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PubMed1997

[The validity of therapeutic utility and intrinsic value as indicators of drug prescription quality: an analysis of treatments in cases of the common cold].

OBJECTIVE: To determine the validity of intrinsic value and therapeutic utility. DESIGN: The medicines prescribed in a random sample of 50 cases of common cold from each health centre evaluated were classified according to their intrinsic value (ordinal classification using five categories) and therapeutic use (dichotomized classification based on their intrinsic value). Patients with immunodeficiency or underlying pathology (COPD, cardiopathy, diabetes) were excluded. Each of the generic and non-specific indicators were studied to determine sensitivity and specificity for detecting problems in the rational prescription of medicines. SETTING: A representative sample from 8 primary care centres in the Murcia region. MEASUREMENTS AND MAIN RESULTS: The operative replies curve for intrinsic value revealed that this indicator was of little use in evaluating the quality of prescription. CONCLUSIONS: The low validity of the generic prescription indicators suggests that systems to monitor quality based on a specific focus (linking the prescription to the disease treated) should be designed.

Common Cold↗
PubMed1997

[The quality of antibacterial prescription in a primary care district. Its evolution in 1994-1995].

OBJECTIVES: To analyse the profile and quality of antibacterials (ABs) prescription in a primary care (PC) district during 1994 and 1995. DESIGN: A longitudinal, descriptive and retrospective study. SETTING: PC doctors from the PC district Bahía de Cádiz (Cádiz). MEASUREMENTS AND MAIN RESULTS: The prescriptions for ABs belonging to the following groups were studied: JO1 (systemic antibiotics), JO3 (systemic chemotherapy drugs), GO4A (antiseptics and drugs for urinary infection) and RO5C1 (expectorants, with mucolytic drugs included with anti-infection ones). The unit of measurement was the daily defined dose (DDD). DDD per 1,000 inhabitants per day (DID) and the DDD percentage of each AB versus the total were used as quantitative indicators. The qualitative indicators were: origins of use of ABs in PC and %DDD of non-justified associations (NJA) (RO5C1 group). CONCLUSIONS: The prescription profile of ABs in the area is similar to, and somewhat more favorable than, that described in the literature for similar areas. In the reconverted network there was a more rational prescription than in the non-reconverted network for the two years of the study. In both types of network a light improvement in the indicators studied was observed from 1994 to 1995.

Anti-Bacterial Agents↗
PubMed1998

[Written documentation of drug prescriptions. Accordance between medical records and dispensing records].

UNLABELLED: A comparison of drug prescriptions entered on case records and nurses' drug lists is presented. Of 144 patients admitted to a general internal medicine ward, nine received no drugs. The remaining 135 had 606 (75.0%) items on both case record and drug list, 114 (14.1%) on the case record only, and 88 (10.9%) on the drug list only. For 48 patients (35.6%) drug lists were in accordance with their case record concerning the number and type of drug prescribed. Prescriptions on both documents were characterised by lack of accuracy. Of the 709 prescriptions on case records and 684 on drug lists, 428 (60.4%) and 411 (60.1%) respectively were unambiguous. CONCLUSION: Drug prescribing based on transcription from case records to nurses' drug lists implies a considerable risk of discrepancies. Thus, there is a significant risk of incorrect drug administration. A standardised card for drug prescriptions for common use by both physicians and nurses will therefore now be taken into use.

Adult↗
PubMed1998

The street value of prescription drugs.

BACKGROUND: Although most physicians are aware of the potential for abuse and resale of prescribed medications, little has been done to document it. The purpose of this study was to determine which prescription drugs have street value, what that value is and why these drugs are used. METHODS: A descriptive cross-sectional survey using a semistructured interview technique was carried out on 2 weekdays (Mar. 10 and Apr. 1, 1997) in Vancouver's Downtown Eastside. A total of 58 users and dealers of prescription sedative/hypnotic and narcotic drugs were approached. Information collected included the demographic characteristics of those interviewed, the common street names of the drugs of interest, and their value and method of use. RESULTS: Thirty-two people agreed to participate in the study (participation rate 55%), 7 of whom were dealers. The range in price of sedative/hypnotic drugs was $0.10 to $2. For narcotic drugs the range was much greater, at $0.25 to $75. Descriptive analysis identified the minimum and maximum price and the mode of each preparation. Among the weak narcotic drugs the index drug (highest in demand on the street) was Tylenol No. 3 and among the more potent narcotics, MS Contin 30 mg. INTERPRETATION: A wide variety of prescription sedative/hypnotic and narcotic drugs are available on the street. The mark-up from pharmacy cost can be considerable. Factors influencing pricing include the relative inexperience of the buyer, the availability of illicit narcotics, the current street supply of prescription medications and the time of the month (before or after issue of social assistance cheques).

