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PubMed1984

Computer-based prescription audit as a research, educational and management tool.

An existing dedicated pharmacy computer system (MIDAS system, Alfred Hospital and Health Computing Services, Victoria) used primarily for pharmacy labelling and dispensing, has been rewritten for an in-house minicomputer, with enhancements that allow it to be used in budgetary predictions, drug use monitoring, therapeutic audit and as a research tool. An automatically updated hard copy record of individual patient prescription profiles is generated and represents a valuable addition to the patient medical record. Allied to automatic "sorting" and retrieval techniques, all patients on nominated drugs can be identified and their records examined for particular combination use. Current application to assessment of nifedipine- beta blocker use will be presented, as will an application to cimetidine audit. Prescriptions can be scanned and segregated in terms of numbers of prescriptions in addition to segregation in terms of a particular therapeutic agent. Initial application to audit has detected an unacceptable level of polypharmacy (more than 26% of all prescriptions involve greater than or equal to 5 items and more than 3% involved greater than or equal to 10 items). Statistical information on the volume and unit cost of outpatient prescribing allows a precise estimate of ongoing budgetary commitments, while trends in discharge medication profiles allow a basis for prediction of budgetary trends, particularly with respect to the use of recent additions to the formulary. The system allows for expansion at minimal cost with potentially revolutionary applications, for example, interactive prescriber education if and when "on-line" capabilities are developed. Cross-linking with relevant data-bases will allow a major expansion of applied research into therapeutic drug use and its consequences.

Australia↗
PubMed2001

[Prescription of central nervous system stimulants].

BACKGROUND: The Child and Adolescent Unit at Nordland Psychiatric Hospital has conducted a review of the prescription practice in its region with regard to central nervous system stimulants. MATERIAL AND METHODS: Data were collected from the region's pharmacies on the type of drug, the type of medical practitioners prescribing them, and patients's sex, age and community of residence. RESULTS: The total numbers of users of Ritalin/Dexamin (methylphenidate/dextroamphetamine) were 199 children (under 18) and 21 adults (above 18). The male/female ratio was 4:1, boys between 8 and 13 being the largest group. Users in the below-18 group constituted 0.35% of their age group in our region. Prescriptions to children were in 188 out of 199 cases written by child psychiatrists or paediatricians. Prescription patterns in the seven local hospital areas in the region were almost identical, with one area forming an exception. INTERPRETATION: This survey suggest that because of insufficient knowledge of the diagnostic criteria for attention deficit/hyperactivity disorders, many children with this type of problems do not get the treatment they may need. Adequate treatment based on competent diagnostic assessment is assumed to relieve distress and counteract the development of further problems. Similar surveys in other Norwegian regions would enable us to compare prescription practice nation-wide.

Adolescent↗
PubMed2001

Role of diagnostic labeling in antibiotic prescription.

OBJECTIVE: To evaluate the association between diagnostic labeling of respiratory tract infections (RTIs) and antibiotic prescription rates in family practice. DESIGN: Descriptive analysis of outpatient chart review supplemented by interviews with physicians. Charts of patients attending 73 general practitioners were reviewed between October 1997 and February 1998. Two days of practice were evaluated per physician. SETTING: Urban family practices in greater St John's, Nfld. PARTICIPANTS: Of 96 family physicians contacted, 73 (76%) agreed to participate. MAIN OUTCOME MEASURES: Rates of diagnoses and antibiotic prescriptions for acute infections. Physicians were divided into "low prescribers" and "high prescribers" based on overall rates of prescription to patients with infections. Low prescribers were compared with high prescribers with respect to physician characteristics, patient characteristics, and diagnoses assigned. RESULTS: Of all patients seen, 22% were seen for acute infections; RTIs accounted for 76% of diagnoses. Low prescribers and high prescribers were of similar ages and saw similar numbers of patients of similar ages with very similar presenting complaints. Both groups diagnosed urinary tract and skin and soft-tissue infections at similar rates, but differed markedly in their rates of diagnoses of RTIs. High prescribers diagnosed bacterial RTIs in 65.4% (147/225) of their patients; low prescribers diagnosed bacterial RTIs in 31.0% (66/213 (P < .001). CONCLUSION: Family doctors frequently prescribe antibiotics. The difference in rates of prescription between high prescribers and low prescribers is largely explained by assignment of diagnoses of RTIs.

