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PubMed1997

Use of sumatriptan in Denmark in 1994-5: an epidemiological analysis of nationwide prescription data.

AIMS: We describe the use of medication with symptomatic relief of migraine as specific indication by analysing prescription data from the entire Danish population in 1994 and 1995. METHODS: The data for sumatriptan were analysed at the level of the individual user. We used aggregated data for ergotamine drugs. RESULTS: Sumatriptan constituted 46% of the total amount of defined daily doses (DDD) sold and 94% of the total pharmacy retail price expenses in the drug-group studied. In total, 43389 users of sumatriptan were identified who presented 340148 prescriptions, corresponding to 2.2 million DDD of sumatriptan. The quarterly consumption increased by 50% during the study period. Tablets accounted for 92% of consumption. The 1 year period prevalence of use of sumatriptan among persons 16 years and older was 7.8 per 1000 in 1995 with a female to male prevalence ratio of 3.8:1. Use was most common in the age interval 35-54 years. Regional differences in use, which were not large, were positively correlated to the degree of urbanization. The incidence of use of sumatriptan was estimated at 3.6 per 1000 person-years. The intensity of use of sumatriptan varied greatly with 1.1% of patients (n = 507) using 60 DDD or more within 30 days at some time during the observation period. Long-term high use of tablets was common in this group. CONCLUSIONS: We conclude that sumatriptan had a considerable impact on the treatment of migraine with prescription drugs in Denmark. The underlying reasons for high use of the drug in a smaller fraction of the patients deserve further study.

Adolescent↗
PubMed1997

A prescription survey in a hospital hypertension outpatient clinic.

AIMS: The objective of this study was to investigate drug utilization in the management of hypertension in Hong Kong. METHODS: We conducted a prescription survey to examine the use of antihypertensive drugs in a hypertension clinic in a regional hospital and the resulting expenditure incurred. The use of concurrent medications such as antidiabetic drugs and lipid-lowering agents was also examined. RESULTS: During a 7-week study period, 530 prescriptions were collected. All except 14 patients received antihypertensive drugs with 262 (50.8%) on monotherapy and 254 (49.2%) on combination therapy. Calcium channel blocking agents and beta-adrenoceptor blocking agents were the two most popular antihypertensive drugs used in both monotherapy (38% and 31%, respectively) and combination therapy (27% and 33%, respectively). Forty-nine patients (19%) received three antihypertensive drugs or more. The number of antihypertensive drugs showed a significant positive correlation with the duration of attendance at the clinic (r=0.88, P < 0.001). Of the total 530 prescriptions, 5.6% and 10% contained antidiabetic drugs and lipid-lowering agents, respectively. Calcium channel blocking agents, angiotensin converting enzyme (ACE) inhibitors and lipid lowering agents, accounted for 82% (HK$211,654; pounds sterling 1 approximately HK$12) of the total drug expenditure (HK$258,115). Seventy-nine percent of the lipid lowering agents prescribed were hydroxymethylglutaryl coenzyme A (HMG CoA) reductase inhibitors. Amlodipine accounted for 26% of usage but contributed to 41% of the overall costs of calcium channel blocking agents. Alpha1-adrenoceptor blocking agents were only used infrequently and were the most expensive class of drugs, due to the preferred use of doxazosin rather than prazosin which is far cheaper than the former. CONCLUSIONS: In view of the use of these often costly drugs for long-term therapy, monitoring of their use and its correlation with clinical outcomes and quality of life is essential to ensure the optimal use of health care resources.

Antihypertensive Agents↗
PubMed2001

Effectiveness of educational interventions on the improvement of drug prescription in primary care: a critical literature review.

This paper is a critical review of studies of educational programmes designed to improve prescription practices in ambulatory care. Scientific articles were selected from the following bibliographical indices: MEDLINE, IME, ICYT and ERIC. The searches covered the time period between 1988 and 1997. The search criteria included: primary-care, educat*, prescription* and other related keywords. The inclusion criteria were studies describing educational strategies aimed at general practitioners working in ambulatory settings. The study outcome was change in prescribing behaviour of physicians through prescribing indicators. The following data were extracted: study design, target drugs, type of intervention, follow-up period of the prescription trends, type of data analysis, type of statistical analysis and reported results. We found 3233 articles that met the search criteria. Of these, 51 met the inclusion criteria and 43 studied the efficacy/effectiveness of one or various interventions as compared to no intervention. Among seven studies evaluating active strategies, four reported positive results (57%), as opposed to three of the eight studies assessing passive strategies (38%). Among the 28 studies that tested reinforced active strategies, 16 reported positive results for all variables (57%). Eight studies were classified as a high degree of evidence (16%). We concluded that the results of our review suggest that the more personalized, the more effective the strategies are. We observe that combining active and passive strategies results in a decrease of the failure rate. Finally, better studies are still needed to enhance the efficacy and efficiency of prescribing practices.

