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PubMed1996

Coping with the cost of prescription drugs.

African Americans have higher rates of nonprescription drug utilization than white Americans, but lower rates of prescription drug use. In light of this discrepancy, this study examines 281 lower income African American households in the rural South for access to prescription drugs and coping strategies when households cannot afford prescription drugs. About half of the households could not always afford needed prescriptions, and ability to pay was related positively to Medicaid coverage. Households that could not afford prescriptions employed five strategies: (1) prioritizing, (2) financing, (3) rationing, (4) substituting, and (5) postponing. Financing, postponing, and rationing were cited most frequently. The impact of culture and areas for future research are discussed.

Adult↗
PubMed2004

[Drug prescription for pregnant women: a pharmacoepidemiological study].

Prescription drug use by pregnant women should be viewed as a public health issue, since there are numerous gaps in knowledge on the consequences for both the mother and the fetus. Pharmacoepidemiological studies can help minimize the inherent risks in drug treatment by establishing a profile of drug consumption during pregnancy, providing an evaluation of this service, and identifying intervention measures. The purpose of this study was to establish a prescription profile for pregnant women treated under the National Health System (SUS) in Piracicaba, São Paulo State, Brazil, using prescription indicators recommended by the World Health Organization and the U.S. Food and Drug Administration classification of medicines according to risk to the fetus. According to the current study, during prenatal consultations 44.7% of the women received drug prescriptions, and the most widely prescribed group of drugs were those acting on the hematopoietic system (34.9%). Of this total, 26.0% of the drugs were included in fetal risk category C, 1.5% in category D, and 1.5% in category E. These data point to the medicalization of pregnancy and the need for intervention measures aimed at rational prescription drug use during the prenatal period.

Adolescent↗
PubMed2004

Point prevalence of drug prescriptions for elderly and non-elderly inpatients in a teaching hospital.

CONTEXT: Age-related pharmacokinetic and pharmacodynamic changes have been extensively documented, and several concurrent diseases may underlie multiple drug therapy in the elderly. As a result, the risk of adverse drug reactions and drug interactions increases among aged patients. However, only a few studies have compared the prescribing patterns for different age groups of hospitalized patients or have evaluated the effect of age on drug prescription. OBJECTIVE: To compare the prevalence of drug prescriptions for elderly inpatients, with those for non-elderly inpatients, in order to assess age-related differences in the number of prescribed drugs, drug choices and prescribed doses, and to evaluate the prescription appropriateness for the elderly patients. TYPE OF STUDY: Cross-sectional survey. SETTING: 400-bed tertiary care general teaching hospital. PARTICIPANTS: All inpatients on one day of June 1995, except for the Intensive Care Unit and for the Departments of Psychiatry, Pediatrics and Obstetrics and Gynecology. PROCEDURES: All medicines prescribed to the eligible patients on the study day were recorded from the prescription sheets provided by the hospital pharmacy. MAIN MEASUREMENTS: Name, therapeutic class, and mean daily dose of the prescribed drugs. RESULTS: Of the 273 eligible inpatients, 46.5% were 14-44 years old, 33% were 45-64 years old and 20.5% were > 64 years old. Cancer was significantly more frequent among the elderly. The mean number of prescribed drugs was five for all age groups. The five most prescribed drugs for all patients were dipyrone, ranitidine, dipyrone in a fixed-dose combination, metoclopramide and cefazolin. The elderly had significantly more prescriptions for insulin, furosemide and enoxaparin. For most drugs, the mean prescribed dose showed that there was no dose adjustment for elderly patients, and drug choices for this age group were sometimes questionable. CONCLUSIONS: There was little variation in the prescribing patterns for the elderly when compared with the other age strata.

Adolescent↗
PubMed2001

Effect of triplicate prescription policy on benzodiazepine administration in nursing home residents.

