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PubMed2002

Advanced age and adjuvant tamoxifen prescription in early-stage breast carcinoma patients.

BACKGROUND: Adjuvant tamoxifen is recommended for all women with estrogen receptor-positive breast carcinoma without regard for age. We investigated age-dependent variations in adjuvant tamoxifen prescription patterns in a cohort of women 80 years of age and older. METHODS: We studied 92 women diagnosed at four U.S. sites with primary, early-stage breast carcinoma. Each woman consented to a medical record review and participated in two telephone interviews. We compared the proportion of tamoxifen prescriptions received by women 85-92 years of age with those received by women 80-84 years of age. Relative risks (RR) and 95% confidence intervals (95% CI) were generated using generalized estimating equations. Confounding by demographic, disease, and treatment characteristics was assessed. RESULTS: Before adjustment, patients 85-92 years of age were 28% less likely to receive a tamoxifen prescription compared with patients 80-84 years of age (RR = 0.72, 95% CI 0.57-0.91). In this sample, patients not prescribed tamoxifen had substantially more comorbidity. After adjusting the crude finding for comorbidity, the RR was 0.74 (95% CI 0.58-0.93). In addition, the oldest patients and those not prescribed tamoxifen were significantly less likely to be married or have living children. After adjusting the crude finding for these two factors, the RR was 0.75 (95% CI 0.59-0.95). There was no confounding by the other demographic, disease, or treatment covariates assessed. CONCLUSION: Given the increasing longevity of the oldest old, undertreatment with adjuvant tamoxifen may put older breast carcinoma patients at an increased risk of disease recurrence and breast carcinoma mortality.

Age Factors↗
PubMed2006

Drug prescription in mild cognitive impairment: the physicians' perspective in Italy.

OBJECTIVES: Today there are no data on the type of drugs prescribed to MCI patients nor the prevalence of their prescription. The aim of this study was to describe which drugs were prescribed in 2004 for cognitive and non cognitive disturbances of patients with MCI in a sizable group of Italian expert centers for the diagnosis and treatment of Alzheimer's disease. METHODS: Eighty-eight of the 314 contacted UVAs (28%) agreed to take part to the present study. The physicians were surveyed with a structured questionnaire assessing questions related to prescription of drug therapy based on their subjective judgement. RESULTS: Cholinesterase inhibitors are prescribed to 90% of patients with AD but, interestingly, to about one in four patients with MCI (27%). Gingko and nootropics are prescribed infrequently, but in MCI two to three times more often than in AD. About one in four (27%) and one in ten (9%) MCI patient are prescribed SSRIs and benzodiazepines, a proportion similar to that of AD (28% and 10%), while atypical and traditional neuroleptics are virtually never used in MCI patients. Vitamin E is prescribed to more than half of MCI (57%) and in about half as many AD patients (27%). CONCLUSIONS: These data suggest that lacking approved or clearly effective drugs for cognitive symptoms, physicians respond with 'analogy treatments' and by increasing the prescription of 'accessory drugs'. Non cognitive symptoms in MCI are managed virtually exclusively with SSRIs and benzodiazepines.

Aged↗
PubMed2007

Clinical correlates of clozapine prescription for schizophrenia in China.

AIMS: Few studies have investigated the prescription patterns of clozapine in outpatients with schizophrenia in China. It is an important issue due to clozapine's high efficacy and potentially fatal side effect profile. This study examined the use of clozapine and its correlates in China. METHODS: Three hundred ninety-eight clinically stable outpatients with schizophrenia were randomly selected and interviewed in Hong Kong (HK) and Beijing (BJ). Assessment instruments included the Structured Clinical Interview for DSM-IV, Brief Psychiatric Rating Scale, Simpson and Angus Scale of Extrapyramidal Symptoms, Barnes Akathisia Rating Scale and the Hong Kong and Mainland China World Health Organization Quality of Life Schedule-Brief version. Assessments were performed by the same investigator in both sites. RESULTS: Clozapine was prescribed to 15.6% of (n = 62) patients. There was a wide inter-site variation between HK and BJ. Use of clozapine was associated with age, age at onset, extrapyramidal side effects (EPS), having health insurance, use of depot and typical antipsychotic and anticholinergic drugs and benzodiazepines as well as history of suicidal attempts. On multiple logistic regression analysis, the number of hospitalizations, site (HK vs. BJ), use of typical antipsychotics, polypharmacy and co-prescription with anticholinergics were significantly associated with the prescription of clozapine. No significant differences were found between the clozapine and non-clozapine groups with regard to any of the quality of life domains. CONCLUSION: A combination of economical and clinical factors, health policies and the characteristics of the treatment settings plays important roles in determining clozapine use. Clozapine appears to have little significant influence on quality of life in clinical stable Chinese patients with schizophrenia.

