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PubMed2004

Evaluation of drug prescription at the Geneva prison's outpatient service in comparison to an urban outpatient medical service.

PURPOSE: To analyse non-psychotropic drug prescription in a prison outpatient clinic in comparison with an urban medical outpatient service. METHODS: Comparative study during 3 weeks at Geneva: prison outpatient service and medical policlinic (MP) of the University Hospital. RESULTS: The most often prescribed non-psychotropic drugs at the Geneva prison were systemic analgesics (mostly non-steroidal anti-inflammatory drugs (NSAID) and paracetamol), dermatologicals, systemic anti-infectives and drugs for the gastrointestinal system. For most types of non-psychotropic drugs, frequency of prescription as well as the prescribing patterns were similar in the prison ambulatory service and the urban MP. Dermatologicals were prescribed more frequently at the prison than at the MP. Analgetics have been prescribed mainly for osteoarticulary reasons, especially low back pain at the MP, and for traumatism and headache at the prison. CONCLUSIONS: The higher frequency of dermatological prescriptions could be due to prison environmental factors. We do not have arguments for any overprescription of analgesics or other non-psychotropic drugs. The data did not show any prescription or co-prescription of several substances that violated clinical guidelines.

Adult↗
PubMed1990

Prescription monitoring of drug dosages in the county of Jämtland and Sweden as a whole in 1976, 1982 and 1985.

Prescribed doses of drugs for which individualisation of dosage is deemed necessary were recorded from one national and one local Swedish prescription monitoring study for the years 1976, 1982 and 1985. Dose patterns were analysed in order to determine whether the practice of individualising drug doses had become more widely adopted by physicians. Amongst drugs eliminated primarily by metabolism, (propranolol and amitriptyline were prescribed in highly variable doses (30-fold or more). The three commonest doses of these agents accounted for about 60% of the prescriptions. In general, doses decreased with increasing patient age. Prescribing practices for piroxicam differed markedly from those of propranolol and amitriptyline, with one fixed dose of piroxicam accounting for about 90% of all prescriptions. For drugs eliminated mainly by renal excretion (digoxin, cimetidine and atenolol) there was an 8-10-fold variation in the prescribed doses. The most frequent dose of these drugs accounted for 40-60% of the prescriptions. Doses of cimetidine and atenolol were lowered only in the oldest patients. The doses of digoxin decreased more evenly with increasing age, and were reduced in elderly patients on long-term maintenance therapy. The difference in digoxin dose between young and old patients increased during the study period. Prescription monitoring as a method for following-up drug usage may be instrumental in evaluating the effect of drug educational efforts.

Adolescent↗
PubMed1990

Prescription of antibiotics to out-patients in hospital clinics, community health centres and private practice.

Prescription of antibiotics in Sweden varies between countries within a range of 13-20 DDD/1000 inhabitants/day. In Malmöhus county, which accounts for the highest prescription rate, the amounts and proportions of erythromycin and tetracyclin prescribed are particularly large. All prescriptions for antibiotics dispensed in half of the pharmacies in the county during a one-week period were examined with respect to type of antibiotic and category of physician responsible for the prescription. Among 5,165 antibiotic prescriptions examined, broad spectrum antibiotics were more frequent in urban than in rural areas, and were more often prescribed by hospital physicians and private practitioners than by district physicians. Erythromycin was particularly often prescribed by paediatricians, the frequency being comparable to that of phenoxymethylpenicillin. Retrospective analysis of consultations at the ENT and paediatric clinics for respiratory tract infections showed that phenoxymethylpenicillin was not always the drug of choice by hospital physicians, despite a recommendation to that effect by the Board of Health and Welfare. The findings suggest that the choice of antibiotics is determined not only by medically relevant factors and Board recommendations but also by the habits of the consulting physicians.

Anti-Bacterial Agents↗
PubMed2004

Early detection of drug interactions utilizing a computerized drug prescription handling system-focus on cerivastatin-gemfibrozil.