Acute Disease↗
PubMed2002

[Changes in antibiotics prescription in primary care].

BACKGROUND: Bacterial resistance to antimicrobial drugs constitutes a considerable problem in clinical practice. Overprescribing of these drugs contributes to bacterial resistance and current literature shows a growing interest in the rationalization of antibiotic use. OBJECTIVES: To observe the appropriateness of antibiotic prescriptions to children in an outpatient primary care setting, before and after a critical analysis of prescribing habits was performed. PATIENTS AND METHODS: Children aged 0-4 years attending the outpatient pediatric clinic were surveyed in two different periods: 1997 and 2000. The number of visits, infectious and respiratory diseases observed, and courses of antibiotics prescribed was determined. RESULTS: A total of 456 children, 2,339 diseases, and 829 antibiotic prescriptions were included. Several differences were observed between the two periods: the number of antibiotic courses administered to each child in one year averaged 2.3 in the first period and 1.5 in the second (p < 0.001). The number of processes receiving antibiotic prescription decreased from 38.8 % to 31.7 % (p < 0.001). The appropriateness of the decision to treat increased from 85.1 % to 93.3 % (p < 0.001), and the appropriateness of the antibiotic prescribed increased from 56.3 % to 78.7 % (p < 0.001). The most frequently diagnosed infectious diseases were common cold, tonsillopharyngitis, otitis and bronchitis. The most frequently prescribed antibiotic drugs were amoxicillin, amoxicillin-clavulanate and V penicillin. CONCLUSIONS: Physicians' knowledge of their own antibiotics prescription profiles with subsequent critical comparative analysis with current literature on the subject can help to modify prescribing habits.

Anti-Bacterial Agents↗
PubMed2002

Prescription drug coverage for people with Medicare.

Medicare currently does not provide outpatient prescription drug coverage. People with Medicare who do not have continuous prescription drug coverage face higher out-of-pocket expenditures and may not comply with their prescriptions in order to save money. This brief explores some of the issues facing beneficiaries without drug coverage and describes some of the different options available to help offset the costs of prescription medications.

Aged↗
PubMed2003

Over-the-counter and prescription medicine misuse in Cape Town--findings from specialist treatment centres.

OBJECTIVE: To provide community-level public health surveillance information on over-the-counter (OTC) and prescription medicine misuse. METHODS: A retrospective study of OTC and prescription medicine misuse among 9,063 patients from 23 specialist substance abuse treatment centres in Cape Town, South Africa, between 1998 and 2000. RESULTS: OTC and prescription medicine misuse places a burden on health and social services in South Africa. This is evidenced through the constant demand for treatment for OTC/prescription medicine misuse. Benzodiazepines are the class of medicines for which users most often receive treatment, followed by analgesics. Analgesic misuse is most often accounted for by the use of codeine-containing medicines, many of which are available over the counter. Patients using OTC/prescription medicines as their primary drug of abuse are significantly more likely to be female, and aged over 40 years. In contrast, patients using OTC/prescription medicine as an additional drug of abuse tend to be male and over 40 years of age. CONCLUSIONS: This study points to the need to develop primary health care protocols for detection, management and referral of patients misusing OTC/prescription drugs and the need to debate the re-scheduling of codeine as a prescription-only substance. The study also points to the need for further community-based research on the nature and extent of OTC/prescription drug misuse among the general population.

Adult↗
PubMed2003

[Effects of "Qiang Gu Kang Wei" compound prescription on biochemical indices of bone and related organs in rats under simulated weightlessness].

