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PubMed1991

Epidemiological use of drug prescriptions as markers of disease frequency: an Italian experience.

All Italian citizens are covered by the National Health Service (NHS) and medical records of individual drug prescriptions are routinely collected and processed. A procedure entitled EPIFAR has been developed which, on the basis of a computer routine, makes it possible to trace back the prescription history of each individual included in the NHS. The validity of information gathered through the EPIFAR procedure to provide estimates of tuberculosis (TB) prevalence has been evaluated. A comparison with routine surveillance data has been made. The EPIFAR procedure identified a total figure of TB patients seven times higher than that from official notifications. A sample survey was conducted among the prescribing physicians in order to quantify the proportion of TB cases among subjects receiving prescriptions of anti-TB drugs. According to general practitioner recall 66.4% of the patients were treated because of TB diagnosis, TB prophylaxis and TB relapse.

Antitubercular Agents↗
PubMed1996

Salmeterol: a study by prescription-event monitoring in a UK cohort of 15,407 patients.

OBJECTIVE: To examine the safety of the long-acting beta2-agonist, salmeterol, in general medical practice in the U.K. DESIGN: In Prescription-Event Monitoring (PEM) the exposure data are derived from prescriptions confidentially provided by the Prescription Pricing Authority. Outcome data are obtained by questionnaires (green forms) on which prescribing medical practitioners recorded event (safety) data. Additional information is obtained from the patients' lifetime clinical records, from follow-up of all pregnancies, and from death certificates. SETTING: PEM provides an observational cohort study in which there is no interference with the medical decision on which drug is prescribed for individual patients. SUBJECTS: A total of 15,407 patients were given salmeterol and observed for a minimum of 1 year. RESULTS: Headache, tremor, and palpitations were associated with the use of salmeterol. No unexpected major adverse events were noted, although in this study there was a total of 1022 deaths. Of these, 73 were due to asthma, but only 39 of these patients were taking salmeterol in the last month of life. All of these deaths appear on careful examination of the clinical records to have been due to natural causes, although in a minority (four, 10%) of the group of 39 subjects, a temporal relationship between death and the use of salmeterol makes it difficult to exclude a possible association. The study suggests that advanced age and severity of disease were the most likely factors contributing to asthma mortality in the population studied. CONCLUSION: Headache, tremor, and palpitations occur as adverse effects of salmeterol and lead to withdrawal of the drug in some subjects. No unexpected adverse reaction has been noted and paradoxical bronchospasm was reported in only three subjects. The study has produced no evidence that salmeterol contributed to death in any of the patients examined.

Adolescent↗
PubMed2004

Prescription drug use in pregnancy.

OBJECTIVE: The purpose of this study was to provide information on the prevalence of the use of prescription drugs among pregnant women in the United States. STUDY DESIGN: A retrospective study was conducted with the use of the automated databases of 8 health maintenance organizations that are involved in the Health Maintenance Research Network Center for Education and Research on Therapeutics. Women who delivered of an infant in a hospital from January 1, 1996, through December 31, 2000, were identified. Prescription drug use according to therapeutic class and the United States Food and Drug Administration risk classification system was evaluated, with the assumption of a gestational duration of 270 days, with three 90-day trimesters of pregnancy, and with a 90-day period before pregnancy. Nonprescription drug use was not assessed. RESULTS: During the period 1996 through 2000, 152,531 deliveries were identified that met the criteria for study. For 98,182 deliveries (64%), a drug other than a vitamin or mineral supplement was prescribed in the 270 days before delivery: 3595 women (2.4%) received a drug from category A; 76,292 women (50.0%) received a drug from category B; 57,604 women (37.8%) received a drug from category C; 7333 women (4.8%) received a drug from category D, and 6976 women (4.6%) received a drug from category X of the United States Food and Drug Administration risk classification system. Overall, 5157 women (3.4%) received a category D drug, and 1653 women (1.1%) received a category X drug after the initial prenatal care visit. CONCLUSION: Our finding that almost one half of all pregnant women received prescription drugs from categories C, D, or X of the United States Food and Drug Administration risk classification system highlights the importance of the need to understand the effects of these medications on the developing fetus and on the pregnant woman.

Databases, Factual↗
PubMed2004

Resistance training effectiveness in patients with Charcot-Marie-Tooth disease: recommendations for exercise prescription.

