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Changing prescription drug sector: new expenditure methodologies.

Estimating spending for prescription drugs has become increasingly difficult over the past 15 years as extensive changes have taken place within the retail prescription drug industry. Expenditures for prescription drugs in retail outlets grew rapidly during the 1980s and early 1990s. New retail outlets emerged and existing sites lost market share. New mechanisms for reimbursing drug purchases led to the flow of rebates between manufacturers and insurers, bypassing retailers. These and other major industry changes required the development of new estimating methodologies for tracking prescription drug expenditures within the National Health Accounts (NHA).

Centers for Medicare and Medicaid Services, U.S.↗

Patient behavior patterns regarding prescription refills.

This study was conducted to examine the association between drug price, drug category, duration of coverage of the original prescription, units prescribed per day, and a patient's failure to obtain authorized refills of prescription medication. A two-stage sampling of pharmacies and prescriptions yielded a total sample of 1,058 prescriptions. The Drug Possession Ratio (DPR), defined as the ratio of number of days of medication dispensed to number of days of medication prescribed, was significantly related to drug price and drug category (p less than 0.05). The highest DPR was associated with the most expensive medication. Tranquilizers, antidepressants, and sedative hypnotics exhibited high DPR, while antihistamines and decongestants exhibited low DPR.

Drug Prescriptions↗

Physician acquisition of prescription drug information.

The authors explore how the characteristics of prescription drug information sources influence the perceived usefulness of those sources. Physicians were asked in a survey to assess several prescription drug information sources and source characteristics. Their perceptions were examined statistically to determine whether they vary among physician subgroups (general practitioners versus specialists and younger versus older physicians). The results show that physician subgroups differ not only in their likelihood of using prescription drug information sources, but also in the importance they attribute to the information source characteristics. A situationally derived model of physician prescription drug information acquisition is advanced and a variety of academic and practitioner implications are discussed.

Advertising↗

[Evaluation of drug prescription in the primary care clinic in Geneva in 1997].

INTRODUCTION: The analysis of drug prescription in a primary care clinic is a useful tool to evaluate the quality of medical care provided to outpatients. METHODOLOGY: We analysed drug prescriptions of the first consultations with 701 patients attending between May 14 and June 6 1997, and compared this data to previous surveys conducted in 1988, 1991 and 1993. RESULTS AND DISCUSSION: The three most common diagnoses were hypertension, lumbar pain and diabetes. The prescription of non steroidal antiinflammatory drugs (NSAID) increased from 7.1% in 1988 to 20% in 1997. For acute lumbar pain physicians prescribed NSAID to 58% of patients and paracetamol only to 33%. Further, doctors often prescribed muscle relaxants although an additional antalgic effect has not been proven. The prescription of psychotropic drugs decreased from 22.5% in 1988 to 12.7% in 1997. ACE inhibitors and calcium antagonists were the most frequently prescribed antihypertensive drugs. Therefore physicians do not follow the American (JNC VI) and our institutional guidelines, which recommend beta-blockers and diuretics as first line agents.

Acetaminophen↗

[Effectiveness of a program for improving drug prescriptions and hospitalization reporting at a university hospital].

OBJECTIVES: To evaluate the effectiveness of a method for improving the quality of care applied to the formulation of medical prescriptions and to the release of hospitalisation reports. The actions comprised the diffusion of results of audits and recommendations of good practice. METHODS: For each of the 41 services, 30 visits from 1996 were selected at random. 3289 prescriptions and 1067 correspondence files were analyzed. The results were compared to those obtained from the previous two years. RESULTS: Patient identification was complete in 44% of prescriptions, the identification of the prescribing doctor and his signature were present in 62% and 19% of cases respectively. 37% of medicines included all information. 7 indicators out of 12 for the quality of prescriptions improved (p < 0.0001). Files were found for 83% of hospital visits and 56% were sent (released) within a week. The practitioner was identified in 79% of cases, the main diagnosis in 96% and the treatment in 65% of cases. Five out of nine indicators of the quality of correspondence improved (p < 0.01). For each theme, the number of indicators improving was similar (p > 0.05). The services that improved for one theme didn't necessarily improve for the second (p > 0.05). DISCUSSION: The evaluation of the programme, based on a strategy of quality assurance, shows modest progress. Given that the improvement of two themes for a given service are not correlated, the programme appears to sensitise professionals at an individual level rather than collectively. However, this programme is an important step for introducing a mode of continued improvement of quality.

Drug Prescriptions↗

[Survey of dental drug prescriptions].

6665 prescriptions written out by stomatologists of a large town within three months were analysed with the aid of commercially available slotted cards for which a special hole-saving code had been established. There were differences between the prescriptions from the different fields of stomatological activity (policlinic, privately conducted practice, university clinic) as to contents, which is probably due to their differing tasks. Selected problems, e.g., the prescriptions for personal use (the proportion of which was 12%) and the prescriptions of analgesics were discussed in detail. The results obtained were compared with previous literature reports.

