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PubMedDate not supplied

[Patterns of medical prescriptions for individuals with diabetes mellitus type 2 at the primary care level].

A cross-sectional study was conducted to investigate the prescription patterns of general practitioners for non-insulin dependent diabetes mellitus patients in Guadalajara, Mexico. Two hundred and forty medical prescriptions were evaluated. These were indicated by 16 primary care physicians. Results showed that physicians prescribed pharmacologic agents in 93 per cent of the cases, dietary control in 73 per cent, and physical exercise in 48 per cent. A combination therapy of these three measures was employed in 40 per cent of the patients, but the combination regimen of diet and exercise was given only to 3 per cent of the patients. Data showed significant differences in prescribing patterns according to gender of physicians; male physicians prescribed the three measures by more than 10 per cent; On the contrary, female physicians prescribed the drug as the only therapy 27 per cent of the time. The proportion of prescribing diet and exercise measures increased with more years of professional experience. These observations support the findings that prescription patterns by primary care physicians do not meet the criteria currently recommended by international committees for diabetes therapy. We discuss some implications for the metabolic control of the disease and the quality of medical care.

Chi-Square Distribution↗
PubMed1995

[Reduction in prescription of B-preparations in general practice].

In order to evaluate the effect of a collective agreement on change in GP's prescribing habits with regard to benzodiazepines and analgetics containing codeine, the prescriptions, measured in DDD, for the period September - November 1993 were compared with the prescriptions issued during the same period in 1994. All 11 general practitioners in three neighboring municipalities around the small town of Røros took part in the project. Co-operation with the only pharmacy in the region was established. In 1993, baseline consumption of the actual drugs was slightly below the average for Norway. A total decline of approximately 50% in prescribed DDD was obtained, with a reduction in prescriptions for hypnotics, anxiolytics and analgetics alike.

Analgesics↗
PubMed1994

[Variation in drug prescription costs and general practitioners in an area of North-East Italy. The use of current data].

In this paper we analyse all General Practitioners (GP) prescriptions in a Friuli-Venezia Giulia area (North-eastern Italy). The sample included of 181 GPs and 242,564 patients with 1,191,122 prescribed items. The regional Health Data Base is the source of all data. Data analysis was performed according to the multiple regression and LISREL models. We assessed for all GPs the years of medical profession, patients listed, percent of patients exent from prescription rates, patients over 60, number of active compounds prescribed and related drug companies. Two factors, the number of active compounds prescribed and patients listed, significantly contributed to the multiple regression model. The model explained 56% of variation in prescribing pointing out the importance of those factors in influencing the cost per patient. LISREL model shows a causal chain going from the years of medical profession to cost per patient passing through the number of active compounds and drug companies related. In fact, the older the GP the less the cost per patient and number of active compounds used. A main finding is that the cost per patient is highly influenced by the number of different active compounds prescribed. As in other studies the percent of patients exent from prescriptions rates and aged over 60 are somehow fundamental in influencing the cost per patient. Finally we discussed models and literature on the issue.

Aged↗
PubMed1996

Evidence of depression provoked by cardiovascular medication: a prescription sequence symmetry analysis.

Many cardiovascular drugs have been implicated as causes of depression. With the exception of beta-blockers, few have been studied in formal epidemiologic designs. I present a new approach to such analyses that effectively controls for confounders that are stable over time. I analyzed the exposure histories of 11,244 incident antidepressant users, using the Odense University PharmacoEpidemiologic Database. All persons starting both beta-blockers and antidepressants during a predefined period were identified. If beta-blockers do not cause depression, this particular population should show equal numbers of persons starting either drug first. A depression-provoking effect of beta-blockers would generate an excess of persons starting beta-blockers first, that is a nonsymmetrical distribution of prescription orders. Confounders causing the two drugs to be co-prescribed would rarely be expected to affect the symmetry. The initial screening showed nonsymmetrical prescription orders for a wide range of cardiovascular drugs. After adjustment for an increasing incidence of antidepressant prescribing, I found a depression-provoking effect only for angiotensin-converting enzyme (ACE) inhibitors (rate ratio = 1.29; 95% confidence interval = 1.08-1.56) and calcium channel blockers (rate ratio = 1.31; 95% confidence interval = 1.14-1.51). This prescription sequence symmetry analysis may be useful as a screening tool.

