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PubMed2003

Allowing central fill pharmacies and retail pharmacies to fill prescriptions for controlled substances on behalf of retail pharmacies. Final rule.

DEA is finalizing a Notice of Proposed Rulemaking (NPRM) defining central fill pharmacy activities and permitting central fill pharmacies to prepare controlled substances prescriptions on behalf of retail pharmacies with which the central fill pharmacies have a contractual agreement to provide such services or with which the pharmacies share a common owner. When one retail pharmacy receives a prescription and a second pharmacy prepares and subsequently delivers the controlled substance medication to the first retail pharmacy for dispensing to the patient, the second pharmacy is engaging in a "central fill activity". Records must be maintained by both the central fill pharmacy and the retail pharmacy that completely and accurately reflect the disposition of all controlled substance prescriptions dispensed. With respect to security, central fill pharmacies would be required to comply with the same security requirements applicable to retail pharmacies including the general requirement to maintain effective controls and procedures to guard against theft and diversion of controlled substances. DEA is creating an allowance for retail pharmacies that also perform central fill activities to do so without separate DEA registration, separate inventories, or separate records. This rulemaking is sought by the regulated industry and will allow for more efficient delivery of controlled substance prescriptions to patients.

Contract Services↗
PubMed2003

Do consumers' attitudes predict prescription purchasing behavior?

Consumers may face prescription choices in three-tier plans, primarily between lower-cost generic drugs, formulary (tier 2) brands, and higher-cost nonformulary (tier 3) brands. To determine if consumers' beliefs about medications influence their prescription choices, a preliminary evaluation of the effect of such beliefs on prescription purchasing behavior was conducted in an MCO population. Attitudes about prescription drug coverage and perceptions regarding medications had no demonstrated effect on formulary compliance or rates of discontinuation of nonformulary medications. The findings appear to support the concept of three-tier plans, and increasing copayments seems to facilitate greater adherence to health plan formularies.

Adolescent↗
PubMed2003

The role of special group article in ancient chinese medical prescription.

In the traditional medicine of the East, a prescription to cure diseases consisted of plural sorts of active natural products. Every article of those products has native features respectively, but each article was supposed to carry out fixed roles in the prescription. An article contains generally some sorts of active compounds, therefore it could be able to divide the role from the chemical, medicinal natures of those compounds. For example two groups of articles could be able to list up, each of which was supposed to carry out the proper role in various prescriptions. G. I. Articles were expected to adjust the whole of a prescription, to aid other articles on the induction of them in the inner part and on the removal of waste materials, with their mild, innocuous (or fragrant) natures GUI, JIAO, JIANG, GANCAO, RENCAN, GEGEN, YUANZHI. G. II. Articles were expected to carry out the leading role for cure even on serious diseases, to act on the cause of illness actively, and to remove the harmful product due to diseases, with their strong physical operations WUTOU , LANGDANG, DAHUANG, BADOU, SHEXIANG, SHAOYAO, MAHUANG. The conclusion - many compounds in those articles have physiological and medicinal effects for human body originated in their molecular structures, and these facts could endorse above expectations.

China↗
PubMed2004

Consumer attitudes and factors related to prescription switching decisions in multitier copayment drug benefit plans.

OBJECTIVES: To examine patient attitudes related to formulary medications and medication-related decision making in multitier copayment prescription drug plans. STUDY DESIGN: A cross-sectional retrospective analysis. METHODS: Data were collected via mail survey from a random sample of 25,008 members of a managed care organization. The selected members were enrolled in a variety of 2- and 3-tier copayment plans and were taking prescription medication to treat 1 or more of 5 chronic disease states. RESULTS: Most respondents did not believe that formulary drugs were safer or more effective than nonformulary drugs, but 39.7% thought that formulary drugs were relatively less expensive. Most respondents appeared willing to consider switching from a nonformulary drug to a formulary drug with a lower copayment. The percent of respondents who reported they would be very unlikely or unlikely to switch was only 15.3% for a new prescription and 24.2% for a refill prescription. Medication efficacy and physician opinion were important factors in plan members' switching decisions. Cost was an important factor for some members, but older plan members were less likely to report that cost was important. CONCLUSIONS: Multitier plan members generally believed that drugs are placed on the formulary for reasons of cost rather than safety or efficacy. Most plan members were receptive to switching from a nonformulary to a formulary medication, but financial incentives alone may not convince some plan members to make the switch.