Adult↗
PubMed2005

Antibiotic utilisation in community practices: guideline concurrence and prescription necessity.

PURPOSE: To evaluate the indications, concurrence with prescribing guidelines and potential necessity for antibiotic (AB) prescriptions written in community practice. METHODS: We reviewed the charts of all patients with infection-related illnesses seen by family physicians during two random days of regular practice between 1 Oct 1997 and 30 Jan 1998. Guideline concurrence of AB prescribing was assessed using regional AB prescribing guidelines. Likelihood of AB indication for respiratory tract infections was assessed using published clinical practice guidelines for determination of likely viral versus bacterial etiology. RESULTS: Of 4218 visits captured, 949 (22%) were for newly acquired infections. Sixty four percent (n=604) of consultations for newly acquired infections resulted in an AB prescription. Based on the doctors' diagnoses, 61% of AB prescriptions were concurrent with prescribing guidelines, 10% were for the wrong drug, 20% were not indicated and in 10% of cases a lower line AB was available. For respiratory tract infections, 12% of these infections were likely bacterial, whereas the physicians determined that 56% were bacterial. CONCLUSIONS: A large proportion of ABs administered in community practices were not in concurrence with community AB prescribing guidelines. Improvements can be made in AB choice and in decisions about likely viral etiology for respiratory tract infections.

Adolescent↗
PubMed2006

Predictors of recall of over-the-counter and prescription non-steroidal anti-inflammatory drug exposure.

PURPOSE: Because of the difficulty in establishing a gold standard, data on accuracy of recall of over-the-counter (OTC) medication use are sparse. METHODS: We studied a cohort of 1889 persons living in the Philadelphia area to assess recall of non-aspirin non-steroidal anti-inflammatory drug (NANSAID) use during the preceding 8 weeks. Our analyses were based on the assumption that among the group of subjects, on average, the reported usage of NANSAIDs should not vary over the previous 8 weeks. To model the effect of time on reported usage while allowing for the inherent correlation of responses within subjects over time, we employed alternating logistic regression. RESULTS: We documented a significant decline in reported use of OTC NANSAIDs but not prescription NANSAIDs during the 8-week study period (p = 0.3 for frequent prescription NANSAIDs, p = 0.2 for infrequent prescription NANSAIDs, p < 0.001 for frequent OTC NANSAIDs, and p < 0.001 for infrequent OTC NANSAIDs). Reported rates of frequent and infrequent OTC NANSAID consumption declined from 6.3 to 4.6% and from 17.1 to 12.8% between the most recent week and eight weeks prior, respectively. CONCLUSIONS: Interviews focusing on medications used on an as needed basis should be performed as close as possible to the index date. Likewise, data on frequent use of OTC NANSAIDs may be more reliable than that on infrequent use, particularly when subjects are asked to recall more than a few weeks back in time.

Adult↗
PubMedDate not supplied

Antihypertensive drug-associated sexual dysfunction: a prescription analysis-based study.

