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PubMedDate not supplied

[Medical schools: opportunities to improve drug prescription].

This paper reviews different strategies to improve medical prescription. Medical schools, responsible for the education and updating of physicians, should strengthen educative strategies, both curricular and extracurricular. They must also support managerial and regulatory strategies in collaboration with institutions that provide health services and governmental health ministries. Some characteristics of rational and irrational medicinal prescription are listed. Some educational strategies are described, such as a decrease in the number of drugs reviewed during pharmacology courses, the inclusion of the concept of essential medicines, the use of sources of information about drugs, and problem-based learning. Some managerial strategies are mentioned, such as a research on medicine use and the production of therapeutic guidelines that require the involvement of health services providers and that might be supported by medical schools. This paper also points out the need for continuing medical education and explains some related experiences that have been successful in improving drug prescription practices in other countries.

Drug Prescriptions↗
PubMed2006

Fluoride knowledge and prescription practices among dentists.

The purpose of this study was to assess dentists' knowledge about fluorides as well as their prescription practices. The study population consists of all general and pediatric dentists in Houston, and the sample consists of 360 general and forty-one pediatric dentists. Data were collected with a self-administered mail questionnaire, which consisted of thirteen open-ended and twenty-nine precoded items. After three mailings, the effective response rate was 46.4 percent. Respondents had been in practice on an average of 18.9 +/-6.6 years; the majority were male. More than 75 percent of respondents believed fluoride level in drinking water is an important determinant of fluoride supplement prescription, and 29 percent felt the same about a patient's weight. The correct ages at which to begin (six months) and to discontinue (sixteen years) the fluoride supplements to children were identified by 14.7 and 14.9 percent of the respondents, respectively. Only 6.7 percent of those prescribing fluoride supplements routinely tested the fluoride level in the patient's drinking water. Even though pediatric and general dentists differed in certain items, the two groups did not differ significantly in prescribing fluorides (OR=2.4, 95% CI=0.94, 6.27). Deficiencies and ambiguity in respondents' fluorides knowledge as well as prescription practices indicated a need for educational interventions.

Adolescent↗
PubMed2006

The role of bioethics in the international prescription drug market: economics and global justice.

In terms of health care access, bioethics has an important role to inform and shape policy issues and develop interdisciplinary ideas and interventions. The rising price of prescription drugs presents one of the most looming barriers to health care access in the world today. Including both theoretical and practical features of the pharmaceutical industry's behavior is necessary to find ethical solutions towards increasing access. Bioethics can evaluate global justice by weighing human rights theory and future innovation at the macro level, and by addressing market forces and responsibilities at the micro level. Inherent structural features of pharmaceuticals, such as its reliance on research and development, cause the industry to employ pricing strategies that seem counter-intuitive to conventional wisdom, but that result in producing a just allocation as defined by market forces. Parallel trade and drug exportation/reimportation threaten the saliency of the industry's differential pricing scheme; a case-study of a single "Euro-price" within the European Union illustrates how this will actually create harm to the most needy member states. This complex situation requires solutions weighing arguments from human rights theory with those from economic theory to arrive at the most globally just allocation of prescription drugs in the global marketplace, as well as to ensure future innovation and scientific progress. Bioethicists as well as economists need to partake urgently in this discourse for the betterment of the global injustices in the international prescription drug market.

Bioethics↗
PubMed1991

Possible applications of drug prescription monitoring systems in Italy.

Numerous experiences have already been implemented as regards the use of data concerning drug prescriptions and relative expenditure. This article focuses firstly on how such data are used from an administrative point of view in the Veneto Region, and secondly on the cultural and scientific aspects involved. The supply of feedback to general practitioners (GPs) with drug prescription indicators has made possible to cut down farmaceutical expenditure. Moreover, the analysis of the substances used by the GPs highlights the areas which require special attention in order to improve the quality of prescription.

Budgets↗
PubMed1991

Development of an electronic prescription processing option: an aid for general practice.