Adult↗
PubMed1992

Prescription drug diversion control and medical practice.

Concern about the role of prescription drug diversion in drug abuse has led to demands for more stringent regulation and for better ways to detect prescription drug diversion. Advances in technology now allow point-of-sale computer systems to report prescriptions filled by pharmacies to state agencies rapidly and possibly more economically. However, the advantages of more comprehensive control systems must be balanced against their possible effects on medical practice and patient care. Our limited knowledge about prescription drug diversion and the impact of diversion control systems on medical practice is summarized. Needed research is outlined together with the components of a diversion control program that balances reducing drug diversion with minimizing adverse effects on medical practice and patient care. We stress the need for broadly defined practice parameters and peer review by medical experts thoroughly familiar with the complexities of medical practice.

Clinical Pharmacy Information Systems↗
PubMed2004

Prescription and dispensing practices in public sector health facilities in Pakistan: survey report.

OBJECTIVES: To gather information on existing prescription practices, dispensing practices and patient satisfaction in government health services of the NWFP, Baluchistan and Punjab province. METHODS: A cross sectional study design was used for this purpose. Ten health care facilities were selected from each province keeping appropriate representation from first level health facilities, district health facilities and tertiary care hospital. Analysis of selected indicators was carried out on the basis of provinces, health facilities, gender and different age groups. RESULTS: Documentation of 914 responses was completed from three provinces. Almost equal distribution of encounters was maintained representing different health facilities. Forty seven percent of encounters involved children under 15 years of age. Female patients comprised of 56% and the mean age of the entire sample was 26 years. The mean dispensing time was only 38 seconds, the mean consultation time was 1.79 minutes and the average number of drugs per prescription turned out to be 2.7 out of which only 1.6 drugs were being dispensed from the facility. More than half of the prescriptions contained antibiotics and 15% of patients were prescribed with injectables. Only half of the patients expressed satisfaction with their visit to health facility. CONCLUSIONS: Like many other developing countries, prescription and dispensing practices are not satisfactory in public sector health facilities of Pakistan. Appropriate and workable solutions need to be developed and implemented in the country to improve systems. Regular audits and qualitative studies should become part of the effort.

Adolescent↗
PubMed2004

Trends in manufacturer prices of brand name prescription drugs used by older Americans--first quarter 2004 update.

This Issue Brief reports on changes in manufacturers' prescription drug prices during the first three months of 2004 (January through March) for the brand name prescription drugs most widely used by Americans age 50 and over. This report is the first quarterly update in an ongoing study of changes in drug manufacturer prices-that is, manufacturers' prices charged for drugs they sold to wholesalers. A baseline study published in May 2004 by the AARP Public Policy Institute identified steady increases in the average annual manufacturer price from calendar year 2000 through calendar year 2003. This report's focus is on changes in the prices that brand name drug manufacturers charge to wholesalers for sales to retail pharmacies. The manufacturer's charge to wholesalers is the most substantial component of a prescription drug's retail price. When there is an increase in the manufacturer price to wholesalers for a brand name drug, this added cost is generally passed on as a similar percent change in the retail price to most prescription purchasers. The report presents three measures of price change (see methodological appendix). The first set of findings are annual rates of change in manufacturers' prices for widely used brand name drugs, using both rolling average and point-to-point estimates; information is presented on percentage change in manufacturer price and on potential dollar changes in consumer spending. The second set of findings are three-month percentage changes in prices (i.e., changes from December 31, 2003 through March 31, 2004); the distribution of percentage price changes is shown, as well as differences in average percentage price changes by manufacturer and by therapeutic category.

Aged↗
PubMed2004

[An experience of the prescription process].

The high prevalence of drug-related illness in hospitals is now widely acknowledged. The medication pathway, from prescription to administration, can now be computerized in order to reduce the incidence of errors. The Forcilles Medical Center, with a capacity of 391 beds, is a private non profit institution integrated into the French public healthcare system, specializing in nutrition and cancer treatment directly after major surgery. Since 1980, it has gradually developed and integrated a computerized network that encompasses nearly every aspect of the administration. The computerization of the prescription process was made possible by further technological advances in 1999, giving doctors access to patients' charts and allowing them to prescribe medications within the network. A program created by the Center manages each step of the process, from prescription by the physician to dispensation by the pharmacist and, to some extent, administration by the nurse. Built-in checks at each level verify that the proper guidelines and instructions have been followed. The objective of this system is three-fold: prevention of drug-related illness at all levels of care; a more efficient prescription process; and a resulting cost reduction. This computerized system is almost complete and will be further developed. The Center's projected goals for 2004-2008 include propositions to continue to strive for optimal safety, through administration of the right medication to the right patient with the right dose at the right time.

