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PubMed1997

Do patients with asthma fill their prescriptions? A primary compliance study.

OBJECTIVE: To examine primary noncompliance in patients suffering with asthma. METHOD: A prospective matching of prescriptions written and then dispensed for patients with asthma. The subjects were patients who were given a general practitioner's prescription for asthma during a 3 month period (1993) in an isolated rural setting. RESULTS: During the period of the study, participating GPs documented 359 prescriptions and of these only 251 (70%) were dispensed by the pharmacies. Primary noncompliance was therefore 30%. The relative risk (RR) of mild asthmatics not filling their prescriptions is 0.81 (95% CI; 0.771 < RR < 0.92) when compared to severe asthma. Compared to patients of high socioeconomic status; patients of low and medium socioeconomic status have decreased relative odds of filling their prescriptions, that is, RR = 0.84 (95% CI; 0.71 < RR < 1.00). Gender and age had no bearing on primary compliance. CONCLUSIONS: Primary noncompliance is high in patients with asthma and is another factor contributing to morbidity. GPs should spend more time counselling patients on the need for treatment and not only its correct use. Patients with mild to moderate asthma and those in lower socioeconomic groups may need more intensive counselling.

Anti-Asthmatic Agents↗
PubMed2005

Income related inequality in prescription drugs in Denmark.

PURPOSE: To examine income-related inequity in utilisation of prescription drugs in Funen County, Denmark after a new reimbursement system was implemented. METHODS: An individual level prescription database was merged with a health survey of 2927 respondents interviewed in 2000 and 2001 about their health status and socio-economic and socio-demographic characteristics. An index of horizontal inequity was used to estimate the degree of inequity in drug utilisation across income groups, using the indirect method of standardisation to control for age, gender and health status as a proxy for need. The results were compared to estimates from a traditional regression analysis. RESULTS: The least advantaged with respect to income consume a bigger share of the prescription drugs than the most advantaged. After standardisation for age, gender and health status the least advantaged have a lower share of the drug consumption than expected. However, traditional regression analysis showed no signs of an income effect on the level of consumption of prescription drugs. CONCLUSIONS: The index of horizontal inequity suggests that some horizontal inequity favouring the better off is present. However, the results deviate from what can be found by traditional regression analysis.

Adolescent↗
PubMed2004

Laparoscopic gastric bypass results in decreased prescription medication costs within 6 months.

The prevalence of obesity has reached epidemic proportions. The treatment of obesity-related health conditions is costly. Although laparoscopic gastric bypass is expensive, health care costs in obese patients should decrease with subsequent weight loss and overall improved health. Specifically, monthly prescription medication costs should decrease quickly after surgery. Fifty consecutive laparoscopic gastric bypass patients at a university-based bariatric surgery program were enrolled in the study. Medication consumption was prospectively recorded in a database. Patients' monthly prescription (not over-the-counter) medication costs before surgery and 6 months postoperatively were calculated. Retail costs were determined by a query to drugstore.com, an online pharmacy. Generic drugs were selected when appropriate. Costs for diabetic supplies and monitoring were not included in this analysis. Patients were mostly female (86%). Mean body mass index preoperatively was 51 kg/m2. Mean excess weight loss at 6 months was 52%. Patients took an average of 3.7 prescription medications before surgery compared with 1.7 after surgery (P < 0.05). All patients took nonprescription nutritional supplements, including multivitamins, oral vitamin B12, and calcium postoperatively. Laparoscopic gastric bypass resulted in a significant improvement in comorbid health conditions as early as 6 months after surgery. In an unselected group of patients, this led to a substantial overall mean monthly prescription medication cost savings, especially in those with gastroesophageal reflux disease, hypertension, diabetes, and hypercholesterolemia.

Adult↗
PubMed2001

Effect of a three-tier prescription copay on pharmaceutical and other medical utilization.