OBJECTIVE: To estimate the effect of a triplicate prescription policy on administration of benzodiazepines and possible substitute drugs in nursing home residents during 1994-1995. DESIGN: Retrospective cross-sectional study SETTING: Medicare- and Medicaid-certified nursing homes in five states: New York, which has a policy requiring triplicate prescription forms for certain drugs, and four states without such a policy. SUBJECTS: A total of 211,177 nursing home residents. MEASUREMENTS AND MAIN RESULTS: Data were collected using the Minimum Data Set; logistic regression provided an estimated effect of the policy on prescribing benzodiazepines. We also estimated possible substitute drugs for benzodiazepines (e.g., barbiturates, antidepressants, antipsychotics, and miscellaneous sedative-hypnotics) while adjusting simultaneously for potential confounders. New York nursing home residents were less likely to be receiving benzodiazepine therapy than those in nonpolicy states (odds ratio 0.42; 95% confidence interval 0.41-0.44). No increases occurred in administration of benzodiazepine substitute drugs in New York versus states without a triplicate prescription policy. CONCLUSION: Policy did affect prescription and administration of benzodiazepines in nursing homes in states with versus without a triplicate prescription policy Lack of substitution with other drugs makes it unclear whether overprescribing occurred in states without a policy, or undertreatment occurred in the state with a policy.

Affect↗
PubMed1995

Revisiting "the origins of compulsory drug prescriptions".

It has been argued that today's prescription drug market originated in the arbitrary acts of the US Food and Drug Administration (FDA), which in 1938 issued regulations creating a class of drugs that could be sold by prescription only. On the basis of the FDA's administrative records, I argue that the 1938 regulations on prescription drug labeling were initiated by industry and then agreed to by the FDA; that contemporaries understood and accepted the reasons for restricting the use of certain drugs; and that the subsequent evolution of these regulations is best understood as an FDA effort to limit industry abuses of the prescription labeling system. This decade-long war of position ended when drug manufacturers persuaded the US Congress to enshrine their version of prescription labeling in law in a highly politicized struggle over government's role in the economy.

Drug Industry↗
PubMed2006

Geometric probability distribution for modeling of error risk during prescription dispensing.

PURPOSE: The relationship between the number of prescriptions dispensed by individual pharmacy staff during a single workday and the probability of committing at least one dispensing error during that same workday period was evaluated using a geometric probability distribution. SUMMARY: A cross-sectional descriptive study involving 50 pharmacies located in six cities across the United States was conducted. A pharmacist trained to detect dispensing errors recorded the number of prescriptions filled by each pharmacy staff member and noted which prescription represented the staff member's first dispensing error (defined as any deviation from the prescriber's order) made during the observation period. The Kolmogorov-Smirnov tests for discrete distributions revealed that the observed cumulative distribution of dispensing errors could have come from a geometric probability distribution that assumed dispensing error rates of 2-3%. In terms of risk analysis, this study's findings suggest that there can be a quantifiable statistical relationship between a measure of workload and the risk of committing at least one dispensing error. The ability to model dispensing errors using a geometric probability distribution enables the safety and health care practitioner to directly assess dispensing error risk as a function of a pharmacy's accuracy rate and the number of prescriptions a pharmacy staff member should dispense during a work shift. CONCLUSION: A geometric probability distribution effectively modeled the relationship between the number of prescriptions filled and the occurrence of the first dispensing errors.

Drug Prescriptions↗
PubMed2004

Prescription of hazardous drugs during pregnancy.

BACKGROUND: Prescribing drugs to pregnant women requires the balancing of benefits and risks. Only a small proportion of drugs are known to be harmful to the fetus, but for the vast majority of drugs little evidence of fetal safety exists. AIM: To determine the prescription pattern of potentially and clearly harmful prescription drugs during pregnancy with reference to drug safety categorisation, and to define the drug groups primarily responsible for multiple drug use during pregnancy. STUDY DESIGN: A retrospective, register-based cohort study. METHODS: Linkage of three nationwide registers in Finland. Data collection included prescription drugs purchased during the preconception period and each trimester in the pregnant cohort, and the corresponding time periods in the non-pregnant controls. The pregnancy safety categorisation was determined for each drug (Anatomic Therapeutic Chemical [ATC] code) by using the Swedish classification of approved medicinal products (Farmaceutiska Specialiteter i Sverige [FASS]) and if not available, the corresponding Australian (Australian Drug Evaluation Committee [ADEC]) or US categorisation (FDA). GROUPS STUDIED: Women applying for maternity support (maternal grants) during the year 1999 (n = 43 470) plus non-pregnant control women matched by age and hospital district (n = 43 470). RESULTS: In the pregnant cohort, 20.4% of women purchased at least one drug classified as potentially harmful during pregnancy, and 3.4% purchased at least one drug classified as clearly harmful. A significant decline occurred in the number of pregnant women purchasing potentially and clearly harmful drugs during the first trimester when compared with the preconception period, and the decline continued from the first to the second trimester. In the pregnant cohort, 107 (0.2%) women purchased at least ten different drugs during pregnancy. The drugs most commonly purchased in this group were topical corticosteroids and nasal preparations. CONCLUSION: The use of hazardous prescription drugs declines during pregnancy but prescriptions of known teratogens and the relatively frequent practice of polypharmacy in epilepsy place emphasis on the need for careful pre-pregnancy counselling. However, drug safety classifications give a very crude estimation of risk and should only be used as general guidelines when planning treatment. Risk assessment must always be made on an individual basis, and pregnant women with illnesses requiring treatment must be treated adequately.