British Columbia↗
PubMedDate not supplied

[Analysis of prescriptions for psychotropic drugs in a psychiatric hospital].

A study on the prescription of psychotropic drugs was carried out at St-Egreve Psychiatric Hospital (Isère,--France) based on in-patient prescriptions (adults only). Analysis of the 200 prescriptions issued by 26 different practitioners found an average of 3.3 psychotropic drugs per patient (including 1.7 neuroleptics). A combination of neuroleptics was very frequent (63 pour cent of the schizophrenics receiving at least 2 neuroleptics). Half of the patients treated with neuroleptics received antiparkinsonian drugs. The other psychotropic medications often combined with neuroleptics, were anxiolytics (50 per cent), hypnotics (45 per cent), antidepressants (28 per cent) and normothymics (25 per cent). Among the antidepressants, the SSRI were the most commonly prescribed, even above tricyclics, reflecting their better clinical tolerance. The significant differences in prescribing practice between the services prompted the creation of a working group comprising practitioners and pharmacists to study the prescription of psychotropic drugs and compare this with the literature.

Adolescent↗
PubMedDate not supplied

Prescription errors. Legibility and drug name confusion.

Inadvertent drug substitution occurred in several instances in our practices due to the combination of the physician's illegible handwriting on prescriptions and the pharmacist's misinterpretation of subtle clues, which might have prevented the errors. The literature on the legibility of physician handwriting is reviewed. Our specific recommendations include using preprinted prescription pads, training staff assistants who write prescriptions, printing complete directions on each prescription, and aggressively educating each patient about the name and purpose of all drugs being prescribed. Patients are encouraged to bring their medications to each office visit to identify potential errors.

Handwriting↗
PubMed2006

Prescription of tamoxifen for breast cancer prevention by primary care physicians.

BACKGROUND: Although tamoxifen citrate has been approved for primary reduction of breast cancer risk since 1998, little is known about the prescription of tamoxifen by primary care physicians. METHODS: To investigate the determinants of prescription of tamoxifen for breast cancer prevention by primary care physicians, we mailed a national survey to 350 primary care physicians, including specialties of family practice, obstetrics and gynecology, and general internal medicine, regarding past prescription of tamoxifen, intention to prescribe tamoxifen in hypothetical scenarios, and potential predisposing and enabling factors. RESULTS: Ninety-six physicians (27.4%) reported having prescribed tamoxifen for breast cancer prevention at least once in the prior 12 months. After multivariate adjustment, having prescribed tamoxifen was associated with the physician having a family member with breast cancer (odds ratio [OR], 2.66; 95% confidence interval [CI], 1.21-5.85), patients who asked for information about tamoxifen (OR, 3.98; 95% CI, 1.44-11.04), and the beliefs that the benefits of tamoxifen outweighed the risks (OR, 1.86; 95% CI, 1.07-3.24) and that eligibility was easy to determine (OR, 2.67; 95% CI, 1.35-5.29). In hypothetical scenarios, the prescription of tamoxifen was affected by the patient's family history of breast cancer but not by her risk for endometrial cancer (ie, hysterectomy status). CONCLUSIONS: A minority of primary care physicians have prescribed tamoxifen for breast cancer prevention. The decision to prescribe tamoxifen is affected by the ability to determine eligibility, patient demand, and personal experience with breast cancer as much as perceptions of the risks and benefits. A woman's risk of endometrial cancer from tamoxifen seems to have less impact on prescribing decisions than the magnitude of her breast cancer risk.

Adult↗
PubMed2005

Adolescents' reports of parental knowledge of adolescents' use of sexual health services and their reactions to mandated parental notification for prescription contraception.