PURPOSE: To determine whether primary care physicians take into consideration age, gender and diabetes mellitus as risk factors for sexual dysfunction (SD) when prescribing antihypertensives. METHODS: A prescribing survey on hyperternsive patients with or without diabetes mellitus in primary care setting of Bahrain was carried out. RESULTS: In 5301 hypertensive patients, we found that a beta-blocker (atenolol) was the most commonly prescribed drug and was significantly more often prescribed for young male hypertensives (< 45 years). A relatively high dose of atenolol (100 mg/d) was extensively used as both mono- and combination-therapies. With the exception of middle-aged hypertensives (45-64 years) and elderly diabetic-hypertensives (> or = 65 years), no significant age- and gender-related differences were observed regarding the prescription of thiazide diuretics. A significant trend of prescribing methyldopa in females as monotherapy was evident. Angiotensin converting enzyme (ACE) inhibitors, the second most commonly prescribed drugs, were significantly more often prescribed for young, middle-aged hypertensive males and for middle-aged diabetic-hypertensive males. beta-blocker/diuretic combination was prescribed least for the young and elderly hypertensive males. However, prescription of an ACE inhibitor with either a diuretic or a calcium channel blocker (CCBs) was less frequent and lacked gender-related differences. CONCLUSIONS: We infer that antihypertensive-induced SD received little attention as was evident from: (a) over-prescription of relatively high dose of beta-blockers to young hypertensive males; (b) lack of gender- and age-related difference regarding the type and dose of diuretics prescribed; (c) underutilization of effective and complementary combinations expected to cause least impact on sexual function, such as ACE inhibitors with either a diuretic or with a CCB; and (d) a relative lack of discrimination while selecting antihypertensive drugs, particularly as monotherapy between hypertensive versus diabetic-hypertensive patients. With the exception of ACE inhibitors alone and combination of diuretic/beta-blocker, the choice of antihypertensives did not conform to international guidelines. In view of drug-induced SD adversely influencing the quality of life and thereby drug-compliance, interventions aimed at improving physicians' awareness should be attempted.

Adult↗
PubMedDate not supplied

Doctors' prescription behaviour regarding dosage recommendations for preparations of kava extracts.

BACKGROUND: There are many publications on the use of kava extracts as a treatment alternative to tricyclic antidepressants and benzodiazepines, but little has been done to investigate the potential adverse effects that may be associated with prolonged or high-dose usage. OBJECTIVES: To investigate the extent to which physicians comply with the recommended daily dose (RDD) of an antidepressant such as kava and the consequences of this behaviour with regard to the safety and efficacy of frequently prescribed kava extracts (Trade names: Antares, Laitan and Kavasporal forte). METHOD: The analysis was carried out using the patient database MediPlus, which provides anonymous access to a representative and valid panel of physicians and patients in Germany. RESULTS: Prescriptions for Antares showed that the RDD of 1 tablet per day was exceeded in 58.2% of the cases, while those for Laitan showed that the RDD of 1 capsule per day was significantly exceeded in 75.6% of the cases; a one-off prescription was issued in 66% of the cases. As a result, the required effect diminished very quickly. Prescriptions for Kavasporal forte showed that the daily dosage of 2 capsules per day complied with the recommendations in only 49.1% of the cases; in 38.8% of the cases, the dosage dropped below the respective recommendation. As a consequence, the lower-dosed Kavasporal forte was prescribed for longer periods than the higher-dosed Antares and Laitan. CONCLUSIONS: In the case of a low-dosage recommendation, we saw a trend to over-dose in prescribing behaviour, which increases the risk of undesirable adverse reactions. On the other hand, we saw a trend to under-dose in the case of a higher dosage recommendation. This fact may explain the unexpected inefficacy of the therapy. These trends affected the duration of therapy, whereby a dosage lower than the RDD was prescribed for a longer period than a dosage higher than the RDD.

Behavior↗
PubMed2005

Prescription and choice of diagnostic imaging by physician specialty in Alzheimer's Centers (Unità di Valutazione Alzheimer - UVA) in Northern Italy.

BACKGROUND AND AIMS: Physician's specialty has been shown to have an effect on health outcomes and financial expenditure in a number of conditions. This is particularly true in the differential diagnosis of cognitive deterioration, in which technological procedures are needed. The aim of this study is to assess the effect of physician specialty on the prescription of diagnostic imaging (CT and MR) in patients with cognitive impairment, referred to Alzheimer Evaluation Units (Unità di Valutazione Alzheimer) in Northern Italy. METHODS: An ad-hoc questionnaire was sent to UVA referents in northern Italy (Lombardy, Piedmont, Trentino, Emilia-Romagna and Veneto), requesting information on the frequency of prescriptions for CT and MR and reasons for the choice, on a 0 to 7 scale. RESULTS: The physician-in-charge was a neurologist in 22 and a geriatrician in 22 Alzheimer's centers. Intensive use of CT was similar in neurologists and geriatricians (64 vs 68%), whereas intensive use of MR was more frequent in neurologists (41 vs 10%; p = 0.03). Overall, organizational factors (availability of the scanner on-site and waiting list for imaging, mean weight = 1.6 +/- 1.4) were as important as patient-related factors (age, severity of cognitive impairment, and clinical suspicion of cerebrovascular disease, mean weight 1.7 +/- 1.4; p = 0.84). Sixty-five percent of neurologists based their choices between CT and MR on patient-related and 35% on organizational factors, whereas the opposite proportion was found for geriatricians (29 vs 71%, p = 0.04). CONCLUSIONS: The high weight of organizational factors on the prescription of diagnostic imaging is not consistent with an evidence-based diagnostic system.

