Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “PRESCRIPTIONS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 793 records · Page 44Linked to original sources
PubMedDate not supplied

Prescription medication use in older Americans: a national report card on prescribing.

BACKGROUND AND OBJECTIVES: Due to their high prevalence of disease, older Americans receive more prescription medication than any other age group. We evaluated prescription medication use in patients age 50 or older; categorized and reported medication use by age group, drug class, and therapeutic class; and examined differences in prescribing patterns for older patients. METHODS: All prescription medications reported in the 1995 National Ambulatory Medical Care Survey, a nationally representative sample of ambulatory care visits in the United States for patients age 50 and older (n = 16,289), were evaluated in a cross-sectional analysis. We evaluated the number of prescription medications reported for each patient visit and ranked use of drug and therapeutic classes. RESULTS: Most patients seeing physicians (61%) had a prescription for at least one medication, ranging from a mean of 1.27 medications in patients ages 50-64 to 1.58 in patients over 85. Calcium channel blockers and angiotensin-converting enzyme inhibitors were prescribed more than beta blockers in all patients. Data also indicated a significant decrease in estrogen/progestin and antidepressant medication use in older patients. CONCLUSIONS: Our findings indicate prescribing patterns inconsistent with national guidelines and decreased medication use, suggesting underprescription. Active intervention may be needed to improve the pharmacological treatment of older patients.

Age Distribution↗
PubMed1998

[Quality in compliance and prescription of nursing treatment orders for injectable drugs].

OBJECTIVES: To analyse the quality of prescription and compliance with nursing treatment orders (NTOs) in primary care teams (PCTs), in order to identify potential problems and establish interventions. DESIGN: Observational, crossover study. SETTING: Three health districts in Santa Coloma de Gramenet. PATIENTS AND OTHER PARTICIPANTS: NTO forms for injectable medication referred to nursing from PCTs between March 1 and November 30, 1996. MEASUREMENTS AND MAIN RESULTS: 1,088 NTO sheets containing 1,119 prescriptions were evaluated. 64.61% of the NTOs came from PCTs. Compliance with the NTO on the length of treatment (63.33%), on length and guidelines taken together (58.00%) and on allergies to medicine (28.31%) was deficient. The most prescribed therapeutic groups were medicines for the locomotive apparatus (36.10%) and drugs for infections (24.66%). 56.03% of prescriptions had high intrinsic value. It was difficult to justify 72.48% of prescriptions. CONCLUSIONS: Deficiencies were detected in compliance with NTOs, due to the absence of information which was vital for correct administration. There was low-quality prescription and over-use of parenteral administration.

Cross-Over Studies↗
PubMed1998

Prescription patterns of recently graduated physicians in Colombia: a survey during the mandatory social work period.

MAIN OBJECTIVE: To quantify prescribing patterns of physicians during their year of social work in health centers of Bogotá, Colombia, for three tracer conditions: acute respiratory infection (ARI), systemic hypertension (SH) and acute diarrhea (AD). DESIGN: Cross-sectional survey. SETTING: Primary Care Health Centers in the city of Bogotá. STRATEGY: The Health District Department of Bogotá (Secretaria Distrital de Salud) provided the sampling frame of SILOS (Local Health System) and UPAS (primary health service units) with a physician in the social work year. Samples of patient-physician encounters for the three tracer conditions within UPAS were examined, and detailed information collected on prescription indicators. RESULTS: Information was collected on a total of 1099 patient-physician encounters. Results show that 61% (95% CI: 58.6-63.1) of prescriptions in these settings are non-generic, and only 62% (95% CI: 59.5-64.0) are from the Colombian essential drug list. Number of medications prescribed per encounter were higher with ARI, as well as prescriptions for non-generic forms, antibiotics, and medications outside of the Colombian essential drug list. Inappropriate prescriptions were seen in 31% (95% CI: 28.1-33.7) of all encounters. DISCUSSION: Inadequacy of prescriptions (based on diagnosis) suggest that the teaching of rational prescribing patterns should be targeted with much more emphasis in schools of medicine. Interventions focused on the outstanding deficiencies should be designed and properly evaluated.