CONTEXT: Legislation has been proposed that would mandate parental notification for adolescents younger than 18 years (minors) obtaining prescription contraception from federally funded family planning clinics. OBJECTIVE: To determine the extent to which parents are currently aware that their teenage daughters are accessing reproductive health services and how minors would react in the face of mandated parental involvement laws for prescription birth control. DESIGN, SETTING, AND PARTICIPANTS: A total of 1526 female adolescents younger than 18 years seeking reproductive health services at a national sample of 79 family planning clinics were surveyed between May 2003 and February 2004. MAIN OUTCOME MEASURES: Proportions of minor females who reported that a parent or guardian was aware that they were at the family planning clinic and, under conditions of mandated parental involvement, proportions of minors who would access prescription contraceptives at family planning clinics or engage in unsafe sex. RESULTS: Sixty percent of minors reported that a parent or guardian knew they were accessing sexual health services at the clinic. Fifty-nine percent of all adolescents would use the clinic for prescription contraception even if parental notification were mandated. This response was less common (29.5%) among adolescents whose parents were unaware of their clinic visits and more common (79%) among those whose parents were aware. Many adolescents gave more than 1 response to mandated parental involvement. Forty-six percent would use an over-the-counter method, and 18% would go to a private physician. Seven percent said that they would stop having sex as one response, but only 1% indicated this would be their only reaction. One in 5 adolescents would use no contraception or rely on withdrawal as one response to mandated notification. CONCLUSIONS: Most minor adolescent females seeking family planning services report that their parents are aware of their use of services. Most would continue to use clinic services if parental notification were mandated. However, mandated parental notification laws would likely increase risky or unsafe sexual behavior and, in turn, the incidence of adolescent pregnancy and sexually transmitted diseases.

Adolescent↗
PubMed1998

Nourishing the body through use of process prescriptions in group therapy.

OBJECTIVE: This clinical report describes a creative process for developing between-session prescriptions which sustain and strengthen the momentum of change occurring in group treatment sessions. METHOD: Therapists in this model use words and phrases depicting the group as a body in order to guide the treatment process and develop between-session prescriptions. Maintaining a perspective of the treatment group as a body facilitates development of member commitment to the well-being of a physical and psychological body, and between-session assignments employ the developmental phases of the therapy for illuminating the disorder and effecting its resolution. This approach was developed in an ongoing, open-ended treatment group provided at a community mental health center for 14 years. RESULTS: Examples are presented of process prescriptions which simultaneously address several dynamic levels: (a) the theme of interactions between the individuals in each session; (b) the particular stage of the group's development, and the ways this level of maturation determines how interactions arise and themes are selected; and (c) the underlying functions of the eating disorder. DISCUSSION: Using the metaphor of the body to guide the language of between-session prescriptions links developmental group treatment process with members' day-to-day engagement with the eating disorder. By participating directly in the development of the treatment experience, the group members become committed to a developmental process that engages them in accountability and caring for a body, and, by extension, their own bodies.

Adult↗
PubMed1996

A 1-year study of drug prescriptions and adverse drug reactions in psychiatric hospital practice.

Drug prescribing habits and adverse drug reaction occurrence were investigated in a psychiatric hospital ward for chronic resident patients, and the usefulness of a drug prescription and adverse event (AE) routine monitoring programme in this setting was assessed. A computerized data base was established and updated bimonthly with clinical data concerning each patient. In particular, information about drug prescriptions was routinely obtained from the clinical records, stored in the data base and periodically retrieved and analysed. The ward doctors were required to report on a form the AEs, which were subsequently examined by a panel of clinical pharmacologists and hospital consultants, to assess their relationship with drug treatments. Moreover, the data base was periodically scrutinized, to search for further AEs. Drug prescription monitoring, besides providing valuable information about drug utilization, allowed identification of some questionable issues (e.g. polypharmacy, low frequency of treatment revisions). The AE monitoring system proved to be effective and the participation of the ward doctors was satisfactory. It is concluded that in this psychiatric hospital setting a drug prescription and AE routine monitoring programme can provide useful information and promote improvement of the quality of care.

Journal Article↗
PubMed2007

Influence of age on the prescription of vitamin K antagonists in outpatients with permanent atrial fibrillation in France.