OBJECTIVES: Based on the recent cerivastatin experience, we retrospectively evaluated the effect of notifying a drug alert utilizing a computerized drug-handling system. METHODS: The evaluation was carried out during three periods: period I corresponded to all prescriptions issued during April, 2001 ("baseline period"), before the Spanish Drug Agency issued alerts on the concomitant therapy with cerivastatin and gemfibrozil; period II (June) corresponded to a time in which a first informative note had been released; and period III (July) after the second warning alert was issued. RESULTS: Data collected included the reading of 2,693,656 drug prescriptions, 1,937,083 (71.9%) of which contained patient information. Forty-four patients received combined therapy with cerivastatin and gemfibrozil over the three periods, yielding 55 exposures: 27 during the baseline period, and 28 between periods II and III, when the alert bulletins had already been released. Moreover, 41.6% of doctors included in the follow-up repeated the hazardous prescription during those two periods. CONCLUSIONS: The effect of the informative notes about the risk of prescribing cerivastatin and gemfibrozil concomitantly on doctors' prescribing habits was limited. The system for screening information from drug prescriptions presented herein allows the early detection of drug interactions by identifying the doctors who issue hazardous prescriptions as well as patients at the highest risk of adverse drug reactions, thus allowing a personal feedback with both of them.

Drug Interactions↗
PubMed2006

Associations between socio-economic factors and the use of prescription medication during pregnancy: a population-based study among 19,874 Danish women.

OBJECTIVE: To examine the association between socio-economic factors and use of prescription medication during pregnancy in a population of Danish women. METHODS: This was a population-based cohort study. Using record linkage from public administrative registries, we described the use of prescription medication during pregnancy and the financial and educational resources for each pregnant woman in the cohort. RESULTS: The analyses included all 19,874 primiparous women delivering singletons in North Jutland county, Denmark, in 1991-1998. We identified 24,243 prescriptions filled by the women during their pregnancies. The highest overall prescription medication use was among women with basic schooling (OR 1.3; 95% CI 1.2-1.4), and lowest among women with the highest education (OR: 0.8; 95% CI 0.7-0.9) compared with women who had vocational education. Stratified analysis of therapeutic subgroups revealed that socio-economic factors were associated with the use of anti-infective and anti-asthmatic medications during pregnancy. CONCLUSION: Maternal educational level, and to a lesser degree household income, paternal educational level and cohabitation status, was associated with the use of prescription medication during pregnancy. However, the analyses did not take into account important clinical variables such as maternal illness, and the results could be affected by differential misclassification of exposure information, by confounding or chance.

Adult↗
PubMed2001

Are there differences in the use of selective serotonin reuptake inhibitors and tricyclic antidepressants? A prescription database study.

AIM: The aim of the present study was to analyse the utilisation of antidepressants (ADs) and to compare the utilisation of the various ADs with special reference to duration of treatment courses. METHOD: From the Odense Pharmacoepidemiologic Database (OPED), all users of and prescriptions for ADs in the County of Funen, Denmark (about 470,000 inhabitants), were identified for each year from 1992 to 1997 (6 years). Duration of treatment courses was calculated for the first incident period of continuous use of one AD and was compared for the various ADs using Kaplan-Meiers survival statistics with log rank tests. Continuous use was defined as use of a minimum of one tablet per day. Furthermore, the proportion of users presenting only one prescription was determined for each AD. RESULTS: In total, 37,598 patients presented 392,524 prescriptions during 1992-1997. The 1-year prevalence rose from 2.1% to 4.1% in 1997 and the incidence was 1.3% in 1997. The 1-year prevalence increased with age up to 16.5% in 1997 for patients aged 90 years or older. Citalopram was the most-used AD, but there were still a considerable number of patients commencing treatment with TCAs in 1997. Median duration of treatment courses was 196 days for TCAs versus 120 days for SSRIs (P < 0.0001). Duration of treatment courses increased with age. The proportion of users presenting only one prescription was 22% for the SSRIs versus 33% for tricyclic antidepressants (TCAs). CONCLUSION: This study showed that the use of ADs continues to increase because of the increase in the use of the new ADs. There was, however, still a considerable number of patients who started on TCA treatment in 1997. For repeated prescriptions, TCAs were used for longer times than SSRIs. In the very old, there was an apparently inappropriate high use of ADs.