Ambulatory Care↗
PubMed2001

Quality of antimicrobial drug prescription in hospital.

There is worldwide concern about the development of antimicrobial resistance [1]. Selective pressure by antimicrobial drugs is by far the most important driving force for the development of resistance. Antimicrobial drugs are among the most commonly prescribed drugs in hospitals. In developed countries, some 30% of the hospitalized patients will be treated with these drugs. It is generally accepted that antimicrobial prescribing is often suboptimal, even in a country like the Netherlands, where both antibiotic consumption and microbial resistance rates are low [2,3]. The major problem with inappropriate prescribing is because of insufficient education in infectious diseases and antimicrobial therapy. Often, the prescription of these drugs with little toxicity is unjustified because of insecurity about the diagnosis of the clinician; 'drugs of fear' [4]. In our surveys, some 15% of the antibiotic prescriptions in surgical and internal medicine wards were considered unjustified [5,6]. Many prescribers are not yet fully aware that their justified or unjustified prescription adds to the resistance problem. In this paper, aspects of the quality of antimicrobial prescribing in the hospital setting will be discussed.

Advertising↗
PubMed2003

Prescription patterns of diuretics in chronic heart failure: a contemporary background as a clue to their role in treatment.

BACKGROUND: Diuretics are the cornerstone of treatment for the congestive symptoms of heart failure (HF). Despite their widespread use, diuretic prescription data in clinical practice are scarce. In this study we evaluated the prescription pattern of diuretics in a large population of HF outpatients, enrolled by a national network of hospital-based cardiologists. METHODS AND RESULTS: Among 11070 HF outpatients (mean age 64 +/- 12 years, 72.9% men, 29.8% New York Heart Association [NYHA] class III-IV, mean left ventricular ejection fraction [LVEF] 35+/-12%), 9247 took a diuretic, the most frequently prescribed therapeutic agent (83.5%). Loop diuretics were prescribed alone (65.5%) or combined with other diuretics in 91.6% of patients. By multivariate analysis, the strongest independent predictors of diuretic use were a previous hospital admission for HF (odds ratio [OR] 2.55, 95% confidence interval [CI] 2.28-2.86), NYHA class III-IV (OR 2.52, 95% CI 2.14-2.96), LVEF < 30% (OR 1.87, 95% CI 1.57-2.24). Aldosterone antagonists were prescribed to 2142 patients (23.1%); independent predictors of their use overlapped with those of diuretics and moreover included treatment with loop diuretics (OR 3.52, 95% CI 2.66-4.66) and digoxin (OR 1.45, 95% CI 1.29-1.64). CONCLUSIONS: In this wide series of stable HF outpatients, cardiologists prescribed diuretics in accordance with published guidelines. Evolving prescription patterns of aldosterone-receptor blockers need to be further evaluated.

Diuretics↗
PubMed1996

[Relevance of general practitioner's prescriptions for hospital pharmacotherapy. A survey of hospital physicians].

BACKGROUND AND OBJECTIVE: At hospital admission drugs prescribed by the general practitioner (GP) are often changed. This may have a negative impact on the relationship between family and hospital physicians as well as on the family doctor-patient-relationship. The study set out to examine the attitudes of hospital physicians towards GPs' prior ambulatory medication, especially in the case of drugs of unproven efficacy (e.g. certain drug combinations and homeopathic or herbal drugs). PARTICIPANTS AND METHODS: A total of 129 doctors of the surgical and medical wards of the Göttingen University Hospital received a standardized questionnaire focusing on drugs prescribed by referring GPs (response rate: 65.9%). Three case vignettes were presented describing "popular" GP prescriptions. Doctors of surgical and medical departments were asked whether or not they would follow these prescriptions. Differences in the answers between the groups of doctors were tested by Fisher's exact test. RESULTS: More doctors on the surgical than on the medical wards would usually follow GPs' medication (82 vs 25%; P < 0.001). According to these attitudes, more doctors of medical departments would stop the prescription of drug combination (82 vs 41%; P < 0.001); both groups would be hesitant to accept homeopathic drugs (89 vs 59%; P < 0.01) or herbal drugs (89 vs 55%; P < 0.01) as prescribed by the GP. The critical attitude especially of doctors of the medical departments towards drug combinations and herbal drugs was in line with their decision in the case vignettes (e.g. Capozide, Tebonin forte). CONCLUSION: Especially doctors working in medical departments keep in line with conventional clinical pharmacological criteria. If they have to decide whether or not to follow patients' ambulatory medication, they may overlook GPs' decision-making process underlying their prescribing.