PURPOSE: The aim of the study was to describe the current rate and determinants of the prescription of antithrombotics in outpatients with permanent atrial fibrillation, with a pre-specified emphasis on the influence of age on the prescription of vitamin K antagonists. METHODS: This was a prospective observational survey in France among 5893 consecutive outpatients with documented permanent atrial fibrillation being seen by 770 physicians from August to December 2002. We recruited physicians from two random lists of general practitioners and cardiologists, respectively, stratified according to their administrative region, from the list of all French private general practitioners and cardiologists. RESULTS: The mean age of patients was 75.8 years. Mean duration since diagnosis of atrial fibrillation was 5.0 years; 31.7% of patients had valvular heart disease and 60.3% hypertension. An antithrombotic was prescribed to 95.5% of patients at the time of consultation. The percentage of patients treated with vitamin K antagonists was 76.4%; it decreased from 86.0% in patients aged 60-70 years to 63.5% in patients aged 80 years or above. On multivariate analysis, high age was a significant predictor (p = 0.001) for the non-prescription of vitamin K antagonists. In patients above 70 years currently receiving an antithrombotic, the probability of prescription of vitamin K antagonists decreased on average by 9.6% per year. CONCLUSIONS: Vitamin K antagonists are administered to most outpatients with permanent atrial fibrillation at high thromboembolic risk seen by French physicians in private practice. However, their use decreases with age.

Age Factors↗
PubMedDate not supplied

Prescription behaviours of office-based doctors to standardized common cold patients in Korea.

PURPOSE: To investigate real pictures of prescription behaviours of office-based doctors in Korea, especially focusing on the prescription of oral antibiotics and injections. METHODS: Prescription information was collected from 18 standardized patients (SPs) with the symptoms of the common cold who visited doctors' office. RESULTS: For these patients antibiotics were prescribed by 96 doctors (64.7%) out of 148 and the rate of antibiotic prescription increased with age of doctors, increasing number of medicines, and cost of medicines. Analgesics were most frequently prescribed (91.8%), and gastrointestinal drugs (81.6%), antitussivies (61.2%), antithistamines (61.2%), decongestants (59.2%), mucolytics (51.0%) and proteolytic enzymes (32.7%) followed. More than half of the doctors intended to give injections to the patients, which was higher among internists and doctors prescribed more medicines. CONCLUSIONS: Antibiotics and injections were frequently prescribed for mild common colds in Korea. Action to ensure judicious use of antibiotics and injection is urgent.

Adult↗
PubMed2004

The use of non-prescription medicines by general practitioner attendees.

PURPOSE: Against a background of increasing availability and use of non-prescription medicines, this study set out to explore: use of such medicines by patients seeing their general practitioner (GP); frequency of GP enquiry about such use; and frequency of recommendations to use a non-prescription medicine. METHOD: Patients attending four general practices in Aberdeen, Scotland, completed separate questionnaires (before and after seeing their GP). RESULTS: Some 461 individuals waiting to see their GP were invited to participate: 427 (93%) completed the pre-consultation questionnaire and 305 (71% of questionnaires issued) completed the post-consultation questionnaire. Almost half (45%) of all participants reported using non-prescription medicines in the 7 days prior to visiting their doctor; with 20% of the medicines purchased from non-pharmacy retail outlets. Thirteen per cent of participants were asked about their use of non-prescribed medicines by their GP. Eight per cent of participants were recommended to use a non-prescription medicine by their GP. CONCLUSION: Although there was a high level of recent use of non-prescribed medicines by the general practice attenders, relatively few reported being asked about such use, or were recommended to use such medicines by their GP.

Age Distribution↗
PubMed1998

Pattern of antimicrobial drug prescribing and prescriptive behaviour for acute otitis media among physicians in Sicily.

