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Contact lens prescriptions: a clinicolegal view.

The release of contact lens prescriptions is regulated by a variety of laws, and optometrists need to be familiar with these requirements to determine when prescriptions must be provided to patients or third parties. We recommend that contact lens prescriptions include the refractive data, lens parameters, lens manufacturer, expiration date, number of permissible refills, the notation "for daily wear only" if the lenses are not intended for extended wear, and other appropriate information intended to ensure that the patient will obtain the lenses prescribed if the prescription is presented to a dispenser.

Contact Lenses↗

The Prescription Drug Marketing Act of 1987.

The Prescription Drug Marketing Act of 1987 is described, and its implications for hospitals and other health-care entities are discussed. The act, which became effective on July 21, 1988, is intended to reduce public health risks from adulterated, misbranded, and counterfeit drug products that enter the marketplace through drug diversion. The law provides that prescription drug products manufactured in the United States and exported can no longer be reimported, except by the product's manufacturer. It also establishes restrictions on sales of prescription drug products and samples. Samples of prescription drug products may be distributed only if a licensed prescriber requests them. Other distribution channels for samples specified in the law are permissible, provided records are maintained. Under the law, wholesale distributors must be licensed by the state and meet uniform standards. Penalties for violations of the law are also identified. According to FDA's advisory guidelines on the statute, the law will permit hospitals to return drug products, provided the return is made to the manufacturer or wholesaler and provided written notice is secured that the goods were received (for manufacturers) or the goods were destroyed or returned to the manufacturer (for wholesalers). The final chapter on drug diversion must await issuance of final FDA regulations.

Commerce↗

Drug prescription patterns for rheumatic disorders in Sweden.

Drug prescription patterns, expressed in defined daily doses (DDD), were registered during the 1970s for disease modifying antirheumatic drugs (DMARD) and for nonsteroidal antiinflammatory drugs (NSAID). An increased prescription of DMARD was found at a national level (Sweden), starting with chloroquine, followed by penicillamine and finally by gold. This same tendency was seen at a county (Västerbotten) and a university hospital level (Umeå). Among NSAID for oral use, the prescription of indomethacin and phenylbutazone gradually decreased in Sweden. Naproxen and ibuprofen increased rapidly, surpassing the others from 1975. This increase was far less marked at the county level and at the rheumatology department of Umeå in which the overall prescription of NSAID for inpatients decreased during the 70s.

Administration, Oral↗

A study of telephone prescriptions in family practice.

Telephone prescriptions are a unique aspect of North American medicine which has received relatively little attention. This paper examines certain behaviors of the physician and the patient with respect to prescriptions in the office and over the telephone. The results indicate that patients receiving prescriptions over the telephone are demographically distinct, tend to receive large amounts of psychotropic drugs, and are more likely to be seen by their physicians as "problem patients." Suggestions are made to help identify the habitual telephone prescription patient to allow the physician to review the need for the medication and the status of the physician-patient relationship.

Adult↗

[Benzodiazepines: prescription study in a primary health care unit].

PURPOSE: The objective of this survey was to study the prescription rate of benzodiazepinics in a Primary Health Care Unit, in the city of Pelotas, RS, Brazil. METHOD: Every consultation during a 12 month period was recorded, including the prescription of drugs. In order to analyze the prescription of benzodiazepinics we considered only the 3,368 consultations of patients above 25 years. RESULTS: Patients whose age ranged from 45-64 years experienced the highest prescription rates, benzodiazepinics being the third most prescribed drug for males and the fourth for females. CONCLUSION: The results show that benzodiazepinics are among the most prescribed drugs.

Adult↗

[Drug interactions: study of 409 prescriptions at the time of discharge from geriatric hospitalization].

In order to specify the frequency and the potential consequences of drug interactions in the elderly, we retrospectively analysed 409 discharge prescriptions. The possibility of drug interactions was screened out for each prescription in the software version of the Vidal drug compendium. It appears that prescriptions are mainly adapted to the elderly with respect to posology and pharmacokinetics. Potentially dangerous drug interactions ('contraindicated' or 'unsuitable' associations) were found in 6 per cent of prescriptions; after careful assessment, this frequency decreased to less than 1 per cent. The most common orthoergic side effects were sedation (15 per cent) and hypotension (14.5 per cent). This study points out the multiplicity of criteria to be considered in order to prevent drug interactions, and the gaps in available software.