Adult↗
PubMed1991

Prescription intentions in relation to therapeutic information: a study of 117 French general practitioners.

In 1987 we conducted a mailed questionnaire survey involving 250 GPs, randomly drawn from the 3061 GPs in the 'Rhône-Alpes' region in France, in order to study how general practitioners (GPs) react to information about drugs in terms of their prescribing practices. The aim of the questionnaire was to investigate the GPs reactions (prescription intentions) to 25 statements containing information concerning drugs. These included results from randomized clinical trials with adequate clinical criteria (pertinent information), but there were also some statements containing non-relevant information such as intermediate criteria, physiopathological or pharmacological information, and some containing general information such as advice from colleagues, the established position of the drug etc. The GPs were also asked through which channels they commonly received therapeutic information (i.e. medical journals, conferences). A total of 117 GPs returned completed questionnaires. We found the prescription intentions, for pertinent information to be between 76.9% and 95.7%, whilst the intentions, as a result of personal knowledge and/or success with a drug were around 93%. More theoretical information resulted in prescription intentions which were more widely scattered (between 23.1% and 80.3%), and for external advice the intentions were not as high but they were also widely scattered (between 3.4% and 65%). The search for latent dimensions corresponding to GPs reactions to therapeutic information, with both principal component analysis and Rasch Modelling, showed that two orthogonal latent dimensions, i.e. 'sensitivity to clinical and theoretical information', and 'sensitivity to external standards', best explained the responses to the questionnaire. These two dimensions appeared to be independent of age, sex, medical school and type of practice (urban, rural). The use of the journal 'Prescrire' by GPs was found to be significantly associated (P less than 0.005) with low scores, or good quality of perception of pertinent information in the first dimension. The use of specialists' prescriptions was associated with similar scores for the first dimension, but also with poor quality of perception of pertinent information scores (i.e. high scores) for the second dimension. These results could be used to draw up proposals for the improvement of post-graduate medical education, which should take into consideration these two dimensions of therapeutic information assessment by doctors, in order to obtain better quality of perception profiles for information assessment and prescription by doctors.

Adult↗
PubMed2006

A cross-national study of prescription nonadherence due to cost: data from the Joint Canada-United States Survey of Health.

BACKGROUND: In Canada and the United States, patients who have difficulty paying for prescribed medications are less likely to obtain them and may experience increased risks for morbidity and mortality and/or increased health care costs due to nonadherence. As prescription drug costs have risen, the ability to pay for medications has emerged as a critical public health issue. OBJECTIVES: The objectives of this study were to estimate the rates of cost-associated nonadherence in Canada and the United States, and to identify factors that predict cost-associated nonadherence in both countries. METHODS: This original analysis used data from the 2002/2003 Joint Canada-US Survey of Health, a household phone survey jointly conducted by Statistics Canada (Ottawa, Ontario, Canada) and the US National Center for Health Statistics (Hyattsville, Maryland). The sample included 3505 adults in Canada and 5183 adults in the United States. Weighted group comparisons and logistic regression analyses were used to identify population factors predictive of cost-associated prescription nonadherence. RESULTS: Residents of Canada were much less likely than residents of the United States to report cost-associated nonadherence (5.1% vs 9.9%; P < 0.001). Americans without health insurance (28.2%) and Americans and Canadians without prescription-drug coverage (16.2%) were significantly more likely than those with insurance (6.2%) to report cost-associated nonadherence (P < 0.001). In addition to country of residence and insurance coverage, significant risk factors predictive of nonadherence were young age, poor health, chronic pain, and low household income. CONCLUSIONS: The results of this analysis suggest that people with low incomes and inadequate insurance, as well as those with poor health and/or chronic symptoms, are more likely to report failing to fill a prescription due to cost. The overall rate of cost-associated nonadherence was significantly higher in the United States than in Canada, even when other person-level factors were controlled for, including health insurance and prescription-drug coverage.

