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At least 1,441 records · Page 80Linked to original sources
PubMed1996

Delisting of drugs in Ontario. How attitudes and prescribing strategies of family physicians in the Kingston area changed.

OBJECTIVE: To assess how attitudes and prescribing strategies of family physicians changed when drugs were delisted from the Ontario Drug Benefit formulary. DESIGN: Mailed, self-administered survey. SETTING: Family physicians' offices in Ontario. PARTICIPANTS: All family physicians practising in the Kingston, Frontenac, Lennox, and Addington Health District. MAIN OUTCOME MEASURES: Physicians were presented with six vignettes involving patients receiving a delisted drug. The choices were to recommend the patient pay for the medication, to substitute a drug still listed on the formulary, to make a special request that the medication be covered for this patient, or to offer another option. As well, the physicians were asked to indicate, on a 5-point Likert scale, their opinions regarding the effect of delisting on themselves and their patients. RESULTS: Physicians were most likely to change to a medication that was still on the formulary. Patient sex and ability to pay were factors in physicians' decisions. Physicians believe that the delistings are not likely to have adversely affected patients' health, that noncompliance is a problem because many once-daily formulations have been removed, that suitable alternatives are not always available, and that physicians should have been consulted more before the changes were made. CONCLUSIONS: Physicians usually substitute listed medications for medications that have been delisted. This is especially true for female patients and patients who are unable to pay.

Adult↗
PubMed1996

Sharing resources to create a district drug formulary: a countywide controlled trial.

BACKGROUND: Creating a drug formulary takes considerable time, but merely adopting one lacks local perspective and ownership. Sharing resources between several practices treads a middle path between these extremes, but is it effective? AIM: The aim of the study was to audit the influence of a district primary care drug formulary on prescribing by general practitioners. METHOD: A controlled trial was carried out to compare prescribing by 50 general practitioners from 11 urban and semirural practices in south Bedfordshire that participated in creating a district drug formulary with prescribing by all other general practitioners in the county. RESULTS: The proportion of prescription items that were for drugs listed in the formulary rose significantly in three therapeutics groups: cardiovascular (by 7-12% above control practice values); musculoskeletal (by 1-11% above control practice values); and obstetrics and gynaecology (by 6-9% above control practice values). The number of items prescribed per prescribing unit fell significantly in three therapeutic groups: musculoskeletal (by 1-7% below control practice values); nervous (by 7-12% below control practice values); and nutrition and blood (by 15-21% below control practice values). The estimated saving resulting from the creation of the formulary was 150,000 pounds (3000 pounds per doctor) per year. CONCLUSIONS: Sharing resources between practices to create a district-wide primary care drug formulary can lead to changes in prescribing and reduce costs sustained over 3 years.

Cost Savings↗
PubMed1996

Formulary revision: eliciting the opinions of users.

BACKGROUND: Few peer-reviewed reports have been published that document the extent and type of use of published formularies in general practice. As publishers of the Practice Formulary of the Royal College of General Practitioners, the Northern Ireland Faculty Board commissioned a large-scale survey to quantify these issues, for the purpose of improving the revision process. AIM: The aim of the survey was to investigate the extent to which general practitioners in Northern Ireland use the Practice Formulary and the ways in which they use it, and to elicit their opinions on ways in which it could be improved. RESULTS: A total of 371 completed questionnaires were received (response rate of 38%), 49 respondents (13%) stating that they had not received the formulary. Out of the 322 respondents who had received it, 84% used the formulary occasionally, and 41% either had or were producing their own practice formulary (32% of these had used the RCGP formulary in its production). Almost all respondents (90%) considered a formulary useful in general practice. The presentation and layout was approved by 273 respondents (85%) and 259 (80%) agreed strongly with the drug selection. The formulary was used as a source of drugs information by 191 respondents (59%) and as a teaching aid by 103 (32%). A total of 65 criticisms or suggestions for improving the next edition were received. Revision is now under way and 18 of the original respondents have volunteered to be members of the revision committee. No judgement was made about the non-respondents. CONCLUSION: The largest survey yet conducted of published formulary use in one region elicited the extent of use, type of use, criticisms and suggestions for improvement. These suggestions are being used as a guide to revision of the next edition.