Adrenergic beta-Antagonists↗
PubMed1996

Computerized urea kinetic modeling to prescribe and monitor delivered Kt/V (pKt/V, dKt/V) in peritoneal dialysis. Fresenius Randomized Dialysis Prescriptions and Clinical Outcome Study (RDP/CO).

A computerized urea kinetic model of peritoneal urea transport (PACK-PD) has been developed and used to calculate prescription parameters which would result in the prescribed weekly peritoneal urea clearance (pKpt/V) required to achieve levels of weekly summed renal + peritoneal urea clearance (pKprt/ V) targeted at 1.75 and 2.16. Baseline kinetic data were obtained and analyzed with PACK-PD on 88 patients, and the program then used these data to calculate the required pKpt/V and subsequently the delivered Kpt/V (dKpt/V) from the dialysate collections. A total of 108 prescriptions were written and compared to dKpt/V measured over one to 24 months in the 88 patients. Both continuous ambulatory peritoneal dialysis and automated peritoneal dialysis (APD) were studied (APD consisted of PD+ with one or two diurnal and two to four nocturnal cycler exchanges). The correlation of dKpt/V to pKpt/V showed r = 0.93 with 95% confidence limits (CL) on agreement of +/-20% over a range of pKpt/V 0.52-2.55. The 95% CL on (dKpt/V-pKpt/V) were +/-0.30. We concluded: (1) that the prescription can be modeled as reliably in peritoneal dialysis as in hemodialysis (HD) where dKt/V and pKt/V agree to +/-25%, (2) that any individual weekly dKpt/V may vary as much as 0.3-0.4 from pKpt/V, and (3) that frequent measurement of dKpt/V and adjustment of pKpt/V as needed are required (as in HD) to control mean dKpt/V to within +/-10% of mean pKpt/V.

Capillary Permeability↗
PubMed1996

Prescription of antidepressants by general practitioners: recommendations by FHSAs and health boards.

BACKGROUND: In order to cut costs of prescribing by general practitioners family health service authorities (FHSAs) and health boards in the UK have been instructed to improve the quality and cost-effectiveness of prescribing by general practitioners in their area by tailoring advice to individual general practices. AIM: As over 95% of patients suffering from depression are treated by their general practitioner, a study was set up to investigate the effectiveness of the advice given by FHSAs and health boards to general practitioners on treatment of depression and prescription of antidepressant drugs. METHOD: The recommendations on prescription of antidepressants of professional advisors from all 117.FHSAs and health boards in the UK were elicited by telephone. Those who had produced written information for the general practitioners in their area regarding depression and antidepressants prescribing during the study period were asked to send a copy to the researchers. RESULTS: An excellent response rate (100%) was obtained to the telephone survey, and all of the bodies that provided their general practitioners with written information on depression and prescription of antidepressants sent in copies. Most of the documents received were informative and accurate; however, others provided information that was incorrect. CONCLUSION: Bulletins and newsletters from FHSAs and health boards are capable of influencing the prescribing patterns of general practitioners in their area, and must contain accurate and up-to-date information if they are to improve the management of depressed patients in the community.

Antidepressive Agents↗
PubMed1997

[Analysis of prescriptions for mass-produced drugs from various pharmacotherapeutic groups. Diuretics].

The present paper links up with the studies carried out at the Department of Organization and Management of Pharmacy within the framework of a grant. It analyzes prescription of diuretics, the characteristics of identification being age and sex. Also the frequency of occurrence of diseases and the individual diagnoses according to the International Statistical Classification, 10th revision, were examined. The authors analyzed the assortment structure of the diuretics prescribed (number of medical prescriptions, number of packages) and examined which mass-produced preparations from other pharmacotherapeutic groups were prescribed in combination with diuretics. The analysis was made in a pharmacy of the Region of East Slovakia-City in the year 1995. The source of information were the medical prescriptions issued in the selected pharmacy.

Adolescent↗
PubMed1997

[Prescription of generic drugs in the health area of Zamora. Benefits for the users and the National Health Service].

