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PubMed2004

[Prescription and use of benzodiazepins in Saint-Louis in Senegal: patient survey].

Prescription and use of benzodiazepins were evaluated with a patients survey. Direct interview were conducted with 150 patients in ten pharmacies in the city of Saint-Louis, Senegal from January to June 2002. Ten of the 15 retail pharmacies in this city agreed to participate in the survey. All patients gave their agreement to participate to the study; the questionnaire contained essentially closed questions. Writers of prescriptions were general practitioners (38.67%), specialists (34.67%), nurses (18%) and midwifes (8.66%). The most prescribed benzodiazepins were prazepam, dipotassic clorazepate, lorazepam and diazepam. Use of these drugs during night is most recommended. Nevertheless, 26.67% of the prescriptions indicated the drug should be use during the day. The period of use was between one and three Months for 33.99% of patients and three Months or more in 42%. Benzodiazepins were used by 66.67% for insomnia, alone or associated with another condition, for anxiety by 14.6% and for epilepsy by 10%. Prescriptions were for benzodiazepins alone in 47.37% of the patients and in combination with other psychotropic drugs for 19.33%. Somnolence and dependence were the most reported side effects.

Adult↗
PubMedDate not supplied

[Pharmaco-epidemiology of antipsychotic prescription practices for schizophrenic patients (1995 and 1998 cross sectional surveys)].

OBJECTIVE: The two cross-sectional surveys reported here concern the field of pharmaco-epidemiology of prescription practices. The objective is to describe and understand these practices in regard to antipsychotics and their evolution in all indications which go beyond the field of psychotic pathology. The research presented here only concerns schizophrenic pathology. METHODOLOGY: These 2 cross-sectional surveys were carried out in public psychiatric sectors in 1995 and 1998 applying the same methodology in the same services. On a given day, in each sector, they concern all patients aged from 18 to 64 and receiving an antipsychotic prescription. A hospital unit and a consultation unit were included to take into account practices which could be different in these two places of care. A comparison was made between the 1995 stage and the 1998 one for a better understanding of evolution in practical terms. An unvaried analysis was carried out to test the differences observed between 1995 and 1998 as well as a correlation test to evaluate evolution according to age and duration. RESULTS: The main results were as follows: the number of antipsychotics slightly decreased significantly from 1.74 (+/- 0.02) in the 1995 survey to 1.69 (+/- 0.04) in the 1998 one (p<0.05); the number of patients receiving antiparkinsonian medicines, correcting extra pyramidal effects, decreased from 60% in 1995 to 50% in 1998. The following associated factors were noted concerning prescription of antipsychotics. Women received a mean number of antipsychotics significantly lower than that of men. For each sex the mean number was lower in the 1998 survey, but not significantly so. In the two surveys, there was a positive correlation between the mean number of antipsychotics and age; it increased as the patient grew older. The mean number of antipsychotics tended to increase significantly with length of illness, in 1995 as well as in 1998. It was for the shortest periods that the mean number of antipsychotics was lowest. The mean number of antipsychotics was significantly higher in the hospital field as compared to the ambulatory. The greater was the mean number of antipsychotics, the greater was the proportion of patients who received antiparkinsonian medication. Firstly, these surveys shed light on what may underlie prescription practices such as sex and age of the patient, length of illness and the place of care. Secondly, the evolution of practices in time can be followed, taking into account the increase of knowledge concerning this subject.

Adolescent↗
PubMed2000

Prescription of drugs during pregnancy in France.

A survey of the records of the French Health Insurance Service of drug prescriptions during pregnancy in 1000 women living in Haute-Garonne, southwest France, showed that 99% of the women received a prescription for at least one drug during pregnancy with a mean of 13.6 medications per woman. 1.6% of women received one or more prescriptions of drugs from the US Food and Drug Administration X category (fetal risk outweighs benefits). 59% of women had a prescription of drugs from the D category (fetal risk but benefits may be acceptable) and 79% of women were exposed to drugs for which information about safety in pregnancy was not available from animal or human studies.

Adolescent↗
PubMed1984

Prescription of contraindicated and interacting drugs in elderly patients admitted to hospital.