Journal Article↗
PubMed1998

Psychosocial modifiers of drug prescription: the hidden face of pharmacology?

Apart from placebo, there is scant medical knowledge regarding the influence of psychosocial effect modifiers in pharmacology. Phenomena such as the nocebo, Hawthorne, Oedipus and complacency effects have been previously described as sources of bias in clinical trials; however, the effects related to prescription patterns have been widely ignored to date. Under certain circumstances, psychosocial effects may even be catalysts for changes in the official regulations on drug prescription--changes often lacking an adequate scientific basis--and, subsequently, induce major changes in drug use worldwide. In spite of this, the study of psychosocial effects in pharmacology has been confined to anecdotal reports. The present overview of this topic is aimed at encouraging the identification of psychosocial effects in pharmacology. It also suggests that commercial case studies of drugs are a suitable method for studying prescription and effect modifiers. Triazolam's commercial history provides a good example of this approach. A better knowledge of these effects may contribute to a better understanding of the prescription habits observed in clinical practice. It may also prevent paradoxical changes in prescription patterns or in drug regulations.

Journal Article↗
PubMed2003

Prescription practices of diagnostic imaging in dementia: a survey of 47 Alzheimer's Centres in Northern Italy.

BACKGROUND: To date, there are no data at the national or European level on the prescription practices of imaging (CT, MR, and SPET) in the diagnosis of cognitively impaired elderly patients. METHODS: We addressed prescription practices of diagnostic imaging in 47 Alzheimer's Centres in Northern Italy, with an ad-hoc questionnaire. RESULTS: The use of imaging in new cases was relatively intensive: 62% of the Alzheimer's Centres prescribed CT to more than 95% of cases, 24% prescribed MR to more than 33% of cases, and 33% prescribed SPET to more than 5% of cases. A minority of Alzheimer's Centres (n = 3, 6%) prescribed imaging to less than 100% of new cases. The association between onsite scanner availability and frequency of prescription increased from CT (Odds ratio (OR) = 1.8) through MR (OR = 2.4) to SPET (OR = 4.6), although only the latter was significant (95% confidence interval (CI) 1.2-17.7, p = 0.003). Patient-related factors (age, severity of cognitive impairment, and clinical suspicion of cerebrovascular disease) influenced prescription of structural imaging in 30-53% of Alzheimer's Centres and organizational factors (onsite scanner availability, and waiting list) in a similar proportion (32 and 43% respectively). CONCLUSIONS: Organizational factors play a relevant role in the prescription of imaging exams in patients with cognitive impairment and, at least for CT, the perceived diagnostic added value is rather low, suggesting a high degree of uncertainty in the clinical use of imaging techniques.

Dementia↗
PubMed2002

Inappropriate prescriptions for the aging population of the United States: an analysis of the National Ambulatory Medical Care Survey, 1997.

PURPOSE: Generally, elderly patients in the United States tend to consume more prescriptions than younger adults. The purpose of the study is to examine nationwide prescription patterns for elderly patients who visited physicians' offices in 1997. METHODS: The database of a nationwide sample survey of practicing physicians participating in the National Ambulatory Medical Care Survey, 1997 was used. Inappropriate medicines for the elderly were identified using previously published and widely accepted criteria. RESULTS: During 1997, patients aged 65 years or older made more than 191 million visits to physicians' offices in the United States. Four or more prescriptions per visit were issued with the following frequencies: 17.7% for females; 16.4% for males; 17.0% for Whites, 22.7% for Blacks, and 6.1% for other minorities including American Asians, Indians, Eskimos, Aleuts and Pacific Islanders. The frequencies with which at least one inappropriate medication per visit was prescribed were: 10.8% for females; 8.9% for males; 10.3% for Whites; 9.7% for Blacks; and 1.9% for other minorities. DISCUSSION: Four or more prescriptions issued per visit and inappropriate prescriptions for the elderly in the United States were evident, and may put a vulnerable aging population at risk of adverse drug events.

Aged↗
PubMed2004

Assessment of doctor-shopping for high dosage buprenorphine maintenance treatment in a French region: development of a new method for prescription database.