OBJECTIVE: To know the highest possible saving in pharmaceutical expenditures for the active user and for the National Health System (NHS), by replacing trademark specialties of Social Security prescriptions in 1995 by other generic medicines. DESIGN: Economic evaluation study for minimizing cost. SETTING: Health Area of Zamora, 1995. MEASURES AND MAIN RESULTS: 32 active components were selected (58 presentations and 24 therapeutic groups) marketed under generic denomination that were equivalent to specialties with identical composition-presentation and more expensive. For all those medicines that include the 32 active components, the following data were obtained from the pharmacy Management Computer System (SIFAR in Spanish): number of containers, amount and percentage prescribed to pensioners and active population, breaking down the amount of actives for the Health System and for the user. Out of the 153,885 dispensed containers analyzed in the study, 2.83% belong to those dispensed under generic denomination. The estimated possible saving could have been about 56,991,515 PTAs corresponding to 85.5% of pensioners and 14.5 of the active population. The saving for active users could have reached 4,387,523 PTAs. CONCLUSIONS: The prescription of generic medicines allows us to improve the efficiency of the NHS because the saving generated may positively have an effect on the system itself without loosing quality or freedom in the prescription.

Costs and Cost Analysis↗
PubMedDate not supplied

[Minimizing the costs of prescription of anti-infective drugs in two areas of primary health care].

BACKGROUND: Pharmaceutical costs are the main cost item in basic health care. The need to contain health care expenditure has led to the search for alternatives in this area, one of which would be to foster a prescription policy which uses the cheapest presentation for each active principle. The aim of this study was to evaluate the amount which would be saved by prescribing the cheapest alternative from a selection of anti-infective drugs. METHODS: Pharmacy prescriptions in two different health areas were analyzed using the database on turnover of pharmaceutical products for 1995. Single principle drugs with anti-infective action were selected, and for each active principle and presentation the most economic alternative was sought using the records provided by the Ministry of Health and a cost minimisation analysis was undertaken. The cost of applying this prescription policy was not considered. RESULTS: Total pharmaceutical expenditure in the areas was pesetas 8.547 bn in 1995. Expenditure on selected anti-infective drugs was pesetas 522 million (6.1% of the total). The overall saving estimated was 7.63% (pesetas 39,901,778). This saving was centred on the following subgroups: penicillins, quinolones, cephalosporins and macrolides. Of potential savings identified, 75% would be achieved by prescribing the cheaper alternative of 2 active principles: amoxacillin and cyprofloxacine. CONCLUSIONS: The study shows the possibility of containing expenditure in our area and offers a basis for action in this direction. It would be advisable to increase information and training for prescribers and dispensers in order to stimulate the use of the most economical alternative of each medicament prescribed, especially in cases in which there are significant margins to be saved.

Anti-Infective Agents↗
PubMed1998

Prescription of cardiovascular drugs in outpatient care: a survey of outpatients in a German university hospital.

AIMS: We evaluated ambulatory prescriptions by general practitioners for outpatients with cardiovascular (CV) disease referred to the cardiology outpatient clinic of the Frankfurt University Hospital in order to prove adherence to generally acknowledged therapy standards for treating CV disease. METHODS AND RESULTS: Appropriateness of current CV medication was assessed according to the following criteria: aspirin or anticoagulants obligatory after myocardial infarction (MI), unless contraindicated; beta-blockers should be prescribed after MI, unless contraindicated or not tolerated; ACE inhibitors should be given in left ventricular dysfunction (LVD) after MI, unless contraindicated; and hypertension should be adequately controlled. 346 patients (28-94 years) received a median of 3 CV drug prescriptions (range 0-7). 240 patients had CAD, 142 patients previous MI, 121 patients had LVD (59 after MI), 143 patients were hypertensive. Aspirin was used appropriately in 80% of all MI patients, 13% received oral anticoagulants due to atrial fibrillation. However, 7% received no antithrombotic therapy. ACE inhibitors were administered in 65% of the MI patients with LVD. beta-blockers were used in 25% of the MI-patients. In the remaining patients, beta-blockers were contraindicated, not tolerated, and/or verapamil had been prescribed. However, in 14% of the patients beta-blockers were withheld without evident reason or alternative drug. In 41% of the hypertensive patients, blood pressure was not sufficiently controlled. CONCLUSION: A considerable number of ambulatory prescriptions for CV drugs are not in accordance with current therapeutic guidelines. The role of a cardiology outpatient clinic to detect the misuse or underuse of CV drugs is emphasised.

