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PubMed1983

Decentralized preparation of short-term prescriptions for discharged patients.

The rationale for and implementation of a decentralized system for filling short-term discharge prescriptions are described. To prevent interruption of drug therapy, orders for three-day supplies of medications were filled in the outpatient pharmacy and returned to patients before discharge. Under the old system, more than 20% of medications ordered were not received by patients. Reasons for this problem were identified, and a new system was designed in which these discharge prescriptions were filled in satellite pharmacies. A follow-up study under the new system showed that only 1.5-3% of discharge medications were not received by patients and that patients' use of the discharge medication program was increased. Implementation of a decentralized discharge prescription program using the existing satellite pharmacies allowed increased efficiency in delivery of medications to patients at the time of their discharge from the hospital.

Boston↗
PubMed1978

[Frequency of drug prescriptions and their adverse effects in a medical department].

The enquiries carried out in our unit since 1971, in some 1600 patients who received in all more than 13000 drug prescriptions and who were observed during 3 periods whose total duration was 12 months, prompt the following conclusions. The number of adverse reactions in which the relationship of cause and effect with one or several drugs was either definite or probable amounted to 217, 2--3% among patients at admission and 5--11% of patients during their hospital stay. The average number of prescriptions per patient remained stable and the average number of drug reactions per 100 prescriptions varied from 0.6 to 1.6. Severe drug reactions occurred in 1.1% of patients at admission and 1.1% of patients during their hospital stay.

Drug Prescriptions↗
PubMed1981

Improved antibiotic usage following introduction of a novel prescription system.

We investigated the impact of a novel antibiotic prescription system on antibiotic use. After a two-month baseline monitoring period, an antibiotic prescription form was introduced on surgical and medical wards, which obliged physicians to categorize antibiotic use as prophylactic, empirical (culture results unavailable), or therapeutic. Depending on the category, administration of antibiotics was automatically discontinued after two days (prophylactic), three days (empirical), or seven days (therapeutic) unless the physician renewed the order or specified an alternate duration of administration. In the subsequent two-month intervention period, 233 (60%) of 390 surgical patients received prophylactic antibiotics compared with 281 (68%) of 413 in the baseline period. Mean duration of prophylaxis was reduced from 4.9 +/- 2.4 days to 2.9 +/- 1.6 days. In the intervention period, 11% of patients received their first prophylactic dose postoperatively, compared with a 30% baseline rate. The percentage of urology patients receiving appropriate therapy for urinary tract infection increased from 38% to 89%. No significant changes in antibiotic use were noted on the medical service. This antibiotic prescription system may have a substantial impact on antibiotic use.

Adult↗
PubMed1980

Illegibility of prescriptions: some worrisome implications.

Stimulated by frustration, we have begun an effort to quantify the impact of illegibility of prescriptions on both potential error rates and time consumed in filling prescriptions. In an experimental situation, despite more than 14 seconds being expended on each prescription, almost 30% of the interpretations were erroneous. The implications for patient care and for negligence allegations, plus for the costs of both, are obvious.

Drug Prescriptions↗
PubMed1995

Signalling drug-induced rash with 36 drugs recently marketed in the United Kingdom and studied by Prescription-Event Monitoring.

This study examines skin rash, as a reported event, in the patients who used one of the 36 drugs recently released to the UK market and studied by Prescription-Event Monitoring between 1985 and 1992. The results are also compared to the voluntary reports on rash as a possible adverse drug reaction sent to the Committee on Safety of Medicines (CSM). Specific types of skin rash (e.g. exfoliative dermatitis) are excluded. The rate of rash has been calculated for 2 periods, the first month (T1) and the subsequent 5 months (T2) after the first prescription for the drug. Despite the heterogeneity of the patient groups, the rate for rash between the 2nd and 6th months was consistent in the 36 drugs and probably represented the baseline rate of rash due to a variety of nonspecific causes. This rate (T2) was around 1 per 1,000 patients per month (ranging from 0.5 to 2 per 1,000 patients per month). On the other hand, in the first month after the first prescription for the drug, the rate (T1) varied substantially from 0.9 to 6.4 per 1,000 patients per month. Diltiazem had the highest first monthly rate. These rates are listed for the 36 drugs. The difference of the rates was tested by 2 methods: a standard statistical test assuming a Poisson model and a method based on the ratio of the rates for the 2 periods. When the 2 rates (T1 and T2) were similar to each other, drug induced rash was considered to be rare.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[The prescription and drug interactions: prospective study in 896 patients treated for arterial hypertension in general medicine].