PURPOSE: To assess the extent of doctor-shopping for buprenorphine maintenance therapy in a French region with a specific indicator. METHODS: Use of a quasi-exhaustive prescription database in a French region (information system of the French General Health Insurance Scheme). Extraction of all buprenorphine prescriptions between September 1999 and December 2000. Definition and calculation of three quantities for each patient: delivered, prescribed and doctor-shopping quantity. The calculation of these three quantities is done by an automated and reproducible method determining the overlaps in prescription periods of different physicians for a given patient. Calculation of the corresponding daily dose was done for each quantity. RESULTS: A total of 64 326 prescriptions of buprenorphine by 1313 physicians to 3259 patients were extracted. Quantities and doses were calculated for 2587 patients. The total doctor-shopping quantity represented 18.6% of the delivered quantity. Doctor-shopping involved a minority of patients and was highly concentrated: 87 patients with doctor-shopping doses superior to 16 mg/day were responsible for 45.4% of the total doctor-shopping quantity. CONCLUSIONS: Doctor-shopping appears to be an important problem for buprenorphine maintenance treatment in France but may be resolved by regulatory interventions. The use of adequate indicators on prescription databases may help to limit the effects of such interventions on legitimate care. The method presented here may be used with slight adaptations for other medications to assess their abuse potential.

Buprenorphine↗
PubMed2005

The application of prescribing indicators to a primary care prescription database in Ireland.

OBJECTIVE: To develop appropriate prescribing indicators and apply these to Irish prescription data. METHODS: A postal survey of 145 randomly selected general practitioners working within the Eastern Health Board region of the State-supported General Medical Services scheme in Ireland regarding the applicability of selected prescribing indicators was carried out. Such indicators were then applied to aggregate prescription data. RESULTS: Prescribing indicators based on agents of questionable efficacy/poor quality prescribing and those based on good prescribing practice were thought to make suitable indicators. Low rates of prescribing were noted for indicators based on drugs of limited efficacy, e.g. cerebral and peripheral vasodilators (rate 3.1 per 1,000 prescriptions), whilst indicators based on drugs associated with good prescribing practice were associated with higher prescribing rates, e.g. the prescription of aspirin in patients receiving nitrate therapy(rate 7.13 per 1,000 patients). However, a low rate of generic prescribing (4.6%) was found amongst general practitioners in the study. The largest variability in prescribing was seen with the prescribing of peripheral and cerebral vasodilators (75th/25th centile=5.6) and the prescription of long-acting sulphonylureas (75th/25th centile=66.6). CONCLUSIONS: Quality indicators based on aggregate prescribing provide valuable information on prescribing standards and should be developed with the close involvement of prescribers.

Databases, Factual↗
PubMed1999

[Drug prescriptions and multiple falls in community-dwelling frail elderly subjects].

The purpose of the study was to identify associations between drug prescriptions and the risk of falls in community-dwelling frail elderly people. 360 frail elderly patients underwent a comprehensive geriatric assessment during hospital stay. After discharge, the home falls were recorded by a questionnaire during the follow-up year and a home visit was carried out at the end of the year. Of 279 final patients with complete data, 141 subjects (50.5%) fell once; 62 subjects (22.2%) had a history of two or more falls during the follow-up period. Compared with subjects who did not fall or fell at the most once, those subjects with two or more falls showed a significantly higher prescription of tranquillizers/hypnotics, neuroleptics, diuretics, nitrates, and five or more different drugs. In multivariate analysis the prescription of tranquillizers/hypnotics with an adjusted odds ratio of 2.02 (95 percent confidence interval, 1.14 to 3.68) and the prescription of five or more different drugs with an adjusted odds ratio of 2.25 (95 percent confidence interval, 1.03 to 4.49) were found to be independent risk factors for multiple falls. In this prospective study in community-dwelling frail, elderly people the prescription of tranquillizers/hypnotics and five or more different medications could be identified as independent risk factors for multiple falls.

Accidental Falls↗
PubMed1996

[Practical and safe prescription of controlled drugs to patients with chronic pain].