Adult↗
PubMed1998

Should emergency contraceptive pills be available without prescription?

Leading health agencies, including the World Health Organization and the US Food and Drug Administration, consider emergency contraceptive pills (ECPs) safe and effective and have called for better access to them. Yet debate about whether ECPs should continue to be available by prescription only has been limited. After measuring the characteristics of ECPs against criteria developed to assess the necessity for prescription status for drugs generally, we argue that ECPs can safely be marketed over the counter. Professional assistance is not necessary since the woman diagnoses her own need for the pills and takes them herself. ECPs do not need to be adjusted for the individual woman and pose no potential threat of overdose or addiction. There are no contraindications except confirmed pregnancy (in which case the therapy will not work), and monitoring is not necessary. We conclude that prescription requirements that keep ECPs from women provide little, if any, benefit.

Contraceptives, Postcoital↗
PubMed1998

Clinical nurse specialist prescriptive authority and the legislative process.

Despite certification and graduate education, clinical nurse specialists are denied prescriptive authority in many states. Restrictions on their scope of practice and prescriptive authority are barriers to potential contributions to the health care delivery system. The article describes the experience of the New Mexico Council of Clinical Nurse Specialists in the process of obtaining prescriptive authority. It discusses council formation, lobbying activities, the legislative process, and ways to become politically involved. Clinical nurse specialists are encouraged to become politically active and work through their state nurses association to change restrictive policies.

Drug Prescriptions↗
PubMed1989

Prescription of psychotropics to children in office-based practice.

Multiple authors have stressed the need for close follow-up and simultaneous psychotherapy in most children treated with psychotropic drugs. However, little is known about the actual prescription of psychotropic medications in pediatric settings. Using the 1985 National Ambulatory Medical Care Survey, we investigated the frequency of follow-up arrangements and concurrent psychotherapy among US children in visits to office-based practices. We then explored determinants of psychotropic drug prescriptions. Mental health indicators, sociodemographic characteristics, provider type, and provider familiarity with the patient were important predictors of psychotropic prescriptions. Few providers report referral or concurrent psychotherapy for their patients receiving psychotropics, and follow-up plans were no different for children with or without psychotropics after controlling for other variables. This means that many children in outpatient care who are taking psychotropic medications may not be receiving optimal management for behavioral or emotional problems.

Adolescent↗
PubMed1999

Therapeutic jurisprudence: integrated inquiry and instrumental prescriptions.

This paper considers the manner in which one could apply a therapeutic jurisprudence (TJ) analysis to a controversial approach to the treatment of sex offenders. Rather than attempting to resolve the difficult questions regarding this form of intervention, however, this paper uses this issue as an opportunity to examine some theoretical concerns about the nature and limits of the TJ research program. As interpreted here, TJ consists of a program of scholarship and law reform intended to promote integration of conceptual, empirical, and normative inquiry. TJ does not in itself resolve normative issues, but it promotes integrated analysis that can sharpen our ability to articulate and examine those normative concerns. TJ remains normatively neutral at the levels of value and theoretical neutrality. Prescriptively, it cannot generate principled normative prescriptions, but it can generate instrumental prescriptions. The long-term measure of the TJ program rests upon its success in promoting innovative and integrated interdisciplinary scholarship and law reform.

Humans↗
PubMed1996

Prescription drug utilization following patient co-payment changes in Australia.

In November 1990 major patient co-payment changes were introduced into the Pharmaceutical Benefits Scheme (PBS), which accounts for around 90% of all community prescriptions in Australia. Interrupted time series analyses were performed to assess the impact of these co-payment changes on the prescription levels of defined groups of 'discretionary' and 'essential' drugs for both the general community and for a subgroup comprising elderly returned servicemen and women. While the co-payment changes themselves had a significant immediate effect on lowering the use of both categories of drugs, the effects were substantially larger for the 'discretionary' groups in both cases. Notably there was a clear post-intervention trend for increased prescriptions of 'essential' drugs after the initial decline, which was not evident for the 'discretionary' drugs. The introduction of programmes to compensate high risk groups in Australia may have enabled the co-payment to become a more selective policy instrument than has been shown in other settings.

Journal Article↗
PubMed1998

Cholesterol-lowering drugs and antidepressants--a study of prescription symmetry.