Adult↗
PubMed2006

Abuse of prescription drugs and the risk of addiction.

Abuse of several categories of prescription drugs has increased markedly in the United States in the past decade and is now at alarming levels for certain agents, especially opioid analgesics and stimulants. Prescription drugs of abuse fit into the same pharmacological classes as their non-prescription counterparts. Thus, the potential factors associated with abuse or addiction versus safe therapeutic use of these agents relates to the expected variables: dose, route of administration, co-administration with other drugs, context of use, and expectations. Future scientific work on prescription drug abuse will include identification of clinical practices that minimize the risks of addiction, the development of guidelines for early detection and management of addiction, and the development of clinically effective agents that minimize the risks for abuse. With the high rates of prescription drug abuse among teenagers in the United States, a particularly urgent priority is the investigation of best practices for effective prevention and treatment for adolescents, as well as the development of strategies to reduce diversion and abuse of medications intended for medical use.

Analgesics, Opioid↗
PubMed2006

Incidence and antecedents of nonmedical prescription opioid use in four US communities. The Coronary Artery Risk Development in Young Adults (CARDIA) prospective cohort study.

BACKGROUND: Nonmedical use of prescription opioids has emerged as a major public health problem during the last decade, but direct measures of incidence and predisposing factors are lacking. METHODS: We prospectively measured incidence and antecedents of nonmedical prescription opioid use in The Coronary Artery Risk Development in Young Adults study among 28-40-year-old African- and European-American men and women with no prior history of nonmedical opioid use. RESULTS: Among 3163 participants, 23 reported new nonmedical prescription opioid use in 2000-2001 (5-year incidence 0.7%; 95%CI: 0.4-1.0%). All 23 had previously reported marijuana use (p<0.001). Five-year incidence was significantly higher among European-American men (OR=3.3; 95%CI: 1.3-8.3), and among participants reporting a history of amphetamine use (OR=24; 95%CI: 6.9-83) or medical opioid use for treatment of pain (OR=8.6; 95%CI: 2.5-30). These associations remained strong when examined among marijuana users and after adjusting for demographics, social factors, and other antecedent substance use. Amphetamine use was the best single predictor of future nonmedical use (sensitivity 87%, specificity 79%). CONCLUSIONS: Initiation of nonmedical prescription opioid use is generally rare in 28-40-year-old adults, but is observed to be more common with a previous history of substance abuse and legal access to opioids through prescription by a physician.

Adolescent↗
PubMed2006

Evaluation of drug utilization and prescribing errors in infants: a primary care prescription-based study.

The purpose of this study is to evaluate the drug utilization trends and to describe the prevalence and type of medication-related prescribing errors in infants treated at primary care health centers in Bahrain. Prescriptions issued for infants were collected over a 2-week period in May 2004 from 20 health centers. Prescribing errors were classified as omission (minor and major), commission (incorrect information) and integration errors. Medications were classified according to the British National Formulary. In infants with a mean age of 6.5 months (+/-3.1) drugs per prescription were 2.52 (+/-1.1). Paracetamol and sodium chloride nasal drops were the topmost prescribed systemic and topical drugs, respectively. In 2282 prescriptions, 2066 (90.5%) were with omission (major), commission, and integration errors. In 54.1% of prescriptions with omission errors, length of therapy was not specified in 27.7%, and in 12.8% the dosage form was not stated. In 43.5% of prescriptions with errors of commission, dosing frequency (20.8%) and dose/strength (17.7%)-related errors were most common. Errors of integration such as potential drug-drug interaction comprised 2.4% of all prescribing errors. The proportion of drugs prescribed irrationally were: contraindicated medications, notably chlorpheniramine, promethazine, and corticosteroids (16.1%); medications prescribed on a p.r.n. basis (13.3%); missed information regarding strength of medications (2.8%); medications prescribed over extended periods (2.7%); low dosing frequency (2.6%); supratherapeutic doses (2.3%); excessive dosing frequency (0.8%). Irrational drug therapy in infants, with prescribing errors were apparent in primary care practice, which may be related to a lack of drug information, pharmacovigilance programme, and nonadherence to basic principles of prescribing. Establishing a national drug policy and pharmacovigilance programme for promoting rational drug use are to be considered. There is also a need to evaluate the effectiveness of interventions by measuring the outcomes.