Acute otitis media (AOM) is one of the most common diseases of childhood, but it is less common in adults. Usually, in clinical practice therapy cannot wait until the laboratory report and the choice of an antibiotic prescription is initiated on an empirical basis. Moreover, several studies have shown great variability in antibiotic prescription for AOM. The study was carried out in order to describe the antibiotic prescribing pattern and the prescriptive behaviour among Sicilian general practitioners (GPs) in choosing an empirical antibiotic regimen for treatment of AOM. Each GP completed a questionnaire for each therapeutic intervention which ended with an antibiotic prescription. Diagnoses and drugs were classified according to the International Classification of Diseases (ICD-10) and to the Anatomical Therapeutic Chemical (ATC) classification system, respectively. Antibiotics, issued for AOM, accounted for 11.1% of total antimicrobial therapy in paediatrics and 3.4% in adults. The commonest therapeutic groups were: cephalosporins (44.1%), macrolides (26.1%), extended spectrum penicillins (16.1%), combination of penicillins and beta-lactamase inhibitors (11.4%). The route of administration appeared to be influenced by age of the patients, by a subjective clinical assessment of disease severity and by the presence of concurrent diseases. The diagnostic criteria and the marked variation in antibiotic prescribing pattern for AOM among Sicilian GPs reflects a lack of knowledge of any local or national guidelines.

Acute Disease↗
PubMed1991

Drug-prescribing patterns in old age. A study of the impact of hospitalization on drug prescriptions and follow-up survey in patients 75 years and older.

A prospective drug surveillance study was undertaken in 300 elderly patients admitted to a geriatric clinic. Prescribing patterns were determined on admission, at discharge and 3.6 and 18 months after discharge. Patients referred from long-term care institutions were on significantly more drugs than non-institutionalized subjects. A 34% reduction in the number of medicines prescribed at discharge was accompanied by a significant decrease in the mean number of prescriptions per patient, from 4.3 to 2.8, irrespective of whether the patient was institutionalized. Polypharmacy, defined by 5 or more concomitant drugs, declined from 43 to 17%. Dosage schedules were simplified in the majority of patients, as expressed by a significant decrease in the mean number of daily doses to be taken from 6.7 on admission to 4.4 at discharge. Cardiovascular drugs, diuretics and psychotropic drugs accounted for 64% of all drug prescriptions. At discharge, prescription frequencies were reduced for most medication categories, except diuretics and gastrointestinal drugs, which were being taken more often. The prescribing frequency of cardiac glycosides, the single most frequently prescribed drug class, decreased from 60 to 33% of the patients. Three months after discharge, prescribing patterns and frequencies were found to be very similar to the pre-admission situation. Eighteen months after discharge, overall drug use had increased by 15% compared to admission, and polypharmacy was recorded in 54% of patients. It is concluded that a substantial reduction in drug prescriptions was possible in the majority of elderly patients, particularly if they are institutionalized, on admission to a geriatric clinic.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2001

[Medical ethics of heroin prescription by physicians].

Due to increasing public health and social issues as secondary problems of opiate dependence (e.g. mortality, risk of HIV- and hepatitis infection, high rate of criminal activities) heroin prescription to opiate addicts has been suggested. Scientific data do not yet allow a solid evaluation of this treatment. As generally accepted, the main criteria for an ethical evaluation of new treatments are a) beneficence (duty to help patients further their important and legitimate interests), b) respect for the patient's autonomy and c) social justice in the allocation of the limited resources of the health care system. Ethical problems of heroin prescription relate to the differentiation between medical concern for the individual patient's health and the public interests in reducing social problems, the problematic capability of addicts of a balanced evaluation of heroin prescription and economic considerations of the costs of heroin prescription in comparison with other forms of treatment of opiate addiction, especially methadone maintenance treatment.

Contraindications↗
PubMed2004

Safety profile of raloxifene as used in general practice in England: results of a prescription-event monitoring study.

