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PubMed1991

[Intervention to improve the quality of continuing drug prescription at a primary care center].

An evaluation study has been done on the quality of long-term drugs prescription. The aim was to check the effectiveness of certain corrective measures agreed by the professionals working in a primary care centre. Using the results of a first evaluation made in 1989, a series of recommendations were made to reduce the prescription of drugs with a low intrinsic value (LIV). A further evaluation took place 9 months later. A relative reduction of 20.2% in LIV drugs was obtained. This represented a reduction from 25% to 20.8% of the total number of prescriptions. In the relevant pharmacological subgroups a reduction of 77.9% in the prescription of nitrites linked to barbiturites was obtained; of 60% in LIV antacids; of 50.3% in antivaricose drugs; of 36.1% in LIV laxatives; and of 30.1% in Dipiridamol. There was no improvement in the prescription of external LIVs nor cerebral vasodilators. It is concluded that the intervention has proved its usefulness in the improvement of long-term drugs prescription.

Ambulatory Care Facilities↗
PubMed1991

[Improving drug prescription in primary care: a controlled and randomized study of an educational method].

BACKGROUND: The aim of the present study was to assess whether educational intervention on the primary care physician may be an effective method to improve drug prescription. METHODS: An experimental randomized controlled study was carried out in 244 physicians of the management area No. 5 of the Institut Català de la Salut. Intervention consisted in 3 individualized interviews with the 123 physicians of the study group (IG), during which written informative material was also presented. The issues were: cerebral and peripheral vasodilators (CPVD) and antibiotics. The changes in the prescription of CPVD, combination of anti-infective agents with expectorants, mucolytics and/or balsamics (R05C1) and cephalosporins were specially evaluated in both groups. Subsequently, a stratified analysis was carried out depending on the volume of prescription of the physicians. RESULTS: The IG showed a greater reduction in the prescription of CPVD (9.78 bottles per physicians and months versus 6.43, p less than 0.01). The relative reduction in R05C1 prescription was also higher in the IG (12.3% versus 6.7%, p less than 0.01). The expenditure showed similar results. The use of oral cephalosporins increased in the IG and was reduced in the CG (p less than 0.01). CONCLUSIONS: The results show a favorable impact of personalized information in the groups with high prescription volume, which is particularly remarkable in the highest prescribers.

Drug Prescriptions↗
PubMed1989

Prescriptive authority: debunking common assumptions.

Prescription of drugs is an act integral to the assessment, diagnosis and treatment cycle in the provision of primary care. To provide primary care and specialty services, advanced practice nurses are seeking prescriptive authority. This article examines the historical development of medical prescriptive authority, challenges four commonly held assumptions regarding prescriptive authority for nurses, and discusses how medicine's dominance in prescriptive authority for nurses, and discusses how medicine's dominance in prescriptive authority relates to nursing's struggle for power and autonomony. Nurses must direct their political and educational activities toward developing true structural and attitudinal autonomy in all aspects of nursing practice.

Drug Prescriptions↗
PubMed1989

The use of non-prescription salbutamol inhalers by asthmatic patients in the Hunter Valley, New South Wales. Newcastle Retail Pharmacy Research Group.

Because of concern over the unsupervised use of bronchodilator aerosols, we studied the characteristics of a group of asthmatic subjects who purchased their salbutamol inhalers and a group of asthmatic subjects who obtained their inhalers by prescription. Community pharmacists distributed 360 questionnaires to consecutive patients who requested salbutamol inhalers; 320 questionnaires were returned (response rate, 89%). Of these, 240 respondents described themselves as asthmatic and stated that they obtained their inhalers exclusively or predominantly by either purchase (120 subjects) or prescription (120 subjects). Purchasers were younger than were users of prescribed inhalers and were more likely to be in current employment. The "purchase" group perceived less disability from chest disease than did the "prescription" group but were not different from the prescription group with respect to more-objective measures of disease severity, such as the occurrence of wheeze every day, nocturnal wakening with wheezing, and admissions to hospital with asthma. The purchasers had a low rate of consultation with family practitioners and specialists and reported a low use of prescription-only medications, particularly of inhaled corticosteroid agents. This study highlights the possible disadvantages of providing bronchodilator aerosols without prescription, and emphasizes an important counselling role for community pharmacists in the management of bronchial asthma.