Bahrain↗
PubMed2004

General and URTI-specific antibiotic prescription rates in a Malaysian primary care setting.

Antibiotic prescribing by primary care doctors has received renewed interest due to the continuing emergence of antibiotic resistance and the attendant cost to healthcare. We examined the antibiotic prescribing rate in relation to selected socio-demographic characteristics of the prescribers at the Seremban Health Clinic, a large public primary care clinic, designated for teaching, in the state of Negeri Sembilan, Malaysia. Data were obtained from: (1) retrospective review of prescriptions for the month of June 2002 and (2) a questionnaire survey of prescribers. A total of 10667 prescriptions were reviewed. The overall antibiotic prescribing rate was 15%; the rate (16%) was higher for the general Outpatient Department (OPD) than the 3% for the Maternal & Child Health Clinic (MCH). The antibiotic prescription rates for upper respiratory tract infection (URTI) were 26% and 16%, respectively, for the OPD and MCH. Half of all the antibiotic prescriptions were for URTI making prescribing for URTI an appropriate target for educational intervention. The URTI-specific antibiotic prescription rate did not correlate with the prescribers' intention to specialise, patient load, perceived patient's expectation for an antibiotic, or the score for knowledge of streptococcal tonsillitis. Prescribing behaviours and record-keeping practices requiring correction were identified.

Adult↗
PubMed2005

Technology induced error and usability: the relationship between usability problems and prescription errors when using a handheld application.

This paper describes an innovative approach to the evaluation of a handheld prescription writing application. Participants (10 physicians) were asked to perform a series of tasks involving entering prescriptions into the application from a medication list. The study procedure involved the collection of data consisting of transcripts of the subjects who were asked to "think aloud" while interacting with the prescription writing program to enter medications. All user interactions with the device were video and audio recorded. Analysis of the protocols was conducted in two phases: (1) usability problems were identified from coding of the transcripts and video data, (2) actual errors in entering prescription data were also identified. The results indicated that there were a variety of usability problems, with most related to interface design issues. In examining the relationship between usability problems and errors, it was found that certain types of usability problems were closely associated with the occurrence of specific types of errors in prescription of medications. Implications for identifying and predicting technology-induced error are discussed in the context of improving the safety of health care information systems.

Adult↗
PubMed2005

Determinants of physician use of an ambulatory prescription expert system.

PURPOSE: To determine whether physician experience with and attitude towards computers is associated with adoption of a voluntary ambulatory prescription writing expert system. METHODS: A prescription expert system was implemented in an academic internal medicine residency training clinic and physician utilization was tracked electronically. A physician attitude and behavior survey (response rate=89%) was conducted six months after implementation. RESULTS: There was wide variability in system adoption and degree of usage, though 72% of physicians reported predominant usage (> or =50% of prescriptions) of the expert system six months after implementation. Self-reported and measured technology usage were strongly correlated (r=0.70, p<0.0001). Variation in use was strongly associated with physician attitude toward issues of system efficiency and effect on quality, but not with prior computer experience, level of training, or satisfaction with their primary care practice. Non-adopters felt that electronic prescribing was more time consuming and also more likely to believe that their patients preferred hand-written prescriptions. CONCLUSION: A voluntary electronic prescription system was readily adopted by a majority of physicians who believed it would have a positive impact on the quality and efficiency of care. However, dissatisfaction with system capabilities among both adopters and non-adopters suggests the importance of user education and expectation management following system selection.

Ambulatory Care Information Systems↗
PubMed2005

Comorbid conditions in the AMICA study patients: effects on the quality of life and drug prescriptions by general practitioners and specialists.