BACKGROUND: In response to rising prescription drug costs, plan sponsors are increasingly implementing three-tiered pharmacy benefits. OBJECTIVE: This study examined the effect of a three-tiered pharmacy benefit on pharmaceutical utilization and expenditures, medication continuation, and use of other medical resources in a population of continuously eligible, commercially insured enrollees of a preferred provider organization (PPO). RESEARCH DESIGN: A quasi-experimental prepost with comparison group design was used. The pre- and postperiods were each 12 months long. SUBJECTS: The intervention group included enrollees whose employer moved from the PPO's two-tier benefit to a three-tier benefit (n = 6881). The comparison group included enrollees whose employer remained under the PPO's two-tier benefit (n = 13,279). MEASURES: Key dependent variables included total prescription claims and costs, net costs (total minus copay), medication continuation, office visits, and inpatient and emergency room use. RESULTS: Relative to the comparison group, the intervention group experienced lower prescription utilization and expenditures and reduced net costs. Medication continuation rates were lower at 6 and 11 months in one of four chronic therapy classes examined; however, discontinuation could not be clearly linked to tier-three medication use. No significant differences in physician office visits, inpatient, or emergency room use rates were found. CONCLUSIONS: Three-tier prescription copays can control drug costs without evidence of change in use of other medical resources in the year following implementation. Future research should examine a variety of three-tier designs.

Cost Sharing↗
PubMed1997

Exercise by prescription.

General Practitioners (GPs) see over 90% of their practice population in three years. Over 50% of the adult population is below the perceived level of physical activity as recognised by the Allied Dunbar Physical Activity score (Allied Dunbar, Health Education Authority and Sports Council, 1992). Physical fitness levels in adolescents and children are declining, while the incidence of obesity is increasing. GPs, with their Primary Health Care Team, are in a unique position to be able to discuss the health benefits of regular physical activity with their patients during the consultation and offer, if appropriate, a prescription for a course of physical activity to a local leisure centre or community activity centre. Many communities have facilities for physical activity. These include leisure centres, schools, village and church halls, the home and the general practice surgery. A directory of resources for physical activity for all age groups should be available in the surgery waiting room area. A community co-ordinator can network community facilities and resources to meet individual need. The co-ordinator can be funded by the general practice surgery, Health Authority, Local Authority, Parish or District Council. An agreed protocol for exercise prescription referrals to suitable community facilities can benefit patient health care for a variety of medical, surgical, social and mental conditions. Auditing exercise prescriptions shows a health benefit, with improved quality of living and reduced prescription medicines.

Adolescent↗
PubMed1999

Internet availability of prescription pharmaceuticals to the public.

BACKGROUND: The Internet holds great but uncertain promise for increased access and cost control in health care. OBJECTIVE: To determine access to and cost of prescription pharmaceuticals over the Internet. DESIGN: An Internet search conducted during February and March 1999. SETTING: The Philadelphia region. MEASUREMENTS: Data were collected on availability and cost of medications and physician Internet visits, requirements for physician prescriptions, and geographic location of Web-based companies and consulting physicians. Costs of comparable physician visits were obtained from Medicare and managed care organizations in the Philadelphia region. Costs of medications came from five Philadelphia community pharmacies. RESULTS: Forty-six Web sites were identified. Thirty-seven sites (33 based in the United States and 4 based outside the United States) required a prescription from a personal physician or from an Internet physician consultation. Nine sites based outside of the United States did not require a prescription or physician consultation. The median cost of an Internet physician visit was $70 (range, $20 to $90), more than 15% higher than that for a general practice visit in the Philadelphia region. Quality of physician consultation, physician qualifications and specialty, and geographic location were unknown. Median price per pill of the two most commonly offered medications was 10% higher on the Internet (before shipping charges) than at Philadelphia pharmacies ($5.49 and $4.50 for sildenafil; $1.94 and $1.83 for finasteride). CONCLUSIONS: The Internet may expand patient access to health-related services but at overall increased cost. In addition, the quality of physician Internet care is uncertain, and potential for serious abuse exists. Patients can easily provide incorrect or false information to obtain medications. Furthermore, conflict of interest exists for Web-based firms because they profit from selling medications and physician consultations.

Conflict of Interest↗
PubMedDate not supplied

Adverse events associated with prescription drug cost-sharing among poor and elderly persons.