OBJECTIVE: To investigate effects of "Qiang Gu Kang Wei" prescription on biochemical indices of bone and related organs in tail-suspended rats. METHOD: Rats were tail-suspended (-30 degrees) for 21 d to simulate weightlessness. The effect of this prescription on biochemical indices such as Ca, P in serum, osteocalcin (BGP) in serum and bone, oxyproline hydroxyproline (Hyp) in bone, alkaliphosphatase (ALP) in serum, small intestine and bone in these rats were examined. RESULT: Comparing with the normal control, serum Ca decreased significantly (P<0.05) while serum P showed only a trend to decrease, at the same time BGP dropped in both serum and bone (P<0.05) and Hyp dropped only in bone (P<0.05). There was significant decrease of ALP activity in serum, small intestine and bone (P<0.01 or P<0.05) in suspended rats. The prescription showed different effects with different doses. In all the three dose groups (30 g/kg, 20 g/kg, 10 g/kg) Ca and P in serum levels increased (P<0.01 or P<0.05), BGP in serum and bone improved (P<0.05) or showed only a trend to increase. ALP activity increased in serum, small intestine and bone (P<0.05). Increase of Hyp in bone was found in the middle and the small dose groups (P<0.05). CONCLUSION: This prescription shows an effect of improving biochemical indices in bone and related organs such as serum and small intestine in tail-suspended rats. But no distinct concentration-dependence was found.

Alkaline Phosphatase↗
PubMed2004

Is the Kentucky prescription reporting system useful in the care of hospitalized patients?

Patients who are physically dependent on prescription drugs often create clinical management problems during hospitalization. Identifying those patients who have prescription drug problems can be difficult at the time of admission, but the information of the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system can be useful clinically. The purpose of this study was to examine the value of the KASPER system in the management of patients admitted to an acute care hospital. A convenience sample of 58 hospitalized patients was evaluated. The patients' clinical and demographic data were abstracted from the medical record. The KASPER data were used to confirm the patients' history of drug use. In this sample, the KASPER data supplied additional, clinically useful information that was not available from the clinical history or screening toxicology from 30 (51.7%) of these patients. We conclude that the KASPER system has the potential to assist physicians in the care of hospitalized patients who take controlled drugs that are obtained by physician prescription and filled in Kentucky pharmacies.

Adult↗
PubMed2004

Prescriptions and dosages of anti-tuberculosis drugs in the National Tuberculosis Control Programme of Malawi.

SETTING: All 44 non-private hospitals in Malawi treating pulmonary tuberculosis (PTB) patients with an oral regimen (0.5RHZE/1.5R3H3Z3E3/6HE). OBJECTIVES: In new smear-positive PTB patients, to determine whether: 1) numbers of tablets were correctly prescribed according to pre-treatment weights, and 2) medication dosages were adequate, too low or too high. DESIGN: Retrospective review of TB registers and TB treatment cards for patients registered with new smear-positive PTB between 1 October and 31 December 2001. RESULTS: Of 1970 patients aged > or = 15 years, 1211 (62%) had treatment cards and pre-treatment weights. Incorrect prescriptions were given to 88 (7%), and many of these received dosages of anti-tuberculosis drugs that were too high or too low. For those receiving correct prescriptions, daily treatment in the initial and continuation phases was generally associated with adequate dosages of drugs. However, in the initial intermittent phase, between 3% and 40% of patients received anti-tuberculosis drug dosages that were too low. CONCLUSION: A small percentage of patients receive incorrect prescriptions, which can be resolved by training and supervision. In those receiving correct prescriptions, intermittent treatment provides dosages that are sometimes too low. Weight bands for intermittent treatment should be re-examined.

Administration, Oral↗
PubMed2004

[Expressions of hTERT, p53, c-erbB-2 and Bcl-2 in colonic adenocarcinoma mouse models with liver metastases: effects of classical traditional Chinese medicine prescriptions for promoting circulation and removing blood stasis].

