month prevalence for polydrug use involving alcohol and abusable prescription drugs was 12.1% (including 6.9% simultaneous polydrug use). The majority of polydrug use involving alcohol and each class of prescription drugs was simultaneous polydrug use, with the exception of sleeping medication. Simultaneous polydrug use was more prevalent among undergraduate students who were male, were white, and reported early initiation of alcohol use. Simultaneous polydrug use was associated with more alcohol-related and other drug use-related problems than concurrent polydrug use. CONCLUSIONS: Based on the high prevalence and increased risk for consequences associated with simultaneous polydrug use of alcohol and prescription drugs, collegiate prevention efforts aimed at reducing substance abuse should clearly focus on co-ingestion of alcohol and prescription drugs.

Adolescent↗
PubMed1993

Prescription and nonprescription drug use among black and white community-residing elderly.

OBJECTIVES: To examine and compare concomitants of prescription and nonprescription drug use of Black and White community-dwelling elderly. METHODS: Information on prescription and nonprescription drug use, demographic and health characteristics, and use of health services was obtained from a probability-based sample of Black (n = 2152) and White (n = 1821) community-resident elderly in the Piedmont area of North Carolina. Descriptive statistics were calculated. Linear regression, in which sample weights and design effects were taken into account, was used for the final models. RESULTS: For prescription drug use, 37% and 32% of the variance was explained for Whites and Blacks, respectively (6% and 5% for nonprescription drugs). Health status and use of medical services were the strongest predictors of prescription drug use for both races (with Medigap insurance also important for Whites and Medicaid important for Blacks). Demographic characteristics and self-assessed health were significant factors in the use of nonprescription drugs. Race independently predicted use of both types of drugs but explained only a small proportion of the variance. CONCLUSIONS: Health status and use of health services are importantly related to prescription drug use. Non-prescription drug use is difficult to explain.

Black or African American↗
PubMed1997

Cost-related information to be provided by computerised drug-prescription systems to promote cost-effective prescribing.

Drug prescriptions are a source of steadily increasing healthcare expenditure in most developed countries. As the use of Computerised Drug Prescription Systems (CDPS) increase both in hospital and community-care settings, the potential of such systems to promote cost-effective prescribing and help contain prescription costs should be considered. This article describes the cost-related information that could be provided by a CDPS, namely decision-support information to be provided on-line during the prescription entry, and retrospective information made available by processing stored prescription records. The review also describes design and specification requirements for building a cost-information module that can be used in various health-delivery systems. These are: (i) adequate and well-organised data; (ii) pertinent background knowledge of the domain; and (iii) algorithms that allow adaptation to site-specific features. The propositions expounded in this article result from a part of the work performed during the Optimisation of Drug Prescription using Advanced Informatics (OPADE) European project.

Cost-Benefit Analysis↗
PubMed2001

Direct-to-consumer promotion of prescription drugs. Economic implications for patients, payers and providers.

Spending on outpatient prescription drugs in the US is accelerating rapidly. Although numerous factors are driving this trend, attention has recently focused on the role played by the marketing, promotion and advertising of pharmaceuticals, in particular direct-to-consumer (DTC) advertising. In 1997, the US Food and Drug Administration (FDA) issued a 'guidance' on such mass media promotion. The guidance altered existing FDA rules and effectively permitted pharmaceutical companies to promote prescription drugs on television and radio without giving detailed or even summary information on indications, efficacy or potential adverse effects. Since then, television commercials, in particular, and print advertisements in consumer magazines and newspapers have proliferated rapidly. Pharmaceutical companies spent $US1.8 billion on DTC advertising in 1999, a 40% increase over 1998. This spending in 1999 was heavily concentrated on about 50 drugs. Evidence is growing that DTC promotion of prescription drugs is: (i) alerting consumers to the existence of new drugs and the conditions they treat; (ii) increasing consumer demand for many drugs; (iii) contributing increasingly to the recent sharp increase in the number of prescriptions being dispensed; (iv) raising sales revenues; and, thus, (v) contributing to the higher pharmaceutical costs of health insurers, government and consumers. The public policy issues surrounding DTC advertisements centre on the following questions: (i) are the advertisements leading to the inappropriate clinical use of some drugs? (ii) are the advertisements inducing both consumers and physicians to choose more costly new brand-name drugs over less expensive, but equally effective, older brand or generic drugs? (iii) do television advertisements for prescription drugs contain a balanced amount of information on benefits versus potential adverse effects? and (iv) will the revenue benefits generated by DTC advertising cause pharmaceutical companies to focus more on developing products to treat prevalent but not life-threatening conditions, such as baldness, sexual dysfunction or memory loss? These questions are just beginning to be probed despite prescription drug spending, insurance coverage and payment policies having become major political issues in the US.