Administration, Inhalation↗
PubMed1984

Do patients cash prescriptions? An audit in one practice.

It has been suggested that up to 20 per cent of patients do not cash their prescriptions. To investigate this possibility, the rate of uncashed prescriptions in a group practice was measured. Out of 1,395 prescriptions studied, 89 (6.4 per cent) were uncashed. An association between having to pay prescription charges and prescriptions being uncashed was shown. Measurement of the rate of uncashed prescriptions deserves to be more widely used as a means of self-audit.

Drug Prescriptions↗
PubMed1994

[Determining factors of the quality of prescription measured in intrinsic value and its potential use].

OBJECTIVE: To determine whether the following factors-medical training in family practice, age of the doctor, health care organization and percentage of patients over 65 years--influence the quality of pharmaceutical prescription as measured in terms of its intrinsic value and potential use of the prescription. DESIGN: Descriptive cross study. SITE. Regional health authorities of Costa de Ponent. Barcelona. PARTICIPANTS: 400 general practitioners throughout the whole of 1992. MAIN MEASUREMENTS AND RESULTS: Doctors belonging to the new health system and specialising in family practise, present higher intrinsic value and potential use of the prescription (statistically confirmed), as well as a greater concentration of prescription of the top 100 prescribed medicines. Doctors no more than 40 years old had better prescription but no statistical differences were found. An aged population had nearly no influence. CONCLUSIONS: The characteristics of the doctor (organization, training) are conditioning factors in the quality of pharmaceutical prescription.

Adult↗
PubMed1993

The effects of copayments and generic substitution on the use and costs of prescription drugs.

Rising costs of prescription drugs are a concern to both private and public purchasers. Common methods of controlling or sharing costs include copayments and incentives to use generic substitutes. A study of prescription drug use and costs for a set of employer groups reveals that a common change in the rate of copayment from $3 to $5 per prescription is estimated to be associated with a 5% decrease in the number of prescriptions, an offsetting increase in ingredient costs per prescription, a 10% decrease in employer costs per person, and an increase in employee costs of approximately the $2 copayment per prescription.

Cost Sharing↗
PubMed1993

[The evaluation of a computer program for the filling of repeat prescriptions].

OBJECTIVE: To study the long-term prescriptions at our health centre, using information supplied by the data base of the long-term treatment programme (LTP). Secondly, to evaluate the programme's efficiency as regards the best use of available time at our Health Centre. DESIGN: Descriptive study. SETTING: Zumaia Health Centre (Guipúzcoa). PATIENTS: The 533 patients at present included in the long-term treatment programme. MEASUREMENTS AND MAIN RESULTS: 7.9% of the adult population were included in the LTP. There was a significant increase, greater than expected, in the 65-74 age group. On average, the patients received 8.2 jars of medicine at each check-up, which on average took place every 54 days. 60% of patients needed three or less different drugs. On average, the programme printed 560 prescriptions per week, thus avoiding a manual filling of prescriptions calculated at 4 hours and 40 minutes. CONCLUSIONS: The transferral to computers of the filling and control of repeat prescriptions is an alternative of sufficient importance to justify its general use. Modification of the present form authorizing repeat prescriptions would greatly increase efficiency. Further studies are required in order to look deeper into the origin and adequacy of prescriptions.

Adolescent↗
PubMed1993

[Prescription of benzodiazepines in general practice].

General practitioners are responsible for about 90% of all prescriptions for psychotropic drugs which benzodiazepines account for approximately 75%. In order to obtain a quantitative and qualitative assessment of the consumption in Svendborg, all benzodiazepine prescriptions were registered during a two-month period (February and March 1990). A total of 3364 prescriptions were issued to 6% (2262 persons) of the population. Of these, 1837 (54.6%) were prescriptions for tranquillizers, 1272 (37.8%) for hypnotics and 255 (7.6%) for both tranquillizers and hypnotics. The prevalence of benzodiazepine users increased with age and women were responsible for about 2/3 of the total consumption. Small but frequent prescriptions were issued to the younger users of benzodiazepines while older users generally received prescriptions for greater quantities at longer intervals. One in four persons over 80 years of age used sedatives. On account of the pharmaceutical, social and economic consequences of the widespread use of benzodiazepines in the elderly population, restrain should be observed in prescribing benzodiazepines.

