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PubMed1997

Methods for estimating the occurrence of polypharmacy by means of a prescription database.

OBJECTIVE: Concurrent use of multiple drugs (polypharmacy, PP) may cause health risks such as adverse drug reactions, medication errors and poor compliance. The objective of this study, based on data from a prescription database, was to evaluate estimators of PP in the general population. METHODS: Data were retrieved from Odense Pharmaco-epidemiological Database (OPED) and consisted of all prescriptions in 1994 from a 10% random sample of drug users (n = 26,977) in the county of Funen, Denmark. For each prescription, the period of consumption was calculated by setting the duration of treatment to equal the amount of drug purchased, as measured in defined daily doses (DDD), thereby assuming a daily intake of one DDD. PP was defined as overlapping periods of consumption for different drugs. A Venn diagram was used to illustrate and compare this estimator of PP with two other indicators of multiple-drug use: the number of drugs purchased in 3 months and the mean number of drugs used in 1 year. A receiver operating curve (ROC) was used to evaluate the possibility of predicting episodes of PP from the number of drugs purchased in 3 months. RESULTS: The proposed estimator of PP was robust towards changes in DDD. On an average day in 1994, the prevalence of PP was 9.9% and the standard deviation (SD) between days was 0.3%. Two to four drugs (minor PP) were used by 8.7% of the population (SD, 0.2%) and five or more drugs (major PP) by 1.2% (SD, 0.1%). The number of individuals displaying PP for the first time in 1994 stabilised after approximately 6 months, resulting in an incidence of major PP of 0.2% and of minor PP of 1.2% per month. For individuals exposed to PP, the median number of days of exposure was 61 and 10.5% were exposed for more than 350 days of the year. Purchase of five or more drugs in the first 3 months of 1994 predicted episodes of major PP in the same year with a positive predictive value of 80%. CONCLUSION: Epidemiological measures of multiple drug use can be estimated from data in a prescription database. From a conceptual point of view, an estimator based on the number of simultaneously used drugs (calculated from the date of purchase and the number of DDD) is preferable, but the number of drugs purchased in a 3-month period may also be a useful estimator.

Databases, Factual↗

PubMed2004

Objective survey of the prescription of occlusion therapy for amblyopia.

PURPOSE: To identify the variation within and consistency amongst orthoptists when prescribing occlusion therapy for amblyopia in an objective survey. METHODS: A questionnaire was designed with five case examples of amblyopic children and distributed at annual meetings of orthoptists in The Netherlands and Germany. It was filled in simultaneously within 15 min in complete silence to avoid any exchange of opinions between orthoptists that would reduce variability. For each case the orthoptists were asked to give their prescription of hours or days of occlusion. RESULTS: The questionnaire was filled in by 177 Dutch orthoptists and 227 German orthoptists. Their prescriptions of occlusion therapy were classified into five main regimens: part-time; part-time not every day; full-time; also occluding the amblyopic eye; alternating; and no occlusion therapy. The variation was large: the standard deviation was half the average prescribed hours of occlusion for each regimen in each of the five cases. All orthoptists were assigned a rank number for each of the five cases depending on whether their prescription was above or below average. These five rank numbers were not consistently above or consistently below average value per case. CONCLUSIONS: The number of prescribed hours of occlusion varied widely per regimen per case. Orthoptists were not consistently strict or lenient in their prescription of occlusion therapy.

Amblyopia↗

PubMed2005

Prescription errors with cytotoxic drugs and the inadequacy of existing classifications.

OBJECTIVE: To quantify the amount of potential prescription errors for anticancer drugs in order to improve the quality of care. SETTING: The cytotoxic reconstitution unit at the Laennec Hospital in Paris, France during 6 months in the year 2000. METHOD: Pharmacist carried out a systematic analysis (e.g. dose, protocol, physicochemical properties) of the prescriptions for anticancer drugs (ACDs) before the compounding and handling at the cytotoxic unit of the pharmacy took place. The detected errors and potential errors were documented and analysed. MAIN OUTCOME MEASURE: Numbers and kinds of medication errors. RESULTS: Documenting data was difficult because of the inadequacy of existing classifications that usually do not include potential errors in prescriptions for with ACDs. Despite the presence of a formulary on the clinical wards, 349 errors were detected and documented, mainly concerning pharmaceutical aspects. Physicians were not aware of this type of errors due to lack of studies about their impact. Teaching aids such as a computer program for prescribing and production of ACDs could help in minimising these errors. CONCLUSION: The 349 detected errors involved mainly the physicochemical properties of preparations. A computerised prescription network could possibly reduce the number of such errors. Furthermore, a redefinition of the classifications of errors for cytotoxic preparations seems desirable, and such classifications should include typical pharmaceutical problems, and potential errors that do not reach the patient.