Advertising↗
PubMed2006

Regular prescriptions for benzodiazepines: a cross-sectional study of outpatients at a university hospital.

OBJECTIVE: To investigate 1) the patterns of regular prescriptions for benzodiazepines among department clinics in a university teaching hospital, 2) the effects of patient's characteristics on regular benzodiazepine prescriptions, and 3) the patterns of benzodiazepine prescriptions among department clinics from the perspective of pharmacological half-life. PATIENTS: Patients were 22,099 outpatients (51% female; mean age: 56 years) who were prescribed any drug three or more times. METHODS: Cross-sectional study of patient-based data (July 2002 to August 2003) from the database of a computer ordering system at a university hospital. The patterns of regular prescriptions for benzodiazepines were compared among the clinical departments (i.e., Internal Medicine, Psychiatry, and Others). A logistic regression model was used to assess the effects of patient gender and age, and the clinic visited on the issuing of regular prescriptions for benzodiazepines. RESULTS: Regular benzodiazepine users were 3,204 (14.5%). Benzodiazepines were more likely to be prescribed for women (61.3%) than for men and were prescribed most often by psychiatrists (31.7%), followed by internists (20.1%). Multivairate logistic regression model showed that being female and elderly, and being prescribed by a psychiatrist were significantly associated with regular benzodiazepine prescriptions. With regard to the pharmacological half-life, internists were more likely to prescribe short half-life benzodiazepines than were psychiatrists (p < 0.001). CONCLUSION: A large number of outpatients at a Japanese university hospital appeared to be maintained on a regular supply of benzodiazepine drugs. Educational programs are needed to promote the rational prescribing of benzodiazepines.

Age Distribution↗
PubMed1997

Are patients more satisfied when they receive a prescription? The effect of patient expectations in general practice.

OBJECTIVE: To test the hypotheses that patient expectations are a driving force in drug prescribing and that fulfilment of expectations is followed by higher satisfaction. DESIGN: Pre- and post-consultation survey of patients; parallel doctor survey (matched pairs). SETTING: Primary health care in Göttingen, a town of about 130,000 inhabitants in Germany. SUBJECTS: Ten general practitioners and 185 randomly addressed patients. MAIN OUTCOME MEASURES: Patient expectations with respect to the result of the consultation; doctor's perception of patient expectations; agreement between patient and doctor; patient satisfaction. RESULTS: Nearly half of the patients (86/185) expected a drug prescription from their doctor; 68% (125/185) received a prescription. The doctors recognized the expectation of a prescription in only 40.7% of the patients. A high percentage (82.6%) of patients expecting a drug were issued a prescription. Nearly all the patients (45/48) who expected a drug according to their doctor's judgement left the surgery with a prescription, and 58.4% of the remaining patients were prescribed a drug. There was no difference in satisfaction scores between patients whose expectations were or were not fulfilled. CONCLUSION: These results are in some contrast to the main hypotheses. As fulfilment of expectations was not associated with higher satisfaction, physicians need not necessarily worry that patients will change their doctor if he or she refuses a pharmacologically dubious prescription.

Adult↗
PubMed1991

Indices of drug misuse for prescription drugs.