Adult↗
PubMed1993

[Compliance with long-term drug treatment: the prescription as a means of health education].

OBJECTIVE: To examine whether the new prescription form, when it is correctly filled in and gives adequate information about the meaning of the treatment instructions, provides long-term patients with a higher level of understanding of their drugs treatment than the old prescription form. DESIGN: Prospective, descriptive study. SETTING: Primary Care level. PATIENTS AND OTHERS PARTICIPANTS: Those users of the Health Area undergoing long-term pharmacological treatments and supervised by the nursing staff using the Health Centre Medication Card. INTERVENTIONS: The 193 users who fulfilled these criteria for inclusion in the study were given three questionnaires. The first contained the old prescription form; the second, the new prescription form, without the spaces for the treatment instructions being filled in; the third, the new form, with the treatment instructions filled in and their meaning explained. MEASUREMENTS AND MAIN RESULTS: Users were faced with the old prescription form and the new one correctly filled in plus explanation. Comparison between the two showed that out of 38 cases of error with the old form, 14 (36.84%) increased their understanding of the treatment. This was a statistically significant improvement: [Tc] < [Te] with an average of (-3.77), with a typical deviation of 1.16 and p < 0.05. CONCLUSIONS: The prescription form can be a good way of improving the efficacy of staff intervention.

Drug Prescriptions↗
PubMed1996

The safety effects of child-resistant packaging for oral prescription drugs. Two decades of experience.

OBJECTIVE: To evaluate the effectiveness of child-resistant packaging in reducing the mortality rate for children younger than 5 years from the unintentional ingestion of oral prescription drugs. DESIGN: Annual mortality rates for children younger than 5 years associated with the unintentional ingestion of oral prescription drugs are constructed for 1964 through 1992. The effect of child-resistant packaging on the child mortality rate during the postintervention period (1974 through 1992) is evaluated with a multivariate time series regression model. The analysis controls for changes in the consumption of oral prescription drugs over time and for long-term safety trends. SETTING: United States. SUBJECTS: Children younger than 5 years. MAIN OUTCOME MEASURE: Estimated reductions in the child mortality rate associated with the use of child-resistant packaging. RESULTS: After controlling for covariates, the use of child-resistant packaging was associated with an annual reduction in the oral prescription drug-related mortality rate of 1.40 (95% confidence interval, 0.85-1.95) deaths per million children younger than 5 years. This suggests a reduction of about 460 child deaths from 1974, the year oral prescription drugs became subject to child-resistant packaging requirements, through 1992-a mortality rate reduction of about 45% from levels projected without the child-resistant requirements. CONCLUSION: Child-resistant packaging reduces child mortality from the unintentional ingestion of oral prescription drugs.

Administration, Oral↗
PubMedDate not supplied

[Drug prescription and current data of the science: factors of the discrepancies].

Randomized clinical trial is the main source of evidence in medicine. Information from clinical trials, however, is limited because only a limited number of questions can be addressed with this approach and, in particular, the issue of drug effectiveness (in real life) remains unanswered. On the other hand, the literature about drug effects (through animal studies, model of effect, observational studies, etc) is very large, but provides little scientific evidence useful for drug prescription: most studies do not address relevant clinical questions or have methodologic problems. In practice, physicians are overwhelmed by thousands of new articles among which they have to select the few that are useful and valid for their practice. This task is difficult because physicians do not have enough time in their clinical activity and they are not trained for critical appraisal of the literature. Therefore, they are extremely dependent on the diffusion process that selects and synthesizes the information for them. Another important factor that has been shown to influence prescription is patient's opinion, as one of the main objective for physicians is patient's satisfaction. Some physicians also use prescription as a way to terminate a consultation or as a medical act independently from the drug which is prescribed (drug prescription being part of the physician-patient relationship). At least, the absence of real control over drug prescription is considered to be one of the main factors explaining the large discrepancy between numerous prescription guidelines (from consensus conference or expert opinions) and the reality.