OBJECTIVES: To determine the effects of a 12-week, home-based resistance exercise program on strength, body composition, and activities of daily living (ADLs) in men and women with Charcot-Marie-Tooth (CMT) disease and to design an ADL-based resistance exercise prescription template. DESIGN: Double-blind, placebo-controlled study. SETTING: Testing in a university setting; exercise in patients' homes. PARTICIPANTS: Twenty CMT patients who volunteered. INTERVENTION: Subjects progressively strength trained at home 3 d/wk for 12 weeks. MAIN OUTCOME MEASURES: Timed ADLs, isometric strength, and body composition. RESULTS: Absolute strength was greater in men with CMT in only 4 of 10 baseline measures (P<.05), but not when strength was normalized by lean mass. Training compliance was 87% with no gender differences. At baseline, women had 80% of normal strength in 4 of 10 measures, whereas men did not achieve 80% of normal strength in any measure. After training, women had 80% of normal strength in 8 of 10 measures, whereas men only had 80% of normal strength in 1. Training volumes and strength change scores showed no gender differences. ADLs improved after training with no gender differences (P<.05). An exercise prescription template was developed by using chair-rise time to estimate starting weights for lower body and supine rise for upper body. CONCLUSIONS: Resistance training improved strength and ADLs equally in men and women. We designed an exercise prescription recommendation, based on ADL performance.

Activities of Daily Living↗
PubMed2005

[Comparison of prescriptions by pediatricians and general practitioners: a population-based study in Franche-Comté from the database of Regional Health Insurance Fund].

OBJECTIVES: To compare the medical management of children by private pediatricians or by general practitioners. POPULATION AND METHODS: A retrospective cohort study analyzed information from the automated database of the Regional Health Insurance Fund for salaried workers in Franche-Comté from January 2001 through December 2002 and compared the mean rates of prescriptions in the populations seen only by general practitioners or mainly by pediatricians. RESULTS: Analysis concerned 1 535 208 visits (office and home). Management by pediatricians was associated with 25% fewer consultations and 6% fewer hospitalizations. Pediatricians also wrote 25% fewer prescriptions for drugs, 17% fewer for laboratory tests, and 42% fewer for speech and language therapy. Children seen by pediatricians took antibiotics much less often (penicillin: -24%; cephalosporins: -74%; macrolides: -53%) as well as half as many corticoids and NSAIDs. Their vaccination coverage was more complete (31% more hepatitis B vaccines, 7% more MMR), as was prevention against rickets and cavities (twice the rate of vitamin D and fluoride prescriptions). The population followed mainly by pediatricians included 25% more children with a chronic disease. CONCLUSION: General practitioners and pediatricians appear to differ significantly in their management of children. Other studies that can take into account such confounding factors as health status are needed to confirm these results.

Adolescent↗
PubMed2004

Impact of prescription coverage on hospital and physician costs: a case study of medicare beneficiaries with chronic obstructive pulmonary disease.

BACKGROUND: It is widely believed that appropriate use of prescription medicines can reduce avoidable hospitalizations and more expensive nonpharmacologic therapies, but identifying such cost offsets in operational programs is elusive. Any possible impact would be most apparent in patients with medication-sensitive disease conditions, such as chronic obstructive pulmonary disease (COPD). OBJECTIVE: The goals of this study were to develop an observational study design appropriate for estimating potential cost savings in the US Medicare budget as a result of extending drug coverage to persons with particular chronic diseases and to apply these study methods, in an exploratory analysis, to a sample of Medicare beneficiaries with COPD. METHODS: Spending for drugs, hospitalizations, and physician services was compared for COPD patients with and without prescription coverage using data from the 1999 and 2000 US Medicare Current Beneficiary Survey. To control for channeling bias, multivariate matching on observable variables was combined with tests for missing variable bias. The matching algorithm used propensity score weighting to ensure comparability between the 2 groups on all observed characteristics at baseline. RESULTS: Our sample comprised 462 beneficiaries with prevalent COPD in the year 2000: 384 (83.1%) had prescription coverage the entire year and 78 (16.9%) had no coverage. After adjustment, drug coverage was associated with 61% higher spending on medications and 29% lower spending on physician services (both, P < 0.05). Hospital costs appeared slightly lower for those with drug benefits, but the difference was not statistically significant. No statistically significant effects were found for services specific to COPD. However, effect sizes were large even for nonsignificant findings. CONCLUSIONS: Although this analysis did not establish a strong causal link between drug benefits and lower costs, 11 of our 12 comparisons had signs consistent with the cost-offset hypothesis.

Aged↗
PubMedDate not supplied

The use of simplified constitutional indications for self-prescription of homeopathic medicine.

