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PubMed1972

Prescription data processing--its role in the control of drug abuse.

Prescriptions in an outpatient setting were kept on file for immediate recall by computer terminals. Drugs with abuse potential were found to make up 33.6 percent of all prescriptions, and 12.4 percent of these prescriptions were for excessive quantities. An additional 2.6 percent of these prescriptions represented irrationally large quantities of drugs dispensed by multiple prescriptions. The physician was cooperative and willing to correct this situation when it was brought to his attention by the pharmacist.

California↗
PubMed1978

Duplicate prescription system to facilitate communication between a hospital pharmacy and community pharmacies.

A duplicate prescription system which enables a university hospital pharmacist to fill a copy of the prescription and return the original prescription to the patient for obtaining continuing supplies in his local community is described. The system is based on a prescription form and carbon duplicate with designated space for notations, and clarifications by the pharmacist. Instructions for use of the form and a statement that the prescription copy cannot be filled legally at any other pharmacy assures that the system will not be misused. The system helps assure that an initial quantity of medication is obtained by the patient before he leaves the hospital. Time spent by patients and prescribers in establishing initial and continuing supplies of medication is decreased under the system. The system is of substantial benefit to patients and health care providers.

Drug Prescriptions↗
PubMed1978

Errors on doctors' prescriptions.

All prescriptions dispensed by one pharmacist during one month were examined for errors. Only 5.1 per cent of 2,237 prescription forms contained an error which meant the pharmacist had to contact the doctor. Thirty-seven per cent of prescriptions were either wholly or partly written by the receptionist. There was considerable variation between doctors and this varied from zero to 64 per cent; 4.0 per cent of prescriptions written by the doctor contained errors while those written by the receptionist were almost twice as likely (seven per cent) to do so. The majority of mistakes were obvious and trivial but five were potentially serious.It is recommended that if doctors expect their receptionists to write prescriptions they should ensure that they are adequately trained to do so. The pharmacist can be a valued and trusted colleague who serves to protect patients from doctors' errors.

Drug Prescriptions↗
PubMed1995

[Potentially inappropriate benzodiazepine prescriptions in elderly nursing home patients].

OBJECTIVE: To evaluate the incidence of benzodiazepine overprescription as a cause of benzodiazepine overuse in nursing homes. DESIGN AND SETTING: Physicians were asked to complete a multiple-choice questionnaire for patients receiving at least one benzodiazepine and to indicate the reason for the prescription. To control for social desirability bias, two fictitious cases were submitted to each physician. Overprescription was defined as a prescription for benzodiazepine that differed from the indications given in the product monograph. PARTICIPANTS: Family physicians of patients living in three nursing homes in the Quebec City area were solicited by mail to take part in the survey. RESULTS: Fifteen physicians treating 152 patients, whose average age was 82.1 years (range 50 to 100 years), agreed to take part in the study. It was found that 77.1% of the patients had been taking a benzodiazepine for more than a year. For 14.5% of the prescriptions, there was no official indication. The reasons most frequently cited for these prescriptions were that the physician was renewing a prescription given before he took charge of the patient, the patient's refusal to discontinue use of the medication, pressure from the nursing staff, and the fact that the patient was causing a disturbance. In 4% of the cases (6 answers), the physician acknowledged that there was no indication for prescribing a benzodiazepine. CONCLUSION: This study shows that, in 14.5% of cases, overprescription could be a cause of benzodiazepine overuse in nursing homes.

Aged↗
PubMed1994

Overview of the New York State program for prescription drug benefits.

New York State's prescription drug benefits program is described. The Empire Plan, a part of the New York State Health Insurance Program, includes a prescription drug benefits program. The prescription drug program began in 1986 and covers more than 700,000 people. In 1988 the state started a therapeutic drug-use-evaluation (DUE) program in correct with the supplier, Health Information Designs, a subsidiary of ValueRx Pharmacy Program. In 1991 the partnership with ValueRx was expanded to include patient profilling and physician education. In 1993 the state implemented a prior-authorization program for certain high-technology drugs, also administered by ValueRx. New York's public work force is heavily unionized, and the unions have been deeply involved in program design and vendor selection. Program participants have access to a large network of community pharmacies. The program also provides mail-order service. Quality is at the center of the state's and the unions' prescription drug program philosophy. Saving money is also a major objective; savings totaling $19.5 million were realized from 1988 through 1993 under the partnership between the state and ValueRx. The Empire Plan's prescription drug benefits program is building quality and saving money by integrating DUE, prior authorization, education, community pharmacy, and mail-order service.