Aged↗

[Intervention for improving the quality of antibiotic prescription in a basic health area].

OBJECTIVE: To evaluate the effectiveness of corrective measures introduced in a health area (HA) to improve the way antibiotics (AB) are prescribed. DESIGN: Intervention study, with a control. SITE. Two HAs: Cervera and Tarrega. The intervention was carried out in the first; the second serving as the control group. PATIENTS OR OTHER PARTICIPANTS: All the doctors in both areas' primary care teams (PCT). INTERVENTION: Monographic sessions of the PCT during June and October, 1991, analysed consecutively the following, which had taken place in the health area during 1990: the quality control methodology applied to the prescription; the quality indicators in the prescription--among them its classification by intrinsic value (IV)--; and the general level of prescription with the proportion of ABs prescribed. MAIN MEASUREMENTS AND RESULTS: The pharmaceutical listing of the 100 most prescribed drugs in relation to the number of containers were used as a data source for evaluating the November, 1990, AB prescription; with a re-evaluation in November, 1991, after the introduction of the corrective measures. Significant reductions could be observed in the health area where the intervention took place, both in the percentage of low IV drugs prescribed (-10.8%) and of intramuscular injections used (-23.5%). In the area used as the control group, there were no variations. CONCLUSIONS: The effect of the intervention on the improvement in the way ABs were prescribed, was clear.

Anti-Bacterial Agents↗

[Control of prescriptions of B-preparations. A registry study of B-preparations in Oslo and Akershus].

In two Norwegian counties all prescriptions for benzodiazepines and analgesics containing codeine were registered over a two month period and the records were subsequently transferred to a database. 93,000 prescriptions were registered, equivalent to this 2.8 millions DDD. The registration showed great variation, both in the doctors' volume of prescribing and their prescribing patterns. 30 doctors of the total of 4,000 were responsible for 13% of the total volume prescribed. We propose that the doctors with unacceptable prescribing rates should be offered a special education program provided by the Norwegian Medical Association. The computer routines of the pharmacies appear to be inadequate for registration and research purposes. In 2% of all the prescriptions the doctors name could not be identified. Thus it seems warranted to use the doctors' identity number on prescriptions for these drugs. A reduction of the number of tablets in the largest packages dispensed should be considered by the authorities. For effective quality control of prescribing, better understanding is needed of the differences in doctors' prescribing patterns.

Benzodiazepines↗

[Trends in the prescription of cardiovascular drugs in a geriatric hospital].

Analysis of drug prescriptions in a geriatric hospital between 1988 and 1993 shows a high prescription rate for cardiovascular drugs (50 to 60%). Moreover, multiple prescriptions are more frequent for patients receiving cardiovascular drugs. The most widely prescribed drugs are coronary vasodilators and diuretics, followed by digoxin and calcium antagonists. The prescription of coronary vasodilators and ACE-inhibitors was clearly increasing over the last 6 years. Beta blockers are rarely used in very old people.

Aged↗

[Psychopharmaceuticals in primary care: prescription quality].

OBJECTIVE: Using criteria based on the bibliography, to assess drugs prescription in a Health Centre, in order to put forward corrective measures in line with the defects identified. DESIGN: Descriptive and retrospective study. SETTING: Santa Maria de Benquerancia Health Centre (Toledo). PARTICIPANTS: A sample of 40% of the clinical records of patients over 14 produced records of patients treated with drugs for psychic disorders between October 1990 and October 1991. MEASUREMENTS AND MAIN RESULTS: 248 prescriptions for these drugs were found. The most common diagnoses were: neurotic depression (33.1%), anxiety (25.8%) and insomnia (10.1%). Benzodiazepines made up 78.2% of the prescriptions. Of 8 quality criteria assessed, the compliance level was acceptable by WHO standards except in the recording in the notes of the diagnosis or problem for which the drug was prescribed (74.2% non-compliance); Alprazolam and Triazolam were not considered first-choice benzodiazepines (31.3% non-compliance); and there was 44.5% non-compliance by Primary Care physicians with the non-prescription of anti-psychotic or stimulant MAO inhibitor antidepressants. CONCLUSIONS: Quality-control studies, such as this one, in order to identify problems, to take corrective measures and subsequently assess them, are useful in improving care procedures.

Drug Prescriptions↗

[Analysis of repeat prescriptions in chronic treatments at a health center].

