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At least 1,225 records · Page 68Linked to original sources
PubMed2006

A pilot study to describe antidepressant prescriptions dispensed to veterans after stroke.

BACKGROUND: Stroke is the third leading cause of death in the United States, following only heart disease and cancer. Approximately 500,000 strokes occur each year in the United States. Patients suffering from poststroke depression have higher rates of morbidity and mortality, slower physical recovery, and lower functional status than stroke patients without depression. Depressed stroke patients may benefit from early treatment with an antidepressant. OBJECTIVES: The objectives of this study were to (1) describe antidepressant-dispensing patterns to veteran patients during the 6-month period before their stroke and 1-year time afterward and (2) examine the association of poststroke antidepressant treatment with mortality. METHODS: Veteran patients (n=543) with one or more hospital discharges during FY2001 with a primary diagnosis of stroke were identified. The discharge date minus the length of stay indicated the index hospitalization date. Antidepressant prescription dispensing records were obtained from the Veterans Integrated System Network 8 Veteran's Affairs (VA) Pharmacy Benefits Management database. RESULTS: One-third of eligible veteran patients were dispensed one or more antidepressant prescriptions (n=181) either before or after the index hospitalization. Of these veterans, 146 received an antidepressant after the index hospitalization. More than 80% of veteran patients survived the stroke for 1 year or longer (n=448). Among the veteran patients who were discharged from the index hospitalization alive, those with no antidepressant or an antidepressant dispensed only before the stroke had a higher 1 year all cause mortality rate (8.0%) compared with those who were dispensed a prescription for one or more antidepressants afterward (4.8%). CONCLUSIONS: Veterans dispensed an antidepressant after their stroke appeared to have benefited. Opportunities to reduce poststroke sequelae and improve recovery may be lost.

Adult↗
PubMed2005

Evaluations of care by adults following a denial of an advertisement-related prescription drug request: the role of expectations, symptom severity, and physician communication style.

As patients continue to take a more active role in their health care, an understanding of patient requests of health care providers, including what happens when requests are not fulfilled, is becoming more important. Although its merits have been debated, direct-to-consumer advertising of prescription drugs generates patient requests. The objective of this study was to assess the influence of physician communication style, respondents' expectations of receiving a requested prescription, and perceived symptom severity on respondents' evaluations of care following a physician denial of a prescription drug request stimulated by direct-to-consumer advertising. A 2 x 2 x 2, between-subjects experimental design was used. The respondents were made up of employees of the University of Mississippi. Physician communication style, respondents' expectations, and respondents' perceived symptom severity were manipulated using vignettes. Respondents' post-visit evaluations of care were assessed by measuring trust in the physician, visit-based satisfaction with the physician, and commitment toward the physician. Factorial analysis of variance procedures for a three-way design were used to test the hypotheses and assess the research questions. Manipulation checks suggested that the independent variables were appropriately manipulated. No significant first-order or second-order interactions were noted in any of the analyses. Post-visit evaluations of care were significantly associated with physician communication style (a partnership response led to better evaluations of care). There were no significant effects of either prior expectation of request fulfillment or perceived symptom severity. However, non-significant trends in mean scores suggested a potential role of these variables in the evaluation process following request denial. The manner in which a physician communicates with an individual is an important determinant of the evaluation of care following the denial of a request. The results suggest that health care providers attempting to minimize the effect of request denials on patient evaluations should make an effort to involve the patient in the decision-making process.

Adult↗
PubMed1997

Temporal decline in filling prescriptions for terfenadine closely in time with those for either ketoconazole or erythromycin.

Temporal changes in the rates of filling terfenadine prescriptions within 2 days of those for either oral erythromycin or oral ketoconazole were described with use of paid pharmacy claims data from 1988 through 1994 in state Medicaid programs from Michigan and Ohio and in a large health maintenance organization. There were rapid and significant declines in the rates of filling prescriptions for either erythromycin or ketoconazole within 2 days of prescriptions for terfenadine in all three databases that coincided with 1992 publicity about the cardiovascular risk of terfenadine. These findings suggest that the use of terfenadine with contraindicated medications has declined in response to relabeling and publicity concerning the safe use of terfenadine. Further study is necessary to estimate the absolute level of concurrent use of terfenadine with contraindicated medications.

Adolescent↗
PubMed1994

Prescription drug dependence in the elderly population: demographic and clinical features of 100 inpatients.