Controlled Clinical Trials as Topic↗
PubMed1996

[Prescription of antidepressants in family practice].

OBJECTIVE: To evaluate the prescription of antidepressants in general practice. DESIGN: Retrospective observational study. SETTING: Three health centres and one practice with two partners in the Western part of the Netherlands (near Leiden). METHOD: Medication data and daily medical records of general practitioners (GPs) were analysed in the anonymous data set of Registratie network universitaire huisartspraktijken Leiden en Omstreken (RNUH-LEO, with a total of about 23,000 patients) of patients 18 years of age and over, whom the GP issued a first prescription for an antidepressant in the period May 1994-April 1995. For indication 'depression' we also evaluated whether the prescription was repeated and a minimal effective dosage was reached. RESULTS: In one year 218 patients received a first prescription of an antidepressant (9/1,000/year), mostly a classical antidepressant. In 61% the indication 'depression' was found in the medical records. Sixty-three per cent had a repeat prescription after one month. Serotonin reuptake inhibitors were repeated more frequently than classical antidepressants, especially for patients under the age of 65. The minimally effective dosage was reached in 61% of the patients with depression for the classical antidepressants, and for 98% of patients with serotonin reuptake inhibitors. CONCLUSION: Serotonin reuptake inhibitors were not prescribed more frequently than classical antidepressants. The percentage of patients with repeat prescriptions showed that the GPs should pay continued attention to compliance with therapy when prescribing antidepressants. The effective dosage appeared to be reached most often with serotonin reuptake inhibitors.

Adolescent↗
PubMed1997

The impact of increasing patient prescription drug cost sharing on therapeutic classes of drugs received and on the health status of elderly HMO members.

OBJECTIVE: To assess the impact of increased prescription drug copayments on the therapeutic classes of drugs received and health status of the elderly. HYPOTHESES TESTED: Increased prescription drug copayments will reduce the relative exposure to, annual days use of, and prescription drug costs for drugs used in self-limiting conditions, but will not affect drugs used in progressive chronic conditions and will not reduce health status. STUDY DESIGN: Each year over a three-year period, one or the other of two well-insured Medicare risk groups in an HMO setting had their copayments per dispensing increased. Sample sizes ranged from 6,704 to 7,962. DATA SOURCES/DATA COLLECTION: Automated administrative data systems of the HMO were used to determine HMO eligibility, prescription drug utilization, and health status. ANALYSIS DESIGN: Analysis of variance or covariance was employed to measure change in dependent variables. FINDINGS: Relative exposure, annual days of use, and prescription drug costs for drugs used in self-limiting conditions and in progressive chronic conditions were not affected in a consistent manner across years by increases in prescription drug copayment. Health status may have been adversely affected. Larger increases in copayments appeared to generate more changes. CONCLUSIONS: Small changes in copayments did not appear to substantially affect outcomes. Large changes in copayments need further examination.

Aged↗
PubMed1997

Green prescriptions: attitudes and perceptions of general practitioners towards prescribing exercise.

BACKGROUND: This qualitative study was part of a broader randomized controlled trial which showed that written exercise advice (green prescription) from a general practitioner (GP) increased physical activity levels among sedentary patients more than verbal advice alone over a 6-week period. AIM: To assess the attitudes and perceptions of GPs towards the practice of writing green prescriptions. METHOD: Participating GPs (n = 25) discussed attitudes and perceptions towards green prescriptions through structured focus groups within 2 weeks of the end of recruitment for the main study. RESULTS: The GPs felt comfortable discussing and prescribing exercise with and to patients. They preferred giving green prescriptions to giving verbal advice alone, and felt they were a valuable tool to formalize and document mutually agreed exercise goals. Time constraints were identified as a major barrier to the widespread implementation of green prescriptions. Appropriate training, resource materials, and patient follow-up mechanisms were identified as important elements for successful implementation of the strategy. CONCLUSION: Overall, the GPs were very positive about the green prescription concept, believing it to be beneficial for patients and achievable within general practice.

Attitude of Health Personnel↗
PubMed1997

[Study of prescriptions issued in base health areas of the Primary Care Administration of Sabadell].