Adolescent↗

[Secure prescriptions].

In an attempt to facilitate access to pain relief treatments, the registered prescription sheets formerly used in France for the prescription of narcotics have been replaced by protected prescription forms complying with the technical specifications established by the AFNOR standards. When these new prescription forms were implemented, there was no modification in the legal regulations controlling narcotic supply to pharmacists.

Analgesics, Opioid↗

Psychotropic drugs prescriptions in Al-Qassim region, Saudi Arabia.

Psychotropic drugs prescriptions for patients attending psychiatric outpatient clinics were studied. Of the 52,168 prescriptions written in 1996, 18,265 were systematically, randomly selected and evaluated. Incomplete prescriptions were found; the data missing included duration of treatment (18.75%), sex (9.25%), age (8.75%) and diagnosis (7.50%). Antipsychotics (33.1%), antidepressants (23.2%), anticholinergics (22.0%) and anticonvulsants (12.9%) were the most frequently prescribed drugs. Polypharmacy (85%) was the predominant mode of practice. The most common diagnoses were mood (23.1%), anxiety (17.7%) and schizophrenic (16.2%) disorders. Medical education and quality monitoring programmes are suggested to improve the quality of psychotropic prescriptions and modify multiple pharmacotherapy practice.

Drug Prescriptions↗

Could repeat prescriptions identify patients needing extended medical review? An exploratory study.

INTRODUCTION: New Medicare Benefit Schedule care planning items require general practitioners (GPs) to identify their patients with chronic medical conditions and multidisciplinary care needs. This paper investigates the use of long term repeat prescriptions to identify general practice patients who meet these criteria. METHODS: Twenty-nine GPs in urban, rural and inner city locations recruited 10 consecutive patients on repeat prescriptions for 12 months for medical (not primarily psychiatric) conditions. These patients reported their disease, service and morbidity (SF-36) profiles. GP attender profiles were compared with chronic disease self help group members (n = 44), an ACT community sample (n = 555) and a national GP consultation survey sample (n = 31,575). RESULTS: GP patients reported common chronic disease profiles, high levels of specialist, hospital and medication usage, with infrequent use of allied health professionals and self help groups. They reported considerable physical and psychosocial morbidity comparable to or worse than other groups. DISCUSSION: GP patients requesting repeat prescriptions may have substantial physical, psychological and social needs that might be met using a multidisciplinary team approach with allied health professionals and self help groups. CONCLUSION: GPs can use long term repeat prescriptions to identify a chronic disease cohort who could benefit from health care planning under the new Medicare Benefit Schedule funding arrangements.

Adult↗

[Prescription patterns of antihypertensive agents in general practice in 1995].

BACKGROUND: Hypertension represents a risk factor in the development of cardiovascular disease. MATERIAL AND METHODS: The prescription of antihypertensive drugs and the daily doses used were examined in a questionnaire-based survey among 2,586 drug-treated hypertensive patients who attended a general practitioner for clinical control in November 1995. RESULTS: The proportion of patients treated with one antihypertensive drug only was 63%. ACE inhibitors, alpha blockers and angiotensin-II antagonists constituted 22.7%, 6.6% and 4.4%, and betablockers, calcium channel blockers and diuretics 21.7%, 23.7% and 16.3% of the prescriptions respectively. Women were more often prescribed diuretics than men, and older individuals more often than younger persons. No striking difference in the prescription of antihypertensive drugs were observed between the five health regions of Norway. There was no reduction in the prescribed daily doses of antihypertensives used in combination therapy compared with monotherapy. In approximately one quarter of the prescriptions there was a positive correlation between the prescribed daily dose and the patient's weight. The number of antihypertensives prescribed did positively correlate with the patient's weight. INTERPRETATION: This survey shows that antihypertensives without any documented effect on morbidity and mortality were frequently prescribed for hypertension in general practice. Except for the low proportion of diuretic users among elderly patients, our results is in accordance with the Guidelines from the Norwegian Society of General Practitioners.

Adult↗

[Prescription of beta-lactams for community-acquired broncho-pulmonary infections in adults. Observations in the hospital environment].