OBJECTIVE: To determine the prevalence of prescription drug dependence among elderly persons in an inpatient treatment setting, to identify apparent risk factors for drug dependence, and to ascertain what factors led to admission of these patients. DESIGN: We reviewed the medical records of 100 elderly patients dependent on prescription drugs who were admitted to the Mayo Inpatient Addiction Program between 1974 and 1993. MATERIAL AND METHODS: Demographic features, chronic medical disorders, categories of substance dependence, diagnoses of mental disorders, and Minnesota Multiphasic Personality Inventory data were compiled and analyzed. RESULTS: The mean annual admissions rates for three substance use disorder groups among all elderly persons treated during the 20-year period of study were as follows: alcohol only, 72%; prescription drugs, 16%; and both alcohol and drugs, 12%. The group as a whole was socially intact. Female gender seemed to be a risk factor for drug dependence. By several measures, these elderly patients were characterized as a psychiatric population. The most frequent drug dependence involved sedatives or hypnotics. General medical data did not suggest that these elderly persons were more physically impaired than the general population. CONCLUSION: In elderly patients, awareness of coexistent diagnoses is essential in avoiding the inappropriate administration of multiple pharmaceutical agents and the possible risk of associated drug abuse and dependence.

Aged↗
PubMed2000

The effect of new and continuing prescription drug use on cost: a longitudinal analysis of chronic and seasonal utilization.

OBJECTIVE: To provide basic information about 2 factors contributing to rising prescription drug costs--utilization trends and product selection. BACKGROUND: Prescription drug costs have risen sharply in recent years, and continued growth is expected. There is little consensus about appropriate cost-management strategies, in part because quantitative data on the causes and implications of increased drug costs are lacking. METHODS: This study followed 463,820 continuously enrolled adult (> or = 18 years of age on January 1, 1996) utilizers of 15 chronic or seasonal therapeutic classes for 2.5 years (January 1996 through June 1998) using a pharmacy benefit manager's multiple-payer claims database. Outcome measures included (1) change in utilization rate, (2) relationship between new use and utilization growth, (3) stability of the treated population (ie, mostly long-term use vs high rates of turnover), and (4) product mix changes (ie, cost per dispensed day for 1996 vs 1997 and for new vs continuing users, controlling for inflation). RESULTS: Of the 463,820 utilizers, 97% were commercially insured and 3% enrolled in Medicare risk plans; 40% were enrolled in managed care and the remainder covered by indemnity insurance. Rates of growth and turnover varied substantially by class. The highest 2-year utilization rate change was 66.7% for antihyperlipidemic agents; change was < 10% in only 3 classes. Across classes, an average of 38.7% of 1997 users were new (ie, no use in 1996) and an average of 34.0% of 1996 users were dropouts (ie, no use in 1997). Utilization growth depended heavily on treatment continuation; classes with high dropout rates (eg, antirheumatic, antiasthmatic) did not have high growth rates, even with high rates of new use. In most classes, costs were not higher for new than for continuing users. In some classes, however (eg, antipsychotic, antidiabetic), both new and continuing users increased their use of newer, more expensive products. CONCLUSIONS: Because factors underlying rising prescription drug costs vary by therapeutic class, cost-containment strategies should address these differences. Further research is needed to assess the clinical and economic costs and benefits of rapid growth in the utilization of certain therapeutic classes.

Adult↗
PubMed2002

The identification of depression and the coverage of antidepressant drug prescriptions in Italian general practice.

BACKGROUND: Studies on antidepressant prescriptions in general practice need to assess the level of prescriptions relative to the need for them ('coverage'), and the variability among doctors. METHODS: Two different cut-off scores on a screening test for depression (the Personal Health Questionnaire, PHQ) are used to predict rates for depression, and rates for depressive patients thought likely to benefit from antidepressants (according to a severity criterion) in primary care patients. These two rates are compared with assessments by 11 GPs of recognised depression, as well as with rates of drug prescribed. RESULTS: The rate for depression thought likely to be treated with antidepressants estimated with the PHQ is broadly comparable with the rate for conspicuous depressive illness, and much lower than that predicted by the PHQ for depression. There was great variability between GPs in their ability to detect depression, and their preparedness to prescribe antidepressants. Antidepressants were only prescribed for 3.5% of the patients, compared to the 8.9% thought to need them. However, antidepressants, mostly SSRIs, are much more likely to be prescribed than tranquillisers. LIMITATIONS: The limitations of the study are that the PHQ is able to estimate 'coverage' but not 'focusing' (the proportion of those receiving antidepressants who needed them). CONCLUSIONS: Although the rate for conspicuous depression is similar to that for depressions thought to be treated with antidepressants, the 'coverage' of antidepressants was only 39.3%. The variability between physicians confirm the need of good practice guidelines and training packages for the identification and management of depression. Large epidemiological studies are needed to overcome the current lack of clinically relevant data on the quality of antidepressant prescriptions in general practice.