OBJECTIVES: To quantify and describe Primary Care (PC) prescription originated by specialists, doctors outside the public health system and users. DESIGN: A descriptive, crossover study. SETTING: Eight base health areas in Primary Care, Sabadell, Barcelona. PATIENTS AND OTHER PARTICIPANTS: The medical prescriptions issued by 96 Primary Care doctors during a month. The information on the treatments begun during the study period were analysed. MEASUREMENTS AND MAIN RESULTS: 34,319 drugs products were prescribed for new conditions. 64.9% of these originated with the Primary Care doctor, 31.9% in specialist or private care, and 3.2% were requested by the user. The main diagnostic groups associated with prescriptions originating elsewhere were acute respiratory pathology, followed by Rheumatism not affecting the joints, anxiety and depression. CONCLUSIONS: In our milieu, a high percentage of prescriptions originate outside Primary Care. This study has identified the distribution of this prescription originating elsewhere and the variability, both in amount and origin, of PC prescriptions. It could also serve as a useful point of reference for other similar contexts.

Adult↗
PubMed1998

[Hypnotic drugs in a population. Prescriptions by the specialist and the general practitioner].

The aims of our survey were to estimate the prevalence of hypnotic drug prescription in a representative sample of population in 5 cities of Northern Italy and to analyse the pattern of prescription of these drugs by general practitioners (GPs) and psychiatrists. The data were collected with the collaboration of pharmacists working in 145 pharmacies. All consecutive patients presenting a prescription for a hypnotic drug were interviewed by the pharmacists during a two-week period. The pharmacists interviewed 7744 consecutive patients. The highest prevalence of prescriptions for hypnotic drugs was found in the elderly and in women. The majority of prescriptions were for benzodiazepines (BDZ), with lorazepam and triazolam accounting for about 50% of the total prescriptions. Short-acting and ultra-short-acting BDZ were more frequently prescribed for sleep induction by GPs than by psychiatrists. Approximately 73% of subjects reported that they had been taking the prescribed drug for one year or more. The high proportion of long-term BDZ users may be a consequence of the short period surveyed, which produced data weighted toward long-term consumption. Our data, however, do not permit to establish whether long-term use is appropriate from a clinical point of view or is the consequence of a physical dependence. We must be aware that this practice needs to be studied more accurately, with the aim to assess the risk/benefit ratio of long-term BDZ use.

Adult↗
PubMed1998

[Evaluation of prescription of antibiotics in an intensive care unit].

OBJECTIVES: In order to optimize prescriptions, we conducted a qualitative evaluation of antibiotic prescription in an intensive care unit. METHODS: A prospective observational study was performed on 100 consecutive prescriptions from 11/95 to 4/96. RESULTS: Among 14 documented cases, initial antibiotic therapy was in accordance with antimicrobial susceptibility patterns in all but one case. Among 86 empirical cases, 38 were secondarily documented, yielding 43 microorganisms. Of these 38, 27 were susceptible to 2 or more empirical antibiotics, 3 to only 1 and 8 to none. Antibiotics were modified in 23/38 (60%) cases, resulting in drug changes (n = 21) or drug addition (n = 2). In all cases, the new prescription was consistent with the antibiogram. In the 48 cases where no microorganism was isolated, antibiotic change was guided by clinical course and occurred in 6 (12.5%) cases. A switch to older, cheaper or more narrow spectrum antibiotics was possible in 18 cases, but was actually done in only 4 (22%). Dosage errors were observed in 5 cases of initial therapy. Second line therapy contained 8(21%) dosage errors. Most frequently, isolated organisms at admission were: Staphylococcus sp. (n = 15), P. aeruginosa (n = 11) and S. pneumoniae (n = 10). New pathogens emerged in 16 patients (16%) receiving antibiotics. The most frequent was P. aeruginosa in 4 patients receiving ofloxacin + amoxicillin +/- clavulanic acid. CONCLUSION: These results are encouraging, however, the use of guidelines and periodic evaluation of antibiotic prescription practices might improve the efficiency of empirical antibiotic prescriptions and reduce overall antibiotic costs.

Anti-Bacterial Agents↗