Antineoplastic Agents↗

PubMedDate not supplied

Prescriptive authority and nurse-midwives.

The purpose of this paper is to provide an overview of issues relevant to the question of prescriptive authority for nurse-midwives. Nurse-midwives can be held liable for prescriptive competency as evidenced by the American College of Nurse-Midwives' statements, physician delegation of prescribing privileges, and recent court rulings. Despite this liability, nurse-midwives are denied legally sanctioned authority if they are not granted prescriptive privilege by specific legislation. This discussion concludes with a position in favor of direct prescriptive authority, regulated by boards of nursing, for all nurse-midwives in order to remove unnecessary restrictions to the practice of an important member of the health-care team.

Drug Prescriptions↗

PubMed1992

Trends in the prescription of antidepressants in urban and rural general practices.

Antidepressant drug (AD) prescriptions written in the period 1983-1988 by all GPs working in Verona, Italy were analyzed. The data were provided by a local drug information system and calculated as Defined Daily Dose (DDD). The area was divided in 25 districts, classified on the urban-rural continuum according to population density. Two indices of service provision and two demographic measures were also used in the analysis. An increase in the levels of prescription of AD was observed over the 6 years. No correlation was found between DDD/1000 inhabitants/day rate and population density. This was confirmed using multiple regression analysis, which showed that only the proportion of females in the population was significantly associated with AD prescription. Harmonic analysis of the seasonal variation in prescription showed a moderate degree of seasonality in all districts. When using multiple correlation analysis the seasonality was correlated only with the number of pharmacies available in each district.

Age Factors↗

PubMed1986

Prescription-writing with a PC.

We described the development of an automated system to perform writing of prescriptions and associated advice. A prototype computer program has been in operation in a dermatologist's office for three years. All prescriptions are routinely generated using the system. The program, originally developed for a multi-user computer system, now operates in a self-contained personal computer. The program is constructed to use external human-readable files as the drug formulary or data base. Experience with this system and efforts to expand its applicability to another ambulatory care setting (gastroenterology) are described. Rapid access to drug names and related information is achieved using diagnosis-specific subsets contained in the personally defined formulary. This organization supports rapid pruning of the list of drugs. From this point, a prescription of the selected drug is displayed on a video terminal. The base-level prescription is easily modified using only five keys organized in a cluster. Preliminary training and performance studies are summarized.

Computers↗

PubMed1987

The use of modern pharmaceuticals in a Filipino village: doctors' prescription and self medication.

The use of pharmaceuticals in common childhood illnesses is evaluated. The extent to which drug use is related to doctors' prescription is assessed. Attention is paid to the social context in which pharmaceuticals are applied. The study shows that the majority of the childhood illnesses are treated without consulting a doctor. In half of the cases, in which no doctor is consulted, pharmaceuticals--both prescription and nonprescription--are used. Symptomatic therapies as anti-diarrhoeals and cough syrups are found to be most popular. All of the anti-diarrhoeals and nearly half of the cough syrups used, are considered unsuitable for use in common childhood illnesses. Prescription practices by doctors have many harmful characteristics in common with self medication. Moreover, the example of doctors' prescriptions seems to encourage the choice for expensive, often dangerous, symptomatic therapy in self medication. To diminish this wasteful and dangerous use of drugs in self medication, reforms in distribution and production of drugs at national level and education in drug use at the community level are recommended. More knowledge of self medication practices is considered crucial in the implementation of such policies.

Common Cold↗

PubMed1986

Relative abuse of diazepam and oxazepam: prescription forgeries and theft/loss reports in Sweden.

Results of previous laboratory studies in humans suggest that the benzodiazepine diazepam has greater abuse liability than the benzodiazepine oxazepam. The validity of these laboratory-based experimental data were examined by analyzing Swedish data on drug abuse. Sales and prescription data showed that use of diazepam was somewhat lower than oxazepam, but of the same general order of magnitude (0.8:1). Prescription data showed that the drugs were prescribed for the same diagnostic indications. After adjustment for differences in use, 'prescription forgeries' and 'mentions in theft and loss reports' were found to be more frequent for diazepam than for oxazepam (2.3:1 and 2.5:1 for forgeries and theft/loss reports, respectively). This effect was consistent for each year examined (1982, 1983, 1984) and occurred when the data were recalculated to exclude Valium, the original and most widely known brand of diazepam. Finally, this pattern with prescription forgeries occurred across different geographical regions in Sweden (1982, 1983).