OBJECTIVES: To develop simplified constitutional indications for homeopathic medicines so that parents of children with recurrent upper respiratory tract infection (URTI) could choose homeopathic medicines for their children more "accurately", and to subsequently evaluate if these choices match the prescriptions of trained homeopaths. DESIGN AND SETTING: To initially select the most commonly used homeopathic medicines for URTI, data from a survey of 1097 patients visiting 80 different Norwegian homeopaths were used. A simplified constitutional indication was then developed for the three homeopathic medicines most frequently prescribed for recurrent URTI and otitis media. The constitutional indications were developed by a group of five homeopaths and were then sent to 20 homeopaths for further evaluation. To evaluate the parents' choice of homeopathic medicines compared to the prescription by trained homeopaths, a group of 11 randomly selected homeopaths were asked to participate. They recruited parents of 70 child patients. RESULT: By using simplified constitutional indications for the three most commonly prescribed remedies, Calcarea carb, Pulsatilla and Sulphur, parents were able to choose the same homeopathic medicine as homeopaths' prescribed for 55% (95% CI 43-67) of children with URTI. There was excellent agreement between parents' choice and homeopaths' prescription for the three medicines (Kappa of 0.77, p<0.001). CONCLUSION: Simplified constitutional indications can be used to improve the quality of the choice of homeopathic medicines purchased over the counter (OTC) for self-treatment.

Child, Preschool↗
PubMed2005

Development of pharmaceutical heroin preparations for medical co-prescription to opioid dependent patients.

Presently, there is a considerable interest in heroin-assisted treatment: co-prescription of heroin to certain subgroups of chronic, treatment-resistant, opioid dependent patients. In 2002, nine countries had planned (Australia, Belgium, Canada, France, Spain) or ongoing (Germany, The Netherlands, Switzerland, United Kingdom) clinical trials on this subject. These trials (and the routine heroin-assisted treatment programs that might result) will need pharmaceutical heroin (diacetylmorphine) to prescribe to the patients. Research into the development of pharmaceutical forms of heroin for prescription to addicts can benefit from the large amount of knowledge that already exists regarding this substance. Therefore, in this paper we review the physicochemical and pharmaceutical properties of diacetylmorphine and the clinically investigated routes of administration, as well as routes of administration utilised on the street in the context of developing pharmaceutical heroin formulations for prescription to addicts. Patient acceptability of the formulation is essential, because heroin-assisted treatment is aimed at treatment-resistant addicts, who often have to be encouraged to participate (or to maintain participation) in a treatment program. This means that the most suitable products would have pharmacokinetic profiles mimicking that of diacetylmorphine for injection, with rapid peak concentrations of diacetylmorphine and 6-acetylmorphine, ensuring the 'rush effect' and the sustained presence of morphine(-6-glucuronide) creating the prolonged euphoria. Diacetylmorphine for inhalation after volatilisation (via 'chasing the dragon') seems to be a suitable candidate, while intranasal and oral diacetylmorphine are currently thought to be unsuitable. However, oral and intranasal delivery systems might be improved and become suitable for use by heroin dependent patients.

Analgesics, Opioid↗
PubMed2005

Medical and nonmedical use of prescription pain medication by youth in a Detroit-area public school district.

The purpose of this descriptive study was to examine the nonmedical use of prescription pain medications in a sample of public school students in the Detroit metropolitan area. The Web-based survey occurred during a two-week period in May 2003 and drew on a diverse population between the ages of 10 and 18 years. An 87% response rate was achieved, providing a final sample of 1017 students. Twenty-two percent of girls and 10% of boys reported lifetime nonmedical use of a pain medication (chi2 = 25.2, d.f. = 1, p < 0.001). Fifteen percent of girls and 7% of boys reported past year nonmedical use (chi2 = 12.7, d.f. = 1, p < 0.01). Compared to nonusers, nonmedical users of prescription pain medication were seven times more likely to smoke cigarettes, five times more likely to drink alcohol and smoke marijuana, almost four times more likely to binge drink, and eight times more likely to have used other illicit drugs. Of those reporting lifetime nonmedical use of prescription pain medication, 70% noted how they obtained the drugs; 34% reported getting the drugs from a family member, 17% from a friend and 14% from a dealer or theft.

Adolescent↗
PubMed2006

The relationship between past-year drinking behaviors and nonmedical use of prescription drugs: prevalence of co-occurrence in a national sample.