An interactive computer-supported prescription processing system has been developed as an add-on to existing general practitioner information systems. The aim of the system is to improve the clarity, efficiency and economy of drug treatment choices and prescription writing. It enables the doctor to choose the best treatment from the system's formulary according to the patient's complaint, symptom or diagnosis. The selections are based on complaints and diagnoses from the International classification of primary care (ICPC). A prescription is printed and the potential exists for individualized patient instruction leaflets to be printed. Furthermore, the system may prove useful for retrospective and prospective statistical and epidemiological studies. This implies continuous adaptation, which is also necessary to keep the system updated. As well as an aid in daily general practice, the system is also designed to serve the needs of graduate and postgraduate training programmes.

Drug Prescriptions↗
PubMed1991

[General practitioners' attitude to prescription of psychopharmaceuticals. Autonomy versus paternalism, education and understanding of disease].

The object of this investigation was to illustrate the attitudes of general practitioners to prescription of psychotropic drugs and to mental illness. The qualitative research interview method was chosen as the method employed here. Fourteen general practitioners were interviewed while one did not wish to participate. A marked difference was found between the attitudes of the general practitioners to respect the autonomy of the patients or to act paternally. The paternal general practitioner could either prescribe psychotropic drugs on his own initiative or refuse prescription. General practitioners who respected autonomy were relatively restrictive in their prescribing habits so that respect for autonomy was by no means expression for free prescription of psychotropic drugs. Their goal was that the patient should be placed in a situation where he/she could choose and determine personally. The general practitioners considered that their undergraduate and postgraduate training in treating patients with mental illness was inadequate. Taking into consideration how frequently patients with conditions of this nature are seen in general practice, this must be regarded as a serious deficit in medical training. A number of general practitioners have, however, received postgraduate training in this subject. General practitioners did not consider patients who consulted them with mental conditions as mentally ill but they did not have an alternative disease model by which they could classify the problems and complaints of these patients.

Attitude of Health Personnel↗
PubMedDate not supplied

Implications of the reclassification of drugs from prescription-only to over-the-counter status.

More than 200 over-the-counter (OTC) products and dosage forms were formerly restricted to prescription use. The reclassification process is gaining momentum; another 50 or so prescription drugs are targeted for transfer to OTC status. The transfer of drugs from prescription to OTC status is a logical and systematic development of today's health-care environment. The availability of safe and effective OTC drug products is sure to promote the general health of the American populace and to benefit members of the health-care system across the board.

Drug Prescriptions↗
PubMed1991

[Generic prescription/substitution. A 6-month project in a general practice concerning prescription of synonymous preparations].

During a period of six months, two general practitioners with a total of approximately 2,800 Danish National Health Service patients investigated the advantages and disadvantages of generic prescription. Only preparations from Group C (heart and vascular disease) and Group M (bones, joints and muscles) were included. A total of 1,421 prescriptions were issued and synonym preparations were issued for 280 of these. A total of 135 out of 140 possible patients received synonym preparations and 98 (72.6%) out of 135 possible patients replied to a questionnaire sent to them. Out of these 82 (83.7%) were so satisfied with the arrangement that they considered that it should continue. Out of the total of 1,421 prescribed preparations, the savings involved were 6.4% from the Danish National Health Insurance, 4.5% for the communities and 8.4% for the patients. This corresponds to a total saving for Groups M and C of 18,628 Danish crowns (approximately 1,555 pounds) out of the original sum of 278,296 Danish crowns (approximately 23,200 pounds) which corresponds to 6.7%. In Denmark, Groups M and C constitute approximately 25% of all the prescriptions issued. More extensive investigations are recommended to illustrate this subject and before any definite conclusion are drawn.

Denmark↗
PubMedDate not supplied

Effect of health education in promoting prescription refill compliance among patients with hypertension.

A multifactorial health-education program designed to enhance compliance with a once-daily regimen of atenolol was evaluated among 453 patients enrolled in health maintenance organizations (HMOs). The initiation of the 180-day study period was used to classify patients as either new or existing cases of hypertension. In turn, patients in these two categories were randomly assigned to a control or an experimental group. Patients assigned to the experimental groups received an enrollment kit upon exercising their initial prescription (new patients) or their first refill request (existing patients). The kit contained: a 30-day supply of atenolol; an educational newsletter about hypertension; information on nutrition and life-style changes; and an explanation of the intent and content of the program. Before the next scheduled prescription-refill date, each patient was contacted by telephone to inquire about his or her experience with the therapy and to stress the importance of adherence to the regimen. Each month thereafter, the newsletter and an enclosed prescription-refill reminder were mailed to each patient. The medication possession ratio, defined as the number of days' supply of atenolol obtained by a patient during the 180-day study period, was significantly (P less than or equal to 0.001) enhanced for the new and existing experimental groups relative to the control groups. Multiple regression analyses revealed that enrollment in the health-education program increased the number of days' supply of atenolol obtained by existing patients by 27 (P less than or equal to 0.001), and by new patients by 40 (P less than or equal to 0.001).