Administration, Intranasal↗
PubMed1992

Prescription cost sharing: economic and health impacts, and implications for health policy.

Cost sharing for prescription pharmaceuticals--in the form of copayments, coinsurance, or deductibles--is now common in healthcare systems throughout the world. Although there are no studies that directly or convincingly measure the effects of prescription cost sharing on health status or treatment outcomes, cost sharing does appear to reduce utilisation of pharmaceuticals; however, more information is required concerning the relationship between cost sharing and prescription-filling behaviour. Additionally, outcomes studies are needed to define appropriate and inappropriate cost-sharing levels for particular groups of patients, based on income, disease, employment status, and other factors. Cost sharing for pharmaceuticals and other medical services is likely to increase in the near future. As a result, consumers will have a greater role in treatment decisions and will also become more interested in knowing the value of the medicines they are asked to purchase. They are therefore likely to demand pharmaceutical products that are more cost-effective and products that improve quality of life. The increased implementation of cost-sharing programmes necessitates the adoption of appropriate cost-sharing policies, which incorporate the following general principles: 1. Consumers must be provided with the information required to make informed decisions, including the value of the medication, its importance in the treatment plan, and the consequences of not having the prescription filled. 2. Aggressive or abusive cost-sharing features that deny access to optimal pharmaceutical therapy must be avoided. 3. Inappropriate cost sharing, either fixed level or percentage of the prescription cost, may affect disease control and ultimately health or functional status. 4. Cost sharing restricted to pharmaceuticals may encourage replacement of drug therapy with more expensive forms of treatment; therefore, cost sharing should apply to the full range of medical services to prevent service substitution.

Aged↗
PubMed2006

Trends in outpatient prescription drug use and related costs in the US: 1998-2003.

OBJECTIVE: To present a brief synopsis of trends in the number of prescriptions and retail costs of outpatient drugs dispensed in the US between 1998 and 2003. METHODS: Data were extracted from IMS Health, the National Prescription Audit Plus and the National Disease and Therapeutic Index databases. RESULTS: In 1998, 2.7 billion outpatient prescriptions were dispensed versus 3.6 billion in 2003. This equates to a 33.3% increase over the 6-year period. Of the top 20 most dispensed drugs by volume, 40% were launched in the 1990s or 2000s. Retail costs for the total market of dispensed outpatient prescription drugs were 96.1 billion US dollars in 1998 and 196 billion US dollars in 2003, a 104% increase. Of the top 20 most dispensed drugs by retail cost, all were tradename drugs and were launched in the 1990s or 2000s. CONCLUSIONS: These data indicate a large increase in the US over a short time period in dispensed outpatient prescriptions and their associated retail costs.

Databases, Factual↗
PubMed2003

Prevalence of and change in the prescription of methylphenidate in Israel over a 2-year period.