The present legal requirements for the prescription of controlled drugs remains an impediment to adequate therapy for chronic pain because of an abundance of legal regulations. The physician prescribing opioids must consider the permitted maximum amount per prescription, the period of time the drug is prescribed for, numerous cross references, and other special regulations, and he still cannot be sure that he does not violate certain legal requirements. Often these difficulties result in withholding necessary pain treatment! In the authors' opinion it should be sufficient to write a specific prescription form for controlled drugs in the same way as any other ordinary prescription without jeopardizing the safety of the drug control system. It is important that the use of the narcotic be justified in the sense of paragraph 13 Abs. 1 of the drug control regulation, as judged by the responsible prescriber of the drug, and that any offence be punished. The use of triplicate prescriptions guarantees sufficient proof. Legislation is requested that will substitute for the present drug control regulations, which are difficult to handle.

English Abstract↗
PubMed1996

[The prescription of opioids from the point of view of clinical and market research].

According to WHO guidelines, morphine is the first choice for the treatment of chronic cancer pain, preferably as a controlled-release preparation administered orally. The WHO classifies the quality of pain management of a particular country by its morphine consumption for medical reasons. For this article, data from clinical and market research were collected. In Germany, the amount of morphine prescribed is low, both in the total quantity of morphine prescribed and related to the individual patient treated. Also the number of patients receiving opioid prescriptions is low. In a longitudinal evaluation of general practitioners' prescription practices, only 0.1 % out of 1,218,436 patients were given a controlled opioid prescription. Only 0.04 % of more than 16 million prescriptions were opioid prescriptions. Only 1.2 % of 47,252 cancer patients received a strong opioid. The reasons for this low use of opioids are to be found in the special regulations for controlled drugs, specified by German narcotic drug legislation. The report also focuses on physicians' subjective viewpoints and prejudices. When strong opioids are only rarely prescribed, a general practitioner then has difficulties in assessing pain and possible side effects and treatment evaluation. Clinical research, too, is hampered by special regulations concerning controlled opioid administration.

English Abstract↗
PubMed1999

[Pharmacist's attitudes towards opioid prescription].

UNLABELLED: The prescription of strong opioids underlies a special legislation. The attitude of the pharmacists towards the long-term treatment with these analgesics and their opinion about the legislation is unknown in Germany and other European countries. METHODS: A questionnaire was included in the Journal "Mitteilungsblatt der Apothekerkammer Westfalen-Lippe" and send to all 2300 pharmacists of the region Westfalen-Lippe in December 1997. RESULTS: 797 (35%) questionnaires were returned. In 82.4% of the pharmacies strong opioids are kept in stock. However, 140 pharmacists do not have opioids in stock due to too many different preparations or low prescription rate. 54% of the pharmacists warn their patients about endangering by the medication. The fear of psychological addiction (48.1%) is the main argument, also in patients with regular intake of the opioids (20.1%) and related to long acting opioids (10.8%). Nevertheless, 73% of the pharmacists advocate for a liberalization and 10.7% for an abolishment of the actual prescription laws. DISCUSSION: The importance of the therapy with strong opioids is well accepted by the pharmacists. An ease of the prescription is demanded to improve the situation of the patients with chronic pain. However, the majority of the pharmacists warns the patients about this medication. Contact between prescribing doctors and pharmacists and an intensified education concerning the therapy with opioids are needed in addition to the education of the medical staff and the liberalization of the prescription laws.

English Abstract↗
PubMed2004

Transferring scientific evidence to oncological practice: a trial on the impact of three different implementation strategies on antiemetic prescriptions.