Adult↗
PubMed1984

Dermatologic prescriptions requiring compounding.

Dermatologists responding to a mail survey supplied 520 prescriptions as examples of prescriptions requiring compounding. A total of 195 different ingredients were used, with an average of 2.5 ingredients per prescription. Anti-inflammatory agents were most frequently used. Brand-name medications were frequently incorporated with other ingredients.

Adult↗
PubMed2000

[Failure of an educational intervention to change anticholesteremic drug prescription in primary care].

OBJECTIVE: To evaluate the effectiveness of an intervention for decreasing hypocholesterolemic drugs prescription in patients with low cardiovascular risk profile. DESIGN: Quasi-randomized intervention study. SETTING: Public primary health care centres in the province of Valencia (Spain). PARTICIPANTS: 238 general/family practitioners from 23 primary health care centres. INTERVENTIONS: The centres were assigned to either an experimental group that received the educational intervention (individual scientific information by outreach detailing and invitation to a workshop about treatment of hypercholesterolemia in the primary care setting with the participation of an opinion leader) or a control group. MEASUREMENTS AND MAIN RESULTS: The effectiveness of the intervention was measured through the monthly mean daily defined doses (DDD) from the 4 months prior to the intervention until 5 months thereafter. Mean DDD increased along the study period in both groups, with no detectable differences between them. Similarly, there were no between-group differences after controlling the initial prescription levels using a mixed lineal model. CONCLUSIONS: The educational intervention as it was implemented was ineffective for changing overall hypocholesterolemic drug prescription in primary care. Consequently, this intervention is not justified for reducing pharmaceutical expenditure.

Anticholesteremic Agents↗
PubMed2003

[Prescription of non-steroidal anti-inflammatories and gastric protectors in emergency service].

OBJECTIVES: To find the number of patients seen in casualty who received gastropathy prophylaxis with NSAIDs that complied with the pharmaco-therapeutic guidelines of the health district. DESIGN: Descriptive study of technical-scientific quality. SETTING: The Casualty Department of the Ramón y Cajal hospital. PARTICIPANTS: Randomised sample of 400 emergencies attended in January 1999 and 2000, excluding paediatric cases, people previously treated with gastro-protectors, patients admitted and the deceased. Main measurements. On the basis of casualty records: suitability of indication and criteria used; if unsuitable, how; adequacy of selection of the principle, patient' age and sex, digestive pathology history, area and year of care. RESULTS: NSAIDs were prescribed in 37.9% of cases (33.27-42.79), with prescription unsuitable in 21.19% (15.2-28.3). 15% (9.5-22) were unsuitable by default; and 54.2% (35.1-72.1), by excess. Unsuitability was greater among women, if there was history of digestive pathology, and among older people, with no differences found for area or year of care. The choice of gastric protector was not suitable in any case. CONCLUSIONS: Given the amount of primary care prescription originating in hospital casualty departments, and its effect on the training of family medicine interns, strategies coordinated between health care levels must be introduced in order to improve gastric protection prescription in NSAID gastropathy prophylaxis. The effectiveness of these strategies must be evaluated.

Adult↗
PubMed2004

[Induced prescription from reference hospital Universitari Vall d'Hebron to general practitioners].

OBJECTIVES: Our objectives were to describe proportion of patients with induced prescription (IP) from reference hospital, the information about diagnosis and treatment that GP get as well as their agreement with the prescription. We also analyzed the quality of IP assessed by GP's quality of prescription criteria. DESIGN: Cross-sectional study. SETTING: Six urban health care centers. PARTICIPANTS: Patients and drugs prescribed from the reference hospital and derivated to health care center to get treatments. MEASUREMENTS: Origin of patients, diagnosis, treatment and the GP's agreement with it, and whether that information was enough to allow patient's control. MAIN RESULTS: Thirty six GP collected data from 323 patients and 844 drugs from reference hospital. 52% (95% CI, 47-58) of IP came from the emergency room. Medical conditions more frequently associated with IP were chronic obstructive pulmonary disease, lumbosciatica and traumatism. The most prescribed drugs were analgesics and NSAIDs. GP's agreement with IP reached 63% (95% CI, 60-67). Most frequent disagreement cause was drug selection (61 drugs; 7.2% of IP). In some 20% (95% CI, 16-25) of patients information wasn't sufficient enough to assume patient's control. CONCLUSIONS: A stronger relation between GP's and hospital doctors would be needed to establish common treatments for patients' frequent conditions and their follow-up.

