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PubMed1982

Inadequately written prescriptions: prescriber rationales for "take as needed" and "take as directed.".

An audit of a large sample of prescriptions written by 39 physicians revealed considerable variation in the rate at which they specified adequate dosage instructions. When asked for their rationales for saying "Take as needed" or "Take as directed" on prescriptions, the physicians cited several circumstances where these instructions may be indicated. "Take as directed;; is defended 1) when the patient has a history of compliance with the regimen being prescribed; 2) when the prescription is accompanied by verbal or auxiliary written instructions; 3) when oral contraceptives are ordered; and 4) when the prescribers may need to make frequent changes in a regimen and wish to communicate these changes orally. "Take as needed" is defended when the drug is to be taken only when the patient determines that sufficient symptoms have appeared. Prescribers are cautioned to consider whether the assumed advantages of nonspecific dosage instructions are outweighed by the possible risks of patient confusion.

Drug Labeling↗
PubMed1982

The effect of Medicaid on the quantity of drugs dispensed per prescription.

Several studies have been conducted in order to determine the effect of the Medicaid program on drug utilization. This paper describes a research project that attempted to determine whether the Medicaid program has any effect on the quantity of drugs dispensed per prescription. A sample of privately paid prescriptions was compared to all Medicaid prescriptions in Iowa during the fiscal year 1972-73. A randomized block design for analysis of variance was used. The results showed that, overall, the quantity prescribed per patient was greater in the Medicaid population than for the privately paying sample. However, when broken down by therapeutic category, 4 of the 15 drug classes examined displayed higher quantities in the privately paying sample. These four categories were classified as maintenance drugs.

Drug Prescriptions↗
PubMed1989

Assessing potential prescription reimbursement changes: estimated acquisition costs in Wisconsin.

Potential impacts from two methods of changing prescription drug ingredient reimbursement in the Wisconsin Medicaid program were estimated. Current reimbursement amounts were compared with those resulting from either direct prices for eight manufacturers' products and average wholesale price less 10.5 percent for other products or wholesaler cost plus 5.01 percent for all products. The resulting overall average ingredient cost reimbursement reductions were 6.64 percent ($0.56 per prescription) and 6.94 percent ($0.59 per prescription) for the two methods, respectively. The results should be viewed from the perspective of both program savings and reduced pharmacists' revenues.

Costs and Cost Analysis↗
PubMed1999

Medicinal plants: pharmacopoeial prescriptions.

Medicinal plants still account for 25% of medical prescriptions in developed countries and for more than 80% in developing countries. Vegetable raw materials available in the commercial market frequently do not comply with the requirements of constant activity, efficacy and quality. There is a need for more strict specifications of vegetable drugs and the pharmacopoeial prescriptions usually provide these specifications. The characteristics of pharmacopoeial prescriptions are discussed in view of most common problems in drug quality.

Consumer Product Safety↗
PubMed1999

Reference-based pricing of prescription drugs: exploring the equivalence of angiotensin-converting-enzyme inhibitors.

BACKGROUND: Reference-based pricing is a cost-containment policy applied to prescription drugs that are in the same class and deemed to be therapeutically equivalent. Recent reference-based pricing measures have targeted several drug classes, including angiotensin-converting-enzyme (ACE) inhibitors. The objective of this study was to assess whether patients treated for hypertension with various ACE inhibitors differed in their utilization of health care services and hence, whether the various ACE inhibitors should be considered therapeutically equivalent. METHODS: A retrospective cohort was formed from 4709 Saskatchewan residents aged 40-79 years who initiated treatment for hypertension with 1 of the 3 most frequently prescribed ACE inhibitors (captopril, enalapril or lisinopril) between Jan. 1, 1991, and Dec. 31, 1993. Information obtained from universal insurance databases included prescription drug use, the number of visits to a general practitioner (GP) or specialist and the number of hospital admissions during the year before treatment was initiated and during a follow-up period of up to 4 years. Rates were statistically adjusted for potential confounding variables and compared across treatment groups. RESULTS: Of the 4709 patients, 529 were prescribed captopril initially, 2939 enalapril and 1241 lisinopril. After treatment was initiated patients prescribed captopril were dispensed more medications on average, with an overall rate of 18.6 prescriptions per patient per year (v. 16.4 and 14.7 for enalapril and lisinopril users respectively); they were admitted to hospital more often, and they made more visits to GPs and specialists. The adjusted rate ratio of the number of visits to a GP for patients receiving enalapril, relative to captopril, was 0.84 (95% confidence interval [CI] 0.80-0.88), and for those receiving lisinopril it was 0.79 (95% CI 0.74-0.83). The adjusted rate ratios for the number of visits to a specialist were similar but lower, and for the number of hospital admissions they were 0.82 for patients prescribed enalapril initially (95% CI 0.73-0.93) and 0.65 (95% CI 0.56-0.75) for those prescribed lisinopril. INTERPRETATION: Patients with hypertension who are initially prescribed captopril used health care services more than those initially prescribed enalapril or lisinopril. This suggests that ACE inhibitors may not be therapeutically equivalent.