Cost Control↗
PubMed1992

Use of prescription-refill records to assess patient compliance.

Prescription-refill records were used to assess patient compliance, to evaluate factors previously associated with compliance, and to determine the association between selected drugs and compliance. Records were selected from a computerized database containing prescription-coverage claims, based on the following criteria: (1) the prescriptions were refilled during 1987-1989 and within two times the days' supply after the dispensing date, (2) they involved any of 12 drugs selected for study, (3) they required one to four doses per day, and (4) at least 20 records with the same regimen were available. Compliance was defined as refill within 0.2 times the days' supply after the refill-due date, and it was assessed by calculating the compliance rate and the compliance index (which describes the relationship between the refill-due date and the actual refill date). Data from 19,118 prescription-refill records were analyzed. The compliance index improved slightly as the number of concurrent medications increased, worsened as the number of doses per day increased, and improved as the immediacy of the risk of noncompliance increased. Different medications and indications were associated with different degrees of compliance. Medication compliance generally improves as the number of daily doses decreases, may improve slightly as the number of concurrent medications increases, and varies with the particular drug and indication.

Drug Prescriptions↗
PubMed2006

Requirements on content and format of labeling for human prescription drug and biological products. Final rule.

The Food and Drug Administration (FDA) is amending its regulations governing the content and format of labeling for human prescription drug products (including biological products that are regulated as drugs). The final rule revises current regulations to require that the labeling of new and recently approved products include highlights of prescribing information and a table of contents. The final rule also reorders certain sections, requires minor content changes, and sets minimum graphical requirements. These revisions will make it easier for health care practitioners to access, read, and use information in prescription drug labeling. The revisions will enhance the safe and effective use of prescription drug products and reduce the number of adverse reactions resulting from medication errors due to misunderstood or incorrectly applied drug information. For both new and recently approved products and older products, the final rule requires that all FDA-approved patient labeling be reprinted with or accompany the labeling. The final rule also revises current regulations for prescription drug labeling of older products by clarifying certain requirements. These changes will make the labeling for older products more informative for health care practitioners.

Biological Products↗
PubMedDate not supplied

[Prescription drugs and the elderly: results of the Argento study].

OBJECTIVE: To evaluate prescription drug use in the elderly and in particular, to determine the number and types of medications taken, whether and to what extent drugs that are contraindicated in this age group are being used, and what type of prescription check may be performed by primary care physicians. DESIGN: A survey was performed in a sample of non-institutionalised elderly subjects (= 65 years). These were selected by cluster sampling in 11 of 20 Italian regions and were interviewed in the home by trained interviewers using a standardised questionnaire. RESULTS: Eighty-seven percent of interviewed subjects reported that they had taken at least one medication in the previous year; higher frequencies were found in age groups= 75 years. The most common therapeutic classes of drugs used in all participating regions, in the previous week, were cardiovascular, gastrointestinal, metabolic (including drugs to treat diabetes) and nervous system. Among interviewed subjects, 45.3% reported using 4 or more different drugs, though wide regional differences were observed (Campania 60.5%, Bolzano 35.6%); 7.2 % were taking potentially inappropriate drugs while 2.3% were taking medications that may lead to potentially harmful interactions. In addition, 84.9% of subjects reported that their primary care physician regularly checked their drug prescriptions. CONCLUSIONS: The high frequency of prescription drug use observed in the elderly is a diffuse phenomenon, related to the worsening health conditions that inevitably accompany aging. Considering the extent of this phenomenon, care should be taken to improve qualitative (i.e. contraindications in the elderly, potential drug-interactions) and quantitative (high number of medications taken by the elderly) appropriateness in physician prescribing. In addition, special attention must be placed on regularly checking drug therapies in the elderly.

Aged↗
PubMed1990

[The indicators of the quality of the prescription for chronic pathologies].