Aged↗
PubMed1998

National surveillance of Helicobacter pylori eradication therapy in Denmark. Results from registration of 34,582 prescriptions.

BACKGROUND: We wanted to characterize the use of Helicobacter pylori eradication therapy in Denmark (5,227,862 inhabitants). METHODS: All H. pylori eradication treatments from a nationwide database including all redeemed drug prescriptions in the period January 1994 to June 1996 were identified. So were all outpatients receiving a drug prescription for H. pylori eradication. RESULTS: We recorded 34,582 prescriptions for H. pylori eradication therapy given to 28,784 patients. The incidence of new consumers was 220 per 10(5) inhabitants per year, with a maximum at 70-79 years of age. Eighty-six per cent of the patients had only one treatment course. In 16% of the eradication therapies, nonsteroid anti-inflammatory drugs had been prescribed within the previous 3 months, and 45% had an anti-ulcer drug prescribed 1-12 months after the H. pylori eradication therapy. Consumption of antibiotics used for H. pylori eradication accounted for 1.4% of the total consumption of antibiotics. CONCLUSIONS: The incidence of H. pylori eradication therapy was fairly stable but with changes in the pattern of drug regimens used. Anti-ulcer drugs were often given after H. pylori eradication therapy, suggesting an inappropriate use of treatment.

Adolescent↗
PubMedDate not supplied

Fifteen solutions to the problems of prescription drug abuse.

In the 17 years since the publication of Pills, Profits, and Politics by Silverman and Lee, not one of that book's proposals has been fully implemented. This article begins by identifying the elements of prescription drug abuse: inappropriate physician prescribing, patient noncompliance, and poor doctor-patient communication. It then offers 15 solutions to these problems; these are divided into nonregulatory and regulatory solutions. Multiple prescription form laws are singled out for special attention and the experience with such a law in New York is discussed. Finally, the article offers some reflections on the optimal balance between nonregulatory and regulatory approaches to the problem of prescription drug abuse.

Drug Prescriptions↗
PubMed2006

Development of clinical guidelines for the prescription of orthoses in patients with neurological disorders in The Netherlands.

The objective of this study was to develop guidelines for the prescription of ankle-foot, knee, wrist-hand and elbow orthoses for patients with neurological disorders. The study is part of a more comprehensive study focusing on the development of clinical guidelines for the prescription of these orthoses in a wider patient population. Evidence from literature (reviews, randomized controlled trials with good quality), information from literature with a lower degree of evidence and information from structured interviews with experts in the field of orthotics, form the basis of statements presented in a Delphi procedure. The Delphi technique was used to gain consensus on statements published on the Internet. A group of experts in the field of orthotics and neurological disorders was asked to give their opinion on 41 statements. Statements with a general agreement of at least 75% were accepted. Statements with less general agreement were rewritten and the experts could react in a second and possibly in a third round. Afterwards, an opinion-based workshop was organized in which participants could react on preliminary guidelines and on Delphi-statements with between 65% and 75% agreement. Consensus on 32 statements was gained during the three rounds and the opinion-based workshop. These statements form the basis of the consensus based clinical guidelines for the prescription of orthoses in patients with neurological disorders.

Consensus↗
PubMed2006

Trends in morphine prescriptions, illicit morphine use and associated harms among regular injecting drug users in Australia.

This paper examines population trends in morphine prescriptions in Australia, and contrasts them with findings from annual surveys with regular injecting drug users (IDU). Data on morphine prescriptions from 1995 to 2003 were obtained from the Drug Monitoring System (DRUMS) run by the Australian Government Department of Health and Ageing. Data collected from regular IDU as part of the Australian Illicit Drug Reporting System (IDRS) were analysed (2001 - 2004). The rate of morphine prescription per person aged 15 - 54 years increased by 89% across Australia between 1995 and 2003 (from 46.3 to 85.9 mg per person). Almost half (46%) of IDU surveyed in 2004 reported illicit morphine use, with the highest rates in jurisdictions where heroin was less available. Recent morphine injectors were significantly more likely to be male, unemployed, out of treatment and homeless in comparison to IDU who had not injected morphine. They were also more likely to have injected other pharmaceutical drugs and to report injection related problems. Among those who had injected morphine recently, the most commonly reported injecting harms were morphine dependence (38%), difficulty finding veins into which to inject (36%) and scarring or bruising (27%). Morphine use and injection is a common practice among regular IDU in Australia. In some cases, morphine may be a substitute for illicit heroin; in others, it may be being used to treat heroin dependence where other pharmacotherapies, such as methadone and buprenorphine, are perceived as being unavailable or undesirable by IDU. Morphine injection appears to be associated with polydrug use, and with it, a range of problems related to drug injection. Further research is required to monitor and reduce morphine diversion and related harms by such polydrug injectors.