OBJECTIVES: To describe the social-health profile of the population attending for the renewal of prescriptions for long-term treatments; to quantify the possible pharmacological interactions; to measure cognitive function in a sample of this population. DESIGN: Crossover study. SETTING: Urban Health Centre. PARTICIPANTS: All the patients (359) who were seen during a one month period at any of the centre's nursing stations for the renewal of long-term treatment prescriptions. MEASUREMENTS AND RESULTS: All the social-health data of every patient were collected on a form. Cognitive function was assessed in one of every three cases by means of Folstein's Minimental test. Average age was 64 +/- 0.76; 37% were men and 63% women. The mean number of chronic diagnoses per patient was 3.2 +/- 0.08 and of medicines per patient 2.9 +/- 0.09. 15% medicated themselves. Pharmacological interactions were possible in 41% of the patients who took more than one medicine. 8% were illiterate and 16% only knew how to read or write. 24.54% displayed overall cognitive deterioration and 48%, lapses in memory. CONCLUSIONS: Patients seen at our Centre for renewal of prescriptions were an elderly population group, with pluripathology, taking several medicines, with a low cultural level and deterioration in their cognitive functions. The risk of pharmacological interactions is very high. Repeat prescriptions for long-term treatments should not just be an administrative function: it should be performed by trained health staff.

Aged↗

[Prescription for diazepam 5 mg tablets in Vestfold 1989 and 1995].

During the last five years, the prescription of tranquillizers has been reduced by 26% in Vestfold County compared with 19% in the country as a whole. This is probably a result of two initiatives: a common strategy to reduce prescription in the county, and monitoring prescription rate of the individual general practitioners. We examined the prescription of diazepam 5 mg tablets and found a reduction of more than 30% from 1989 to 1995. The reduction was greatest among the younger age groups and decreased with increasing age. The most probable reason for this pattern is a more restrictive attitude among general practitioners towards using diazepam to treat the young and middle-aged. The results for 1995 show that women still receive about 60% more diazepam than men, and women aged 70-79 years receive 117% more than women aged 40-49 years.

Adult↗

A study of unclaimed prescriptions in Hospital Universiti Sains Malaysia (HUSM).

An analysis of 524 unclaimed prescriptions (which contributed 0.9% of the total prescriptions) showed that 23.8% were for vitamins, 17.7% for anti-inflammatory drugs, 16.4% medications for skin and mucous membrane and 9.9% for antibiotics. The unclaimed prescription rates varied inversely to the staff-strength working in the dispensary. Sixty-eight point nine per cent of the unclaimed drugs could be purchased at the pharmacy shops without doctor's prescription.

Adult↗

[An analysis of long-term computerized prescriptions for those over and under 65 at a health center].

OBJECTIVES: To analyse the origin, diagnoses and types of medicine used in computerised long-term prescription at our centre, which are classified by age distribution; and to extract, if possible, use parameters for monitoring internal activities. DESIGN: Descriptive study. SETTING: Zumaia Health Centre (Guipúzcoa). PATIENTS: 976 patients divided into those over and those under 65, included in the programme of long-term treatment cards. MEASUREMENTS AND MAIN RESULTS: 54% of patients were over 65 and 46% under. Average medicines per patient were 3.24 and 2.23, respectively. 34% of long-term prescription originated in primary care, although primary care was only the main indicator to a significant degree in group K (CIAP) diagnoses for under-65's. The commonest diagnoses belonged to group K, independently of the origin of the prescription. The most prescribed medicines were those in groups M and C (IMC), significantly higher in the over-65's. CONCLUSIONS: Only one third of the prescriptions originated in PC. A significant reversal of this tendency was observed in young people with chronic group K pathologies. The indication of long-term treatment for psychological problems often escapes the public health system; when the PC doctor indicates this treatment, he/she usually does so on the basis of symptomatic conditions. Monitoring new cases could help us find the efficacy of the corrective measures introduced, both at the level of structural innovations and changes in care procedure.

Aged↗

[Benzodiazepine prescriptions in general practice. An analysis of the pattern of use in first time users].

