What's in the way of nurse prescribing?
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OBJECTIVE: To inventory the similarities and differences of the contents of regional general practice formularies. DESIGN: Descriptive. SETTING: Department of General Practice Medicine, University of Groningen, the Netherlands. METHOD: Through personal contacts and an appeal in the journal Medisch Contact, 14 formularies were acquired. Of these, seven recent, still valid Dutch general practice formularies were compared as to pharmacotherapy and health problems listed. RESULTS: Volume and contents of these seven formularies showed major, inexplicable differences with regard to pharmacotherapy, while the choice of the health problems listed was not argued anywhere, and not based on prevalence figures. CONCLUSION: The regional general practice formularies examined showed little similarity in the drugs and health problems listed.
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BACKGROUND: Previous studies have suggested that prescribing formularies may promote rational prescribing. The range of drugs prescribed may be one aspect of rational prescribing. AIM: To determine whether the introduction of prescribing formularies helps general practitioners (GPs) to prescribe from a narrower range of non-steroidal anti-inflammatory drugs (NSAIDs). METHOD: General practices in Lincolnshire were offered help in developing prescribing formularies. Ten practices decided to develop a formulary for NSAIDs. Level 3 PACT data were used to determine whether changes in prescribing had occurred with the introduction of the formulary. Matched controls were used to determine whether similar changes had occurred in other practices. RESULTS: Between April and June 1992, and during the same period in 1993, practices that introduced a formulary for NSAIDs reduced the mean number of different drugs used (14.3 versus 13.1, P = 0.04) and increased the percentage of NSAID-defined daily doses coming from the three most commonly used drugs (70.1% versus 74.8%, P = 0.02). Similar changes were not seen in control practices. CONCLUSION: Following the development of a formulary for NSAIDs, practices prescribed from a narrower range of drugs and focused a greater proportion of their prescribing on their three most commonly used drugs.
REFERENCE-BASED PRICING has had a major impact on medical practice in British Columbia. Anne Mullens discusses the new system's first 2 years. She says physicians outside BC should pay attention, because RBP may be heading their way. It is set to land in Australia next month.
It pays to pay attention to drug costs, as prescription outlays rise as much as 20 percent a year at many health plans. Despite a wave of direct-to-consumer ads for pricey new meds, HMOs are fighting back by cutting the number of drugs they'll pay for and hiking copays, among other strategies.
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This article is the second in a series looking at the knowledge needed for nurses to prescribe. It considers the use of drugs that have an effect on the digestive tract and incorporates essential knowledge from the biological sciences.
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Change is sweeping the nation's health care system. During this period of rapid change, the federal health care system-the nations's largest managed care system-may serve as a barometer for changes likely to occur in other managed care settings.
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During his long career as a physician in Charlottetown, Dr. John Mackieson (1795-1885) compiled 4 medical manuscripts: 2 sets of case records, a synopsis of the medical conditions that were common in his day and a formulary. As primary sources, these documents provide information about medicine in 19th-century Canada and augment our knowledge of the problems of medical practice in that era. They illustrate aspects of the work of Dr. Mackieson, a generalist with interests in surgery and obstetrics, and they facilitate an understanding of the rationale underlying the treatments that he and his contemporaries used. Although 150 years old, the case records can be appreciated for their relevance to the art of medicine. Two excerpts from the case records, presented in this article, provide a sense of Dr. Mackieson's writings and introduce a discussion on the significance of these manuscripts in relation to the ideas on disease and treatment that governed medical practice, both in Prince Edward Island and elsewhere in Canada, in the 19th century.
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