Adolescent↗
PubMedDate not supplied

Is the information "fair and balanced" in direct-to-consumer prescription drug websites?

This study applies the Food and Drug Administration's (FDA's) "fair-balance disclosure" provision to examine the content of prescription drug websites, specifically focusing on the quantity and quality of risk information. The results show that even though most prescription drug websites provide both risk and benefit information, the two types of information are presented differently. This study suggests directions for regulators to consider in writing a more specific rule to ensure that information on prescription drug websites is balanced.

Advertising↗
PubMedDate not supplied

Evaluations of the prescription order entry system for outpatient clinics by physicians in the 80 university hospitals in Japan.

We investigated the evaluations of the prescription order entry system by the physicians who are the direct users of this system. Questionnaires were sent to 400 staff physicians of 80 medical school affiliated hospitals, out of which 76% responded. Among the respondents, 48 per cent are making use of the computerized outpatient prescription order entry system, and 52 per cent are not. The result shows 78% of the physicians are in favor of the prescription order entry system; the most dissatisfied opinion of the physicians toward the system was that the input took too much time thus reduced the communication with the patient. Physicians who are using the system seemed to favor the system more than the physicians who are not using it.

Attitude to Computers↗
PubMed2001

Infectious diseases and public health: risk-taking behavior during participation in the Swiss program for a medical prescription of narcotics (PROVE).

The medically controlled prescription of narcotics program (PROVE) followed a uniform protocol from January 1, 1994 until December 31, 1996. The program included 800 slots for heroin prescription, 200 slots for intravenous methadone prescription, and 200 slots for intraveneous morphine. Admission criteria were age 20 and above, minimum 2-year duration of daily heroin consumption, failure in at least two previous treatments, and documented social and/or health deficits. There was a very high seroprevalence of hepatitis B (73%) and hepatitis C (82%) among the 1035 entrants. The rate of HIV (15%) was also high compared with prevalence of infection in other therapy programs (methadone program, inpatient therapy). The prevalence of HIV and hepatitis B/C increased with the duration of drug dependence and cocaine use. During treatment, use of street heroin and cocaine could be reduced substantially. After 18 months of continued participation in the program, 74% of patients reported no illegal heroin consumption, and the rate of cocaine abstinence increased from 15% at entry to 41%. Significant declines in visits to the drug scene, illegal income, and needle sharing were also observed. The high prevalence of HIV and hepatitis B and C confirm that a group of drug dependence with severe medical problems was reached in accordance with the admission criteria for the studies. During treatment, a significant reduction in risk-taking behavior was observed in a target population of heroin-dependent persons who failed in previous treatments.

Adult↗
PubMedDate not supplied

Balancing diversion control and medical necessity: the case of prescription drugs with abuse potential.

Narcotics and other prescription drugs play a significant and legitimate role in medical practice. The illicit use of prescribed medicines, however, remains a major problem. This paper examines the effectiveness of two drug diversion control programs, multiple copy prescriptions programs (MCPP) and electronic data transfer (EDT) systems, and their impact on medical practice. Current evidence demonstrates that these programs decrease prescription drug use, with much of the decrease due to declines in inappropriate use. MCPPs appear more effective than EDT in preventing diversion. More research is needed. however, to assess their effects on medical practice, particularly patient quality of care.

Clinical Pharmacy Information Systems↗
PubMed2004

The use, misuse and diversion of prescription stimulants among middle and high school students.