573 elderly patients admitted to the general medical and geriatric beds of a teaching hospital in January, 1983, were receiving an average of 2.14 drugs on admission, 5.48 during inpatient stay, and 3.47 on discharge. Contraindicated or adversely interacting drugs were identified in 200 (3.2%) of 6160 prescriptions. 136 (23.7%) patients were affected. 7 patients received drugs to which they had had adverse reactions. There were a further 60 contraindicated and 133 adversely interacting drugs. 117 prescriptions were potentially hazardous and another 27 interactions may have led to suboptimal treatment. 131 (65.6%) undesirable prescriptions were deemed avoidable and a further 36 (18%) were probably so. The frequency of errors was higher in admission medication (5.3%) than in hospital prescriptions (2.9%). The importance, origin, and prevention of prescribing errors in drug-induced morbidity in the elderly are discussed.

Aged↗
PubMed1998

American Pharmaceutical Association review of literature on prescription to over-the-counter drug switches.

Research was conducted by staff of the American Pharmaceutical Association (APhA), the national professional society of pharmacists, to inform the APhA policy process. Findings indicate that many consumers view products that were switched from prescription to over-the-counter (OTC) status as being more effective than products that have not previously been designated as prescription drugs, and they prefer to purchase switched products. Consumer purchases of switched products replace utilization of prescription drugs, physician visits, and laboratory services, but no data were found concerning increased utilization that may eventually result from foregone or delayed medical attention. Evidence exists that many comparatively well-informed consumers are knowingly using these products in a manner inconsistent with their labeling, and are using complementary and alternative medications for which labeling is uninformative in lieu of either prescription or OTC products. A need exists for more and better-quality pharmaceutical care services from pharmacists to support informed self-care decision making by consumers.

Antifungal Agents↗
PubMed1999

Selective serotonin reuptake inhibitors have broadened the utilisation of antidepressant treatment in accordance with recommendations. Findings from a Swedish prescription database.

BACKGROUND: With the advent of the selective serotonin reuptake inhibitors (SSRIs), the use of antidepressants has increased drastically in Sweden. The use of tricyclic antidepressants (TCAs) has, however, decreased. METHODS: We surveyed a prescription database in the Swedish county of Jämtland and compared prescription patterns for patients prescribed SSRIs with those prescribed TCAs. RESULTS: The incidence of treatments of antidepressants increased from 0.76% to 1.33% during the period 1991-1996. There were no significant differences between SSRIs and TCAs with regard to patients having only one prescription dispensed within three months from the index prescription, or patients who switched class of antidepressant. Only a minority of the treatments were continued for at least six months, but significantly more SSRI than TCA treatments (42% and 27%). A second treatment period suggesting recurrence was three-times more common in the TCA group than in the SSRI group. CONCLUSION: Provided that the increased use of SSRIs is mainly for depression, these drugs appear, despite a lower efficacy in severe depression, to have enabled a broader utilisation of antidepressants with regard to incidence, dosage and duration, in accordance with recommendations. Further analyses of this phenomenon relative to diagnostic criteria and outcome measures are required.

Adult↗
PubMed2002

A survey of group-level antibiotic prescriptions in pig production in France.

There is world-wide concern that antimicrobial use in food-producing animals might contribute to antimicrobial resistance both in animals and in humans. The relationship between antimicrobial use and resistance is likely to be related to frequency of prescription of the compound, dose and duration of treatment. Routine collection of that information is not possible today in France. A postal survey of French pig veterinarians therefore was carried out in October 2000. The questionnaire focused on the last antibiotic group-level prescription made; data were collected on the type of animals, presumptive clinical diagnosis and drug prescription. The list frame was defined using a veterinary yearbook. All practitioners with mention of pig in the treated species or with employment in intensive animal production were sent the questionnaire. Out of the 431 selected practitioners, 303 responded to the self-administered questionnaire (overall return proportion 70%). 159 prescriptions were received and analysed (response proportion 37%). Their repartitions according to indications and active compounds were summarised. Mean prescribed daily doses and mean treatment length were calculated for four antibiotics: amoxicillin, colistin, oxytetracycline, tylosin. Prescribed daily dose were in the range of dosages used and recommended in Europe. High variations were encountered in treatment length: from 3 to 21 days.

Animals↗
PubMed1998

Effects of user charges on the use of prescription medicines in different socio-economic groups.