OBJECTIVE: Osteoarthritis (OA) has been identified as the disease with the highest rate of comorbidities, which may increase the likelihood of disability. The AMICA study evaluated how the presence of a coexistent disease and/or its chronic pharmacological treatment influenced the prescription of pharmacological and nonpharmacological therapy in patients with OA. PATIENTS AND METHODS: The 2764 general practitioners (GPs) and 316 specialists (98 rheumatologists, 166 orthopedic surgeons, 52 physical medicine specialists) participating in the study were asked to enroll 10 consecutive patients with OA diagnosed according to the American College of Rheumatology clinical criteria. Information was collected regarding demographics, the clinical characteristics of OA, and previous diagnostic and therapeutic interventions. Pain intensity was assessed using a 100-mm visual analog scale (VAS); the patients were also asked to report on their quality of life and joint function, as well as the presence of any concomitant disease and/or therapy. The influence of comorbidities on the quality of life, pain, and drug prescription was evaluated. RESULTS: A total of 29,132 evaluable patients was observed (25,589 recruited by GPs and 3543 by specialists). The most frequent comorbidities were hypertension (52%), osteoporosis (21%), type II diabetes mellitus (15%), and chronic obstructive pulmonary disease (12%); myocardial infarction and/or angina pectoris were present in 6% and peptic ulcer was present in 5%. Comorbidities were more frequent in older patients and, except in the case of hypertension, were closely related to more intense pain and a decreased quality of life; they were also generally associated with worsened joint function. The presence of peptic ulcer was associated with a reduction in the prescription of nonsteroidal antiinflammatory drugs (NSAIDs) (odds ratio (OR) 0.61; confidence intervals (CI) 0.53 to 0.69) and the more frequent use of Coxibs (OR 1.15; CI 1.03 to 1.28) and simple analgesics (OR 1.42; CI 1.26 to 1.61), as well as with greater use of physical therapy. Hypertension was associated with a reduction in the prescription of physical therapy. NSAIDs and Coxibs were less frequently prescribed if the patients were on anticoagulant therapy (NSAIDs: OR 0.86; CI 0.70 to 1.06; Coxibs: OR 0.77; CI 0.64 to 0.93). Gastroprotective therapy was more frequently used in patients treated with NSAIDs, Coxibs, and analgesics, with GPs giving greater preference to proton pump inhibitors than specialists. CONCLUSIONS: Comorbidities decrease the quality of life and worsen the joint function in OA patients. Comorbidities and their treatment generally do not influence the physician's choice of OA treatment, with the exception of peptic ulcer and anticoagulant therapy, both of which were associated with a reduction in the prescription of antiinflammatory drugs. There was a preferential use of Coxibs in patients with peptic ulcer, and an underuse of gastroprotective measures in OA patients treated with NSAIDs.

Aged↗
PubMed2006

[Patterns of prescription and usage of triptans in Alsace (France): misuse is frequent and avoidable].

AIMS: To analyze use of triptans in the Alsace region of France: patients, disorders motivating, doses, analgesics and migraine prophylactics associated treatments, contra-indications. To study major consumers (more than 144 intakes per year) and to determine among them the proportion who suffering from chronic headache. METHOD: Data concerning all prescriptions of triptans and analgesics as well as migraine prophylaxis prescriptions were obtained from the computer databases of five of the French National Health's local health agencies in Alsace, recorded between April 1, 2003 and March 31, 2004. Data about motivating disorders and the clinical context were obtained using a questionnaire sent to prescribers. Data about patients with more than 144 intakes per year were provided by medical advisors of French Health insurance. RESULTS: We founded 20686 users: 92.1 percent used between 0 and 6 intakes per month. 11.5 percent of disorders motivating the prescription that were mentioned by prescribers were for off-label use: tension-type headache 2.7 percent, mixed headache, 8.8 percent. Prescribers declared at least one contra-indication for triptan use for 7.8 percent of patients. Over all, prescriptions were off-label for 16.1 percent of patients. Patients who used more than 144 intakes per year accounted for 1.9 percent of the total number and self-medication accounted for 19.2 percent of all triptan intakes. Half of the patients were suffering from daily chronic headache (chronic migraine in 66 percent). 15.6 percent of these patients presented at least one contraindication (high blood pressure or ischemic disease). All in all we estimate that use of triptan is a misuse for 25 percent to 30 percent of the intakes. Quantities of other analgesics used increased simultaneously with triptan use: on average 65, 119 and 244 Defined Daily Doses (DDD)/person/year for patients who used between 1 and 72, 73 and 144 and more than 144 intakes respectively. On average 35.4 percent (in DDD) of analgesics used were opiates (dextropropoxyphene, codeine, tramadol). This proportion increased simultaneously with triptan use: 58.9 percent for major users. Prophylactic treatment for migraine was used by 27.9 percent of the patients: lack of prophylaxis was a prescriber's choice in 90 percent of the cases. CONCLUSIONS: The high rate of triptan misuse emphasizes the importance of improving prescription of these drugs.