Cost Control↗
PubMedDate not supplied

[Prescription of cerebral and peripheral vasodilators in primary health care: a study in the health district of Bilbao].

OBJECTIVE: To assess cerebral and peripheral vasodilators prescriptions (uncertain or nil intrinsic value) and determine other associated values (personal, labour and medical training). DESIGN: A descriptive study. SETTING: General Practice. Health district of Bilbao. PARTICIPANTS: 122 general practitioners, observed between September & December 1992 (three months). MEASUREMENTS AND MAIN RESULTS: On average, each doctor filled in 95 prescriptions covering these three drugs, thus representing 2,3% of the overall expenditure. In an ANOVA, the number of pensioners and type of care provided proved to be variables most closely associated to prescriptions. The overall expenditure generated and the number of prescriptions made covering these drugs were lower in the case of primary health care teams. We would like to stress how important it is to perform prescription quality control and suggest actions to be taken for this purpose.

Adult↗
PubMed1994

[Ongoing improvement in the quality of chronic prescriptions at a primary care center: a 5-year follow-up].

OBJECTIVE: To find how the indicators for prescriptions for the chronically ill during the 1988-1992 period evolved, based on the analysis of the repeat prescription archive; and to assess the persistence of the effect of the 1989 corrective intervention. DESIGN: A retrospective and longitudinal evaluation study. SETTING: Primary Care Centre. PATIENTS AND OTHER PARTICIPANTS: Four representative samples of patients with an ongoing prescription card for 1988 (n = 549), 1989 (n = 211), 1990 (n = 193) and 1992 (n = 126). MEASUREMENTS AND RESULTS: Indicators used were: percentage of patients in treatment with some medication of low intrinsic value (LIV), benzodiazepines, peripheric vasodilators (PV), oral non-steroidal anti-inflammatories (NSAID), external NSAID and the percentage of each one of these out of the prescription total. A progressive decrease in the percentage of LIV medication in the 1988-1992 period was detected. There were significant differences, both for oral anti-diabetes drugs of high intrinsic value (HIV) (24.4 and 12.7%), and of LIV (26.6 and 16.9%) (p < 0.001 in both cases). Benzodiazepines went down from 5.4 to 1.2% (p = 0.0006), PVs from 4.4 to 1.2% (p = 0.003) and oral NSAID from 4.7 to 2.4% (p = 0.049). The percentage of patients treated with LIV medication went down from 46.1 to 29.4% (p < 0.001) and from 52.4 to 38.1% (p = 0.004), for HIV and LIV oral anti-diabetes drugs, respectively. Patients treated with benzodiazepines went down from 14.7 to 4.0% (p = 0.0017), with PV from 12.0 to 3.2% (p = 0.005) and with oral NSAID from 12.7 to 7.9% (ns). CONCLUSION: A continuous improvement in the quality of prescription for the chronically ill has been observed over the last 5 years and can be attributed to the primary care team.

Chi-Square Distribution↗
PubMed1993

Effect of value-added utilities on prescription refill compliance and health care expenditures for hypertension.

A randomised trial was undertaken to discern the effect of pharmacy-based value-added utilities on prescription refill compliance with antihypertensive therapy and subsequent health care expenditures. The subjects were 304 Medicaid beneficiaries from the state of Florida, previously untreated for mild to moderate hypertension, prescribed 240 mg of calcium channel antagonist verapamil once daily and monitored regarding prescription refill compliance and health service utilisation for one year. Subjects provided informed consent and were randomly assigned to one of four experimental groups: (1) the control cohort received standard pharmaceutical care with each dispensing of antihypertensive therapy, (2) the second cohort received standard pharmaceutical care and was mailed a medication-refill reminder ten days prior to each sequential refill date, (3) the third cohort received standard pharmaceutical care and was provided unit-of-use packaging with each prescription-refill request and (4) the fourth cohort received standard pharmaceutical care, mailed medication-refill reminders and unit-of-use packaging. Analysis of variance (ANOVA) procedures revealed that patients receiving mailed prescription-refill reminders, unit-of-use packaging or a combination of both interventions achieved a significant (P < or = 0.05) increase in the Medication Possession Ratio (MPR) for antihypertensive therapy relative to controls. Receipt of both interventions resulted in a significant (P < or = 0.05) improvement in the MPR for antihypertensive therapy relative to all other groups no significant difference was discerned between groups receiving either mailed prescription-refill reminders or unit-of-use packaging.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1993

[Trends in consultations and prescriptions for children with COPD].