OBJECTIVE: To observe the effects of classical traditional Chinese medicine prescriptions that function to promote blood circulation and removing blood stasis on the metastatic behavior of malignant tumors, and explore the possible mechanisms of such effects. METHODS: BALB/c mouse models of colonic adenocarcinoma with liver metastases were established by intrasplenic injection of colonic adenocarcinoma cells (CT26) to receive treatment with the three representative classical circulation-promoting and blood stasis-removing prescriptions of traditional Chinese medicine, namely Guizhifuling pills, Didang Tang and Danshenyin, respectively. The expressions of human telomerase reverse transcriptase (hTERT), p53, c-erbB-2 and Bcl-2 were detected in the mouse models with different treatments and in normal control mice. RESULTS: Tumor metastases of various degrees were observed in the mice after inoculation of the tumor cells. The expressions of hTERT, p53, c-erbB-2 and Bcl-2 in the models receiving treatment with either Didang Tang or Guizhifuling pills differed significantly from those of the untreated model group (P<0.05), whereas between Danshenyin group and the model group, only the expression of hTERT showed significant difference. CONCLUSION: Didang Tang and Guizhifuling pills can reduce the expressions of hTERT, p53, c- erbB-2 and Bcl-2, while Danshenyin can only reduce the expression of hTERT without similar effects on the other 3 oncogenes. Such inhibitory effects of the prescriptions on hTERT and the oncogenes might explain their actions to inhibit malignant tumor metastasis, which can be related to performance of the prescriptions in promoting circulation by removing blood stasis.

Adenocarcinoma↗
PubMed2004

Improving information prescription to parents of premature infants through an OWL-based knowledge mediator.

In the Baby CareLink system, information prescription plays an important role in preparing parents of premature infants for the eventual discharge to home of their children. However, the prescription process requires scarce clinician time in order to dispense information, and can become cumbersome as content bases grow in size. We describe the development of an OWL-based knowledge mediator to facilitate information prescription. We describe 1) the initial development of a clinical vocabulary for neonatology using OWL-DL; 2) the reuse of the vocabulary to represent prototypical premature infants and their typical clinical problems and treatments; 3) the software components used to integrate terminology and inferencing services with Baby CareLink. We demonstrate multifaceted uses for description logics in a clinical application, reuse of a base vocabulary for domain knowledge representation, and use of the OWL language in representing clinical vocabularies. We believe that semi-automated knowledge mediation will enhance the process of electronic information prescription using large clinical content collections.

Education↗
PubMed2003

[Advance in the compatibility and dismantlement research on traditional Chinese compound prescription].

OBJECTIVE: The progress in the compatibility and dismantlement research on Traditional Chinese compound prescription was involved to provide references for the exploitation and utilization of the Chinese herbs. METHOD: The major models, methods, objectives of the compatibility and dismantlement research on Traditional Chinese compound prescription were reviewed. RESULT: Multiple and crossing ways were used in the dismantlement study of compound and most of them are foundation studies of reasonable verification of the origin prescription. CONCLUSION: The compatibility and dismantlement research on Traditional Chinese compound prescription has extensive applied prospect and will be developed further.

Animals↗
PubMed2004

[Prescription of betablockers in chronic cardiac failure: results of a national enquiry of cardiologists].

Despite recommendations from various learned establishments, there are strong reservations regarding betablockers, which have been contra-indicated in chronic cardiac failure for a long time. Several published enquiries have found a low prescription rate for betablockers. We performed an enquiry into the apparent modes of betablocker prescription in chronic cardiac failure. Questionnaires were sent to all the cardiologists in France, and 1622 were analysed. The dosage used, reasons for non-prescription, modes of repeat prescription, and the influence of the response to treatment were analysed. This enquiry shows that although the advantage of betablockers is acknowledged, there is still a block to their use.

Adrenergic beta-Antagonists↗
PubMed2005

Utilization of non-steroidal anti-inflammatory drugs in Quebec: adherence to the Canadian consensus on prescription guidelines.