CONTEXT: Rising costs of medications and inequities in access have sparked calls for drug policy reform in the United States and Canada. Control of drug expenditures by prescription cost-sharing for elderly persons and poor persons is a contentious issue because little is known about the health impact in these subgroups. OBJECTIVES: To determine (1) the impact of introducing prescription drug cost-sharing on use of essential and less essential drugs among elderly persons and welfare recipients and (2) rates of emergency department (ED) visits and serious adverse events associated with reductions in drug use before and after policy implementation. DESIGN AND SETTING: Interrupted time-series analysis of data from 32 months before and 17 months after introduction of a prescription coinsurance and deductible cost-sharing policy in Quebec in 1996. Separate 10-month prepolicy control and postpolicy cohort studies were conducted to estimate the impact of the drug reform on adverse events. PARTICIPANTS: A random sample of 93 950 elderly persons and 55 333 adult welfare medication recipients. MAIN OUTCOME MEASURES: Mean daily number of essential and less essential drugs used per month, ED visits, and serious adverse events (hospitalization, nursing home admission, and mortality) before and after policy introduction. RESULTS: After cost-sharing was introduced, use of essential drugs decreased by 9.12% (95% confidence interval [CI], 8.7%-9.6%) in elderly persons and by 14.42% (95% CI, 13.3%-15.6%) in welfare recipients; use of less essential drugs decreased by 15.14% (95% CI, 14.4%-15.9%) and 22.39% (95% CI, 20.9%-23.9%), respectively. The rate (per 10 000 person-months) of serious adverse events associated with reductions in use of essential drugs increased from 5.8 in the prepolicy control cohort to 12.6 in the postpolicy cohort in elderly persons (a net increase of 6.8 [95% CI, 5.6-8.0]) and from 14.7 to 27.6 in welfare recipients (a net increase of 12.9 [95% CI, 10.2-15.5]). Emergency department visit rates related to reductions in the use of essential drugs also increased by 14.2 (95% CI, 8.5-19.9) per 10 000 person-months in elderly persons (prepolicy control cohort, 32.9; postpolicy cohort, 47.1) and by 54.2 (95% CI, 33.5-74.8) among welfare recipients (prepolicy control cohort, 69.6; postpolicy cohort, 123.8). These increases were primarily due to an increase in the proportion of recipients who reduced their use of essential drugs. Reductions in the use of less essential drugs were not associated with an increase in risk of adverse events or ED visits. CONCLUSIONS: In our study, increased cost-sharing for prescription drugs in elderly persons and welfare recipients was followed by reductions in use of essential drugs and a higher rate of serious adverse events and ED visits associated with these reductions.

Adult↗
PubMed2005

Prescription drug use and risk of acute myeloid leukemia by French-American-British subtype: results from a Los Angeles County case-control study.

Chemotherapy is a well-established risk factor for acute myeloid leukemia (AML) but little is known about other prescription drugs and AML risk. We report data from a population-based Los Angeles County study in which 299 matched case-control pairs had complete data on prescription drug use and 88% of cases were subtyped according to the French-American-British (FAB) criteria. Cases were diagnosed between 1987 and 1994. Prescription nonsteroidal anti-inflammatory drug (NSAID) use for at least 4 weeks in the 2 to 10 years before diagnosis was associated with decreased risk (odds ratio = 0.5, 95% confidence interval=0.3, 1.0; p=0.04) with dose-response most evident for FAB subtype M2 (OR = 0.6, CI: 0.1, 2.9 for duration < or =6 months; OR = 0.2, CI: 0.0, 1.6 for >6 months). For subtype M4, ORs increased with increasing duration of benzodiazepine use in the 2 to 10 years before diagnosis (OR = 1.5, CI: 0.3, 9.0 for < or =6 months vs. OR = 5.0, CI: 0.6, 42.8 for >6 months). These results suggest that prescription drugs other than chemotherapy may have FAB subtype-specific effects on AML risk.

Adult↗
PubMed2002

Prescription privileges for psychologists: constituencies and conflicts.

The pros and cons of the proposal to link prescription privileges specifically to psychological training vary from the point of view of the constituencies involved. The present article analyzes those differences. Two surprising facts are noted. First, it is scientist-practitioners who are resisting the move toward prescription privileges, not so much the basic science organizations. Second, while the practice-based organizations have been avid in their support of prescription privileges, the same cannot be said for rank and file private practitioners. On closer examination, the costs, benefits, and views of the different constituencies make sense of these anomalies. The resistance to prescription privileges is not arbitrary or unreasonable and it is not likely to go away any time soon.