The aim of this study was to investigate the occurrence of potential drug interactions in primary health care. It reports the analysis of 896 prescriptions for hypertensive patients collected from 237 general practitioners. The mean number of prescribed drugs was 4.55 +/- 2.14, and each patient received, on average, 1.92 +/- 0.92 antihypertensive drugs. All prescriptions were compared with a French computerized database of drug interactions (Micro-Vidal). A total of 1324 cases of potential drug interactions were found related to 552 patients (61.6 pour cent). Among the most dangerous interactions, there were 26 contra-indications and 168 unsuitable drug pairs. As reported in previous studies, there was a strong correlation between the number of prescribed drugs and the number of interactions. All in all, more than 16 per cent of prescriptions contained a contra-indication or unsuitable drug association. Potential drug interactions occur at a high rate in general practice. This raises questions about the best way to improve general practitioner training and to introduce preventive measures to reduce adverse drug effects.

Antihypertensive Agents↗
PubMed1995

Prescription insoles and footwear.

Current research emphasizes the importance of prevention in caring for the diabetic foot. Prescription footwear has been shown to be a significant factor in prevention of both ulcer recurrence and amputation. In addition, scientific evidence demonstrates the ability of insole materials to reduce shock and shear, the effectiveness of insoles in providing pressure relief, and the ability of rocker soles to relieve metatarsal pressure. This evidence, however, is limited and is often based on clinical investigation rather than on objective, quantitative measurements. Recent advances in biomechanical modeling and in-shoe pressure measurement should allow more objective data on a wider variety of prescription footwear to become available. The importance of prescription footwear as a preventive measure is nonetheless widely recognized. The knowledge and experience of pedorthists make them uniquely qualified to provide the needed shoes, modifications, and insoles for the long-term management of the diabetic foot.

Biomechanical Phenomena↗
PubMed1995

Children's health: racial and ethnic differences in the use of prescription medications.

OBJECTIVES: Although racial and ethnic differences in the use of hospital and physician services have been well established, research has not examined the relationship between minority status and the use of prescription medications for children with some access to the health care system. This study examines differences in probability and number of prescribed medications by race and ethnicity, and whether the differences remain if socioeconomic factors, indicators of need, and number of physician visits are taken into account. METHODS: Using data from the 1987 National Medical Expenditure Survey, multivariate regression analysis was used to examine the probability of receiving a prescription medication and number of medications for two samples of children, ages 1 to 5 (N = 1347) and ages 6 to 17 (N = 2155). RESULTS: Descriptive statistics indicate that compared with white children, black and Hispanic children are less likely to receive a prescribed medication and have on average, fewer medications. The multivariate results of this analysis show that those differences persist, depending on age group of the child, after adjusting for socioeconomic factors, health conditions, and number of physician visits. CONCLUSIONS: The relationship between racial and ethnic status and the use of prescription medication mirrors other types of services, such as physician visits, and affirms that minorities receive fewer services than whites.

Adolescent↗
PubMed1994

Management of contact lens prescriptions.

A patient's access to information in an optometrist's record is regulated by an amalgam of federal and state laws and judicial decisions. The inspection of records by patients is permitted except under extraordinary circumstances, and optometrists who refuse access in contravention to legal requirements face disciplinary action from regulatory boards. Although contact lens prescriptions are part of an optometrist's record, the obligation to release prescriptions is restricted to 17 states. Optometrists in these states must comply with the requirements of state law; in other states, optometrists should establish an office policy for the release of contact lens prescriptions, communicate this policy to patients at the start of the doctor-patient relationship, and ensure that it is properly administered.

Contact Lenses↗
PubMed1994

Diagnoses and prescriptions for patients managed during a free health care day in Eldoret, Kenya.

Diagnoses and prescriptions for 2,218 patients seen during a "Free Health Care Day" in a semi-urban African town were reviewed. There was a marked tendency to over-prescription, coupled with a failure to use available laboratory tests to diagnose conditions such as malaria and intestinal parasites. Only 37 of 413 patients with malaria had a diagnostic blood smear (17 positive, 20 negative) done. Nevertheless, many patients without any clear diagnosis received multiple drugs. The mean number of drugs prescribed was two; and three or more drugs were prescribed for 677 (33%) patients. The adverse pharmacological and financial aspects of excessive drug prescription are stressed in this communication.

Child↗
PubMed1994

[Criteria for the development of a formulary of drugs in a basic health area and impact on prescription].

