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PubMed1994

Patient demand for prescriptions: a view from the other side.

This paper describes patients' ideas about doctor's prescribing habits, their expectations for prescriptions and their self-reported behaviour in cashing prescriptions. It is based on semistructured interviews with 30 adult patients from two general practices. Views about doctors' prescribing habits ranged from those wanting more help with their symptoms saying that doctors underprescribe to those aware of doctors' pressure of work saying that they overprescribe. The desire for a prescription in a consultation can be related to the stage of the illness at which a patient consults; not all patients wanted a prescription or collected it if they received one. It is suggested that in appropriate cases, doctors could ask patients directly if they were expecting a prescription.

Adult↗
PubMed2002

Prophylactic antibiotic prescription for cesarean section.

OBJECTIVES: To assess the use of prophylactic antibiotics for cesarean section, and to identify factors associated with a doctor's intraoperative prescription. DESIGN: A hospital-based, cross-sectional study. STUDY PARTICIPANTS: All 967 medical records of women undergoing cesarean section from January 1998 to February 1999 in a university hospital, Southern Thailand. MAIN MEASURES: Independent variables consisted of patient and doctor factors. The outcome variable was whether any antibiotics were given intraoperatively. Multivariate logistic regression with random effects was used to identify factors associated with the doctor's prescription. RESULTS: Prophylactic antibiotics were prescribed in 82% of all patients. One hundred and eighty-eight patients (21%) received antibiotics postoperatively. Of the patients receiving intraoperative antibiotics after cord clamping, 8% received only a single dose and 53% received an additional postoperative prescription. The most commonly used antibiotic was ampicillin. Intraoperative prescription was significantly associated with longer duration of ruptured membranes, higher number of vaginal examinations and doctors' age. Doctors aged 30-39 years had three and seven times the likelihood of prescribing intraoperative antibiotics compared with their younger and older colleagues, respectively. CONCLUSIONS: Administration of single-dose prescriptions was still an uncommon practice. Prophylaxis was given more commonly to patients with well known risks for infection, and was given by doctors aged 30-39 years.

Adult↗
PubMed1988

Patterns of psychoactive drug prescriptions by house officers for nonpatients.

Substance abuse may be an occupational hazard for physicians, yet the mechanisms of this hazard remain obscure. The present authors tested the hypothesis that a potential source of psychoactive drugs for the physician trainees and other health professionals is prescription writing by house officers. Furthermore, the hypothesis was advanced that house officers may write significant numbers of psychoactive prescriptions for their family members and friends. Of 565 house officers at a medical center, 339 responded to a questionnaire designed to determine the number of prescriptions each had written for nonpatients in the previous eight months for several categories of psychoactive drugs. The largest number of such prescriptions was written for family members and friends, and the second largest number was for fellow house officers. Narcotics were the most frequently prescribed psychoactive drugs. When compared with their representation in the sample, first-year residents and residents in surgery and surgical subspecialties wrote significantly more psychoactive drug prescriptions than other residents. Implications of these findings for residents are discussed.

Academic Medical Centers↗
PubMed1984

The effect of a Medicaid drug copayment program on the utilization and cost of prescription services.

The effect of a copayment for pharmaceutical services in a Medicaid program is presented. Data were collected from Medicaid claim files in South Carolina (experimental program) and Tennessee (control program) for a 4-year period, 1976-1979. Utilization rates and expenditures for 1 year prior to copayment and 3 years after copayment were computed from a stratified sample of 18 counties. Both the level of prescriptions per eligible recipient and the slope of the utilization function after copayment were found to have declined with the implementation of copayment in South Carolina. The level of the expenditure series after copayment also declined, but the series retained a positive trend. Subsequent analysis of prescription quantity concluded that the increasing expenditure function was attributed to the inflation in cost of ingredients rather than an increase in average prescription size. The study concluded that a small (50) copayment for prescription service is a successful mechanism to control the cost and assist in financing a Medicaid prescription drug program.

Adult↗
PubMed1988

Prescription drug use in 1984 and changes over time.

More than 1.5 billion prescriptions were dispensed from retail pharmacies in 1984 at a consumer cost of +18.4 billion. The number of prescriptions dispensed in 1984 equaled the previous record set in 1973. Over 40% of 1984 prescriptions were for four therapeutic classes: cardiovascular drugs, anti-infectives, psychotherapeutic drugs, and diuretics. Prescriptions for cardiovascular drugs and diuretics increased substantially from 1975 to 1984, while prescriptions for psychotherapeutic drugs decreased. Outpatient use of systemic antiinfectives remained fairly stable over the 10-year period. Trends in the use of specific drug categories within these broad therapeutic classes were variable, as were patient age and sex distributions.