Atenolol↗
PubMed1991

Kinetics and quality assurance: prescription therapy through kinetic modeling.

With recent startling statistics showing an increase in mortality risk of dialysis patients in the United States compared to other countries, managers and practitioners have been motivated to carefully examine not only the dialysis prescription, but what is actually delivered to the patient. In October 1990, prior to ANNA's Clinical Concerns in Nephrology meetings in Cincinatti and San Antonio, attendants were invited to participate in an education session examining the monitoring and evaluation of prescription therapy for peritoneal and hemodialysis. The title of the session was "The Nurse's Role in Prescription Therapy--What Does it Really Mean?" The sponsor was Fresenius USA, Inc. This educational offering gave the nephrology nurse the opportunity to learn how to manage the delivery of care based on the theory of kinetic modeling for peritoneal and hemodialysis therapy. Quality assurance indicators, data collection tools, and the latest technology were described for the monitoring and evaluation of the adequacy of therapy. The following article is adopted from the original transcripts of the five-member panel of experts who participated in the session. We appreciate the willingness of the speakers to share this timely and important material with the ANNA Journal readers.

Data Collection↗
PubMed1990

Choices in prescription-drug benefit programs: mail versus community pharmacy services.

Pharmaceutical price increases and greater coverage of outpatient prescription medications have stimulated interest in containing drug benefit-program costs. While mail pharmacy services (MPS) may achieve savings through volume purchasing, high usage of generic drugs, and dispensing larger quantities of medication per prescription, efforts are also underway to adapt community-pharmacy-based services to keep costs down in these areas. No controlled studies document a difference in quality between the two types of services. Third-party administrators and benefit managers need to consider factors such as providing information to patients, monitoring drug therapy, dispensing patients' correct medication, and cost-control incentives when assessing MPS's role in prescription drug programs.

Community Pharmacy Services↗
PubMed1990

Prescription drug control and dispensing.

This paper is formulated to discuss the issues of prescription drug control and dispensing, particularly as it relates to the problem of drug abuse in general, which is the purview of the Committee on Drugs, The issues are several: 1. The large morbidity and mortality associated with the use of prescription and nonprescription drugs in this country. 2. The issue of recreational use of drugs, most important numerically being alcohol, and the many other drugs which are both licit and illicit, primarily illicit. 3. The issue of drug addition and how to prevent and treat it. 4. The issue of law enforcement with regard to both illicit drugs and the diversion of licit drugs and the increasing mortality associated with the trafficking and law enforcement of drug abuse. 5. The issue of restricting the rational use of medicines. The question of whether a governmental system which totally proscribes certain drugs and provides extreme restrictions on the prescription of others will reduce deaths and morbidity is an open one. There seems little doubt that our country has extremely prohibitive and restrictive laws and yet has a huge mortality associated with distribution networks of illicit drugs and also more than ten thousand deaths a year from drug overdose.

Drug Prescriptions↗
PubMed1990

Abuse of prescription drugs.

An estimated 3% of the United States population deliberately misuse or abuse psychoactive medications, with severe consequences. According to the National Institute on Drug Abuse, more than half of patients who sought treatment or died of drug-related medical problems in 1989 were abusing prescription drugs. Physicians who contribute to this problem have been described by the American Medical Association as dishonest--willfully misprescribing for purposes of abuse, usually for profit; disabled by personal problems with drugs or alcohol; dated in their knowledge of current pharmacology or therapeutics; or deceived by various patient-initiated fraudulent approaches. Even physicians who do not meet any of these descriptions must guard against contributing to prescription drug abuse through injudicious prescribing, inadequate safeguarding of prescription forms or drug supplies, or acquiescing to the demands or ruses used to obtain drugs for other than medical purposes.