This study examined the relationship between past-year drinking behaviors and nonmedical use of prescription drugs (NMUPD) in a nationally representative sample. Prevalence estimates in the United States were derived based on data collected from face-to-face interviews using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (n=43,093 individuals aged 18 years and older). Nonmedical use of prescription opioids, stimulants, tranquilizers, and sedatives was more prevalent among individuals with alcohol use disorders (AUDs) than those without AUDs. The odds of reporting NMUPD were 18 times higher among alcohol dependent participants compared to past-year abstainers (OR=18.2, 95% CI=13.9-23.8). Although individuals with AUDs constituted less than 9% of the total sample, those with AUDs accounted for more than one in every three nonmedical users of prescription drugs. The past-year co-occurrence of AUDs and NMUPD was more prevalent among young adults 18-24 years of age than individuals 25 years and older. More than one in every four young adults aged 18-24 years who met the criteria for past-year DSM-IV alcohol dependence also reported past-year NMUPD. These findings suggest that the treatment for AUDs should include a thorough assessment of NMUPD, especially among young adults.

Adolescent↗
PubMed2006

Nonmedical use of prescription drugs among a longitudinal sample of dependent and problem drinkers.

BACKGROUND: Increasing trends in the nonmedical use of prescription drugs (NMPD) have been documented, yet little is known about the demographic, severity, and social network influences related to NMPD among treated and untreated problem and dependent drinkers. METHODS: To determine NMPD over four post-baseline interviews, the current study uses a 7-year longitudinal sample of 1598 dependent and problem drinkers, many also using illegal drugs, who were identified through a probability survey in the general population and consecutive intakes in public and private chemical dependency treatment programs in a California county. A panel model incorporating variables from the four post-baseline interviews was used, with baseline variables added for control. RESULTS: The use of illegal drugs (OR=2.18, CI 1.28-3.70), including marijuana (OR=2.66, CI 1.74-4.08), and the nonmedical use of prescription drugs prior to the baseline interview (OR=2.53, CI 1.48-4.33) were related to NMPD over the study period. Larger heavy alcohol and drug using social networks were also related to NMPD (OR=1.03, CI 1.01-1.05). CONCLUSIONS: When examining a sample of dependent and problem drinkers, many of the results obtained were similar to results in the literature predicting drug, and even alcohol, use more generally. In this sample, illegal drug use, and marijuana use were important predictors of NMPD. Thus, the nonmedical use of prescription drugs may not be the first problem noticed by health and psychiatric providers.

Adult↗
PubMed2004

Seniors' prescription drug cost inflation and cost containment: evidence from British Columbia.

We develop an analytic framework to map out the nature and relative importance of different cost-driving trends in the prescription drug market. This is used to measure prescription drug cost-drivers for the population of seniors in British Columbia during a period when they received comprehensive public drug coverage. Between 1991 and 2001, expenditures on prescription drugs for BC seniors increased from dollar 149 to 320 million. Increases in the population of seniors, and the rate at which they utilized therapies contributed under half of the total cost increase over the period. Changes in the mix of therapies and the type of product selected explained over half of the observed drug expenditure inflation. Increased generic substitution significantly reduced the price of products selected over the period.

Aged↗
PubMed2004

Payment mechanisms and prescriptions in four Thai hospitals.

This paper examines the effect of payment mechanisms on prescription patterns in four district hospitals in provincial Thailand. Outpatients aged 60 or over at the four hospitals belong either to an insurance scheme that funds hospitals on a fee-for-service basis, or to a scheme using capitation. Hospitals have a financial incentive to differentiate between patients belonging to different schemes; however, doctors, who are paid salaries, face different pressures. The paper has two objectives: (i) to describe financial and non-financial influences on doctors' prescribing decisions; (ii) to test for differences between the cost of prescriptions received by fee-for-service and those received by capitated patients. The analysis uses data from treatment records, surveys, and interviews. We find that prescription costs for fee-for-service patients are significantly higher than those for capitated patients, controlling for age, sex, diagnosis and (to a limited extent) socio-economic status. The cost differences are attributable entirely to differences in the probability of receiving expensive drugs, and owe nothing to differences in quantities prescribed.

Capitation Fee↗
PubMed2004

Drug prescriptions and referral to cardiac rehabilitation after acute coronary events: comparison between men and women in the French PREVENIR Survey.

BACKGROUND AND AIM: The problem of a possible gender bias in coronary heart disease management is still controversial. We studied gender differences in secondary preventive drug prescriptions and in referral to cardiac rehabilitation after acute coronary events in France. METHODS: An observational survey was carried out in 1998-1999 in 150 French intensive cardiac care units. A sample of 2626 consecutive patients admitted for myocardial infarction or unstable angina and alive at discharge was included. Data were retrospectively collected from medical records after discharge. RESULTS: The sample was composed of 1921 men and 705 women. At discharge, antiplatelet agents were prescribed in 93.4% of men and 91.5% of women (p=0.09), beta-blockers in 73.4% and 63.7% (p<0.0001), angiotensin-converting enzyme (ACE) inhibitors in 39.9% and 44.3% (p<0.05), and statins in 47.0% and 40.7% (p<0.01). The percentage of subjects referred to a cardiac rehabilitation program at discharge was 26.2% in men and 15.5% in women (p<0.0001). In multivariate analysis, taking into account confounding factors, gender did not appear as an independent determinant of drug prescriptions. Conversely, being a woman was independently associated with a lower probability to be referred to a cardiac rehabilitation program at discharge (adjusted female-to-male odds ratio: 0.44 (95% confidence interval: [0.31-0.64], p<0.0001). CONCLUSIONS: In this study, gender was not an independent determinant of secondary preventive drug prescriptions after acute coronary events. Conversely, we found a gender bias in referral to cardiac rehabilitation programs at discharge.