Drug Prescriptions↗
PubMed2002

Predictors of graduate student attitudes toward prescription privileges for psychologists.

The issue of gaining prescription privileges and its potential impact on the field of clinical psychology has special relevance for graduate students. This study was designed to investigate clinical graduate students' attitudes toward prescription authority, identify salient variables that contribute to these attitudes, and ascertain preferred models of training. Only 42.5% of respondents personally desired to obtain prescription privilege, although 61.8% of respondents favored efforts of the American Psychological Association to acquire prescription authority. Proponents and opponents were compared on their ratings of positive and negative aspects of the debate. There was strong agreement that the training should not be predoctoral and that it should lead to board certification. The strongest predictors of graduate students' attitudes were concerns about fundamental change to the field, malpractice premiums, and whether they considered it a logical extension of the field. This study provides a framework for understanding important factors influencing the decision-making process among clinical psychology graduate students.

Adult↗
PubMed2005

Patterns of therapeutic prescription medication category use among community-dwelling homebound older adults.

PURPOSE: The measurement of prescription medication use is usually through a simple count of medications, which tends to ignore therapeutic categories. This research investigated prescription medication use among homebound older adults, by documenting the therapeutic prescription medication categories used by these individuals and identifying the factors associated with use of multiple therapeutic categories. METHODS: Baseline Nutrition and Function Study (2000-2001) data from 326 homebound older persons who completed the medication review component (visual inspection of medications) of the baseline in-home interview and used > or =1 prescribed medication were included in this analysis. RESULTS: More than 40% (n = 133) regularly took medications from three to four different therapeutic categories and 31.6% (n = 103) used > or =5 different therapeutic categories. The use of respiratory medications declined with increasing age, and more women than men used diuretic and thyroid replacement medications. Independent of other factors, increased use of multiple therapeutic categories was associated with sociodemographic characteristics (gender, age, living arrangement, marital status and medication coverage), medical conditions (diabetes, heart problems and lung disease) and inability to self-manage medications. CONCLUSIONS: Our findings suggest that individual characteristics and medical conditions may help identify homebound elders at high risk for using prescription medications from an increased number of different therapeutic categories. This observation may help clinicians and community-based providers of services to older persons to be aware of differences in therapeutic medication use within an older population, and how patterns of use may alter service needs.

Age Factors↗
PubMed1990

Placing obsolete hypnotics on prescription and the admission rate for acute poisoning with these drugs.

Since January 1 1988, certain older hypnotics have no longer been available over the counter in Belgium, but can still be dispensed on prescription. The influence of this measure on admission to our Emergency Department for acute poisoning with these hypnotics has been examined. From 1983 to 1987, a mean of 93 patients (range 87 to 99) per year were admitted as compared to 15 and 5 in 1988 and 1989, respectively. For older hypnotics that were on prescription before and after 1st January 1988, there was no decrease in 1988, and a reduction was observed in 1989. There was no change in the number of patients with benzodiazepine poisoning. The data indicate that moving these older hypnotics onto the prescription-only list resulted in a decrease in acute poisoning with them. The reduction observed in 1989 for the older hypnotics that were on prescription before as well as after 1988 may have been due to an influence of the measure on the prescribing habits of physicians.

Acute Disease↗
PubMed1989

Use of prescription forgeries in a drug abuse surveillance network.

Data on forged prescriptions in Sweden in 1982-1986 were studied as an indicator in an epidemiological survey of medication abuse. The annual number of prescription forgeries doubled during the 5-year period. Psychotropic drugs accounted for 62% and analgesics for 25% of all forgeries. Benzodiazepines were the major single drug group, comprising 52% of all forgeries during the period. The major benzodiazepines on the market in Sweden (diazepam, oxazepam, nitrazepam and flunitrazepam) were the subject of largest number of forgeries. When calculated in relation to the utilization (either total sales or the number of prescriptions), the analgesics codeine, pentazocine and ketobemidone were clearly at the head of the list, suggesting greater abuse liability of these drugs. It is suggested that the data on forged prescriptions can be used as a "signalling mechanism" in epidemiological surveillance of medication abuse, aimed at detecting changes in the prevalence as well as in the pattern of abuse.