INTRODUCTION: The use of methylphenidate for the treatment of attention deficit-hyperactivity disorder (ADHD) has increased dramatically in the past decade in some countries in Europe and North America. In response to a public debate in Israel, several Knesset members introduced a legislative initiative that aims to limit the prescription of methylphenidate by physicians. The objective of this study was to examine the rate methylphenidate prescriptions dispensed for the treatment of ADHD in children in northern and central Israel in 1999 and 2001. PATIENTS AND STUDY DESIGN: The population included all children aged 0-18 years living in central or northern Israel and insured by the largest national health management organisation who were prescribed methylphenidate at least once in 1999 or 2001. This was a population-based prevalence study comparing the two timepoints using data from the health management organisation and descriptive statistics. RESULTS: The overall 1-year prevalence of methylphenidate prescriptions dispensed to children was 1.01% in 1999 and 1.22% in 2001 (relative risk [RR] 1.21, 95% CI 1.15-1.26), an increase of 21%. Seventy-seven percent of those prescribed methylphenidate were boys. The prescription rate ranged from 0.2% (RR 1.24, 95% CI 0.76-2.05) in Arabic cities to 5.99% (RR 1.19, 95% CI 1.09-1.30) in kibbutzim; this wide variation by type of residence apparently involved cultural, racial and economic factors. CONCLUSION: Israel shows no unusual or unexpected patterns in methylphenidate prescriptions dispensed to children and a lesser increase over time than other developed countries. This suggests that limiting physician freedom to prescribe methylphenidate to children may not be justified.

Adolescent↗
PubMedDate not supplied

Trends in antimalarial prescriptions in Australia from 1998 to 2002.

BACKGROUND: Previous research in a number of countries has suggested considerable variability in prescribing patterns of antimalarial drugs. The aim of this study was to investigate the trends in prescription of antimalarial drugs recommended for chemoprophylaxis in Australia from 1998 to 2002. METHODS: In 2005 data was extracted from the online Australian Statistics on Medicines reports published by the Pharmaceutical Benefits Advisory Committee, Drug Utilization Sub-committee, on antimalarials used in Australia from 1998 to 2002. RESULTS: Doxycycline probably remains the malaria chemoprophylaxis of choice prescribed for Australians visiting multiple drug-resistant malarious areas. Over the past 10 years, there has been marked drop in the prescription of less useful antifolate drugs such as pyrimethamine combination antimalarial drugs, especially pyrimethamine plus dapsone, which was withdrawn by 1999. There has also been a reduction in the number of prescriptions for chloroquine, mefloquine, and proguanil. The number of prescriptions for atovaquone and proguanil remain small, although they have increased steadily since its introduction in 2000, in the absence of a recommendation in the prevailing Australian guidelines. CONCLUSIONS: The prescription of antimalarials such as proguanil, chloroquine, mefloquine, and the pyrimethamine-containing compounds reduced considerably between 1998 and 2002. This was probably largely influenced by the availability of antimalarials, increasing resistance, the issuing of updated guidelines for malaria chemoprophylaxis, and continuing education. Newer drugs such as atovaquone plus proguanil may displace older antimalarials, particularly in the prevention of Plasmodium falciparum infection.

Antimalarials↗
PubMed1998

Prescription drug use and costs among diabetic patients in primary health care practices in Germany.

OBJECTIVE: To evaluate drug prescriptions and costs among diabetic patients in primary care practices in Germany. RESEARCH DESIGN AND METHODS: Computerized data on prescriptions and costs (drug company sales prices) were analyzed in 30,604 diabetic and 17,723 (5% random sample) nondiabetic patients from 362 primary care practices during 1994. Relative use ratios for drug groups were obtained from logistic regression models (odds ratio [OR] for diabetes) controlling for age, sex, and other covariates. Relative costs (diabetic:nondiabetic) were estimated by direct age and sex standardization. RESULTS: Diabetic patients had an increased prescription use for most drugs. A substantial increased use (OR > or = 1.4) was found for cardiovascular drugs, fibrates, gout medication, laxatives, and wound care products. Diabetic subjects (7.9% of all patients) accounted for 21% of total annual prescription costs in the practices. Total costs (U.S. dollars) per patient-year were threefold higher (diabetic patients $384; control subjects $123). After excluding antidiabetic agents and age- and sex-standardization, relative costs were still 1.5 times higher (P < 0.05). Diabetes treatment accounted for 24% of total costs in diabetic patients (insulin 12%; oral antidiabetics 6%). The most important cost factor was cardiovascular drugs (CVDs) (39%). Three CVD groups accounted for about 50% of total CVD costs in diabetic patients (ACE inhibitors 25%; Ca-antagonists 16%; nitrates 10%). CONCLUSIONS: Prescription use among diabetic patients in primary health care practices was predominantly increased for cardiovascular drugs and for treatment of diabetes-associated disorders. Diabetic patients accounted for over one-fifth of the total pharmacy costs in primary practices, indicating that diabetes is a major economic factor in drug use.