Adult↗
PubMed1999

[National surveillance of Helicobacter pylori eradication in Denmark. Results based on registration of 34.582 drug prescriptions].

We wanted to characterize the use of H. pylori eradication therapy in Denmark (inhabitants 5,227,862). All H. pylori eradication treatments from a nation wide database covering all drug prescriptions in the period January 1994-June 1996 were identified. We found 28,784 out-patients having a prescription with drugs for H. pylori eradication, accounting for 34,582 prescriptions in total. The incidence of new consumers was 220 per 10(5) inhabitants per year, with a maximum at 70-79 years of age. Eighty-six percent of the patients had only one treatment course. Forty-five percent 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. In conclusion, 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 eradication treatment.

Adult↗
PubMed2000

[The prescription in dispensary practice].

Although the medical prescription is a well-established process, prescribing in the pharmacy does not follow a well-defined set of rules as, in official terms, there is no such thing as a pharmaceutical prescription. Despite this fact, daily pharmacy practice involves giving professional advice and dispensing drugs not only in fulfillment of a medical practitioner's prescription but also by selling drugs the pharmacist personally advises use of. In this particular case, the pharmacist must assess the patients desire for a specific treatment and determine whether it is well founded. The pharmacist has to decide whether he/she can deal with the presenting symptom or whether the person should be referred to a practising physician. For example, often-recurring mouth disease such as mouth-ulcers and gingivitis can be handled within the pharmacy. The pharmacist may think of implementing a suitable treatment involving dietary and hygienic counselling and dispense carefully selected drugs. The situation is similar in many other clinical conditions. As the pharmacist has had professional training in drugs at the university and teaching hospital, he/she is the expert in drugs and can rightly claim entitled to prescribing drugs within reasonable limits.

Drug Prescriptions↗
PubMed1999

Can dialysis adequacy be achieved by tailoring the dialysis prescription in an Asian pediatric population on nightly intermittent peritoneal dialysis?

This study was undertaken to determine whether tailoring the dialysis prescription in Asian children on nightly intermittent peritoneal dialysis (NIPD), without adding high-dose therapy for cost-savings purposes, was able to achieve dialysis adequacy and improvement in nutrition. Eight children (age range: 5.5-20 years) on NIPD for a mean of 2.1 +/- 0.6 years, were studied at baseline and at 3 months and 9 months after their dialysis dose was tailored. Dialysis adequacy was measured by weekly Kt/Vurea and creatinine clearance (CCr). Fat-free mass (FFM) and percent body fat (%FAT) as measured by bioelectrical impedance, together with anthropometric measurements, serum total protein, and albumin, were used as indicators of nutrition. After the dialysis prescription was tailored, the mean weekly Kt/Vurea increased from 1.89 +/- 0.35 to 2.12 +/- 0.54 at 9 months, and total CCr increased from 36.4 +/- 11.51 L/1.73 m2 to 48.30 +/- 14.30 L/1.73 m2. The increase occurred despite a decline in residual renal function and was attributable to significant improvements in the peritoneal clearances of urea and creatinine (p < 0.05). The mid arm muscle circumference (MAMC) increased significantly (p = 0.006), while FFM increased from 25.68 +/- 7.92 kg to 26.95 +/- 9.83 kg, and %FAT decreased from 21.56% +/- 8.41% to 18.66% +/- 8.16%. The increase in FFM correlated significantly with a decrease in serum creatinine (r = -0.94, p = 0.005). In conclusion, tailoring the dialysis prescription in NIPD, without adding high-dose therapy, resulted in a trend of improvement in dialysis adequacy and some nutritional parameters.

Adolescent↗
PubMed2000

Rheumatoid arthritis in Sweden. Drug prescriptions, costs, and adverse drug reactions.