OBJECTIVE: To promote rational prescription in Primary Care by elaborating a restricted list of medicines in a PC, the implementation of the list and the evaluation of its influence. DESIGN: Controlled intervention study. SETTING: Intervention group: Castelldefels Health Centre. CONTROL GROUP: Molí Nou HC in same health sector. PARTICIPANTS: Doctors from the PC teams of both centres. INTERVENTIONS: Initially the prescription for 1992 of the intervention group was analysed. The main therapeutic groups prescribed for on the initiative of the General Practitioners (GP) of the Castelldefels HC were identified and the intervention was then carried out on them. The PC team from the intervention group, chose the drugs by consensus, on the basis of pharmaceutical advice. MEASUREMENTS AND MAIN RESULTS: Castelldefels HD presented worse indicators than the rest of the Sector's. It was observed that the GPs decided 63.4% +/- 3.9% of their therapeutic prescriptions. The groups most prescribed for on GP initiative were systemic (J) and respiratory apparatus (R) anti-infection therapies. The intervention was verified with Macrolids, Beta-lactamics (excluding Cephalosporins) and Quinolones. In neither of the two HDs were statistically significant differences (p < 0.05) in the consumption of the selected antibiotics between the two periods observed. CONCLUSIONS: This process is aimed at altering GPs' attitudes, it is essential that they participate in the choice of medicines in order to keep them involved; and that the ongoing records of the chosen drugs are verified, with the evaluation of their influence then being just one more tool in this process.

Catchment Area, Health↗
PubMed1994

Quality control of drug prescriptions by positive lists--the European Formulary.

The overall quality of drug prescription is based on three elements: structural, procedural and result quality. In order to improve the clinical outcome (= result quality) of a patient, only drugs with a proven efficacy and a well known risk/benefit-relation should be prescribed. However, in 1992 in Germany, 31.1% of the ambulatory drug prescriptions were for drugs with questionable efficacy or dubious combination preparations. These expenditures therefore cannot be justified, neither from a pharmacological point of view nor from an economic standpoint. One of the main reasons for this poor prescribing quality is a poor structural quality, i.e. too many drugs and lack of transparency on the market and a producer-oriented drug information. In order to improve this structural quality, a drug list will be established by a group of 33 pharmacologists, physicians and pharmacists from 15 European countries. This list aims at 66 diseases, which are thought to be the most common for the general practitioners everyday routine. For these illnesses drug therapies are recommended including information on drug side-effects, possible interactions and contra-indications. Furthermore, basing on published literature, all possible drugs for the 66 indications will be discussed explaining and underlining the choice of the European Formulary Group. However, even a comprehensive drug list may not rule out insufficient procedural quality, i.e. too lengthy prescriptions of benzodiazepines, but may hopefully facilitate the rational choice of drugs and therefore improve patients outcome.

Drug Evaluation↗
PubMed1994

Multidisciplinary committee on the abuse of prescription medications.

A program for (1) coordinating the care of patients suspected of abusing prescription medications and (2) providing data on the long-term outcomes of these interventions is described. A substance abuse committee composed of physicians, psychologists, pharmacists, and administrators was established to review individual cases of suspected misuse or abuse of medications at a large Department of Veterans Affairs medical center. After reviewing each case, the committee recommended specific actions, such as requesting that the identified medication be restricted from the patient or that the patient receive counseling or treatment for substance abuse. To evaluate the program's effectiveness, the records of the 161 cases referred to the committee between 1981 and 1992 were reviewed. The patient's outcome one year after committee intervention could be determined in 105 cases. Of those, 70 revealed either no evidence of continuing prescription drug abuse or reduced use of the targeted medication in the medical center. Eighteen other patients were no longer receiving care at the institution. A multidisciplinary substance abuse committee helped identify and treat patients suspected of abusing prescription drugs.

Drug Prescriptions↗
PubMed1994

Improving the quality of antibiotic prescription patterns in general practice. The role of educational intervention.

OBJECTIVE: To assess the quality of antibiotic prescribing by Victorian general practitioners, and the effectiveness of educational intervention techniques in improving prescribing. DESIGN: A randomised, controlled, parallel group trial. SETTING AND PARTICIPANTS: In rural and metropolitan Victoria, 182 general practitioners (78 control, 104 intervention) began and 103 (41 control, 62 intervention) completed the study. INTERVENTION: Participants recorded their antibiotic prescribing for tonsillitis. The intervention group received an educational mailing campaign. A project pharmacist visited each doctor to discuss campaign messages. MAIN OUTCOME MEASURE: The percentages of prescriptions of antibiotics for tonsillitis complying with those recommended in Antibiotic guidelines. RESULTS: In the intervention group, prescriptions consistent with recommendations in the guidelines increased from 60.5% before the campaign to 87.7% afterwards. Improvement also occurred in the control group, from 52.9% to 71.7% of prescriptions. The improvement within the intervention group was significantly greater than that within the control group. CONCLUSIONS: The educational campaign significantly improved the prescribing of appropriate antibiotics for tonsillitis by general practitioners.