The subject of this study was to investigate the relationship between prescription of cholesterol-lowering drugs and depression. We used prescription of antidepressants as a proxy for depression and analysed the prescription order for cholesterol-lowering and antidepressant drugs. The ratio of persons with antidepressants prescribed second and first translates directly into a rate ratio (RR) associating cholesterol-lowering drugs use with antidepressants. The crude RRs were then adjusted for trends in sales of the drugs over the study period. All residents of Funen, Denmark, who started the two therapies during the period 1 April 1991 through 31 December 1995 were included in the study cohort. Of 184 individuals included in the analysis, 105 started antidepressant first and 79 second, giving a crude RR of 0.75. However, the sales of cholesterol-lowering drugs increased more than the sales of antidepressants. Accordingly, the adjusted RR was higher than the crude, 0.90 (95% confidence interval 0.68 to 1.22). Among three tested cholesterol-lowering drug classes, only simvastatin showed an adjusted RR above unity (1.59, 95% confidence interval 1.08 to 2.45). The hypothesis that the use of cholesterol-lowering drugs has an adverse effect on mood is not supported by the present study. Confounding by indication might explain the apparent association between use of simvastatin and antidepressants.

Journal Article↗
PubMed2004

Prescription of prosthetic ankle-foot mechanisms after lower limb amputation.

BACKGROUND: A correct prosthetic prescription can be derived from adapting the functional benefits of a prosthesis to the functional needs of the prosthetic user. For adequate matching, the functional abilities of the amputees are of value, as well as the technical and functional aspects of the various prosthetic ankle-foot mechanisms. There seems to be no clear clinical consensus on the precise prescription criteria for the various prosthetic ankle-foot mechanisms related to the functional abilities of amputees. OBJECTIVES: To obtain information about aspects of prosthetic ankle-foot mechanisms and daily functioning of amputees with a prosthesis, for appropriate prosthetic prescription criteria. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register of trials (April 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2003), MEDLINE (1966 to April 2003), EMBASE (1983 to April 2003), CINAHL (1982 to April 2003) and reference lists of articles. No language restrictions were applied. SELECTION CRITERIA: All randomised controlled trials and quasi-randomised controlled trials comparing different prosthetic devices for lower limb amputation in adults. No language restrictions were applied. DATA COLLECTION AND ANALYSIS: Two reviewers independently identified potential articles from the literature search. Methodological quality was assessed using a checklist comprising 13 criteria. The reviewers extracted data using pre-defined extraction forms. MAIN RESULTS: Twenty-three trials were included, with a total of 217 participants. The methodological quality was moderate. Only one study was of high quality. No classical RCT's were identified, yet, all included studies used cross-over designs allowing sufficient control for confounding. In high activity transfemoral amputees, there is limited evidence for the superiority of the Flex foot during level walking compared with the SACH foot in respect of energy cost and, gait efficiency. This benefit has only been confirmed in transtibial amputees during decline and incline walking and increased walking speeds. REVIEWER'S CONCLUSIONS: There is insufficient evidence from high quality comparative studies for the overall superiority of any individual type of prosthetic ankle-foot mechanism. In high activity transfemoral amputees, there is limited evidence for the superiority of the Flex foot during level walking compared with the SACH foot in respect of energy cost and, gait efficiency. This benefit has only been confirmed in transtibial amputees during decline and incline walking and increased walking speeds. In prescribing prosthetic-ankle foot mechanisms for lower-limb amputees, practitioners should take into account availability, patient functional needs, and cost.

Amputation, Surgical↗
PubMed1995

Complications resulting from the use of Chinese herbal medications containing undeclared prescription drugs.

OBJECTIVE: Many patients with chronic disease use alternative therapies. Our objective was to investigate complications resulting from the use of Chinese herbal medications containing undeclared prescription drugs, and to analyze these pills. METHODS: Medical records of 5 patients with complications were reviewed. Pills from symptomatic and asymptomatic individuals were analyzed for possible content of undeclared prescription drugs. RESULTS: All pills analyzed contained mefenamic acid and diazepam. Complications related to the presence of these substances included, among others, massive gastrointestinal bleeding. CONCLUSION: Chinese herbal medications may contain undeclared prescription drugs including nonsteroidal antiinflammatory drugs and benzodiazepines.

Adult↗