Analgesics↗
PubMed1995

Epidemiological study of epilepsy by monitoring prescriptions of antiepileptic drugs.

The aim of this study is to evaluate a simple and effective method of acquiring epidemiological information about epilepsy. Data on antiepileptic drug prescriptions was collected, the utilization pattern being based on defined daily doses (DDDs). Antiepileptic drugs are epidemiological tracers of epilepsy due to their chronic and highly specific usage. Consequently, a prevalence rate for the whole population may be obtained by using DDDs. Data on antiepileptic drug prescriptions for a period of 6 months in 1992 and 6 months in 1993 indicate a utilization of approximately 7 DDDs of antiepileptic drugs per 1,000 inhabitants. The prevalence of epilepsy was estimated by correcting the exposure calculated in DDDs by a factor of 0.68. In our sample, the prevalence of the disease was 5.2 per 1,000 inhabitants in 1992 and 4.9 per 1,000 in 1993. Physician prescriptions were concentrated on four compounds, namely phenobarbital, carbamazepine, valproic acid and phenytoin, which together represented 90% of total antiepileptic drug prescriptions.

Anticonvulsants↗
PubMed1996

Analyses of data quality in registries concerning diabetes mellitus--a comparison between a population based hospital discharge and an insulin prescription registry.

To evaluate the data quality in the Danish National Registry of Patients (DNRP) and the Prescription Registry in the country of Northern Jutland (487,000 inhabitants) concerning insulin dependent diabetes mellitus (IDDM) and insulin treated diabetes mellitus, a comparison between data in the two registries was made. From the Regional Hospital Registry in the County of Northern Jutland, containing discharge diagnoses from all admissions to hospitals in the county, we identified all patients with the IDDM diagnosis between 1987 and 1993. From the Regional Prescription Registry all insulin prescriptions taken up at pharmacies in the county in 1993 were identified. All persons were identified by their individual identification number (CPR-number), and a record linkage between the two data sources was made. The predictive value of an IDDM-registration in the DNRP was 96% and the corresponding completeness 91%. In the Prescription Registry the completeness was 96%. Both registries seem to be valuable study bases for epidemiological research in diabetes mellitus.

Denmark↗
PubMed2002

Use of anti-asthmatic drugs in Italy: analysis of prescriptions in general practice in the light of guidelines for asthma treatment.

UNLABELLED: Our aim was to analyse anti-asthmatic drug utilisation in primary health care in a Northern Italian region in the light of guidelines for asthma treatment. METHODS: We collected all prescriptions for anti-asthmatic agents reimbursed in 1998 in six local health authorities (overall population: 1,909,192 inhabitants) of Emilia Romagna (Northern Italy). The asthmatic cohort was defined as the population of subjects aged 20-44 years receiving at least one prescription of an anti-asthmatic agent devoid of indications for transient respiratory diseases. In order to include routine users, the asthmatic cohort was restricted to those subjects with at least one prescription in the first quarter of 1998. Anti-asthmatic agents were classified according to their therapeutic role as follows: maintenance therapy for mild-moderate asthma (Mm); maintenance therapy for severe asthma (Ms); quick relief for mild attack (Qm) and quick relief for severe attack (Qs). RESULTS: The asthmatic cohort included 11,518 subjects; of these, 47% received only one prescription in 1998. The most frequent regimens were Mm+Qm (25%) and Qm alone (23%). Some regimens appeared not to be in accordance with international recommendations. The main reasons were lack of drugs for quick relief (36%), use of long-term beta(2)-adrenoceptor agonists (Ms drugs) without quick-relief or anti-inflammatory agents (10% of the cohort and 56% of the recipients of Ms drugs) and presence of fixed-dose combinations (27%). In 76% of the patients treated with Mm drugs (mainly inhaled steroids), the total amount of drugs prescribed over the 1-year period covered less than 150 days. CONCLUSIONS: The use of anti-asthmatic drugs in general practice in Italy does not seem to comply with the international recommendations especially with regard to the use of quick-relief agents. Active interventions to implement guidelines and monitor the choice of drug regimens are warranted.