Raloxifene, a selective estrogen receptor modulator (SERM) licensed for the prevention of non-traumatic vertebral fractures in postmenopausal women at increased risk of osteoporosis, was launched in the UK in August 1998. The aim of the study was to monitor the safety of raloxifene prescribed in the primary care setting in England using prescription-event monitoring (PEM). Patients were identified by means of prescription data supplied by the Prescription Pricing Authority between September 1998 and November 2000. Demographic and clinical event data were collected from questionnaires posted to primary care physicians (GPs) at least 6 months after the date of the first prescription for each patient. Information on medical events, suspected adverse drug reactions (ADRs), reasons for stopping treatment, pregnancies, and causes of death was requested. Event rates [Incidence Densities (IDs): no. first reports /1000 patient-months of treatment] were calculated. Differences between IDs for events reported in month one (ID(1)) and months 2-6 (ID(2-6)) of treatment were examined. The cohort comprised 13,987 patients [median age 62 years (IQR 55,69); 99.8% female]. The major indication was osteoporosis (40.9%, n=5725). Flushing was the event with the highest ID in month 1 (22.8), reported most frequently by GPs as an ADR to raloxifene (67/461 reports) and as the reason for stopping (700/4592 reports). Events associated with starting treatment included flushing, malaise/lassitude, headache/migraine, nausea/vomiting, sweating, cramp, pain abdomen, dizziness, diarrhea, mastalgia and vaginal hemorrhage. Less common events reported during treatment included deep vein thrombosis (n=13), pulmonary embolism (n=13), thrombophlebitis (n=31) and visual disturbance (n=29). In this study, there were 122 (0.9%) confirmed deaths, of which 32 causes of death were unknown. This study shows that raloxifene is generally well tolerated when used in general practice in England. Potential signals of unrecognised ADRs requiring further evaluation included gastrointestinal adverse symptoms and vaginal hemorrhage. There were also a small number of reports of events associated with venous thromboembolism and visual disorders that require further investigation.

Adverse Drug Reaction Reporting Systems↗
PubMed2004

Safety profile of celecoxib as used in general practice in England: results of a prescription-event monitoring study.

AIMS: A post-marketing surveillance study using the technique of Prescription Event Monitoring was undertaken to monitor the safety of celecoxib, a cyclo-oxygenase (COX)-2 inhibitor, as prescribed in primary care in England. METHODS: Patients were identified from dispensed British National Health Service prescription data supplied in confidence by the Prescription Pricing Authority for celecoxib between May and December 2000. Simple questionnaires were sent to the prescribing general practitioner at least 6 months after the date of the first dispensed prescription for each individual patient. Event incidence densities (IDs) [the number of 1st reports per 1000 patient-months of exposure (pme)] were calculated. ID differences for events reported in month 1 (ID1) and months 2-6 (ID2) were examined for temporal changes in event rate. Information on suspected adverse drug reactions (ADRs), reasons for stopping treatment, outcome of pregnancies and cause of death were also requested. Data were gathered on potential gastrointestinal (GI) risk factors [recent use of other non-steroidal anti-inflammatory drugs (NSAIDs), past history of upper GI disorders and concomitant gastro-irritant agents or anti-ulcer drugs]. Crude IDs per 1000 pme and ID ratios were calculated according to potential risk factors, and age (> or = 65 years, < or = 64 years). RESULTS: The cohort comprised of 17,458 patients [median age 62 years (IQR 51,73); 68.3% female]. The most common specified indication was osteoarthritis (28.1%, n = 4905). Not effective was the event with the highest ID1 (139.9 per 1000 pme). The clinical events with the highest ID1 were dyspepsia (25.4 per 1000 pme) followed by abdominal pain (10.6). These were also given frequently as reasons for stopping (551 and 174 of 9126 reports). Of 436 events in 325 patients (1.9% of total cohort) that were reported as ADRs, the most frequent were events within the alimentary system (186 reports). Uncommon events reported during treatment (not necessarily as ADRs) included allergy (0.10%, n = 17), anaphylaxis (0.01%, n = 2), angioneurotic oedema (0.02%, n = 3) and bronchospasm (0.05%, n = 9). There were 103 reports of events associated with thromboembolism and 111 reports of serious GI events [90 GI bleeds (upper and lower); 21 peptic ulcers] received during treatment or within 1 month of stopping. A past history of dyspeptic/other upper GI conditions and use of concomitant gastro-protective drugs were each associated with a significantly increased risk of dyspepsia and abdominal pain. CONCLUSIONS: Frequently reported adverse events were those GI events commonly associated with treatment with other NSAIDS. Stratification by identified risk factors suggested that channelling of high-risk patients is likely. Serious upper and lower GI events, and thromboembolic events did occur during this study, although the incidence was low (< 1%). Doctors should continue to prescribe NSAIDs, including COX-2-specific inhibitors, with caution.

Adult↗