This study examined the sensitivity towards increases in user charges for different types of drugs and among different socio-economic groups. It was based on responses by 2008 consumers of prescription drugs to a self-administered postal questionnaire sent to a random sample of 8000 inhabitants in Uppsala County in Sweden. The questionnaire included a question about whether the respondents would use fewer prescription drugs if the user charges increased by a specific amount. The increase in user charges was varied between 9 and 150% in five different subsamples. Logistic regression analysis was used to estimate the probability that a respondent would reduce consumption of prescription drugs as a function of the size of the user charges increase, socio-economic characteristics and the type of drug used. Results showed that the price sensitivity decreased with increasing age, income, education and self-rated health status. Price sensitivity was highest for antitussives and lowest for climacteric drugs. If the user charges doubled, 40% of antitussives users would reduce their consumption whereas only 11% of climacteric drugs users would reduce their consumption. It is concluded that sensitivity to increases in user charges varied greatly between different types of drugs and between socio-economic groups. The young, those with poor health status, low education and low income are most likely to decrease consumption of prescription drugs when user charges increase.

Attitude to Health↗
PubMed2002

[Effectiveness of a personalized information system on the quality of family doctors' medical prescription].

OBJECTIVES: To evaluate the effectiveness of a system of personalised prescription information (PPI) to improve prescription habits of family doctors (FD); to examine how useful PPI is in maintaining these habits, and to analyse its influence through factors of the doctor and his/her environment. DESIGN: Cross-sectional, descriptive pilot study to analyse conditioning factors and possible confusion; quasi-experimental intervention study to assess the effectiveness of PPI, with two groups (experimental and control) and 4 determinations (before the PPI and after: short, medium and long-term).Setting. Family doctors in the Murcia Region. SUBJECTS OF STUDY: The prescriptions of all family doctors in the Murcia region which started before PPI and which continued until the end of the study and without absences of over 10% at each measurement.Intervention. The family doctors from the Murcia city area formed the experimental group: they received PPI with specific proposals for improvement. The FDs of Cartagena and Lorca, who did not receive PPI, made up the control group. Statistical analysis. Logistical regression to identify conditioning factors. Z comparison of proportions contrasted with one-tail hypothesis to check the effectiveness of PPI. LIMITATIONS OF THE DESIGN: Non-randomised allocation to groups made comparison difficult: conditioning factors for stratification or adjustment were studied. PRACTICAL APPLICATION: Confirmation of PPI s effectiveness justifies its dissemination. If there is no such confirmation, it will have to be perfected. Isolating the factors conditioning prescription that can be modified helps find ways to improve PPI.

Cross-Sectional Studies↗
PubMedDate not supplied

[The effect of the provider company of reference on drug prescriptions in nursing homes].

OBJECTIVE: To identify the effect of the provider company (PC) of reference on drug prescriptions in nursing homes. METHODS: We performed a descriptive study of all ambulatory prescriptions invoiced by the Catalan Health Service from 106 nursing homes in a health region in 2001. The PCs were grouped into private (n = 23; 1,158 residents) and public (n = 83; 3,163 residents). A system of evaluating quantitative, qualitative and relative use indicators was established according to therapeutic group or active principles. RESULTS: Expenditure in the nursing homes was Euro 7.7 million, representing 6.3% of that generated by the PCs. The results obtained show differences in expenditure per resident, which amounted to Euro 1,601.56 +/- 317.20 in the private sector and Euro 1,843.49 +/- 516.56 in the public sector (p = 0.000). The percentage spent on drugs of high intrinsic value was 89.0 and 82.9% (p = 0.043), respectively. CONCLUSIONS: Because of the study's limitations, the results should be generalized with caution. The volume of prescriptions in nursing homes was high. Moderate cost containment and a relative improvement in the quality of prescriptions in private PCs were observed.

Aged↗
PubMedDate not supplied

[Predictive factors of drug prescription: profile of the overprescribing physician].

Because of increasing pharmaceutical costs, several programs aimed at optimizing physician's prescription have been set up in the last years. However, factors determining prescription volume are not well known yet. The aim of study is to determine which the characteristics of the practitioner (GP) or the working place are related with a higher amount of drug prescription. With data obtained from PE-29, PE-20, and the managing center Human Resources Department databases, concerning the whole GP staff (N = 293), via a multiple regression model, we were able to determine the following factors predicting higher prescription:rural work place, longer distance to reference specialty center, care to children, lack of postgraduate education, short term work contract, and part time staff.

Adult↗
PubMed2003

Public and private sector responses to essential drugs policies: a multilevel analysis of drug prescription and selling practices in Mali.