Adult↗
PubMed2002

Decreased number of antibiotic prescriptions in office-based settings from 1993 to 1999 in children less than five years of age.

OBJECTIVE: Increasing rates of antibiotic resistance have stimulated efforts to decrease antibiotic use. To assess the success of these efforts, we analyzed antibiotic prescribing trends in children younger than 5 years old, the group with the highest use, from 1993 to 1999. METHODS: Data from the National Ambulatory Medical Care Survey were analyzed to determine antibiotic prescribing patterns for office-based visits from 1993 to 1999 for children <5 years old. Data were stratified by US regions, patient's race and gender. Antibiotic prescription rates per 1,000 population were calculated with population data from the US Census Bureau as the denominator. Specific prescribing of penicillins, cephalosporins, macrolides and sulfas was also assessed. RESULTS: Overall antibiotic prescribing in the office-based setting peaked in 1995 at 1,191 antibiotic courses per 1,000 children, then declined to 698 per 1,000 in 1999, a decrease of 41%. Antibiotic prescribing was consistently higher in whites than blacks; however, declines in prescribing over time were observed in both groups. Although there was wide regional variation in antibiotic prescribing in the early 1990's, by the late 1990's prescribing rates were similar in all regions. Prescriptions for penicillins and cephalosporins combined comprised 77 and 70% of total prescriptions during 1993 to 1997 and 1998 to 1999, respectively. Macrolide prescriptions reached a nadir during 1993 to 1997, accounting for 9% of the total, but increased to 16% during 1998 to 1999. CONCLUSION: Since 1995 the rates of antibiotic prescriptions in children <5 years of age have declined substantially. At the same time changes have occurred in the types of antibiotics prescribed. It appears that efforts to reduce antibiotic use have been successful. Whether this decrease in use will be accompanied by lower rates of antibiotic resistance will need to be determined.

Anti-Bacterial Agents↗
PubMed2006

The incidence of potential interactions between dietary supplements and prescription medications in cancer patients at a Veterans Administration Hospital.

OBJECTIVE: The concurrent use of dietary supplements and prescription medications is common among patients with cancer. This study examines potential interactions between dietary supplements and prescription medications in a Veteran Hospital cancer population. METHODS: Eligible patients seen at the Hematology/Oncology clinic at the Veterans Administration Medical Center in Cincinnati, OH, were administered a survey to determine their use of dietary supplements. Medication profiles were compiled from patients' medical charts and pharmacy records. It was also noted whether supplementation was previously documented. Potential interactions between dietary supplements and prescription medications were identified from a literature search of documented interactions. Several demographic factors, including age, race, marital status, education and income, were assessed for differences between patients found to be at risk for interactions and those for whom no risks were identified. RESULTS: Dietary supplements were used by 61% of patients. Multivitamins were the most common supplement (80.3%) followed by minerals (40.6%) and herbal preparations (24.8%). Of the 121 patients taking supplements, 65 patients (54%) reported taking more than one. A potential risk for interaction between dietary supplement and prescription medication was identified in 12% of patients taking supplementations. Three patients were at risk for multiple interactions. Veterans who were not currently married were more likely to be at risk for interactions (P = 0.024). Only 28% of patients taking dietary supplements had this supplementation documented in their medical record. CONCLUSION: Dietary supplementation by a veteran cancer population is common. Interactions between the supplement and prescription medication is a potential problem. Patient-physician discussion and documentation of these issues should be systematically addressed.

Adult↗
PubMedDate not supplied

Effects of opioid prescription medication dependence and detoxification on pain perceptions and self-reports.

The purpose of this work is to document whether prescription opioid medications used for pain enhanced or worsened pain syndromes from medical conditions in patients who received a diagnosis of prescription opioid dependence as determined by a diagnosis by Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria. Further, whether detoxification improved or worsened pain perceptions and self-reports in patients who chronically administered prescription opioid medications. Our study consisted of a retrospective sample of patients taken from the Addiction Treatment Unit at St Lawrence Hospital in Lansing, MI. Patients were selected from those who voluntarily sought detoxification from opioid medications in an inpatient setting. Selection criteria for the study consisted of a DSM-IV diagnosis of opioid prescription medication dependence, willingness to undergo medical detoxification, cooperation with self-report scales, and abstinence from opioid medications. Study patients were randomly selected from discharges in patient census for the years 2001 to 2003. The significant findings were that self-reported pain scores improved during the detoxification from admission to discharge, from a mean of 5.5 at admission to mean of 3.4 at discharge (0 is no pain and 10 is the most pain). The detoxification period extended to an average of 5 days. Whereas oxycodone CR (OxyContin) produced higher levels of self-reported pain at admission than at discharge, and these patients experienced significant levels of pain reduction with decremental opioid doses as with other opioid medications. Patients with a DSM-IV diagnosis of prescription opioid dependence reported (self) less pain with detoxification and abstinence from the opioid medications.