To assess the qualitative characteristics of the prescription for chronic diseases and to select the most appropriate quality indicator, we evaluated 1588 drugs recorded in 549 forms for chronic prescription. 64.9% of the drugs were included in the Index Farmacològic, and the same rate in the Essential Drugs list of the WHO, 73.4% had a high intrinsic value (IV) and 80.7% were monocomponents. The male patients received more drugs included in the WHO list and with high IV, while patients older than age 65 years received more drugs with absent or unacceptable IV. A higher quality in the four indicators was found in the prescriptions from the CAP physicians than in those from specialists. The drug preparations with a not high IV more commonly prescribed belonged to the categories of cerebral and peripheral vascular therapy (16.2%), antacids and antiflatulents (9.3%), oral antidiabetics (8.4%), and antivaricose and antihemorrhoidal drugs (8.4%). It is concluded that the intrinsic value in the most adequate quality indicator for the prescription studies in primary care.

Age Factors↗
PubMed1990

[The pharmaceutical prescription: a comparison between the old and the new model of primary health care].

The possible influence of the model of primary health care (PHC), the educational background of the physician and the type of contract on pharmaceutical prescription were evaluated. The information was obtained from a sample of 1799 prescriptions, which were representative of the overall prescription of the PHC physicians from the Health Service of Palma de Mallorca. The health center physicians (HC) prescribed less expensive drugs than the classical clinic physicians (CC). The mean prize for HC was 498.98, with SD 418.97, and for CC it was 589.65 with SD 750.25. This difference was significant (p less than 0.0001). There were other significant differences, such as a smaller use of preparations with fixed drug associations (p less than 0.01) and parenteral administration (p less than 0.05) by HC. There were no significant differences in the prescription of cerebral and peripheral vasodilators and drugs for the digestive tract and metabolism considered as doubtful indications.

Drug Prescriptions↗
PubMed1990

Modified processing of prescriptions for discharged patients.

A process for designing and implementing a new procedure for handling discharge prescriptions is described. Hospital administration requested that the pharmacy department develop a new procedure to handle discharge medications. The old procedure, in which discharge prescriptions were filled by decentralized pharmacy personnel and delivered to patients' rooms, resulted in lost revenues from third-party payers and in delays for patients leaving the hospital. Under the new procedure, prescriptions are given to patients at the time of discharge; these prescriptions then may be filled either at the central ambulatory-care pharmacy or at a community pharmacy. This new procedure was designed and implemented according to a planned approach: (1) reviewing the problem, (2) evaluating the arguments for and against change, (3) using strategies to minimize resistance, and (4) evaluating the results. Resistance of pharmacy personnel, physicians, nurses and patients to the new procedure was managed by allowing pharmacy personnel to participate in the design of the new procedure; educating all affected hospital staff members about the procedure; structuring the procedure to address the problems of delayed discharge and patient ability to pay for medications; and negotiating with ambulatory-care pharmacists and technicians about the increased workload. The new procedure was implemented on July 1, 1987. The new procedure was evaluated to determine how well it worked and whether continuity of care had been compromised. As a result of this evaluation, the level of staffing and hours of operation of the ambulatory-care pharmacy were increased. A planned approach to implementing a change in the procedure for handling discharge medications was successful in identifying and overcoming resistance to that change.

Aftercare↗
PubMed1990

[Prescription of drugs in Norway to children aged 0-12 years].

The first part of a project initiated at the Department of Pharmacotherapeutics, University of Oslo, on use of drugs in the treatment of children involved a study of prescriptions in September 1986. All pharmacies in the country were asked to record all drugs prescribed to 0-12 year old children during one week. 87% of all Norwegian pharmacies took part in the study and data were recorded for 7,587 prescribed drugs. Drug prescribing was highest in the county of Hedmark, and lowest in the county of Troms. For the age group 0-10 years 23% more drugs were prescribed to boys than to girls. Infants (0-1 year) were prescribed drugs ten times more often than the oldest children. 3% of the infants (0-1 year) were prescribed drugs during the week the study took place. More than 43% of the total prescriptions were for drugs for the respiratory organs. Antasthmatics comprised the largest subgroup (796 prescribed drugs). Boys were prescribed 65% more antasthmatics than girls. Every 20th of the total prescriptions was for an oral decongestant. There are few rational reasons for prescribing drugs in this group. As a single group, systemic antibiotics were the drugs most often prescribed, and accounted for as much as 30% of the total prescriptions. The observed choice of antibiotics does not seem to agree with Norwegian recommendations.