Anti-Bacterial Agents↗
PubMedDate not supplied

Points to consider about prescription drug prices: an overview of federal policy and pricing studies.

Pharmaceutical prices in the United States are under evaluation as policy makers decide how to reduce health care expenditures and public subsidy of the pharmaceutical industry. Furthermore, evidence of higher drug prices in the United States, compared with those in other countries, fuels the prescription drug price debate. These issues are not new to the public forum and much can be learned from prior debates and policies. This paper begins by reviewing the pricing debate with the Kefauver hearings on monopolies held during the late 1950s and early 1960s and continues with the current price debate. Government reports and academic studies are discussed, addressing the methodological differences and their implications to policy makers. Finally, the literature review includes foreign government prescription drug programs with their respective prescription drug expenditures. Evidence provided by academics about the pricing practices of the drug manufacturers indicates product quality and price information would force firms to compete on the price level, thus reducing pharmaceutical product pricing to the "true" market price.

Drug Costs↗
PubMed1993

Qualitative analysis of drug prescription in a geriatric population sample.

The rationality of specialist drug prescription in 154 patients older than 64 in 3 Zagreb homes for the aged was analyzed over an 11-month period. Categories analyzed were: number of prescribed drugs, justification of prescription, adequacy of the dose, route, form and therapy duration of the prescribed drugs, adequacy of the type of the prescribed drugs in the advanced age and the presence of contraindications of drugs used. The criterion of the rational drug use was the WHO's modified definition of rational drug therapy: "Application of an appropriate drug by a correct route in an adequate dose over a sufficiently long period of time". This basic criterion was further elaborated in relation to the analyzed categories. There were 2.66 (+/- 1.65) prescribed drugs per visit in which drugs were prescribed. In all analyzed categories, distinctive aberrations from the principles of rational drug prescription were found. One hundred and sixty-four (41.4%) of all drugs were unjustifiably prescribed and 103 (26.4%) were not dosed correctly. The duration of the therapy was inadequate for 60 (15.4%), route for 41 (10.5%), form for 32 (8.2%) of drugs prescribed. Seventy-five (19.3%) were not adequate because of patients' age and 15 (3.9%) were prescribed in spite of existing contraindications.

Aged↗
PubMed1993

[Computerized prescription service for pediatric intensive care].

Intensive care medicine relies on the fast and flawless organization of data. In addition, control of therapy requires many calculations. The computer program presented here improves and facilitates documentation of medical prescriptions on the ICU. The program can be run on affordable personal computers. Fluid balances can be managed easily while the program calculates the intake of calories, carbohydrates, protein, fat and electrolytes in the background. On entry of medications suggestions for the pediatric dosage are given automatically. Use of this program provides a flexible way of reusing and editing prescriptions, thus adding up to a time-gaining and precise way of writing intensive care prescriptions.

Child↗
PubMed1993

[Differential aspects of drug prescriptions in elderly people living in the northeast area of Granada: study of 366 individuals].

BACKGROUND: The geriatric population consumes greater numbers of medicines than other age groups. We compared drug prescription and consumption in elderly persons residing in a nursing home or living in their own home. METHODS: We studied 366 elderly men and women (older than 65 years) who lived either in nursing homes or in their own home. The variables recorded were the most frequent diseases, number and types of drugs prescribed per person, and adverse reactions of the most frequently prescribed drugs. RESULTS: The most common diseases recorded among subjects living at home were arterial hypertension and rheumatic diseases; among those in nursing homes, the most common ailment was dementia. Subjects in nursing homes were prescribed more different drugs (2.8 +/- 1/person) than individuals living on their own (1.8 +/- 1/person). The percentage of adverse reactions was highest in ambulatory patients (64%) and in patients taking benzodiazepines (56%). A large proportion of all prescriptions (74.5%) were for solid galenic forms. CONCLUSIONS: We draw attention to the greater consumption of drugs by elderly persons residing in nursing homes, as well as the prescription of benzodiazepines and analgesic-antiinflammatory drugs within old age.

Aged↗