Adult↗
PubMed2002

Drug prescription in men and women with type-2 diabetes in Stockholm in 1995 and 2001: change over time.

OBJECTIVE: To describe, and compare between 1995 and 2001, the distribution of prescribed drugs in diabetic men and women. METHODS: Two cross-sectional surveys of medical records of diabetic patients with type-2 diabetes were carried out in two primary health care centres in Stockholm County; age 35-64 years; 59 men and 43 women in 1995, and 80 men and 80 women in 2001. Prescriptions of pharmaceutical preparations, metabolic outcome, cardiovascular risk factors and diabetes-related co-morbidity were noted. Correlation of significant outcomes was performed using logistic regression. RESULTS: The pattern of antidiabetic therapy changed between 1995 and 2001 ( P=0.001), with fewer subjects treated with insulin (15% vs 3%), and more subjects with tablets and insulin combined (13% vs 23%). Prescription rate of sulphonylureas decreased (54% vs 41%; P=0.035), and rate of metformin increased (34% vs 48%; P=0.035). The use of lipid-lowering agents rose from 14% to 37% ( P<0.001). Mean HbA1c value decreased ( P<0.001; 7.6%-units vs 6.5%-units), as did mean cholesterol value ( P<0.001; 5.9 mmol/l vs 5.3 mmol/l). The rate of macrovascular complications decreased among men from 39% to 21% ( P=0.027) and among women regarding coronary heart disease from 26% to 6% ( P=0.003). Improvement in metabolic control and complications was not associated with the changed prescription pattern. CONCLUSIONS: Improved metabolic and cardiovascular outcomes were found, but were not correlated with the simultaneous changed prescription pattern, with increased use of combined insulin and oral antidiabetics, of metformin or of lipid-lowering drugs.

Adult↗
PubMed2003

Prescriptions of antidepressants in primary care in Italy: pattern of use after admission of selective serotonin reuptake inhibitors for reimbursement.

BACKGROUND: Italy is reported to have a relatively low consumption of antidepressants. This is probably due to the fact that until 2000 antidepressants were reimbursed with some restrictions. AIM: To describe the pattern of use of antidepressants in primary care in Italy, after admission of selective serotonin reuptake inhibitors (SSRIs) for reimbursement without restrictions. METHODS: We collected prescription data of antidepressants (ATC code: N06) reimbursed between January 1999 and March 2002 from three local health authorities in Emilia Romagna. Then, we calculated the prevalence of use for the different therapeutic classes of antidepressants, by age and gender. Moreover, after selecting a cohort of incident adult patients to follow for 6 months after the first prescription, we analysed the continuity, the average daily doses and the average duration of treatment. RESULTS: Out of 1000 subjects, 78 received at least one prescription of antidepressants in 1 year. The prevalence of use increased with age from 43 to 136/1000. Women used antidepressants more frequently than men, with a ratio varying from 1.6 to 2, depending on age. SSRIs were the most used drugs (63%), and their prevalence of use diminished with age; on the contrary, use of mianserine and trazodone increased with age, and that of the other antidepressants did not vary. About 60% of the subjects received occasional prescriptions. Continuous treatment was more frequent with SSRIs and in subjects older than 34 years. Daily doses were higher in patients receiving newer drugs (0.9-1 DDD per day), and lower in patients receiving the older agents (0.3-0.4 DDD per day). The average daily doses were usually lower than those recommended for the treatment of the major depression, especially for tricyclics, trazodone and reboxetine. Overall, doses were within the recommended range in about 75% of recipients of newer antidepressants (i.e., SSRIs, venlafaxine, mirtazapine and reboxetine), and in less than 30% of recipients of older drugs (i.e., tricyclics, trazodone and mianserine). In 59% of subjects receiving continuous treatment, the duration of the therapeutic course was at least 6 months. CONCLUSIONS: We found a high prevalence of use of antidepressants in primary care with a frequency of occasional use higher than in other countries. Only rarely were doses and duration of treatment consistent with recommendations for treatment of depression. Recipients of newer drugs received doses consistent with a use for major depression more frequently than others; however, rates of 6 month duration did not differ among drug classes.

Adult↗