Attitude of Health Personnel↗
PubMed1996

Dermatologic formularies in the managed care setting.

Formularies and formulary systems are not a new concept in medical practice. In this country, they have been used in selected settings since the Revolutionary War and formal guidelines were published in 1933. They are in essence a collection of prescribing policies of physicians in a particular practice setting. Formularies are administered by a system in which medical staff members working through a pharmacy and therapeutics (P&T) committee recommend, evaluate, appraise, and select drugs to be included in the medication list. The system also develops, maintains, and enforces policies regarding how restrictive the process will be and what methods will be used to ensure compliance and verify that educational and quality standards are met.

Dermatology↗
PubMedDate not supplied

[Criteria for pharmacologic quality in artificial nutritional support applied in Peru].

This is a report on the metabolic consequences derived from widely using a parenteral nutrition scheme in Peru. That scheme was in disagreement with internationally accepted principles. Its lack of capacity to achieve anabolism is demonstrated. Enteral and parenteral nutrition schemes that clearly achieve anabolism are shown as well as the notorious contrast with the parenteral nutrition scheme referred to previously. These facts set up the basis of the Formulary of Nutritional Support Units of Instituto Peruano de Seguridad Social.

Adult↗
PubMedDate not supplied

Poor utilisation and limited impact of formularies on quality of prescribing by hospital doctors.

We determined the utilisation and perceived value of formularies amongst 104 Non Consultant Hospital Doctors (NCHDs). Only 58% routinely carry a formulary, largely the British, National Formulary (BNF) which is considered by 93% to be the best. The overall quality of prescribing in surgical wards was poorer compared to medical wards. However, after distribution of "free BNF's" significant improvements (p < 0.05) occurred, but only in surgical wards and only in aspects of prescribing specifically highlighted (generic prescribing and limiting the duration of intravenous medications). These improvements lasted four weeks before returning to previous levels. Our results suggest that despite recognising their value a significant proportion of Irish hospital doctors do not routinely carry a formulary. The beneficial effects of distributing free formularies was shortlived.

Chi-Square Distribution↗
PubMed1996

Architecture for a Federated Drug Reference in a managed care environment.

We describe a model of drug information query management that supports the integration of various types of pharmaceutical information and the delivery of that information through a common interface. Our prototype drug reference system makes use of the World Wide Web client/server architecture as a front-end to federate this data. Although originally intended as an electronic Hospital Formulary, the system has been redefined as a result of input from physicians to include formularies of multiple managed care plans. The underlying database is designed for integration with an electronic medical record as well as education and research resources for faculty and students in an academic medical center environment.

Computer Communication Networks↗
PubMed1997

In vivo characterization of sustained-release formulations of human growth hormone.

Long-acting formulations of recombinant human growth hormone (rhGH) were prepared by stabilizing and encapsulating the protein into three different injectable, biodegradable microsphere formulations composed of polymers of lactic and glycolic acid. The formulations were compared in juvenile rhesus monkeys by measuring the serum levels of rhGH and two proteins induced by hGH, insulin-like growth factor-I and IGF binding protein-3 (IGFBP-3) after single s.c. administration. All three formulations, which differed principally in the composition of the polymer, provided sustained elevated levels of all three proteins for several weeks, and the rate of release of rhGH differed among the formulations consistent with the molecular weight of the polymer used. All three formulations induced a higher level of insulin-like growth factor-I and insulin-like growth factor binding protein than was induced by daily injections of the same amount of rhGH in solution. After three monthly injections of one of the formulations, both the rhGH and IGF-I levels remained elevated for nearly 90 days. Immunogenicity of the rhGH released from this formulation, as assessed by the incidence of seroconversion to hGH and the titer of anti-hGH antibody in both the rhesus monkeys and transgenic mice expressing rhGH, was no greater than that of the unencapsulated protein. In addition, the microsphere injection sites appeared normal by macroscopic evaluation between 1 to 2 mo after microsphere administration and by microscopic evaluation between 2 to 3 mo. These results show that serum levels of a therapeutic protein can be sustained for an extended period when encapsulated into different formulations of injectable, biodegradable microspheres.

Animals↗