OBJECTIVE: Analyze beta-lactam prescription patterns used in hospitals for the treatment of community-acquired lower respiratory tract infections in adults. PATIENTS AND METHODS: A prospective study was carried out over 4 months (October 1997 to January 1998) in 54 medical units caring for lung disease, internal medicine/infectious disease, geriatric and general medicine patients in 27 hospitals representative of the public facilities in France. Data were collected on the medical unit, the patients, and the antibiotic prescriptions, including discharge prescriptions. The cost analysis of antibiotic therapy took into account all antibiotics given to the patients during their hospital stay. RESULTS: One thousand eighteen patients were included in the study: 266 were treated for acute bronchitis, 405 for bronchitis infection with underlying chronic respiratory disease, and 347 for pneumonia. Noteworthy findings included: low percentage of protocols within the medical units (25.3%), an unexpected frequency of hospitalization for acute bronchitis generally among elderly women, and prolonged intravenous antibiotic therapy and hospitalization (5 to 6 days and 9 to 12.5 days respectively). CONCLUSION: This study confirms the need to reinforce measures aimed at optimizing antibiotic prescriptions in hospitals.

Adult↗

Prescription drugs in Medicare and the ESRD program.

Prescription drugs have improved the length and quality of life for many persons, particularly those with chronic disease. However, their contribution to total health care costs has been increasing, making it difficult for patients to afford necessary medications. Current Medicare policy, derived from statutory enactments by Congress, precludes payment for prescription medications with the exception a few medications for end-stage renal disease (ESRD) patients. A more comprehensive prescription drug benefit for Medicare has been proposed that might benefit ESRD patients. Design and implementation of a medication drug benefit involves several issues including what medications should be covered, under what circumstances, how cost should be shared, the payment structure, level of payment, and management of the benefit. This report describes the experience with Medicare coverage of prescription drugs for ESRD patients and explores issues in offering a general medication insurance benefit under Medicare.

Drug Prescriptions↗

Impact of the 1994 Northridge earthquake on the utilization and difficulties associated with prescription medications and health aids.

INTRODUCTION: The medical impacts of disasters have focused on the injuries, illnesses, and deaths related to the disaster. Little has been written about the impact of disasters on persons who use prescription medications or those medications that require refrigeration, or those who require health aids. The objective of this study was an evaluation of the level of utilization of prescription medications and medications that require refrigeration as well as the use of health aids by the population affected by the disaster. METHODS: Following the Northridge earthquake of 1994, a survey of Los Angeles County households was conducted to assess the impact of the earthquake. A total of 1247 households completed the 48 minute telephone interview. As part of the interview, 10 questions assessed the utilization of medications and medical aids by household members and the effects that the earthquake had on those medications and devices. Chi-square, analysis of variance (ANOVA), and logistic regression analysis were applied. RESULTS: Of the 1,212 completed interviews, 21% of the households had a family member taking a prescription medication or a medication requiring refrigeration. Associated factors included gender, race, age, household income, level of education, presence of children, and the intensity of the earthquake (by the Modified Mercalli Index). Only 3% of those that reported medication usage noted problems associated with the use of these medications. Thirty-nine percent of the respondents indicated that someone in the household used a health aid (e.g., eyeglasses, hearing aid, etc.). Usage was related to gender, race, age, household income, level of education, presence of children, and the intensity of the shaking associated with the earthquake. Of these, 6.5% reported difficulty with these aids, usually related to loss or breakage. CONCLUSIONS: Although the proportions of the population requiring prescription or refrigerated medications and/or for those using health aids in Los Angeles seemingly are small, this translates to 630,000 households in which someone requires medications and 1.2 million households with a requirement for health aids. Thus, there are a huge number of persons at risk for serious medical problems related to these medications and devices that could produce profound medical problems during a disaster. However, during and following a moderate earthquake, it does not seem that the consequences will be great.

Adult↗

Prevalence and determinants of osteoporosis drug prescription among patients with high exposure to glucocorticoid drugs.

OBJECTIVE: To investigate use of osteoporosis drugs among patients with high exposure to glucocorticoid drugs. STUDY DESIGN: Retrospective review of pharmacy records. METHODS: We identified patients aged > or = 20 years who received prescriptions for > or = 2 g of prednisone (or equivalent) during any 12-month period between January 1, 1998, and December 31, 1999, and who initiated use of osteoporosis-specific drugs (alendronate sodium, etidronate disodium, and calcitonin) during that period. RESULTS: Among 8807 patients who met study criteria, 772 (8.8%) received prescriptions for osteoporosis drugs. Prevalence of osteoporosis drug prescriptions increased linearly during the study and differed markedly by patient sex, age, and exposure to glucocorticoid drugs. Osteoporosis drugs were prescribed for 16.3% of women aged > or = 65 years, for 6.1% of women aged < 50 years, for 6.5% of men aged > or = 65 years, and for 2.2% of men aged < 50 years. Higher glucocorticoid exposure was also associated with higher rate of osteoporosis drug prescription (11.2% of patients exposed to > 4 g/y and 5.6% exposed to 2 to 3 g/y received such therapies). Osteoporosis drugs were 50% more likely to be prescribed by clinicians who prescribed glucocorticoid drugs to > 18 patients than by providers who prescribed glucocorticoid drugs to < 4 patients. CONCLUSIONS: Despite ready availability of bone-specific osteoporosis drugs, few patients with high exposure to glucocorticoid drugs received such therapy. Likelihood of an osteoporosis drug being prescribed for such patients strongly depends on patient sex, age, and exposure to glucocorticoid drugs and on level of practitioner experience in prescribing glucocorticoid drugs.