The aim of the study was to describe first time users of benzodiazepines and to analyze the extent of benzodiazepine prescriptions the following four years. Benzodiazepine prescriptions were issued to 2262 persons in Svendborg during the period February-March 1990 (Study-base: Inhabitants in Svendborg in 1990: n = 40,868). The incidence of first time users was 10 per 1000 person-years. Ninety percent of first time users seemed to be psychologically healthy persons. The most frequent indications were anxiety (1/3), insomnia (1/3), or crisis (1/4). After four years 98% of first time users had ceased their use of benzodiazepines. Most of the patients ceased benzodiazepine medication on their own initiative. The doctor stopped the medication in 11% of the cases. The risk of a "repeat prescription syndrome" in continuation of the first prescription of a benzodiazepine seemed to be negligible among psychologically healthy persons.

Adult↗

[Consumption of prescription drugs in 60-65 years old population in Mexico. National Survey on Addictions, 1993].

OBJECTIVE: To estimate the prevalence of consumption of medical drugs among the population 60 to 65 years old identified in the National Survey on Addictions 1993 and obtain data on the demographic characteristics of these consumers. MATERIAL AND METHODS: A cross-sectional, probabilistic, stratified and cluster sample of subjects between 12 and 65 years old living in urban areas of the country was selected. RESULTS: Of the 911 elderly subjects identified, 218 (23.9%) were consumers of prescription drugs, constituting 17% of men and 28% of women. The most frequently used drugs were central nervous system depressants (22% of women and 13% of men) followed by opiates (7% of women and 5% of men). The onset age of consumption was 60 years old and men started earlier than women. Of prescription drug users, 85% use depressors and opiates by prescription, 3% self-medicate themselves and 5% follow a friend's recommendation. Nine per cent use prescription drugs longer than the prescribed time. CONCLUSIONS: More extensive, specific studies of drug consumption by the elderly should be carried out to explore prevalence of use, which are used most frequently, frequency of adverse effects, effects on quality of life and social support networks for the elderly, among other topics.

Age Factors↗

[Impact of a program of rational use of medicines on pharmaceutical prescription in a health area].

OBJECTIVES: To evaluate the impact of the introduction of a programme for rational use of medicines (PRUM) on the pharmacotherapeutic prescription profile of the primary care teams in the Ciudad Real health area. DESIGN: A longitudinal and prospective intervention study. The Area's total general medical prescription (January, May and August, 1994 and 1995) was used. SETTING: Ciudad Real Primary Care Area of INSALUD. PARTICIPANTS: 166 general practitioners, all the prescribing doctors in the area. INTERVENTION: Introduction of a programme of rational use of medicines. MEASUREMENTS AND RESULTS: Expenditure/inhabitant, prescriptions/inhabitant, expenditure/prescription, units of drugs of low therapeutic value (LTV), cost of calcitonins/pensioner and units of hypolipaemiants/100 pensioners were measured, in function of seven variables of the prescriber and six variables of the population group. Breaking down the prescriber's variables, least expenditure/inhabitant per month corresponded to doctors over 50, followed by temporary doctors, those not in paediatrics and those with their post in an urban centre. There was a positive correlation between expenditure/inhabitant per month and the number of prescriptions issued. CONCLUSIONS: 1. After the initial phase of PRUM, an increase in expenditure and improvement in the qualitative profile of prescription were noted. 2. Information taken from the study has proved to be an adequate planning and management tool.

Catchment Area, Health↗

[Noncompliance with the medical prescription in primary care in a rural setting].

OBJECTIVE: To assess the level of initial non-compliance with treatment. DESIGN: An observational study with interviews of patients, which compared prescriptions filled at the Siruela Health Centre (Badajoz) with those dispensed at the town's only pharmacy. SETTING: Primary Care; rural ambit. RESULTS: 8,100 prescriptions were filled for an attending population of 3,100 people. 218 (2.7%) were not collected at the pharmacy. Non-compliance was considerably greater among active workers (4%) than pensioners (2%) (Z = 5.3; p < 0.001). Non-compliance was also greater when prescriptions were written by locums at weekends or on bank holidays (8.6%) than when they were written by the normal doctor (2.2%) (Z = 9.8, p < 0.001). 50.9% of prescriptions not collected were for pensioners on Social Security and 49.1% for the active population. Causes of non-compliance indicated by the patients were: medicine had little effect (33%), high price (28.4%) and not financed by the National Health System (26.6%). 32.6% of the cases of non-compliance were followed up; 64.8% of them returned to the consultation. CONCLUSIONS: Better information to patients on their pathologies and treatments would avoid many cases of non-compliance.

Adolescent↗