Aged↗
PubMedDate not supplied

Prescription of drugs to pregnant women in France: the HIMAGE study.

The HIMAGE study, conducted in partnership with the principal Public Health Insurance Funds of the Loire region, analysed medicinal prescriptions during pregnancy on the basis of a representative sample of 911 pregnant women resident in this region of France. Altogether 93.5% received at least one prescription, with a mean of 10.9 different drugs per woman. The prescriptions were predominantly for drugs of the following Anatomical Therapeutic Chemical (ATC) classes: "alimentary tract and metabolism" (78%); "genito-urinary system and sex hormones" (62%); "nervous system" (62%); and "blood and blood-forming organs" (57%). Iron supplements, paracetamol, folic acid, magnesium, progesterone, oxaceprol, phloroglucinol, amoxicillin, domperidone and diosmine were the most frequently prescribed drugs. In total, 4.6% of the women were exposed to drugs involving a risk during pregnancy: principally nonsteroidal anti-inflammatory drugs (NSAIDs) prescribed from the sixth month onwards. This study revealed a high frequency of prescription of drugs to pregnant women, largely motivated by non-rational and to some extent culture-specific considerations, and it also highlighted the prescription of drugs known to involve risk during pregnancy. These results provide a basis for advising clinicians on the rational and safe use of drugs during pregnancy.

Adult↗
PubMed1999

Requests for repeat medication prescriptions and frequency of acute episodes in asthma patients.

This study was conducted to determine if suboptimal use of inhaled steroid and over-reliance on bronchodilator medication to control asthma symptoms is associated with higher risk of acute asthma episodes. Details of repeat prescriptions for medication and use of health services over 12 months were collected for 754 adult outpatients with asthma; all were prescribed inhaled corticosteroid. Patients who requested less than five prescriptions per year were considered suboptimal users. Patients who requested seven or more bronchodilator prescriptions and less than five inhaled steroid prescriptions had significantly more family physician consultations for asthma episodes (p < 0.05), more hospital admissions (p < 0.05), and more disturbed nights in the week before hospital or family physician review (p < 0.05). Some patients with more severe asthma put themselves at risk by relying on bronchodilator medication rather than regular inhaled steroid for asthma control. Among patients who were low bronchodilator users, those who requested few inhaled steroid prescriptions were younger and more anxious but did not have an increased risk of acute asthma episodes.

Acute Disease↗
PubMed1996

Who is using antihypertensive drugs? A prescription analysis from Finland.

OBJECTIVE: To analyse the prescribing of antihypertensives in Finland in 1993. DESIGN: A descriptive three-month follow-up study of reimbursed prescriptions for chronic hypertension dispensed in Finnish pharmacies. SETTING: The nationwide prescription data base of the Social Insurance Institution covering 80% of Finnish pharmacies. Material--The study material consisted of 479 744 antihypertensive prescriptions from ATC-groups hypotensives (C02), diuretics (C03), beta blocking agents (C07), and potassium (A12B) for 279 435 hypertensive patients. RESULTS: Of all the prescriptions (excluding potassium supplements), 30% were for beta blocking agents, 24% for diuretics, 22% for calcium channel blocking agents, 20% for ACE inhibitors or ACE inhibitor + diuretic combinations, and 4% for other hypotensives. Two thirds of the men received a drug from a hypotensive group, nearly half were prescribed a beta blocking agent, and 27% a diuretic. Among women the distribution of the different drug groups was more even: more than half the women (55%) were prescribed hypotensives while beta blocking agents and diuretics were prescribed for 43% and 44%, respectively. Due to the different treatment profile between men and women the expenses of treatment also differed. The cost of prescriptions for female patients was, on average, 17% less than that for male patients. CONCLUSION: The choice of antihypertensive drugs depends on the age and sex of a patient. Prescribing antihypertensive drugs does not fully meet national recommendations. New drugs are gaining ground in the treatment of hypertension. An increase in the cost of treatment will result from this development.