Cross-Sectional Studies↗

PubMed1996

Effect of bone density evaluation on hormone replacement therapy prescription.

OBJECTIVES: This study evaluates whether Bone Mineral Density (BMD) results influence HRT prescription. METHODS: Successive charts of 29 postmenopausal women were summarised. For each chart, 3 'simulated cases' were created by modifying the BMD result (based on the Z-score) in order to have 4 groups with the same clinical story but a wide range of BMD values (Group I = Z-score > 0, Group II = Z-score between 0 and -1, Group III = Z-score between -1 and -2 and Group IV = Z-score < -2). The obtained cases were presented to 10 gynaecologists who were asked whether HRT should be prescribed. The gynaecologists were not aware of the above-mentioned manipulation. RESULTS: The overall treatment rate was 74.2%, ranging from 65% for women with the highest BMD (Group I), 73% for Group II, 79% for Group III and 80% for Group IV, i.e. women with the lowest BMD (Friedman analysis of variance; chi-square 17.2; P < 0.001). In approximately a third of the patients (11/29), there was agreement for initiation of therapy, regardless of the BMD. Most of these women presented other indications and no contra-indications for therapy. The prescription frequency of the 10 gynaecologists varied between 63% and 87%; Cochran Q Statistic 39.2; P < 0.0001). For some physicians, a trend to increase prescription was observed in relation to the BMD result, but a statistical difference could only be reached for one physician (P < 0.05). Furthermore, for some physicians no modification whatsoever could be observed. CONCLUSIONS: BMD appears to be a determinant factor for HRT prescription in only a limited proportion of the patients and a small number of the physicians. From an epidemiological point of view, BMD measurements may be useful in order to help deciding women to start HRT, especially those who are reluctant or to those who present relative contra-indications, provided that their physicians are aware of the usefulness of these investigations.

Adult↗

PubMed1992

Prescriptive authority for psychiatric clinical specialists: framing the issues.

Prescriptive authority is of increasing interest to advanced practice psychiatric nurses. A growing number of states have passed legislation authorizing prescriptive authority for this specialty group. In preparing for an orderly assimilation of this intervention into psychiatric nursing's existing scope of practice, it is important to understand some of the unique issues facing the specialty. This report provides an overview of prescriptive practice legislation, legal issues associated with prescribing psychotropic medication to psychiatric clientele, and prescriptive activities common to the specialty practice of psychiatry. Issues for the specialty of psychiatric nursing are reviewed and recommendations are offered for an action plan.

Drug Prescriptions↗

PubMedDate not supplied

Prescriptive authority for advanced nurse practitioners: a blue-print for action.

The pursuit of prescriptive authority is a priority on the legislative agenda of nurse practitioners nationwide. This article describes the legal avenues that have been used by nurse practitioners in 35 states to obtain prescriptive authority. Because prescriptive authority is state regulated, the legislative process for obtaining prescriptive authority differs from state to state. A step by step outline is provided to guide the nurse practitioner through the legislative process from the initial planning stages to the time when a bill is introduced to the state legislature and the follow through until it becomes law.

Drug Prescriptions↗

PubMed1995

Risk of traffic accident injury after a prescription for a benzodiazepine.

The objective of this study was to assess the risk of hospitalization for injuries received in traffic accidents after a first prescription for benzodiazepines (BZD) was filled. Saskatchewan Health supplied study populations of 78,000 adults who received BZD hypnotics, 148,000 who received BZD anxiolytics, and 98,000 control subjects. These populations were monitored for 2 months after the index prescription fill-date for hospitalizations due to traffic accidents. Analysis showed an odds ratio (OR) of 3.9 (1.9 to 8.3) for persons taking BZD hypnotics and an OR of 2.5 (1.2 to 5.2) for those taking BZD anxiolytics, with regards to hospitalization due to traffic accidents within 4 weeks after the prescription was filled. Within 2 weeks after the prescription was filled, the Or had risen to 6.5 (1.9 to 22.4) for hypnotics and 5.6 (1.7 to 18.4) for anxiolytics. After 1 week, the ORs were even higher (9.1 and 13.5), but the confidence limits were wide. The highest risk groups were the youngest age group (20 to 39 years old) and males. From a public health view, the high ORs are of concern and action for prevention is needed.