Many African countries have introduced cost recovery mechanisms based on the sale of drugs and measures aimed at improving drug supply. This study compares prescribing and selling practices in Mali, in 3 cities where the public sector contributes differentially to the supply of drugs on the market. Multilevel models are used to analyse the content and cost of 700 medication transactions observed in 14 private and public legal points of sale. Results show that the objective of improving access to drugs seems to have been achieved in the sites studied. Costs of prescriptions were lower where public health services had been revitalized. Affordable generic drugs were accessible and widely used, even in the private sector. However, measures intended to rationalize the prescription and delivery of drugs did not always have the desired effect. While agents in the public sector tended to prescribe fewer antibiotics, injectables, or brand-name drugs, the data confirm the virtual absence of advice concerning the use or the side effects of the drugs in both public and private sectors. In addition, data supported the notion that the public and private sectors are closely intertwined. Notably, availability of drugs in the public sector contributed to diminishing the prices charged in the private sector. Similarly, the use that agents in the public sector made of the opportunities afforded by the presence of the private pharmaceutical sector provided another illustration of interrelatedness. Finally, the data showed that the presence of a private sector, which has not been affected by measures aimed at rationalizing prescription and sales practices, limits the effects of measures implemented in the public sector. More assertive policies, based on strategies encompassing actors in the private sector, are needed to increase the safety and effectiveness of prescription and sales practices.

Community Health Centers↗
PubMed2003

The effect of ED prescription dispensing on patient compliance.

The objective of this study was to evaluate whether dispensing prescriptions in the ED affects patient compliance and return visits to the hospital. Seventy-four patients who were deemed suitable candidates for outpatient therapy with a macrolide antibiotic were identified and prospectively randomized to receive either an entire course of azithromycin from the ED or a prescription for azithromycin to be filled at a local pharmacy free of charge. Pharmacy records and telephone interview were used to measure compliance with patients. Significantly fewer patients filled their prescription in the pharmacy group (74.2%) compared with the ED group, in which all patients received their medication. However, there was no difference in the self-reported compliance of completing the entire course of antibiotics between patients in the ED group (94.3%) and in the pharmacy group (96.8%). There was no significant difference between groups in return ED visits or hospital admissions. We conclude that delivery of prescriptions in the ED significantly increases the likelihood that the patient will obtain the medication prescribed. Whether the patients actually take the medication as directed is unknown. Patient's self-report did not accurately reflect true compliance and more objective means for measuring compliance is warranted.

Adult↗
PubMed2001

[Transfusion of fresh frozen plasma (FFP): audit of prescriptions].

OBJECTIVE: To review fresh frozen plasma (FFP) prescriptions and compare their validity to the legal french guidelines (law of the 12/03/91). STUDY DESIGN: Assessment of all prescriptions has been carried out by a multidisciplinary committee. PATIENTS: All the adults transfused with FFP over one year in a teaching hospital. METHODS: Following each head of department's agreement and following a written notice to all prescribers within the hospital to inform them of the undergoing study and its methodological validation by the board of quality experts, each delivery of FFP was followed by a questionnaire addressed to the prescriber. A board of experts then assessed the significance of the prescription in accordance with the legal requirements after reviewing each medical file. RESULTS: 144 prescriptions to 89 patients were assessed: 23% were judged inappropriate by the experts and 6% did not respect the law. The inappropriate transfusions distribute as follows: intensive care patients (73% of which 80% in multiple organ failure (MOF) and 20% in haemorrhagic shock), cirrhotic patients (12%), patients treated with vitamin K antagonists (12%), obstetric patients (3%). Nine percent of the appropriate transfusions were judged in insufficient volume. The hospital mortality rate was 48%. Among prescribers, 59% were not aware of the law. CONCLUSION: A significant proportion of FFP transfusions is inappropriate. This study, which is the first step of a quality assurance program, will be followed by local recommendations for clinical practice. The current standards of prescribing FFP are more restrictive than those defined in the legal french guidelines.

Blood Component Transfusion↗
PubMed2005

[Pharmaceutical analysis and validation of hospital prescriptions, a 5-year study].