National data were provided on consultations (first, repeat) and prescriptions in patients having ambulatory care for asthma and COPD combined, by age group (0-4, 5-11, and 12-19 yr) and doctor's category (GP, specialist) over the period 1981-1990. Prescriptions were subdivided into (1) beta 2-agonists, anticholinergics, ketotifen, methylxanthines, cromoglycate, inhaled steroids, oral steroids, (2) antibiotics, (3) other drugs. Age specific rates/1000 persons/year were calculated. Rates for first consultations remained steady, pointing to a stable incidence. Rates for repeat consultations increased in the 0-4 yr age group (GP and specialist) and the 5-11 yr age group (specialist). Prescription rates for the pulmonary medication group also rose in particular in these two age groups. For the GP, however, they were counterbalanced by decreasing trends in prescriptions of the 'other drugs', pointing to a shift towards more rational treatment. The increased ratios of prescription rate to consultation rate, not only for the anti-inflammatory drugs but for the bronchodilators as well, especially in the specialist category, suggest an increased morbidity (severity) from obstructive airways disease in childhood.

Adolescent↗
PubMed1995

Prescriptive authority for advanced practice nurses: current and future perspectives.

PURPOSE: To present an overview of the issues related to prescriptive authority and advanced practice nurses (APNs) in oncology. DATA SOURCES: Professional journals and books, print media, and professional and government releases. DATA SYNTHESIS: Discussion of issues related to complex political, educational, economic, and healthcare environmental factors. Strategies to achieve increased recognition for APN prescriptive authority include increasing APNs' knowledge about the effects of the political process on prescriptive authority, educating legislators and consumers, promoting standardization of pharmacology curricula, and encouraging formation of coalitions. CONCLUSIONS: Failure to pass a national healthcare plan, escalating managed-care markets, and the reform efforts of individual states to forge their own healthcare initiatives will challenge the APN's ability to practice and prescribe. IMPLICATIONS FOR NURSING PRACTICE: The subject of prescriptive authority highlights the controversies and debates that APNs encounter in a dynamic healthcare environment. These include the complexity of state-to-state regulations, non-nursing professions making key decisions regarding scope of practice and prescriptive authority, and the challenge for APNs to carve out new roles while overcoming state regulatory inconsistencies and market-reform barriers. If not resolved, these issues will continue to prevent qualified APNs from providing appropriate and comprehensive care to patients with cancer.

Drug Prescriptions↗
PubMed1995

[Delegated prescription by specialists in primary care].

OBJECTIVES: To describe the qualitative-quantitative features of Primary Care prescriptions originated by specialists. DESIGN: A crossover descriptive study. SETTING: Txantrea Health Centre (Pamplona). PATIENTS AND OTHER PARTICIPANTS: All the prescriptions originated by out-clinic or hospital specialists over a two-month period, in three Health Centre clinics. MEASUREMENTS AND MAIN RESULTS: The number of prescriptions passed on to Primary Care was 3,009, costing 5,303,071 pesetas, which was 31.61% of the drugs prescribed and 38.08% of the pharmaceutical expenditure of the three clinics during the period under study. 65.88% of the prescriptions corresponded to out-clinic specialists and 34.11% to hospital specialists. They were not accompanied by a clinical note, the treatment and the length of treatment in 33.46%, 36.55% and 45.39% of cases, respectively. The group and sub-group with most prescriptions passed on were Cardiovascular Apparatus and Calcium antagonists. The commonest active principal was acetylsalicylic acid. 79.89% were taken orally, 88.20% were single drugs and 73.28% of the medicines had high intrinsic value. CONCLUSIONS: An important proportion of Primary Care's pharmaceutical expenditure was identified as originating with specialists. There was scant information given for following up the patients. Improvement of communication between different care levels on the basis of common procedures and objectives would be a useful step towards better quality of care.