Adolescent↗
PubMed2000

Evaluating the effect of new hospital specialties on GP prescription costs.

The aim of this paper is to examine whether the introduction of new hospital specialties contributed to an increase in GP prescription costs. New specialties were introduced in Dr Gray's hospital, Grampian, North-East Scotland in 1994. Data on prescription costs and volume for groups of drugs associated with the new specialties were obtained for all GP practices in Moray (study practices) and Kincardine and Deeside (control practices). Comparing the periods January-April in 1994 with 1995, and 1995 with 1996, an upward trend in GP prescription costs was detected for ulcer healing drugs and anti-depressants. The trend in Kincardine and Deeside also pointed to rising prescription costs, although to a lesser extent. The number of patients referred to the psychiatric and gynaecology specialties expanded after the introduction of these specialties at Dr Gray's. In conclusion, there is some evidence to support the proposition that the introduction of new specialties at Dr Gray's was associated with an increase in the growth of prescription costs within Moray. Further research should establish more clearly whether this is as a result of increased referrals by GPs or the prescribing of more expensive drugs by consultants. The results have implications for the setting of prescribing budgets.

Drug Costs↗
PubMed2000

[Analysis of drug consumption with indicators of prescription quality].

OBJECTIVE: To evaluate the quality of pharmaceutical prescription by means of various indicators. DESIGN: Cross-sectional, retrospective study. SETTING: Non-hospital prescription in all the INSALUD provinces, except Ceuta and Melilla, for a year (1997). MEASUREMENTS: Different quality indicators were analysed for the following groups of medicines: oral diabetes drugs, anti-platelet aggregation drugs, anti-hypertension drugs, non-steroidal anti-inflammatories, tranquillisers and hypnotic drugs, antibiotics, anti-asthmatic drugs and the omeprazol efficiency indicator. Consumption was expressed in defined daily doses (DDD) and in DDD per 1000 persons and per day (DID). A prescription quality indicator was indicated on the basis of weighing up the indicators. RESULTS: The sulphonylurea drugs varied greatly (15-56%) and deviated negatively a lot from the standard value. AAS and ticlopidine made up 74% of the anti-platelet aggregation drugs. Consumption of calcium antagonists was three times greater than of beta-blockers. Captopril and enalapril were 65% of the ACE inhibitors. Ibuprofen, naproxen and diclofenac made up between 34 and 50% of the NSAIDs. The DID of hypnotics was 44 against a standard figure of 24. Use of first-level antibiotics was 77%. Inhaled adrenergic drugs came to 80% of total anti-asthmatic drugs. The cost of omeprazol treatment per day was 267 pesetas/DID, which was inefficient in comparison with the standard of 190. All provinces had a prescription quality indicator above six out of ten. CONCLUSIONS: The ACE inhibitors, anti-asthmatic drugs and antibiotics were close to the standard. The use of sulphonylurea drugs, beta-blockers, NSAIDs and hypnotics was a long way from standard. The prescription level was acceptable in the different provinces.

Cross-Sectional Studies↗