Adolescent↗
PubMedDate not supplied

[Should general practitioners consider the costs of their prescriptions? Reflections stemming from the "White Paper" and an opinion survey].

The British government proposal to introduce drug budgets will compel general practitioners to consider the financial consequences of prescribing. In our country, the practitioner neither in the past nor now has an incentive to consider the cost of his prescription, and few efforts have been made to influence it, if we exclude the pharmacy industry. In the present article, the situation of both countries is analyzed and the answers of the general practitioners of Girona and Scotland to questions that examine their predisposition towards considering costs when prescribing are compared. The reduction of the prescription costs must be formulated as a part of a rational prescription and should employ a combination of approaches: education, feedback, administrative changes, and incentives. The procedures to encourage a more efficient use of medicines require an active participation of the practitioners in managing the resources of their practices.

Adult↗
PubMedDate not supplied

[Drug prescriptions in Catalonia following the Decree of Selective Financing of Drugs].

OBJECTIVES: To assess the consequences of the Selective Financial Decree for prescription drugs in Catalonia. METHODS: Observational longitudinal study of the registry of prescribed pharmaceutical specialties that were charged to the Catalan Service of Health, from august 1991 to July 1994. 243.8 million of prescriptions were analyzed. RESULTS: Between the 12 months prior to the Decree and the 12 months following, the number of drug prescriptions was reduced by 10%. As a whole, the drugs included in the decree were loosing sales before the Decree; 38% of then were not been prescribed at all during the period studied. The main groups affected by the Decree were, vitamins associations, stimulants an associations with cough suppressants, mainly with a low therapeutic value. There has only been and important and clear substitution effect in antianemic and cough suppressants associations. CONCLUSION: In general, substitutions between pharmaceutical groups were few and positive.

Drug Prescriptions↗
PubMed1990

Prescription and practice of dialysis in Australia, 1988.

Facilities for provision of treatment of end-stage renal failure with hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) are available in many centers, most of which are government-funded. Medicare provides free treatment for all patients. There are no specific criteria for determining a patient's acceptance for dialysis treatment: age, quality of life, and capacity for independent living are important factors. The usual HD prescription is three dialysis periods weekly, hollow-fiber dialyzer, 1.0-1.2 m2 surface area, for 4 to 5 hours, with blood flow rate 250 mL/min and acetate-based dialysate flow rate 500 mL/min. Reuse of the dialyzer is common, but many units practice single use to reduce the expense and time necessary for processing the dialyzer and the risks of formalin exposure. There is only limited use of hemofiltration, or highly efficient dialyzers for shortened hours at higher blood flow rates. The choice of dialysis prescription is influenced by the physician's preference for the patient to be treated at home or in a self-care center with limited assistance. CAPD is preferred for home dialysis, especially for elderly or diabetic patients. There is no personal financial incentive to the physician to favor any particular form of dialysis. The costs of dialysis do influence the provision and prescription of treatment, causing the reuse of dialyzers and the limited use of bicarbonate-based HD and highly permeable dialyzers. Nevertheless, adequate dialysis should be available to all patients, and noncompliance with prescribed dialysis is infrequent. Quality-assurance programs have been developed both for nursing and medical care.(ABSTRACT TRUNCATED AT 250 WORDS)

Australia↗
PubMed1990

A kinetic survey of US hemodialysis prescriptions.

Recent reports indicate increasing mortality correlated to reduced treatment time (t) in hemodialysis (HD) patients. HD prescriptions for 101 patients visiting our unit were subjected to kinetic analysis to assess the amount of dialysis prescribed (Kt/V) and its relationship to t. The analysis showed (1) 98% of the prescriptions were empirical; (2) Kt/V was strongly correlated to protein intake (normalized protein catabolic rate [NPCR], g/kg/d), r = 0.50, N = 101; (3) Kt/V was strongly correlated to t, y = 0.50 + 0.54x, r = 0.54, and fell below 1 when t less than or equal to 3.5 hours; (4) a prescription flux deficit appeared and increased exponentially as t fell below 3.7 hours. These results suggest that in clinical practice, t is individualized as a function of predialysis BUN and is reduced when BUN is low due to low NPCR because of a perceived need for less dialysis. Because of this practice, reduced t is often associated with inadequate dialysis, and kinetic modeling of the interrelationship between blood urea nitrogen (BUN), NPCR, and Kt/V is required to assure adequate dialysis with reduced t.