Drug Prescriptions↗
PubMed1996

[Usefulness of prescription of generic drugs for cost containment in pharmaceutics. Analysis in the Community of Navarra].

OBJECTIVE: To determine the effect of the use of generics drugs on the costs of pharmaceutical prescription, in order to help decide on their use. DESIGN: Descriptive study. SETTING: Prescriptions from all the doctors in the Health Service of Navarra-Osasunbidea. MEASUREMENTS AND MAIN RESULTS: Pharmaceutical products with over 5,000 containers consumed during 1994 in Navarra, and with a generic drug which had the same presentation, were selected. The cheapest generics drug was chosen and the hypothetical saving over the brand-name drug was calculated. None of the 285 products in most common use were generics. Use of generics instead of brand drugs would have saved 109,748,344 pesetas. Use of generics drugs instead of commercial products would reduce cost for the drugs studied by 21%. This saving would mean a 1.2% decrease in the overall cost of pharmaceutical prescription. CONCLUSIONS: Although generics drugs are not readily available, their use would decrease the cost of pharmaceutical prescription, with results comparable to those obtained from negotiation with the industry and pharmacists' representatives. The effect would be more long-lasting, as it would mean a change in doctors' prescription habits.

Cost Control↗
PubMed1977

Multiple prescriptions and drug appropriateness.

The relationship between number of prescriptions per office visit and the appropriateness of the prescribed drugs is examined, using data on more than 20,000 prescriptions purchased for a low-income rural population during 1973 and 1974. Criteria for drug appropriateness are based on an AMA evaluation of drugs. The results show that greater numbers of prescriptions per visit are associated with lower percentages of appropriate drugs prescribed and that patients whose prescriptions were written by specialists received a higher percentage of appropriate drugs than did those whose prescriptions were written by general practitioners. It is concluded, in support of other researchers, that a better knowledge of drugs leads to more conservative use of them.

Age Factors↗
PubMed1997

[Drug interactions in chronic prescription].

OBJECTIVE: Application of computerized program for detection of potential drug interactions (PDI) in chronic prescriptions in four primary care centers. To evaluate the clinical significance of PDI identified according to clinical criterions. DESIGN: An observational crossover study. SETTING: Clutat Vella health district (City of Barcelona). MEASUREMENTS AND RESULTS: Using information of Consejo General de Colegios Oficiales de Farmaceuticos databases and the chronic prescriptions database of the primary care centers, computerized drug-interaction system have been developed for detection of PDI in patients. A panel of primary care physicians and clinical pharmacists developed criteria that were used to evaluate the clinical significance of PDI. 9840 Cards of Authorized Prescription (CAP) were analyzed, 36108 medicaments and 42877 drugs. A total of 2140 patients were involved for a total of 3406 PDI, 21.75% of patients with CAP. Clinical signification for the panel was found in 40.07% of these 3406 PIF; 3.78% were suggest to avoid the association drugs. CONCLUSIONS: The incidence of PDI with clinical signification are lower than other studies of the literature; it suggest a appropriate knowledge of drug prescription. The application of computerized program make much more easy the detection of adverse drug interactions in chronic prescription.

Cross-Over Studies↗
PubMed1997

Prescription of oxygen concentrators and survival in Northern Ireland.

Long-term oxygen therapy (LTOT) has been shown to prolong survival and to improve quality of life in patients with chronic obstructive pulmonary disease (COPD) and in respiratory failure. In Northern Ireland oxygen concentrators have been available on prescription since August 1986, initially on a restricted basis from hospital physicians only. This was followed by open prescribing from April 1989, when concentrators could be prescribed by general practitioners. This study examined prescribing habits of LTOT during both periods, and patient survival. Case notes of all prescriptions of oxygen concentrators in Northern Ireland (to April 1991) were reviewed. Prescription criteria and advice regarding usage during both periods were analysed. A questionnaire survey of subjects during open prescribing documented the advice given at the time of prescription and current usage. 164 charts of 178 total installations were available for review. During both periods many concentrators were installed without adherence to the prescribing criteria at the time (75% restricted, 48% open). The majority of these were on the advice of a consultant respiratory physician and only 14 were prescribed directly by GPs. 89 of 91 subjects receiving current LTOT during the study period completed questionnaires. Of the subjects prescribed LTOT during the restricted period, 2 subjects are still alive (median survival 19 m, range 0-104). From the open period, survival data was available on 107 of 129 subjects with 17 still alive (median survival 22 m, range 0-94). This study documents an inadequate rate of prescribing and a lack of conformity to guidelines in the provision of LTOT in Northern Ireland. We would suggest that familiarisation with the prescribing criteria, formal written advice at the time of prescription, appropriate follow up to ensure adequate supplementation and regular patient education on the use of LTOT would address these problems to a substantial degree.