Accidents, Traffic↗

PubMedDate not supplied

Outcome of new benzodiazepine prescriptions to older adults in primary care.

OBJECTIVE: The objective of this study was to examine the indications for benzodiazepine use, and the baseline characteristics, duration of use and clinical outcomes of older primary care patients prescribed benzodiazepines. METHODS: Computerized records were used to identify outpatients (n=129) aged >or=60 years who received new benzodiazepine prescriptions from primary care physicians of a group model managed care organization. A baseline telephone survey assessed indications for prescription, sleep quality (Pittsburgh Sleep Quality Index), depression (Symptom Checklist depression scale and Structured Clinical Interview for DSM-IV), alcohol use (CAGE) and functional status (SF-36). A 2-month follow-up survey assessed benzodiazepine use, sleep quality and depression. RESULTS: The most common indications for prescription were insomnia (42%) and anxiety (36%). At baseline, participants reported moderate sleep disturbance (mean Pittsburgh Sleep Quality Index=9.3, S.D.=4.0), only 15% met criteria for current depressive episode and only 3% reported at-risk alcohol use. After 2 months, 30% of participants used benzodiazepines at least daily. Both those continuing daily use and those not continuing daily use reported significant improvements in sleep quality and depression, with no difference between groups in rates of improvement. CONCLUSIONS: Initial benzodiazepine prescriptions to older adults are typically intended for the treatment of anxiety or insomnia, with little evidence for occult depression or alcohol abuse. A significant minority develops a pattern of long-term use, raising concerns about tolerance and dependence.

Age Factors↗

PubMed2005

[Medical prescriptions in haemodialysis patients: critical analysis].

AIM: The aim of the study is to analyse haemodialysis patients' prescriptions accordance with legal registrations in 64 chronic haemodialysis patients during a one-month follow-up period. RESULTS: Patients are taking 9.6+/-3 different drugs. A mean of 2.4+/-1.3 prescriptions per patient disagree with the recommended drug use. The directions for use in this specific population are defective in 89%. Moreover, at least one drug-drug interaction is found in 78% of our patients. CONCLUSION: Only 8% of the studied hemodialysis patients benefit from prescriptions in agreement with the legal recordings, as a consequence of the lack of drug studies in this particular population. Therefore, clinicians have to rely on their own experience to establish their prescriptions, which can involve their responsibility in case of litigation. Furthermore, the frequency of drug-drug interactions in these polymedicated patients implies that a close pharmaceutical follow-up should be implemented.

Aged↗

PubMed2006

[Validity of proton pump inhibitors' prescriptions in a department of internal medicine].

INTRODUCTION: Proton pump inhibitors (PPIs) are an efficient therapy, being widely used by physicians. In 2004, cost of PPIs' therapy was as high as 748 millions of euros (for The Caisse primaire d'Assurance Maladie) in France. Although validated indications of PPIs are well known, numerous un-necessary prescriptions of PPIs are common. The aim of this prospective study was to evaluate PPIs' prescriptions of patients in a department of internal medicine. PATIENTS AND METHODS: This is a 12-week assessment of medical charts of patients, receiving PPI therapy in patients in our department of internal medicine. Data were collected by a standardized questionnaire, with regards to: PPIs' nature and regimen, PPIs' indications as well as duration of therapy. RESULTS: The medical charts of 729 consecutive patients, with a mean age of 67 years, were collected. Two hundred (and) twenty-four patients (30.7%) received PPI therapy; 157 of these patients were given PPI before admission in our department. Omeprazole was used in 71% of patients. Duration of PPI therapy was over one year in 45% of cases. Thirty-five per cent of family physicians' PPI prescription were validated and 23.8% of those of physicians working in the department of internal medicine. The main non-conform PPI's indications, by family physicians and internists were as follows: prevention of hemorrhagic risk of anti-platelet agent (21 vs 16.4%), anticoagulant (17.8 vs 16.4%), steroids (8.3 vs 13.4%) or non-steroid anti-inflammatory therapy without risk factor (1.9 vs 9%). Finally, in patients receiving PPI therapy before admission, this therapy was maintained in 76% of cases. CONCLUSION: This prospective study confirms the frequent prescription of PPI therapy in a department of internal medicine (31% of patients). It also underscores the importance of PPIs' use by family physicians and physicians working in a department of internal medicine; this series further highlights the difficulties to interrupt this well tolerated therapy. To date, PPI therapy should be prescribed with a cautious consideration of cost and benefit.