Adult↗
PubMed2006

Perceptions of the influence of prescription medicine samples on prescribing by family physicians.

BACKGROUND: The provision of free prescription medicine samples is a common and traditional marketing strategy used by pharmaceutical companies, but concerns have been raised about their influence on physician prescribing behavior and patient safety. OBJECTIVE: We sought to investigate the knowledge, attitudes, and behaviors of Australian family physicians regarding the use of sample prescription medications. METHODS: Qualitative and quantitative techniques were used, including (1) mailed questionnaires to family physicians, (2) semistructured interviews with family physicians, and (3) sample cupboard inventories. RESULTS: A number of issues about samples were identified by the questionnaires (208) and interviews (17 doctors), including insufficient labeling, poor record keeping, diversion of stock (personal use by doctors, their families, practice staff and pharmaceutical representatives), and wasting of expired stock. Prescription medicine samples also influenced prescribing behavior. Australian doctors were less likely to provide samples to patients on financial grounds compared with a previous study in the United States on medical residents. Six sample cupboards were inventoried. Median wholesale value of sample cupboards was AUD Dollars 4959 (range Dollars 2395-Dollars 8709), with 6% of stock expired. Very little generic medicine was included in the sample cupboards. CONCLUSIONS: Better methods are needed to meet legislative requirements and to ensure quality use of medicines (and optimal public health) with respect to prescription medicine samples. Doctors and practice staff require training on the appropriate handling and storage of prescription medications. Alternative ways for distribution of sample medications need to be investigated.

Adult↗
PubMed2001

Evaluation of a program to improve the prescription-writing quality in hospital.

This paper aims to evaluate the effectiveness of a program designed to improve the quality of drug prescription-writing at a university hospital in France. Improvement actions included feed-back from yearly audits and the dissemination of recommendations on how best to write the prescriptions. A random sample of 30 stays was selected from among the hospitalizations for the year 1996. From each patient, medical records were searched for the first prescription order of the stay and its quality was assessed according to standards. A total of 872 records were relevant and included 3,289 medications. The results were compared to those obtained for the two previous years. Actions to sensitize prescribers resulted in an insufficient improvement of most indicators of prescription-writing quality with results remaining well below ideal standards. The hospital staff concerned had a positive opinion of the program which led to an awareness of prescription problems. This assessment showed that the program had a moderate impact on prescribers' practice and efforts must be continued.

Drug Prescriptions↗
PubMed1981

Patient report validated against prescription records for measuring use of and compliance with antihypertensive drugs.

Drug use and patient compliance in antihypertensive treatment were studied by interview and validated with prescription records in a Finnish population. The original study population consisted of 675 hypertensives identified in a 6.6% random survey of the 25-59-year-old population in 1972. At re-examination in 1977, 310 of the 570 participants had then used antihypertensive drugs during the preceding year. Two thirds renewed prescriptions appropriately within 70% of the correct time (considered as good compliance). Prescription filling patterns of the re-examination non-participants did not differ from those of the participants. Eight per cent of the participants reported not having followed prescription instructions. There was 94% agreement between the re-examination and prescription records; 5% reported taking fewer drugs than the records showed and 1% reported taking more. Drug history given by the patient gave accurate information about the number and type of drugs in use. However, patient interview gave an overestimation of compliance.

Adult↗
PubMed1988

Use of antibiotics and prescription drugs in general during the first 9 years of life in a Swedish community.

The use of antibiotic drugs and of prescription drugs in general during the first 9 years of life was studied among all 1701 children born in a Swedish municipality. Cumulative proportions of children who had received one or more prescriptions for any type of drug and for different groups of antibiotic drugs were estimated by life-table methods. The effects on drug use of the gender and the birth order of the child along with the age, citizenship and marital status of the mother were analysed by Cox's proportional hazards regression model. Half of the children had received at least one prescription for any drug after 0.6 years and at least one prescription for any antibiotic drug after 1.8 years. Higher proportions of children with prescriptions for all drugs and for all antibiotic drugs were found among males than females, among those with older siblings compared with first-borns and among children of younger mothers compared with those of older mothers.