This present study investigated the prevalence and the factors associated with the use, misuse, and diversion of prescribed stimulant medication for attention-deficit hyperactivity disorder (ADHD) in a sample of middle and high school students. As part of a school-based, self-administered web survey in May 2002, students from a Midwestern public school district in the United States in grades six through eleven (n = 1536) reported on three aspects of prescription stimulants; they reported on their use, misuse, and diversion (e.g. trading, selling, offering) of stimulant medication for ADHD. The total student sample was 57% White, 40% African American, and 3% other racial and ethnic groups. Gender and school level were approximately equally distributed in the student sample, and 81% of students had plans to attend college. The illicit use of stimulant medication was reported by 4.5% of the overall sample. Of the students who reported prescription stimulant use, 23.3% reported being approached to sell, give, or trade their prescription drugs. After adjusting for socio-demographic factors, the odds for illicit use of stimulant medication was lower among African American students and higher among those students with no plans for attending college. When compared with students who did not use stimulants or who did not misuse stimulant medications also reported significantly higher rates of alcohol and other drug use. High schools students had the highest rates of alcohol and other drug use. High schools students had the highest odds for being approached to divert their stimulant medications. Our findings suggest that community-based approaches are needed to reduce the illicit use and diversion of stimulant medications within middle and high school student populations.

Adolescent↗
PubMed1998

Perspectives on switching oral acyclovir from prescription to over-the-counter status: report of a consensus panel.

The proposed switching of oral acyclovir from prescription to over-the-counter (OTC) status for the 5-day episodic treatment of genital herpes was considered by a consensus panel. It was concluded that self-diagnosis/misdiagnosis, misuse, and adverse drug effects were potential problems with the OTC use of acyclovir. While acyclovir reduces asymptomatic shedding of herpes simplex virus type 2, the reduction in transmission of virus potentially resulting from increased acyclovir use was felt to be of unknown extent but likely to be of benefit overall. The availability of acyclovir would likely be improved. There were differences in opinion as to whether widespread availability of acyclovir (prescription or OTC) may speed the development of viral resistance. However, all panel members felt that granting OTC status may set an undesirable precedent for the switch from prescription to OTC use of other systemically administered antiinfective agents. The effect of this precedent, in terms of accelerating development of multidrug-resistant bacteria, was a major concern of all panel members. The consensus was that the switch of acyclovir to OTC status could not be supported.

Acyclovir↗
PubMed2005

Ethnic differences in maintenance antipsychotic prescription among adolescents with bipolar disorder.

PURPOSE: The aim of this study was to compare the longitudinal use of psychotropic medications in African-American and Caucasian adolescents with a diagnosis of bipolar disorder following their first psychiatric hospitalization. METHODS: Age- and gender-matched African-American (n=16) and Caucasian (n=16) adolescents, between the ages of 12 and 18 years and meeting Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for bipolar I disorder, manic or mixed, were evaluated over a period of 1 year following their first psychiatric hospitalization for a mood episode. Medication prescription and adherence during follow-up were compared between ethnic groups. RESULTS: African-American adolescents received antipsychotic prescription for a significantly greater percentage of time during follow-up than Caucasian adolescents, after adjusting for rate of psychotic features (79% versus 40%; p=0.05). African-American and Caucasian patients received mood stabilizer/anticonvulsant prescription for similar percentages of time during follow-up. African-American and Caucasian adolescents exhibited similar rates of full adherence to antipsychotics, mood stabilizers/anticonvulsants, and all psychotropic medications. CONCLUSIONS: African-American adolescents were prescribed atypical antipsychotic medications for longer periods of time than Caucasian adolescents, but reasons for this finding were unclear. Additional research efforts in adolescent bipolar disorder are needed to explore factors associated with ethnic disparity in pharmacological treatment interventions.

Adolescent↗
PubMed2006

An integrated graphic scheme for the display of insulin prescription and blood glucose information.

OBJECTIVE: This study was undertaken to determine whether use of an integrated graphic scheme for the display of insulin prescription and blood glucose information has an impact on simulated decision-making in clinical practice. METHODS: Five test cases representing patients treated with multiple daily insulin regimens were selected from a database of stored blood glucose readings. Five endocrinologists made treatment recommendations based on review of aggregated readings and corresponding insulin prescriptions. Twenty subjects were randomized to complete two sets of sequential real-time data management exercises. One set focused on evaluation of insulin prescriptions and readings printed as entries in logbooks. The other focused on evaluation of displays of insulin doses and readings plotted out according to an integrated graphic scheme of representation. RESULTS: Subjects were more likely to make correct decisions in four out of five test cases after reviewing displays. Subjects were less likely to make incorrect decisions in all of five test cases after reviewing displays. Completion times were 30-66% shorter for exercises involving review of displays. CONCLUSION: An integrated graphic scheme that associates representations of insulin doses with metaphor graphic displays of aggregated blood glucose readings may facilitate decisionmaking in clinical practice.

Blood Glucose↗