Aged↗
PubMed2004

Use of prescription medications and complementary and alternative medicines to treat depressive and anxiety symptoms: results from a community sample.

BACKGROUND: Individuals prescribed antidepressants or anxiolytics may replace or augment such medications with complementary and alternative medicines (CAMs). Little is known about the extent to which individuals in the community use CAMs instead of, or in addition to, medications they have been prescribed, for anxiety and depressive symptoms. METHOD: Information on use of CAMs, antidepressants and anxiolytics was obtained from a community sample of 7485 survey participants from Canberra and environs, Australia. Participants aged 20-24, 40-44, or 60-64 were also provided information on sociodemographic attributes, physical and mental health. RESULTS: 6.29% of participants used only prescription medications to treat their depression or anxiety. 2.28% used only CAMs for this purpose while a further 0.59% reported using both types of treatments. Those using CAMs and those who took prescription medications had comparable levels of mental health problems while CAM users had fewer physical health problems and lower neuroticism. Compared with those taking neither CAMs nor prescribed medication, however, CAM users had more depressive and anxiety symptoms, worse mental health, higher neuroticism and lower levels of mastery. LIMITATIONS: Information on use of prescribed and CAMs is self-reported and is subject to the inaccuracies and omissions associated with this method of data collection. CONCLUSION: We found survey participants used CAMs less frequently than prescription medications to treat their depressive or anxiety symptoms. Nonetheless, medical practitioners should be aware that their patients may use CAMs and seek information about such use to reduce the likelihood of adverse interactions between prescribed medication and CAMs.

Adult↗
PubMed2006

Trends in lithium prescription in Spain from 1985 to 2003.

Lithium use for bipolar disorder has decreased in the United States. We aimed at studying lithium prescription in Spain from 1985 to 2003. Prescription data, expressed in daily defined dose per 1,000 inhabitants per day, were obtained. Lithium prescription increased uninterruptedly from 0.21 to 0.79 DID. The psychiatric reform in Spain and a broader definition of BD during the last decades are possible explanations for this rise.

Bipolar Disorder↗
PubMed2006

Psychotropic drug prescription in a psychiatric university hospital in Germany.

A retrospective survey on drug prescription over a 5-year period (1998 to 2003) in 1,540 inpatients in a psychiatric university hospital in Germany was carried out. The aim was to establish a basis for a monitoring of prescription habits and for pharmacoeconomic considerations. It was established that there was only a slight increase in polyvalent drug use between 1998 and 2003. The results are presented in more detail in relation to the diagnosis of organic mental disorders, drug abuse disorders, schizophrenia, mood disorders and personality disorders. Newer atypical antipsychotics, SSRIs and mood stabilizers were increased across diagnoses while lithium and clozapine were prescribed less frequently. The rare occurrence of monotherapy in general might reflect a common trend in psychiatry fostering polydrug use. Studies of this type are biased by the fact that local habits of prescription do not allow generalisation of the findings. Such surveys should be carried out more frequently and simultaneously in different centers. Critical comparisons could help to optimize treatment.

Adult↗
PubMedDate not supplied

Psychotropic medication in adults with mental retardation: prevalence, and prescription practices.

People with mental retardation comprise an overmedicated population. Studies the last 20 years or so indicate that nearly 50% of people with mental retardation receiving care have been using psychotropic medication, in the treatment of psychiatric disorders and/or problem behaviours. The recent years guidelines for prescription of psychotropics have been developed, emphasizing, e.g. the presence of a diagnosis, consideration of alternatives, and evaluation. In spite of all this, we found that 37% of people with mental retardation in one Norwegian county were using psychotropics, mostly neuroleptics. Moreover, prescriptions frequently violated current guidelines, especially when conducted by general practitioners. For example, a lot of prescriptions had not been indicated by a diagnosis, alternatives to medications had rarely been explored, and evaluation of effects and side effects were exceptions. Psychiatrists complied more with current guidelines. Implications of the findings are discussed.

Adolescent↗