BACKGROUND: Adverse events associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs) have led to the publication of Canadian prescription guidelines. Prescription practices following the publication of these guidelines and the introduction of COX-2 inhibitors in the Quebec formulary of reimbursed medications remain largely unexplored. OBJECTIVES: To compare the prevalence of contra-indications and selected risk factors for NSAID-toxicity among COX-2 inhibitor users and non-selective NSAID users. METHODS: A case-control analysis was conducted in a random sample of Quebec adult drug plan members who were treated with celecoxib (n=42,422 cases), rofecoxib (n=25,674 cases), full-dose (anti-inflammatory doses) of non-selective NSAIDs (n=9,673 cases), or low-dose NSAIDs (n=2,745 controls) in the year 2000. Data were obtained from the Quebec prescription and medical services databases (RAMQ). RESULTS: Patients with a history of gastropathy were more likely to be prescribed COX-2 inhibitors than low-dose NSAIDs; the odds ratios were 1.73 (95%CI: 1.56-1.91) and 1.49 (1.33-1.66), respectively for celecoxib and rofecoxib. Corresponding results for concomitant use of anticoagulants were 1.95 (1.34-2.83) for celecoxib and 1.87 (1.26-2.77) for rofecoxib, and for use of corticosteroids they were 1.29 (1.08-1.54) and 1.23 (1.01-1.49). Conversely, patients with the following characteristics were less likely to receive COX-2 inhibitors than low-dose non-selective NSAIDs: age 75+ (OR=0.64; 0.56-0.72 for celecoxib, OR=0.48; 0.76-0.99 for rofecoxib), hypertension (OR=0.83; 0.75-0.92 for celecoxib, OR=0.87; 0.77-0.97 for rofecoxib), and concomitant use of diuretics (OR=0.72; 0.63-0.82 for celecoxib; OR=0.77; 0.66-0.89 for rofecoxib). CONCLUSION: Patients with risk factors for NSAID gastropathy were more likely prescribed COX-2 inhibitors, while the presence of other contra-indications led to the prescription of low-dose non-selective NSAIDs. However, 12.7% of users of full-dose non-selective NSAIDs were age 75+ and 12.0% had a history of gastropathy, which are considered important risk factors for adverse events.

Adult↗
PubMed2005

[Effects on secretory function of rat gonad by Erxian decoction and its disassembled prescriptions].

OBJECTIVE: To explain functions, differences and coordination of three divided combinations of the "Erxian decoction", the famous traditional Chinese formula, on the effective sites of gonad gland at the cell level. METHOD: The effects of Erxian decoction and its main disassembled prescriptions, "Kidney Warming", "Yin Nourishing" and "Chong-ren Adjusting", on the level of testosterone (T) progesterone (P) estradiol (E2), respectively secreted by the primary culture Leydig cell, luteal cell and granulosa cell, were measured by radioimmunoassay. RESULT: (1) Erxian decoction could stimulate the T secretion while its three main disassembled prescriptions would seem no individual promoting effect on the secretion of T. (2) Erxian decoction and the "Kidney Warming" had the stimulating effect on P secretion, and the action of the whole formula being better than that of the "Kidney Warming". (3) Erxian decoction and its main disassembled prescriptions had the stimulating effect on E2 secretion, especially the whole formula. CONCLUSION: Erxian decoction can stimulate the secretion of T of the Leydig cell, P of luteal cell and E2 of granulosa cell. It can be seen that the effect of the whole formula is better than that of its main disassembled prescriptions.

Anemarrhena↗
PubMed2005

The effects of prescription drug cost sharing: a review of the evidence.

OBJECTIVES: To determine whether patients respond to increased cost sharing by substituting less expensive alternatives for medications with higher levels of copayments or coinsurance, and to examine the body of evidence on the relationships between cost sharing and use of essential or maintenance medications, health outcomes, process-of-care measures (such as medication adherence and discontinuation), and costs. STUDY DESIGN: Literature review. METHODS: Healthcare reference databases and key journals were searched to identify peer-reviewed empirical studies that examined the effects of variation in the amount of prescription drug copayments or coinsurance on healthcare utilization patterns. Thirty studies met our search criteria. RESULTS: Higher levels of prescription drug cost sharing generally produce intended effects, namely, decreasing the consumption of prescription drugs and steering patients away from nonpreferred to preferred brand-name drugs. However, patients do not always switch to generic drugs. Although not consistently reported, the most troublesome effects associated with higher levels of cost sharing are treatment disruptions (such as lower levels of treatment adherence, continuation, and initiation) for chronically ill patients. At times, higher levels of cost sharing can affect the use of essential medications and outcomes of care. CONCLUSIONS: Cost sharing reduces the consumption of prescription drugs but may have unintended effects on the process and outcomes of therapy. Further research is warranted in this area. The central question for health plan managers and policy makers is whether we will continue to use cost sharing as is or make modifications to reduce unintended effects.