Aged↗
PubMed1998

[Analysis of opinions, attitudes and knowledge of physicians of health centers of Valencia concerning efficacy and efficiency of drug prescriptions].

OBJECTIVE: To find the views, attitudes and knowledge of Primary Care doctors concerning the efficacy and efficiency of medical prescription. DESIGN: Descriptive, crossover study. SETTING: 10 Health Centres in the city of Valencia. PARTICIPANTS: The 115 doctors, both general and family practitioners, working at these centres. INTERVENTIONS: A survey gathered information on the doctors' views about the appropriateness of considering price when prescribing, on their assessment of ten strategies aimed at improving prescription efficiency, and their understanding of the efficacy and cost of certain medicines used in Primary Care. RESULTS: 1. 81% of those surveyed stated that prescription costs had to be considered at the moment of deciding patient treatment. 2. 70.4% of their opinions of the efficacy of medicines, as measured by the Intrinsic Therapeutic Value, were accurate. 3. 41% of the prices estimated by doctors were correct. There was a tendency to undervalue prices and to eliminate differences between products of identical composition. 4. In the area of strategies to improve prescription efficiency, doctors clearly favoured training strategies (prescription guidelines or in-work training) over strategies involving "assuming economic risks" (pharmacy self-management...).

Adult↗
PubMedDate not supplied

[Prescription of a hematopoietic growth factor, lenograstim, in current practice. Results and commentaries of a national survey from April 1995 to March 1996].

OBJECTIVES: The French drug authorities audited first-time prescription of hematopoietic growth factors using a prescription follow-up survey. Data collected between April 1995 and March 1996 were analyzed then criticized by three clinical experts working in three different areas where lenograstime is most widely used. METHODS: First-time prescription data and follow-up information were recorded on separate inclusion and follow-up diaries by the prescribing physicians. The delivering pharmacies complete the diaries and addressed them to the INSERM unit 330 for analysis. RESULTS: There were 7,102 inclusion diaries and 1376 follow-up diaries from 234 different hospital facilities. Lenograstime was most frequently prescribed in patients with lymphoma (19%), breast cancer (16.4%), and lung cancer (13.8%). Prescriptions involved 377 different chemotherapy protocols, including 196 which concerned a single patient. At the first prescription, lenograstime was given as a preventive measure in 61% of the cases and for curative therapy in 25.3%. The planned duration of preventive treatment was longer than the true period of treatment. DISCUSSION: Pr Rossi, hematologist, Pr Misset, cancerologist and Pr Lebeau, pneumologist criticized the findings.

Antineoplastic Agents↗
PubMedDate not supplied

[Study of narcotics and buprenorphine prescriptions in the Provence-Alps-Côte d'Azur region].

Following the setting up by the Government of their project for the management of drug addicts, and under the guidance of the CEIP (Centre d'Evaluation et d'Information sur les Pharmacodépendances [Centre for Evaluation and Information on Drug Addiction]) in Marseille, a survey of prescriptions written on controlled-drug prescription pads was performed. The aims were threefold: to study the medicines prescribed, to follow up the legislation and to inform doctors and pharmacists. Copies of the prescriptions, dated between 1 January 1996 and 30 June 1996, which were sent by 81 per cent of the 216 pharmacies contacted in 15 towns in the Provence-Alpes-Côte d'Azur (PACA) region were studied. Various criteria, relating to writing of the prescriptions and distribution of the medicines to the patients, were coded and analysed. This survey showed that of 4 prescriptions, 3 were prescribed for maintenance and one for analgesic therapy. The patients receiving maintenance therapy were male in three-quarters of the cases, and were around 30 years old. Analgesics were prescribed in equal proportions for patients of both sexes, who were around 65 years old. Since it was put on the market, Subutex has been quickly prescribed.

Adult↗