Anti-Bacterial Agents↗
PubMed2006

The prescriptions frequencies and patterns of Chinese herbal medicine for allergic rhinitis in Taiwan.

BACKGROUND: The evaluation of Chinese herbal medicines (CHM) to allergic rhinitis (AR) by large-scale pharmaco-epidemiological study is not ease found, although CHM had been reported to have potential effect for AR in some clinical trials. AIMS OF THE STUDY: To explore the frequency and pattern of CHM prescriptions on AR, we have the study by analysing the population-based CHM database in Taiwan. METHODS: The way for this study was linked and processed the complete traditional Chinese medicine database for Taiwanese recorded in the year 2002. The diagnosis of AR was extracted with the only single ICD-9 Code of 477 to calculate the frequency and pattern of prescriptions. Association rule was applied to analyse co-prescription of CHM for patients with AR. RESULTS: In the year 2002, among the 22 520 776 valid beneficiaries of the National Health Insurance, Taiwan, 914 612 subjects (3.8% of the total valid beneficiaries) have diagnosed AR. There were 35.6% of AR patients been treated by CHM. The peak age of AR patients treated by CHM was at the first decade (0-10). For the AR patients, the most common Chinese herbal formula prescription was Shin-yi-qing-fei-tang, or Angelica dahurica (Bai-zhi) for the single Chinese herb. While for the combination treatments the most common prescription was the two formulae, Xiao-qing-long-tang and Shin-yi-san. CONCLUSIONS: Because of the high utilization rate of the CHM treatment for AR, a large-scale randomized trial warrants further research for its efficacy and safety.

Adolescent↗
PubMed2006

Geographic variation in the prescription of schedule II opioid analgesics among outpatients in the United States.

OBJECTIVE: To measure geographic variation in opioid use in a large, commercially insured, outpatient population in the United States. DATA SOURCES: Outpatient prescription drug claims database of a national pharmaceutical benefit manager for 7,873,337 subjects with at least one prescription drug claim in 2000. STUDY DESIGN: We measured the period prevalence of claims for opioid analgesics and controlled-release oxycodone at the state level. We measured geographic variation using the weighted coefficient of variation and systematic component of variation. In county-level multivariable regression, we explored associations between potential explanatory variables and claims for opioid analgesics and controlled-release oxycodone. PRINCIPAL FINDINGS: A total of 567,778 (64.2 per 1,000 total claims) were for oral opioid analgesics. Claim rates by state ranged from <20 to >100 claims per 1,000 total claims. States with long-standing prescription monitoring programs had among the lowest rates. In the county-level data, presence of a statewide prescription monitoring program and proportions of the population aged 15-24 and 65 years and older were independently and negatively associated with claim rates for all opioid analgesics. Surgeons per 1,000, proportion of the population reporting illicit drug use, and proportion who were female were independently and positively associated with claim rates for all opioid analgesics. Only the proportion of the population aged 25-34 and number of surgeons per 1,000 were independently and positively associated with claim rates for oxycodone. CONCLUSIONS: Claim rates for opioid analgesics vary significantly by state. Presence of a statewide prescription monitoring program is associated with lower claim rates at the county level. Future research should use individual-level data to assess whether these findings reflect a reduction in abuse and diversion or suboptimal treatment of pain.

Adolescent↗
PubMed2005

Prescriptions for chronic high-dose cyclooxygenase-2 inhibitors are often inappropriate and potentially dangerous.

OBJECTIVE: To describe the use of coxibs outside of licensed indications and recommended dosing ranges including rofecoxib 50 mg, valdecoxib 20 to 40 mg, and celecoxib 400 mg. DESIGN: Cross-sectional study of coxib utilization in 2002 and 2003 and retrospective cohort analysis of new users. PARTICIPANTS: Patients with known age and sex enrolled in Tennessee's Medicaid program. MEASUREMENTS: The prevalence of coxib use by dose and duration, and the proportion of persons initially prescribed a high-dose coxib and indications for such use. RESULTS: The estimated daily prevalence of nonaspirin prescription nonsteroidal anti-inflammatory drugs (NSAIDs) was 8.7% in 2002 to 2003 (45.7% coxibs). NSAID use peaked at age 65 to 74 with a prevalence of 19.8% (56.3% coxibs). Doses above the recommended daily dose for osteoarthritis accounted for 33.2% (95% confidence intervals [CIs] 32.4%, 33.9%) of celecoxib use, 14.9% (95% CI 14.4%, 15.5%) of rofecoxib use, and 52.2% (95% CI 50.6%, 53.8%) of valdecoxib use. Most of these prescriptions were for a month's supply. For new coxib users, 13.5% were given a month's supply for the highest dose category, and 28% refilled their prescriptions within 7 days of the end of the original prescription. Of these new chronic high-dose users, 17.2% had ischemic heart disease and 7.1% had heart failure. CONCLUSIONS: A substantial portion of coxib prescriptions were for a month's supply at doses above those recommended for most chronic indications. New users were also prescribed high doses despite evidence for cardiovascular comorbidity. These prescribing patterns at doses outside licensed indications are both inappropriate and potentially dangerous.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Patterns and predictors of prescription medication use in the management of headache: findings from the 2000 Medical Expenditure Panel Survey.