OBJECTIVE: Many patients with rheumatoid arthritis (RA) need continuous medication, bringing considerable costs for drugs and a need for monitoring adverse drug reactions. We studied drug exposure, drug costs, and adverse drug reactions in patients with RA in Sweden from 1987 to 1997. METHODS: Prescription patterns, drug costs, and adverse drug reactions, and their distributions and trends were analyzed by cross sectional annual data. Drug exposures and costs were assessed from the National Diagnosis and Therapy Survey. All costs were recalculated to the 1997 level using the drug price index. Information on adverse drug reactions was obtained from the national pharmacovigilance system. RESULTS: The drug prescription level was, on average, 2 defined daily doses (DDD) throughout the study period. Nonsteroidal antiinflammatory drugs (NSAID) accounted for > 40% of the drugs prescribed, methotrexate (MTX) 10%, corticosteroids 10%, and sulfasalazine 5%. Analgesics and opioids made up 14% of prescriptions - a low estimate considering the availability of over-the-counter preparations. Disease modifying antirheumatic drugs (DMARD) increased their proportion from 28.5 to 39.3%. Total costs were stable at $16 million US annually. NSAID costs decreased, while those of sulfasalazine, MTX, and cyclosporine increased. On average, 91 adverse drug reactions were reported annually. Hematological reactions (agranulocytosis, thrombocytopenia, leukopenia, pancytopenia) predominated, constituting 21% of reported reactions. Skin and gastrointestinal reactions, mainly mild, accounted for 15 and 14%, respectively. Deaths from adverse drug reactions were uncommon, about 3 per year, and were mainly attributed to hematological reactions. CONCLUSION: The total volume as well as the total cost of drug consumption for RA in Sweden was relatively constant during our 11 year observation period, despite a notable increase in the use of DMARD. This was mainly due to a decrease in costs per DDD of NSAID, and an increased use of cyclosporine. Drug related adverse reactions were dominated by hematological reactions, and fatal events were few. This emphasizes the need for an extended evaluation of which safety procedures are most cost effective for monitoring the drugs used for RA.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

[Drug prescriptions outside the marketing product license and its responsibilities].

In France, drugs are commercialized after obtaining marketing approval. There are some situations however in which clinicians are authorized to prescribe drugs outside the limits set by the approval document. Clinicians must comply with certain number of regulations. Compliance with prescription modalities, particularly precautions concerning prescription writing or the patient's informed consent, is mandatory. Although patients cannot be reimbursed for drugs prescribed outside the approval limitations, they may nevertheless benefit from special dispositions: temporary approval for use and experimentation within the framework of the Huriet law. We analyze here the question of liability in case of drug prescriptions outside approval limitations, discussing the issues of civil and penal law and patient reimbursement.

Drug Approval↗
PubMed2000

[Interactions and incompatibilities in prescription drugs. Incidents in dental surgery].

Drug interactions can be classified according to their pharmacodynamic and pharmacokinetic mechanisms. Pharmacodynamic interactions are observed when two drugs share a common effect or have the same effect on different receptors of a common function. They can be predicted if the elementary effects of each drug are known. Such are pharmacodynamic interactions are particularly interesting as they are selective for the common effect(s). Pharmacokinetic interactions are more difficult to predict. They occur when one drug modifies the pharmacokinetic parameters of a second drug. Modification may involve variations in oral absorption, tissue distribution, rate of metabolism and/or rate of renal excretion. This interaction cannot be selective as drug concentrations are modified, affecting all the concentration-dependent effects. Mastering drug interactions involve the knowledge of the underlying mechanisms. Answers to following questions are needed: does the association produce conjugated effects? can one drug modify pharmacokinetic parameters of another? Potentially toxic effects may be suspected when at least one drug involved is known for its toxicity. Risk is increased when it also exhibits a narrow range between active and toxic concentrations. Many databases in printed form or as interactive software provide information on drug interactions. Clinicians can also consult a Pharmacovigilance Center for a safe prescription procedure. Finally, the main danger lies in the simultaneous prescriptions by different practitioners unaware of their colleagues prescription. In this case, the pharmacist plays an important role of evaluation of the drugs prescribed.

Drug Antagonism↗
PubMed2000

Patterns of prescriptions and drug use in two tertiary hospitals in Delhi.

The study was carried out to assess prescribing trends in outpatients at Dr. R.P. Centre for Ophthalmic Sciences (RPC) and other OPD's of All India Institute of Medical Sciences (AIIMS) and Safdarjung hospitals, two premier hospitals in Delhi. Prescriptions of 500 patients were audited and analysed under heads of average number of drugs per patient, percentages of drugs prescribed by generic name, antibiotics, injections, drugs from WHO recommended essential drug list, availability of drugs etc. using WHO basic drug indicators. Prescription analysis showed that 75 to 95% drugs were prescribed from essential drug list. The average number of drugs per prescription was 1.42 to 4.07. Percentage of antibiotics prescribed varied from 14.39% to 22.28%. The use of injections was from nil to 4.4%. Availability of drugs was however, not satisfactory. Though maximum drugs were prescribed from essential drug list, the results indicate that there is a considerable scope for improving prescribing habits according to rational drug use and to provide a feed back to hospital authority for making maximum number of drugs available to the patients.

Cost-Benefit Analysis↗
PubMedDate not supplied

[Drug prescription for pregnant women in the department of the Loire] .