Few studies of prescription-drug misuse have taken into account the numbers of prescriptions dispensed for specific drugs. Using data from the Drug Abuse Warning Network (DAWN) and the National Prescription Audit, we calculated indices of drug misuse for specific prescription drugs that are used mainly in outpatient settings and are either benzodiazepines, barbiturates, other sedative-hypnotics, analgesics, or CNS stimulants. In 1983-1985 the drugs associated with the highest numbers of DAWN medical examiner-reported drug-misuse deaths were codeine, diazepam, propoxyphene, phenobarbital, and secobarbital. However, the drugs with the highest indices of DAWN medical examiner-reported drug-misuse deaths/100,000 dispensed prescriptions were methamphetamine, methaqualone, amobarbital, secobarbital, and glutethimide. An index of fatality risk, calculated as 100 x DAWN medical examiner-reported drug-misuse deaths/DAWN emergency room-reported drug-misuse episodes, suggested that the risk of death from a glutethimide-associated drug-misuse episode had increased 92% from 1975-1979 to 1983-1983 and in 1983-1985 was the highest for the drugs studied. These indices might assist public health authorities attempting to design effective strategies to efficiently address the problem of prescription-drug misuse.

Cause of Death↗
PubMed1992

Prescription medication misuse among persons with spinal cord injuries.

Use of prescription medication, alcohol, and illicit substances, and problems resulting from their use as well as depression and disability acceptance, were reported by 96 persons with long-term spinal cord injuries (SCI). Forty-three percent of the sample used prescription medications with misuse potential, and of these persons, 24% reported misusing one or more medications. Persons who used prescription medications were less accepting of their disability and were more depressed than persons who were not using prescription medications. Additionally, persons reporting problems resulting from prescription medication use were more depressed, and persons reporting problems resulting from nonprescription substance use were less accepting of their disability than were persons not reporting these problems. These results suggest that use of prescription and nonprescription substances by persons with SCI is associated with negative psychological outcomes.

Adaptation, Psychological↗
PubMed1995

[Compliance with prescriptions and adverse drug reactions in the elderly].

We performed a survey concerning prescriptions in the elderly to investigate the influence of ageing on compliance and the occurrence of adverse drug reactions. First, we surveyed 222 outpatients attending at our department (average 70.2 y.o.). The physicians in change examined the account of remaining medicines, and we analyzed the relationship between the compliance with prescriptions, age, diseases and medicines. Secondly, we surveyed 282 inpatients (average 68.0 y.o.). We compared the number of prescriptions before hospitalization, at discharge and 6 months after discharge. We also examined the frequency of adverse drug reactions. The number of medicines, which were prescribed for both in- and outpatients, increased according to age. However, no ageing effect on the number of prescriptions per disease was found. The average number of prescriptions per patient at discharge significantly increased compared to that before hospitalization. The average number of prescriptions of the elderly (above 65 y.o.) admitted at emergency case was significantly more than regularly admitted elderly (p < 0.01). The rate of proper medication taking was significantly higher in the elderly than in the young (p < 0.05). The total percentage of adverse drug reactions among inpatients was 18.8%. Among the patients aged above 60 y.o., the frequency of adverse drug reactions increased according to age. Increased number of the prescribed medicines might be involved in the cause of increased adverse drug reactions in the elderly.

Adult↗
PubMedDate not supplied

Evaluation of prescription-writing quality in a French university hospital.

OBJECTIVE: To evaluate the quality of prescription writing at a university hospital in France. DESIGN/PATIENTS: Each of the 42 medical, surgical, and intensive-care departments were invited to participate in the study. The initial medication orders were reviewed for 866 patients, resulting in 3,254 medications prescribed. One prescription per patient was reviewed for a total of 866 patients, presenting 3,254 medications. RESULTS: Of the 866 prescriptions reviewed, 95.5% were dated. Patient identification was complete in 35.3%. The prescriber was identified properly by both full name and signature in 7.5% of prescriptions. Medication information was complete in only 24% of cases. CONCLUSION: This study showed that prescriptions were not written correctly. Results of this study have been disseminated, and education has begun on proper prescription practice.

Drug Prescriptions↗