GOALS: In 1996, a gap between the literature evidence for the prevention of chemotherapy-induced emesis and the prescription pattern in clinical practice was demonstrated in a drug utilization study. This study, carried out in 103 Italian oncological centers (77 new; 26 old that participated in the previous study) evaluates three different intervention strategies to implement these guidelines. PATIENTS AND METHODS: In cancer patients submitted to chemotherapy, prescriptions of antiemetics were prospectively monitored for 2 consecutive weeks in 1999. Simple diffusion of guidelines was evaluated in an observational study in the 77 new centers, while the double combination of simple diffusion and "audit and feedback" strategy was randomly compared in the old centers with the triple combination of the same two strategies plus an "educational outreach visit." MAIN RESULTS: Simple diffusion of guidelines improved the prescription but only for acute and delayed emesis induced by high-moderate emetogenic chemotherapy. No significant difference was detected in the prescriptions against cisplatin-induced emesis. The inappropriate use of 5-HT(3) antagonists for prophylaxis of low emetogenic chemotherapy was found most frequently. Similar poor results were achieved by the audit and feedback strategy, while the educational outreach visit significantly increased the prescription of the optimal prophylaxis for cisplatin-induced acute and delayed emesis. CONCLUSIONS: A combination of interventions, including an educational outreach visit, seems to be a good strategy for transferring the results of antiemetic research to oncological practice.

Adult↗
PubMed2005

Nonmedical use of prescription opioids among U.S. college students: prevalence and correlates from a national survey.

OBJECTIVES: This study examined the prevalence rates and correlates of nonmedical use of prescription opioid analgesics among U.S. college students in terms of student and college characteristics. METHODS: This study analyzed data from a nationally representative sample of 10,904 randomly selected students attending 119 four-year colleges in 2001. RESULTS: The lifetime prevalence of nonmedical prescription opioid use was 12% and the past year prevalence was 7%. Approximately one in every four colleges had a prevalence of 10% or higher for past year nonmedical use of prescription opioids. Multivariate regression analyses indicated nonmedical use was more likely to occur among college students who were white, residents of fraternity and sorority houses, attended more competitive colleges, earned lower grade point averages, and reported higher rates of substance use and other risky behaviors. CONCLUSIONS: This study provides evidence that the nonmedical use of prescription opioids represents a problem on college campuses. These findings have important implications for developing prevention efforts and therapeutic strategies aimed at reducing the nonmedical use of prescription opioid analgesics among college students while not hindering necessary medication management for pain.

Adolescent↗
PubMed2006

Risk and protective factors for methamphetamine use and nonmedical use of prescription stimulants among young adults aged 18 to 25.

This article reports on correlates of past-year nonmedical use of prescription stimulants and methamphetamine among young adults aged 18 to 25. Data from the 2002 National Survey on Drug Use and Health (NSDUH) were used to conduct logistic regression analyses of the demographic, psychosocial, and behavioral correlates of nonmedical stimulant use. The sample size was 23,645. Multivariate analyses revealed that selling drugs and using marijuana and other illegal drugs were associated with increased odds of both methamphetamine and nonmedical prescription stimulant use. Females, individuals not enrolled in college, and those who had been arrested were more likely than their counterparts to have used methamphetamine, whereas black individuals and less religious individuals were less likely than their counterparts to have used methamphetamine. Psychological distress, sensation seeking, binge drinking, and college enrollment were associated with increased risks of nonmedical prescription stimulant use, whereas Hispanic and other ethnic identification were associated with decreased risks of nonmedical prescription stimulant use. Different intervention strategies are needed to prevent methamphetamine use versus nonmedical prescription stimulant use.

Adolescent↗
PubMed2006

Racial differences in reaching target low-density lipoprotein goal among individuals treated with prescription statin therapy.

BACKGROUND: Studies indicate that, overall, African Americans are less likely to achieve control of hyperlipidemia compared with whites. No population-based studies have examined the effect of race on achieving target low-density lipoprotein (LDL) goals among treated individuals. METHODS: Using computerized encounter and laboratory result data, we identified all African American and white patients in a Midwestern health system filling a statin prescription from January 1, 1997, through June 30, 2001 (index prescription), with no prescriptions filled 1 year before index prescription. We followed LDL results for 1 year after index prescription. RESULTS: A total of 16052 new statin users (32.5% African American) were identified. Mean baseline LDL was higher for African Americans (170.2 +/- 36.6) than for whites (161.8 +/- 37.2) (P < .001). Whites were more adherent to therapy, with 48.6% of white patients exposed to statins >80% of follow-up time (31.2% of African Americans) (P < .001). By the end of follow-up, 49.5% of African Americans and 71.1% of whites reached LDL goal. A proportional hazards model adjusting for age, sex, median household income, physician specialty, clinic site, baseline LDL, starting dose, and target LDL indicated that African Americans were less likely to reach goal compared with whites (hazard ratio 0.64, 95% CI 0.61-0.68). Results persisted after controlling for racial differences in statin adherence and LDL testing (hazard ratio 0.60, 95% CI 0.57-0.63). CONCLUSIONS: African American patients initiating statin therapy are less likely to achieve LDL goal, even after controlling for adherence differences and other factors, suggesting that African Americans may require different pharmacologic management.