Blood Urea Nitrogen↗
PubMedDate not supplied

[Designing a module for the prevention of hypersensitivity reactions in an assisted electronic prescription system].

OBJECTIVE: To develop a module for the prevention of drug-related allergies to be integrated within the assisted electronic prescription software PRISMA. METHOD: On module design potential sources of medication errors regarding drug allergies were first analyzed, and ideal module characteristics were defined. Then a review of the literature was performed to define "group allergies", and last of all master archives were created, with their required relations being established. RESULTS: A module for the prevention of drug-related allergies in the setting of an assisted electronic prescription software was designed. By interrelating tables listing active ingredients, excipients, chemical structures/functional groups, and "group allergies" prescriptions may be interactively checked, and useful information is provided to the prescribing practitioner--as well as the whole multidisciplinary team--to help him make his/her decisions.

Drug Hypersensitivity↗
PubMed1997

Approaches for certification of electronic prescription software.

The proper management of drug treatment is essential, since adverse drug reactions are common reasons of hospitalisations. Expenditure on drug therapy has also been growing faster than any other aspect of health care in many countries. Savings and quality improvements in drug treatment could be achieved with computerised prescribing. In this paper, the architecture of an electronic prescription system is described in the light of software certification and registration. An electronic prescription system is an example of a system supporting shared care and therefore it should be person based, integrated, secure and confidential and data should be shared among health care institutions. The system architecture shares the idea of a virtual patient record and a smart card will be used as a key to prescription data located on the network. The certification and registration of medical software is a difficult and costly procedure. Ensuring the quality of software can be based on; certification of development process, voluntary evaluation, and post-market surveillance. Voluntary evaluation practice would be a precious tool for both the customers and software developers, and it would also be an invaluable source of information in terms of developing new software.

Certification↗
PubMedDate not supplied

[Drug prescription in Italian Residential Facilities].

AIMS: To investigate in a representative national sample (N=2,962) of patients living in Residential Facilities (RFs) patterns of polypharmacy as well as related variables, association between diagnoses and therapeutic patterns, and the rate of adverse events. METHODS: Structured interviews focusing on each patient were conducted by trained research assistants with the manager and staff of each RF. Patients were rated with the HoNOS and the SOFAS, and comprehensive information about their sociodemographic and clinical status, and their pharmacological regimes were collected. RESULTS: Conventional antipsychotics and second-generation antipsychotics were prescribed to 65% and 43% of the sample, respectively. Benzodiazepines were prescribed to two-thirds of the sample, while antidepressants were the least-used class of psychotropics. Polypharmacy was common: on average, each treated patient was taking 2.7 drugs (+/- 1.1); antipsychotic polypharmacy was also common. Many prescriptions were loosely related to specific diagnoses. Antiparkinsonianian drugs were prescribed to approximately 1/4 of the sample. Mild or severe adverse events in the previous month were reported for 9.9% and 1.4% of the sample, respectively. About 15% of patients suffered from tardive dyskinesia. CONCLUSIONS: Psychotropic drug prescription patterns for severe patients living in RFs are only sometimes satisfactory and offer the opportunity of improvement. Specific actions are required to improve prescription patterns for severe patients in RFs.

Adolescent↗
PubMed2004

Standardized order form for investigational drugs: effect on completeness of the prescription.

AIM: To compare completeness and quality of orders written before and after introduction of a preprinted medication order form for investigational drugs. Completeness of physician's orders for investigational drugs was compared during two successive periods: before and after implementation of a preprinted form for these orders. METHOD: Orders were checked for six elements: pharmaceutical company's identity, protocol's name, patient's identity (i.e., initials), investigator's signature, order's date, and drug designation. Each element was categorized according to three quality criteria: mistake (wrong information), omission, or imprecision (incomplete information). A total of 536 orders were evaluated corresponding to 268 orders and to 4824 quality criteria in each period. RESULTS: During the baseline study, 228 (85%) problematic prescriptions were detected. Of the 4824 quality criteria evaluated, 422 (8.7%) errors were recorded. Common types of errors were omission of pharmaceutical company's identity, mistaken protocol name, and omission of patient's identity. After the introduction of the order form, 13 (4.9%) prescriptions contained errors. Fifteen (0.3%) quality criteria were not in conformity with the standard. The common types of errors were omission of patient's identity and order date. Physician's orders for investigational drugs are more complete when they use a preprinted prescription form than when they use traditional orders. CONCLUSION: The introduction of a preprinted order form for investigational drugs prevents potential medication errors and contributes to patients' safety.

Clinical Trials as Topic↗