OBJECTIVE: The primary objectives were to examine national trends of prescription medication use for headache and explore patterns of variation in the use of these medications across social and demographic levels. BACKGROUND: Despite widespread use of prescription medication for management of headache, little is known about utilization patterns or patient characteristics associated with receiving this type of treatment. METHODS: This study conducted a secondary analysis of data obtained during the 2000 Medical Expenditure Panel Survey, a representative survey of the U.S. noninstitutionalized population. Weighted descriptive statistics and logistic regression models were used to evaluate patterns and rates of overall prescription medication use in patients reporting headache as a household condition. RESULTS: An estimated 9.7 million people 18 years or older reported suffering from headache in 2000. Of these, 46% reported using at least one medication for the treatment of headache. Migraine-specific abortive medication (ie, selective serotonin receptor agonists and ergotamine derivatives) was the most frequently reported medication class, used by 36% of participants. Opiate analgesics and butalbital-containing products also experienced extensive prescribing reported by 22% and 17% of survey respondents, respectively. After adjustment for covariates, wide variation in the use of prescription medication was observed across sociodemographic characteristics including age, ethnicity, and insurance status. CONCLUSION: The observed variation in prescription medication use by drug class and sociodemographic characteristics suggests strategies are needed for improving current prescribing patterns in this patient population.

Adult↗
PubMed2006

The prescription of psychotropic drugs in psychiatric residential facilities: a national survey in Italy.

OBJECTIVE: This paper reports the prescriptions of psychotropic drugs made to 2962 patients living in 265 residential facilities (RFs) in Italy. METHOD: Structured interviews were administered to RF managers and staff to obtain data on patients' sociodemographic and clinical characteristics; information about current drug prescriptions were obtained from clinical records. RESULTS: Polypharmacy was common: on average, each treated patient was taking 2.7 drugs (+/-1.1). The association of one atypical antipsychotic with one benzodiazepine represented the most common prescription profile. The variable most consistently associated with a higher likelihood of receiving polypharmacy was a history of admission to an acute general hospital psychiatric ward in the previous 12 months. Many prescriptions were loosely related to specific diagnoses. CONCLUSION: Psychotropic drug prescription patterns for severe patients living in RFs are characterized by substantial rates of polypharmacy. Specific guidelines may be helpful for long-stay patients living in RFs, who exhibit complex care needs.

Adult↗
PubMed2005

Prescription practice of biological drugs in rheumatoid arthritis during the first 3 years of post-marketing use in Denmark and Norway: criteria are becoming less stringent.

BACKGROUND: The study was based on the Danish DANBIO and the Norwegian NOR-DMARD databases. OBJECTIVE: To investigate changes in prescription practice during the first 3 years of post-marketing use of biological drugs, and to determine the proportion of patients who would not have received tumour necrosis factor (TNF) blocking agents if the prescription guidelines of the UK and the Netherlands had been applied. METHODS: Patients with rheumatoid arthritis (RA) receiving TNF blocking agents from Denmark (n = 823, median age 56.0, 72.2% women) and Norway (n = 371, median age 52.5, 75.4% women) were studied. Prescription guidelines in the UK and the Netherlands were applied to the data. RESULTS: Baseline disease activity and number of previous DMARDs declined significantly during the 3 years (median baseline DAS28 decreased from 5.8 to 5.2 in Denmark (p<0.001) and from 6.0 to 5.6 in Norway (p<0.01)). 47.9% and 41.3% of the Norwegian and Danish patients, respectively, did not meet the UK criteria for using TNF blocking agents, and 10.5% and 5.7% did not meet the Dutch criteria. CONCLUSION: Danish and Norwegian prescription practices of biological treatments in RA were similar, and became less stringent from 2000 to 2003. Prescriptions agreed well with the Dutch guidelines, but almost half the patients did not meet the UK guidelines.

Aged↗