Anti-Bacterial Agents↗
PubMed1990

[General practitioners' training in psychiatry and prescription of psychotropic drugs. 1. Education, attitudes and extent of prescribing].

The object of this investigation was to describe prescription of psychotropic drugs by general practitioners in relation to their training and attitudes to employment of psychotropic drugs in the treatment of psychosocial conflicts. The investigation was carried out as a multicentre questionnaire investigation in the County of Aarhus in which 192 (89%) out of 215 general practitioners who were invited participated. In brief and prolonged psychosocial conflicts, 58 (31%) and 149 (81%), respectively, considered that prescription of psychotropic drugs constituted poor treatment. More than half of the general practitioners found that the amounts of psychotropic drugs prescribed by themselves and other general practitioners were excessive and that they were, themselves, responsible for this. The majority of the general practitioners found that their attitudes were of great significance for their prescriptions of psychotropic drugs and 71 out of 191 practitioners (37%) found that the pressure of work usually or frequently influenced this. A total of 107 (56%) had had appointments in psychiatric departments (average duration six months) prior to establishment as general practitioners. A total of 117 (61%) had received some form of postgraduate psychiatric training after establishment as general practitioners while 29 (20%) had not received any form of psychiatric training or postgraduate psychiatric education. No connection could be demonstrated between psychiatric training and the extent of prescription of psychotropic drugs.

Attitude of Health Personnel↗
PubMed1989

Evaluation of prescription charges in a health maintenance organization.

Differing patterns in drug use and charge variances among three pharmacy sites were determined for a university-based health maintenance organization (HMO). Computerized prescription claim data for the HMO inhouse pharmacy and those chain and independent pharmacies contracting with the HMO were analyzed on a personal computer using database management and statistical software. Chain and independent pharmacies were under contract to charge the average wholesale price plus a $2.00 fee per prescription. Drug-claim data were separated by pharmacy site (inhouse, chain, and independent), and the data for each site were sorted by national drug code number. High-charge and high-use drugs were identified for evaluation on a unit-charge basis. During the six-month study period, 22,393 prescriptions were filled, representing total charges of $347,063.79. The mean per-prescription charges submitted to the HMO by the chain, independent, and inhouse sites were $14.99, $16.08, and $16.41, respectively. The inhouse pharmacy had many charges in high dollar ranges. Of 10 high-charge drugs analyzed, isotretinoin 40 mg, flunisolide nasal solution, naproxen 250 mg, cyclosporine oral solution, and atenolol 50 mg were dispensed in significantly different proportions at each site. There were significant differences in unit prices of nine high-use drugs among pharmacy sites. This study indicates the importance of evaluating adverse selection among pharmacy sites and the value of auditing claims submitted.

Data Interpretation, Statistical↗
PubMed1988

Implementation of an outpatient prescription drug formulary in a managed-care system.

The development and implementation of an outpatient prescription formulary in an independent-practice model health maintenance organization (HMO) and the role of the pharmacy and therapeutics (P&T) committee in the process are described. Approximately 600 physicians provide medical care and control the operation of this independent practice association (IPA); of approximately 45,000 members, 95% are eligible for outpatient prescription services provided by one of 188 local pharmacies. The formulary, which is restricted to noninjectable medications, was developed by a P&T committee composed of eight IPA physicians, a representative of the local pharmaceutical association, and three staff members of the IPA's pharmacy department. The printed version of the formulary indexed almost 1800 items and included only commonly used medications to limit its size. Requests for additions or deletions of drugs were evaluated monthly. After a four-month period during which physicians were asked to comply with the formulary, mandatory compliance was imposed, with a limit of 16 nonformulary prescriptions per physician per month being allowed. Based on the results of an informal survey, the physicians indicated that the formulary was relatively easy to adjust to (44.1%), somewhat difficult to work with (43.6%), and somewhat disruptive to their prescribing practices (55.3%). When asked about quality of patient care, 74.3% indicated there was no change. Physician compliance with the formulary system increased from 88.0% to 96.1% after the formulary was mandated by the IPA. Under the direction of the P&T committee, a formulary was implemented effectively in this HMO outpatient prescription drug program.

Delivery of Health Care↗