BACKGROUND: Analysis and validation of hospital prescriptions by the pharmacy department, although mandatory since 1991, appears relatively uncommon. Little is known of the nature and frequency of the actions taken by clinical pharmacists during this process. OBJECTIVE: To describe the nature and frequency of pharmaceutical interventions in a large university hospital. METHODS: We reviewed interventions during the pharmaceutical analysis of prescriptions in a surgical ward, a general medical ward and a short-stay hospital unit over a 5-year period. RESULTS: Pharmacists took some type of action in 1438 of the 13,760 prescriptions analyzed (10.4%). Drug interactions accounted for 30.9% of the interventions; 20.2% concerned dose adaptation in cases of renal insufficiency; 13.8% proposed a change from injectable to oral drugs; and 4.1% concerned the physicochemical incompatibility of the simultaneous administration of two drugs through the same infusion line. Drug interactions most frequently involved oral fluoroquinolones and anticoagulants. Dose adaptation was suggested most often for amoxicillin, buflomedil, ofloxacin and allopurinol, while the pharmacists most often proposed changing mixtures of multivitamins, omeprazole, imidazole derivatives and fluoroquinolones from parenteral to oral administration. Physicochemical incompatibility was most frequently associated with furosemide or nicardipine and with antibiotics. CONCLUSION: The analysis of prescriptions by a pharmacist is useful for medical teams: it helps to modify common attitudes towards prescribing drugs and contributes to their appropriate use and to the prevention of adverse events.

Clinical Pharmacy Information Systems↗
PubMed1998

Experiences with the prescription of opioids: a patient questionnaire.

Forty-three German patients who had been treated with strong opioids were questioned about their experiences during therapy. The prescription of opioids was well accepted by most patients. Some, however, felt stigmatized by taking opioids. Fourteen patients (33%) were asked by their relatives, friends, or other patients about the special prescription form. Six patients (14%) had difficulties in redeeming the prescription at the pharmacy, seven patients (16%) were warned against taking the medication by the pharmacist, 21 patients observed that their general practitioner (GP) was mistrustful about the treatment, and 16 patients (37%) reported that the GP terminated the therapy. Despite the beneficial effect for the patient, opioid treatment started and supervised in a pain clinic is not always continued by the GP. In Germany, it may not be possible to administer opioid therapy outside of a specialized pain clinic. In those few cases in which an opioid therapy is successfully instituted, difficulties continue due to prejudices, insufficient education, and complicated prescription laws.

Adult↗
PubMed1998

Inappropriateness and variability of antibiotic prescription among French office-based physicians.

OBJECTIVE: To describe oral antibiotic prescription in the community. DESIGN: Audit of anti-infective prescribing in office-based medical practice. SETTING: Center of France, in the Loiret, a 600,000 inhabitant administrative division. MAIN OUTCOME MEASURES: Clinical hypothesis and antimicrobial drugs used as well as daily doses and durations of treatment. RESULTS: Respiratory tract infections with a presumed viral etiology accounted for 36% of prescriptions. In children, a high percentage of antibiotic prescriptions were underdosed as compared to clinical recommendations, particularly in acute otitis media. The variability of the daily dose was high, with coefficients of variation over 40% in acute otitis media or acute tracheobronchitis. Whatever the clinical hypothesis, the duration of treatment was close to 8 days. In acute otitis media, the coefficient of variation was 14%, the lowest for all diagnoses. CONCLUSION: Our investigation identified two main areas for improving antimicrobial drug prescribing: (1) reduction of useless prescriptions in respiratory tract infections with a presumed viral etiology, and (2) increasing the prescribed daily dose of antimicrobials to the recommended levels.

Administration, Oral↗
PubMed1999

Identifying providers of care to individuals with human immunodeficiency virus for a mail survey using a prescription tracking database.

Unlike cancer and other illnesses for which specialists provide the majority of care for affected individuals, care of those infected with human immunodeficiency virus (HIV) is provided by generalists and many different types of specialists. To assess the utility of a prescription tracking database in identifying low experience and high-experience providers of such care regardless of specialty, we mailed a survey to 1500 physicians identified as having written prescriptions for agents used in care of HIV-infected individuals in the year before the survey. We discovered that physicians who care for patients with acquired immunodeficiency syndrome (AIDS) in the United States come from a broad range of specialties and practice in a variety of settings. Self-report of experience with AIDS care in the prior year was strongly associated with the number of HIV-related prescriptions identified in the tracking information. Response rates were consistent with those of other surveys published in medical journals. This study suggests that prescription tracking databases can be used to identify the breadth of physician/subjects who provide care for patients with HIV infection.

Databases, Factual↗