Choice Behavior↗
PubMed1991

Evaluation of CAPD prescription.

Adequacy of CAPD has not been established. The recommendation is a Kt/V (K, total urea clearance in ml/min; t. time in minutes on dialysis; and V, total body water which is the volume of distribution of urea) greater than 1.5/week and/or a creatinine clearance (residual + dialysis) greater than 40 l/week/1.73 m2. We followed 20 CAPD patients for 38.6 +/- 28 mo. We measured blood urea nitrogen, serum creatinine, body weight, residual renal function (Kr), normalized protein catabolic rate (NPCR), Kt/V/week and creatinine clearance (CC) l/w/1.73 m2. We obtained the following values: B Wt 72 +/- 16 kg, BUN 56 +/- 13 mg/dl, s. Cr. 12.6 +/- 5 mg/dl, Kr 0.6 +/- 1 ml/min, NPCR 0.84 +/- 0.3 g/kg/day, Kt/V/week 1.8 +/- 0.3 and CC 50.4 +/- 10 l/w/1.73 m2. Patients dialyzed with a wide range of prescription. There was a good correlation between Kt/V and CC. There was no correlation between the dialysis prescription changes in weight and biochemical determinations. There was a direct correlation between Kt/V and NPCR: patients who were dialyzed more eat more. Of the 20 patients, 10 had 24 hospitalizations, and of these were 12 due to peritonitis. Dialysis prescription and biochemical findings of these patients did not differ significantly from nonhospitalized patients. Larger prospective studies are necessary to determine the adequate range of CAPD prescription and its relationship to morbidity and mortality.

Adult↗
PubMed2006

Association of income and prescription drug coverage with generic medication use among older adults with hypertension.

OBJECTIVE: To determine whether low-income seniors and those without prescription drug coverage are more likely to use generic cardiovascular drugs than more affluent and better insured adults. STUDY DESIGN: Cross-sectional analysis. METHODS: We used data from the 2001 Medicare Current Beneficiary Survey. Analyses included noninstitutionalized survey respondents over age 65 years with hypertension who used > or =1 multisource cardiovascular drugs (N = 1710). We examined the association of income and prescription coverage with use of generic versions of multisource drugs from 5 classes: angiotensin-converting enzyme (ACE) inhibitors, beta-adrenergic receptor antagonists (beta-blockers), calcium channel blockers, alpha1-adrenergic receptor antagonists (alpha-blockers), and thiazide diuretics. RESULTS: Rates of generic medication use were 88.5% (beta-blockers); 92.8% (thiazides); 58.7% (calcium channel blockers); 60.7% (ACE inhibitors); and 52.6% (alpha-blockers). In multivariate analysis of generic medication use aggregated across the 5 drug classes, individuals with incomes below 200% of the federal poverty level were modestly more likely to use generic medications compared with seniors with incomes above 300% of the poverty level. Seniors who lacked prescription coverage were more likely to use generics than those who had employer-sponsored coverage, although the association was of marginal statistical significance (relative risk = 1.29, 95% confidence interval = 1.00, 1.60). CONCLUSION: Seniors with low incomes or no prescription coverage were only somewhat more likely to use generic cardiovascular drugs than more affluent and insured seniors. These findings suggest that physicians and policy makers may be missing opportunities to reduce costs for Medicare and its economically disadvantaged beneficiaries.

Aged↗