Black or African American↗
PubMed2003

[Study of correlations between antibiotics prescriptions and guidelines in a neonatal intensive care unit].

UNLABELLED: The increasing use of wide spectrum antibiotics has been reported to be associated with a greater prevalence of multi-resistant bacteria. OBJECTIVES: The aims of this study were to survey the use of antibiotics and to evaluate the correlations between patterns of prescription of antibiotics and prescription guidelines in a neonatal intensive care unit. MATERIAL AND METHODS: In this 6-month study, all newborns admitted to the NICU and treated with antibiotics were included. Data regarding criteria of antibiotic prescription, length of treatment, and criteria of withdrawing treatment were collected. The correlation between prescriptions and guidelines was evaluated a posteriori by a non-prescriber physician. One hundred and sixteen newborns were included, of whom nine had received antibiotics on more than one occasion. Mean gestational age was 33.5 weeks. In 82% of cases, the reason for hospitalisation was respiratory distress syndrome. RESULTS: Patients received systemic antibiotics for primary infection (78%), nosocomial infection (17%) and postsurgical prophylaxis (5%). Suspected foeto-maternal infections (SFMI) were the dominant features of primary infection (96%). In 49% of cases, suspected infection was not proven and justified withdrawal of treatment within 3 days. Sixty percent of nosocomial infections occurred in newborns with gestational ages of less than 28 weeks. Bacterial criteria were decision-making factors only in nosocomial infections. An absence of observance of guidelines occurred in 9% of treated newborns, and in most cases involved excessive length of treatment. CONCLUSION: These results show: (1) the majority of antibiotic prescriptions were for not proven SMFI; (2) a low rate of nosocomial infections; (3) the predominance of nosocomial infections in premature newborns; (4) less than 10% of non-observance of guidelines. It appears necessary to develop more precise guidelines to limit antibiotic use and to evaluate them regularly.

Anti-Bacterial Agents↗
PubMed2005

Influence of age and in-patient care on prescription rate and long-term outcome in chronic heart failure: a data-based substudy of the EuroHeart Failure Survey.

AIMS: To evaluate the prescription rate of neurohumoral drugs in chronic heart failure patients and the factors influencing prescription rates. Outcomes and their predisposing factors were also investigated. METHODS AND RESULTS: Of 1482 consecutive patients admitted to 3 Austrian hospitals participating in the EuroHeart Failure Survey, 341 were included in this data-based substudy. Follow-up time to evaluate outcome was up to 46 months. The prescription rates of renin-angiotensin (RAAS) antagonists and beta-blockers at the time of discharge were evaluated. The overall prescription rate and dosage were lower than the recommended levels. Hospitals with cardiac care had a significantly higher prescription rate than those without (p<0.001). Patients older than 75 years received significantly less therapy (p<0.001) and a lower dosage of RAAS antagonists (p<0.01) than younger patients. Younger patients were treated more intensively in hospitals with cardiac care (p<0.05). Patients aged >75 years were under-treated, independent of the hospital (n.s.). Multivariate analysis showed that age was the most influencing factor on survival (chi(2) 15.5, p<0.0001). Additional influencing factors of long-term survival were type of the ward (chi(2) 7.9, p<0.005) and pharmacologic treatment (chi(2) 6.2, p<0.02). CONCLUSION: Patients with chronic heart failure are still under-treated in clinical practice. Younger patients benefit from hospitals with specialized cardiac care. Elderly patients are obviously under-treated compared with younger patients. Of several clinical parameters, age was the only independent variable predicting long-term survival.

Adrenergic beta-Antagonists↗