Adult↗

[Von Siebold's prescriptions (1)].

I interpreted and explained von Siebold's prescriptions kept at the Siebold's Memorial Museum, Nagasaki City. The prescriptions kept at the Municipal Museum of Ohzu City will be analyzed in the next paper. Classifications and statistical analyses of his prescriptions according to the name of drug, dosage forms, drug efficacy, and the name of disease will be provided in the next paper entitled von Siebold's Prescriptions (2).

Drug Prescriptions↗

[Opinion of primary care physicians from Ourense on various features of the pharmaceutical prescription].

BACKGROUND: To learn the opinion of the primary care Physicians of Ourense (Spain) with respect to certain aspects of their prescription of medicines, such as their awareness of the price of drugs, the induced prescribing perceived, their relationship with the pharmaceutical industry and their opinions concerning possible measures for reducing the expenditure on medicines. METHODS: In this transversal descriptive study, all of the primary care physicians in the province of Ourense (243) were surveyed by means of a previously-approved questionnaire sent to them by post. The questionnaire included demographic characteristics of the physicians, the influence of cost when prescribing medicines, their estimate of the price of 15 drugs routinely prescribed and their opinion on different aspects relating to induced prescription, the pharmaceutical industry and different strategies in order to curtail the expenditure on medicines. In order to analyze the results, the chi 2 and Student's t tests and an analysis of the variance were used, together with the Spearman correlation coefficient with alpha = 0.05. RESULTS: The level of participation of the physicians surveyed was 42.8% (104). The average daily duration of visits by pharmaceutical company representatives was 13.6 minutes, with new specialities being the topic of greatest interest. Close to 27% admitted to having participated in clinical testing sponsored by the industry. 23% considered the price to be a priority when prescribing. Induced prescription accounted for 39.7% of the total. The majority of physicians chose co-payment as the means for reducing expenditure on medicines. In the estimate of prices, the overall percentage of error was 45.7%, underestimating the more expensive medicines and overestimating the less expensive. CONCLUSIONS: There is a significant lack of awareness of the price of drugs among the primary care physicians. Most of the physicians do not feel that the price of a drug should be a priority when prescribing medicines. There is a high percentage of induced prescription perceived. With regard to the expenditure on pharmaceuticals, the majority of those surveyed feel that financial measures, specifically co-payment, are the most effective in order to curtail rising costs.

Attitude of Health Personnel↗

[Quality assurance of drug prescription in primary health care. A new database software makes the drug therapy surveillance easier].

Quality assurance of drug prescription is a pre-requisite for rational drug use. From 22 health-care centres in the south-western area of the Stockholm County Council region, drug-prescription data were obtained from the patients' computerised medical recordings. This could be done with the aid of a specially designed database program. The drug-prescription data from the 22 health-care centres were collected and compiled in a central unit. Thereafter the results were brought back to the health-care centres, in which the quality assurance of drug prescription could be started.

Community Health Centers↗

[Prescription of bone remodeling markers in hospitals].

Biochemical markers of bone turnover have for several years been considered as valuable parameters in research clinical studies, but their use in individual patients is still debated. Recently several position papers have proposed guidelines for their use in clinical practice in patients with post menopausal osteoporosis. In the present article, we report the results of a survey which aims at comparing the actual modalities of prescription of French physicians with the above-mentioned recommendations. We contacted by phone clinical chemists from 158 different hospitals and asked them to transmit to the concerned physicians of their hospital a detailed questionnaire for assessing which bone marker(s) is (are) prescribed and for which purpose (s), and if not prescribed, the reason of non prescription. We were able to analyze 309 questionnaires from 89 hospitals including 5 specialties, rheumatology (35.9%), endocrinology (18.1%), gynecology (11.0%), internal medicine (22.0%) and geriatry (12.9%). The results showed large discrepancies between the mode of prescription of a subset of physicians and the guidelines. The most often evoked reason for non prescription was a lack of information about bone markers suggesting a need for teaching courses. This survey has also shown that many physicians do not know exactly which parameters are effectively measured in their hospital and which are addressed to specialized laboratories underlining the importance of the dialogue between clinicians and clinical chemists. We propose that in a given hospital, the present article may serve as a basis for a discussion between clinicians and biologists about the development and/or the optimization of the measurements of these markers of bone turnover.

Biomarkers↗