A prospective drug prescription and descriptive study was undertaken in a sample of 214 pregnant women in the department of the Loire. This population was randomized using pregnancy declaration files from the French Health Care Centre. Data recording was retrospective. A total of 2064 drugs have been prescribed; 90 per cent of women received at least one drug during the course of pregnancy with an average of 11.5 drugs per woman. Antispasmodics are mainly prescribed in the first trimester while vitamins, mineral supplements, antianemics and vasoactive agents are found in the third trimester. Prescriptions do not rise with age but increase in urban areas. Use of PDD/DDD (Prescribed Daily Dose/Defined Daily Dose) is an estimation of prescription customs. For ketoprofen, it is 1.6 in the last trimester, although this drug is contra-indicated.

Adolescent↗
PubMed2001

Acquired limb deficiencies. 3. Prosthetic components, prescriptions, and indications.

UNLABELLED: This self-directed learning module highlights indications for prosthetic components and prescription formulation for adults with acquired limb deficiency. It is part of the chapter on acquired limb deficiencies in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Advantages and disadvantages of specific components of upper and lower limb prostheses are discussed, and a sample prescription sheet for upper limb devices is included. Recent innovations in terminal devices for upper limb prostheses are reviewed. Special considerations for the adult with acquired multilimb deficiency are also examined. OVERALL ARTICLE OBJECTIVE: To describe indications for prosthetic components and prescription formulation for adults with acquired limb deficiency.

Adult↗
PubMedDate not supplied

[Essential drugs: availability and prescription in Monastir (Tunisia) health district].

Shortages in the availability of some drugs are sometimes noted in primary health care (PHC) centres in spite of the steady increase in the drug budgets in Tunisia. We conducted a survey therefore in 1998 in the health district of Monastir to study the availability of certain essential drugs (n = 15) in PHC centres and the main features of the drug prescription. We found that the drugs lacking were generally those prescribed for chronic diseases and as well as oral antibiotics. Antibiotic treatment constituted 71.8% of public prescriptions and 32.3% of these prescriptions were for an injectable treatment.

Anti-Bacterial Agents↗
PubMed1999

[Documents related to a medical prescription book in the Date Museum (Date City, Hokkaido)].

This is a report of a prescription book which Munetomo Murayama, a medical doctor attached to the Date Watari Feudal Clan, inherited from his ancestors and handed on to his descendants. It is now preserved in the Date Museum in Date, Hokkaido, Japan, and the records there show that it was donated by a descendant of Dr. Murayama. The prescription book is unique in its detailed descriptions that are different from traditional medicine. It describes specific illnesses and the medications that were used in their treatment. The illnesses described are not serious ailments but illnesses commonly encountered in daily life and commonly available (over-the-counter) drugs recommended for the treatment of stomach ailments, diarrhea ; drugs for external use, also 'tochino' (a non-prescription drug commonly used for all kinds of illnesses in old times in Japan), drugs for tiredness, hemorrhoids, cough relief, aroma therapy, and others. Some of the drugs are also recognized today as being effective and having medicinal effects. They are thought to be agents with medicinal effects and the treatments reported by Dr. Murayama are separate and different from the Shimizu style in which they are applied.

Drug Prescriptions↗
PubMed2000

[Discussion on the contribution of Thousand golden prescriptions to the art of tuina].

Thousand Golden Prescriptions, including Thousand Golden Prescriptions for Emergencies and Supplements to Thousand Golden Prescriptions is an important medical book containing the main medical achievements before the Tang dynasty. It attaches great attention to daily tuina for health-care, enriches its contents, and makes a description to the method of tuina for children, offering detailed materials for later ages with significant reference value, and makes an important contribution to the art of tuina.

China↗
PubMed2001

Compliance with prescription recommendations by physicians in practices.

OBJECTIVES: Few investigations are available on the primary supply of patients in Germany. But they play a key role due to their relevance in health politics and economics. An analysis has been carried out to determine the extent to which physicians in practices adhere to the recommendations in the package inserts and to determine the consequences of this behavior regarding the safety and efficacy of prescribed drugs. METHOD: The analysis was carried out with the IMS HEALTH mediplus patient database, which is a database providing anonymous access to a representative panel of physicians and patients in Germany. More than 1,000 medical practices including more than 5 million patients and over 75 million prescriptions can be analyzed in a cross and/or longitudinal section. The evaluation time period per patient currently exceeds 10 years with monthly updates. RESULTS: Kava-Kava drug prescriptions indicate that the recommended daily dose was significantly overstepped in 78% of the cases. The recommended daily dose complied in only 41% of the cases whereas in 3 9% of the cases, the drug was underdosed. DISCUSSION: These results may give an explanation why Kava-Kava prescriptions are associated with a high incidence of adverse drug reactions. On the other hand, lack of efficacy in many patients was mainly due to the fact that the drug was underdosed.

Drug Industry↗