Adult↗
PubMedDate not supplied

Pharmacy clarification of prescriptions ordered in primary care: a report from the Applied Strategies for Improving Patient Safety (ASIPS) collaborative.

INTRODUCTION: Prescription errors threaten patient safety and pharmacists often contact providers for prescription clarification. This study describes the principal reasons pharmacies call primary care practices to clarify prescriptions and subsequent implications for quality and patient safety improvement. METHODS: A cross-sectional study of 22 primary care practices participating in a patient safety study was performed. Callbacks from pharmacies were logged for 2 weeks to determine reasons for callbacks, most frequently involved drug classes, whether issues were resolved on the same day of the call, and variability of callbacks among practice types. Analyses were performed using frequencies, t tests, and chi(2) tests. RESULTS: Practices recorded 567 clarification calls, most frequently for prior authorization issues (n = 209; 37%), formulary issues (n = 148; 26%), and unclear/missing prescription dosages (n = 117; 21%). Drug classes most frequently requiring clarifications were gastrointestinal (n = 122; 21.7%), cardiovascular (n = 278; 13.9%), and analgesic/anesthetic (n = 74; 13.2%) agents. Issues were resolved on the same day 62% of the time. Residency practices averaged more issues per call (P < .001). CONCLUSIONS: Clarification calls made to primary care practices involve administrative and clinical issues, potentially impacting patient safety. Pharmacy callback data can identify potential prescription concerns, thereby helping practices develop interventions aimed at reducing errors and improving patient safety.

Cooperative Behavior↗
PubMedDate not supplied

Medical use, illicit use, and diversion of abusable prescription drugs.

The authors investigated the medical use, illicit use, and diversion of 4 distinct classes of abusable prescription medication (sleeping medication, sedative or anxiety medication, stimulant medication, and pain medication) in a random sample of undergraduate students. In spring 2003, 9,161 undergraduate students attending a large, public, midwestern research university in the United States self-administered a Web-based survey. The prevalence rate for illicit use within the past year was highest for pain medication, followed by stimulant medication, sedative or anxiety medication, and sleeping medication. Women generally reported higher past-year medical use rates. However, undergraduate men reported higher illicit use rates. The illicit use-medical use ratio for stimulant medication was the highest among the 4 classes of prescription drugs. Medical users of stimulants for attention deficit hyperactivity disorder were the most likely to be approached to divert their medication. Multivariate results indicated that illicit users of prescription drugs were more likely to use other drugs than were students who did not use prescription drugs illicitly. The authors provide evidence that prescription drug abuse is a problem among college students.

Adolescent↗
PubMed1992

Linking prescription and patient-identifying data: a pilot study.

OBJECTIVE: To link a Pharmaceutical Benefits Scheme (PBS) prescription data set with patient-identifying data held by the Health Insurance Commission (HIC) and to then determine the prevalence of prescribing of cardiovascular drugs, non-steroidal anti-inflammatory drugs, hypnotics and minor tranquillizers, and diuretics (prescribed without other cardiovascular drugs) by age and sex in two defined populations. DESIGN: Prescription data for a three-month period in 1985 were matched with patient-identifying information to obtain a database which included the patient's age, sex and an identifying number, for each prescription record. The percentages of the population taking a drug from each of the drug categories mentioned above were then determined and the effect of age, sex and region of residence on prescribing prevalence was investigated using logistic regression analysis. SETTING: Two rural regions of Australia with a total population of 65,087 residents. MEASUREMENTS AND MAIN RESULTS: Of the 101,383 prescriptions dispensed over the period 96% could be matched with HIC information. In the two regions combined, the percentages of the population taking a cardiovascular drug, non-steroidal anti-inflammatory drug, hypnotic or minor tranquilizer, or diuretic (without other cardiovascular drugs) were 10.4%, 5.8%, 3.5% and 2.5%, respectively. Prescribing rates were higher for females than males, increased with age and varied between the two regions. Approximately 5% of women aged 30-39 years were taking diuretics without other cardiovascular drugs, compared with only 0.2% of men in the same age group. CONCLUSIONS: This pilot study illustrates the use of a patient-identified prescription database for drug utilisation review, therapeutic audit and hypothesis generation.

Adult↗