Drug Prescriptions↗
PubMed1990

Use of the Borg scale in exercise prescription for overweight youth.

Twenty overweight children, ages 9-15 years, participated in a study on the usefulness of the Borg 6-20 perceived exertion (RPE) scale as a means for exercise prescription. As a criterion measure, they cycled at four intensities, based on pre-determined % peak power, giving RPE ratings at each load. During two return visits subjects were asked to set the resistance on the ergometer (cycle tasks) and to walk or run around an oval track (track tasks) at intensities they perceived as RPE = 7, 10, 13 and 16. HR-on-RPE regressions were compared among the criterion, cycle and track tasks. Cycle and track lines differed from the criterion (p less than .001). Subjects were, however, able to discriminate among each of the RPE prescriptions on the cycle. They overestimated intensities on the track tasks. We conclude that overweight children need additional instruction in using the Borg scale for exercise prescription.

Adolescent↗
PubMed1989

A classification of prescription errors.

Three independent methods of study of prescription errors led to the development of a classification of errors based on the potential effects and inconvenience to patients, pharmacists and doctors. Four types of error are described: type A (potentially serious to patient); type B (major nuisance - pharmacist/doctor contact required); type C (minor nuisance - pharmacist must use professional judgement); and type D (trivial). The types of frequency of errors are detailed for a group of eight principals from one health centre. There were a total of 504 errors from 15,916 prescription items (3.17%) during a three month observation period. A close correspondence was found between individual doctor's types of error rates, suggesting that doctors who make type C and D errors are also likely to make type B (major nuisance) errors. A system of feedback of errors from each doctor was devised. No significant reduction was seen in error rates, possibly because the group of self selected doctors taking part had low error rates initially. It is suggested that pharmacists and doctors should work closely together to prevent the potentially harmful consequences of prescription errors.

Drug Prescriptions↗
PubMed1986

Methods of providing prescription drug benefits in health plans.

Drug-benefit programs in health plans that offer varying degrees of risk to pharmacy providers are described. Administrators of health plans attempt to control the total cost of a drug benefit by controlling the cost per prescription, number of prescriptions, and administrative expenses. Specific ways to control these factors, such as through discounted product costs, patient copayments, and audits of prescribing practices, are described. Drug-benefit programs generally follow one of three models: fee-for-service contracts, hybrid fee-for-service risk contracts, and full-risk contracts. Examples of plans within each model are described. Full-risk contracts that provide drug benefits on a capitation basis put pharmacy providers at most risk of financial loss since physicians control prescribing. Pharmacists can control their risk by establishing a joint pharmacist and physician prescription fund that includes contract provisions limiting maximum losses, defining exceptions to the drug benefit, and paying close attention to payment schedules and characteristics of the program administrator. Antitrust issues associated with these new types of drug-benefit plans are described. Drug-benefit programs involving risk contracts can aid pharmacy practice by improving cash flow via negotiated prepayments, defining an enrolled patient population, and creating opportunities for generating additional revenue. Drug-benefit programs involving full-risk contracts and hybrid fee-for-service risk contracts will continue to develop, and understanding these models is the first step toward successful risk contracting by pharmacists.

Contract Services↗
PubMed1985

Optometric prescription writing.

A clearly written prescription is an important part of good optometric patient care. There are seven parts of a well-written prescription, and each of these should be considered individually. This article discusses these seven parts, and also other important aspects of prescription writing.

Drug Prescriptions↗
PubMed1983

[Drugs and general medicine. Study of the profile of prescriptions and requests of the patients].

744 prescriptions written by a general practitioner are analyzed. It emerges that out of 1759 drugs prescribed, 13.5% are considered to have been directly demanded by the patient. This demand, which approaches 30% in women over 65, chiefly relates to hypnotics and tranquillizers. It involves a rise of 13% in pharmaceutical costs if the physician yields to the demands. In this study an average of 2.4 drugs were given per prescription and the average prescription cost is 47.65 Swiss francs. The scope of such demand should be taken into consideration more often when studying drug consumption in general and prescribing patterns in particular.

Adolescent↗