Adult↗

PubMed2004

'Hypnotic' prescription patterns in a large managed-care population.

BACKGROUND AND PURPOSE: Medical treatment of insomnia has declined over the past decade and, when treated, use of non-hypnotic medications has increased. This study assessed the characteristics of the prescriptions for insomnia and of the patients receiving those prescriptions. PATIENTS AND METHODS: The outpatient pharmacy database of the Henry Ford Hospital, Health Alliance Plan (HAP) was searched from 1/1/98 to 6/30/99 for mentions of the 10 most frequently used drugs for the treatment of insomnia listed in the National Disease and Therapeutic Index for 1987-1996. The 10 drugs were alprazolam, amitriptyline, clonazepam, doxepin, flurazepam, lorazepam, temazepam, trazodone, triazolam, and zolpidem. These were classified by their indication as antidepressant, anxiolytic, or hypnotic and the three indication groupings were compared on patient and prescription characteristics. RESULTS: Over the 18 month period the total patient population covered by HAP was 287,456; 20,014 (7%) patients received one or more prescriptions for insomnia. Of these, anxiolytics were most frequently prescribed (55%), then antidepressants (25%), and hypnotics least frequently (20%). Patients receiving hypnotics were more likely to be male, older, and to receive a narrower dose range, in smaller quantities and with fewer refills than patients receiving anxiolytics or antidepressants. CONCLUSIONS: In this large managed-care population, hypnotics are prescribed conservatively, while the non-hypnotics, for which there is limited efficacy and safety data, are prescribed on a more chronic basis.

Anti-Anxiety Agents↗

PubMed2000

Determinants of angiotensin-converting enzyme inhibitor prescription in severe heart failure with left ventricular systolic dysfunction: the EPICAL study.

BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors have been demonstrated to reduce morbidity and mortality rates in patients with heart failure with left ventricular systolic dysfunction. Nevertheless, these drugs are underutilized in current practice and prescribed at doses below those usually recommended. The aim of this work was to identify the social, demographic, laboratory, clinical, and therapeutic factors associated with nonprescription of ACE inhibitors and/or their prescription at doses below those recommended in the treatment of severe long-term congestive heart failure (CHF). METHODS AND RESULTS: An epidemiologic observational study, EPICAL (EPidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine), studied 417 patients with severe CHF surviving after the index hospitalization. Multivariate logistic regression determined the factors associated with ACE inhibitor nonprescription and with their prescription at lower-than-recommended doses. ACE inhibitors were taken by 75% of the patients but 38% took lower-than-recommended doses. Factors shown to be associated with nonprescription included patients >65 years of age with renal impairment (odds ratio 19.5, confidence interval [CI] 7.9-48.0), nonsinus cardiac rhythm (odds ratio 2.0, CI 1.2-3.2), and prescription of potassium-sparing diuretics (odds ratio 2.4, CI 1. 2-4.7). Renal impairment was the single most important factor associated with prescription of lower-than-recommended doses, particularly in elderly patients. CONCLUSIONS: Our results underline the need for optimal and better use of ACE inhibitor therapy. CHF treatment guidelines must be more uniformly applied by all physicians caring for patients with heart failure.

Aged↗

PubMed2004

[Drug prescription typology in primary healthcare centers in Tunisian Sahel].

The objective of this survey was to determine the typology of prescription drugs ordered in primary healthcare centers of the Tunisian Sahel. We conducted a cross sectional descriptive survey to analyze 2586 medical orders written by 20 general practitioners working in the public sector of the Sousse sanitary region. The sample included 5628 types of prescription for 209 pharmaceutical agents. More than half of the prescribed drugs (56%) belonged to two therapeutic families: anti-infectious agents and antalgesic-antiinflammatory agents. The 30 most prescribed drugs in general practice accounted for 80% of the prescription lines for agents belonging to 10 therapeutic families. In this "Top 30" list, we found seven antibiotics and four cardiology medicines. The prescription profile in primary healthcare in the Tunisian Sahel shows widespread use of drugs and reflects the diversity of the morbidity encountered in the general medicine setting which corresponds to an advanced "epidemiological transition" in this geographical area. The development of a "Top 30" list could be the starting point for more efficient pharmaceutical management and for more relevant education in therapeutics.

Data Collection↗