Ambulatory Care↗
PubMed2004

Medical speciality and pattern of medicines prescription.

OBJECTIVE: To describe the prescribing patterns and their quality in relation to the prescriber's medical specialty in a defined population. METHODS: The study was done on a random sample of all primary care medical prescriptions made through the social security system during 1 year in Andorra, a small European country. Number and type of prescribed medicines, prescribers' medical speciality and patients' age and gender were recorded. Medical specialties considered were General Practice, Paediatrics, Cardiology, Pneumology, Gynaecology, Ophthalmology and Other. A set of various quality indicators [World Health Organisation (WHO)/International Network for Rational Use of Drugs (INRUD) indicators and others] was used. RESULTS: The number of medicines prescribed per encounter varied depending on the prescriber's medical specialty and patient's age. Cardiologists and pneumologists tended to prescribe more medicines than other medical specialties. Patients older than 65 years received more prescriptions than younger adults, mostly at the expense of cardiovascular drugs. The contribution of the various groups and subgroups of medicines and the scores of various prescribing indicators showed wide variability across the medical specialties. CONCLUSION: Prescribing patterns and indicators of prescription quality show wide variability depending on the prescriber's medical specialty. This has important implications for priority setting in information, continuous education and research.

Adolescent↗
PubMed2005

Appropriate use of antiplatelets: is prescription in daily practice influenced by the global cardiovascular risk?

OBJECTIVE: To evaluate the appropriate prescription of antiplatelets according to patients' global cardiovascular risk level in everyday practice. METHODS: In a cross-sectional study, general practitioners (GPs) identified a random sample of 10% of patients at cardiovascular risk among all subjects coming to the surgery and collected data on cardiovascular risk factors and history of atherosclerotic cardiovascular diseases (CVD). GPs were asked to do a physical examination and record the results of laboratory tests to define the global cardiovascular risk. The use of antiplatelet drugs in patients with established CVD and in healthy subjects at high risk of developing symptomatic atherosclerotic disease was evaluated. RESULTS: A total of 162 GPs from all over Italy recruited 3,120 subjects (51% female, mean age 64 years). Of the 949 with an indication for antiplatelet treatment for secondary prevention of CVD, 442 (47%) were receiving it. Among the 2,071 without CVD, 11% were taking an antiplatelet drug. In this group, antiplatelets were prescribed in 6, 10, 16 and 23%, respectively, of patients perceived by GPs to be at mild, moderate, high and very high cardiovascular risk. CONCLUSIONS: Prescription of antiplatelets still seems to be far from what is recommended in virtually all patients with a history of CVD. In subjects with cardiovascular risk factors but without CVD antiplatelet prescription increases in relation to global cardiovascular risk but is still low in patients at high or very high risk of cardiovascular events.

Adult↗
PubMed2000

Choosing to encourage or discourage: perceived effectiveness of prescriptive versus proscriptive messages.

The estimated cost of repairing damage caused to recreational sites annually is in the hundreds of millions of dollars. These depreciative activities also reduce the quality of visitors' experiences in the damaged areas. Indirect methods, such as visitor education through brochures and signs, continue to be the least controversial management approaches to depreciative acts. Yet, the literature on studies examining the most effective message presentations remains sparse. A survey mailed to randomly selected National Association for Interpretation members assessed the perceived effectiveness of communications that encouraged positive conduct (prescriptive messages) versus those that discouraged negative conduct (proscriptive messages) in wildland and urban settings. Almost invariably, respondents viewed the encouragement-based prescriptive messages as more effective than the discouragement-based proscriptive messages. This finding stands in sharp contrast to an earlier study that discovered a preponderance of proscriptive versus prescriptive messages on signs in both wildland and urban recreational environments. Thus, although the great majority of interpreters see the encouragement of positive conduct as more effective, in practice, messages on signs are much more likely to discourage negative conduct. Reasons for this discrepancy are considered.

Journal Article↗
PubMed1986

Principles of exercise prescription for patients with coronary artery disease.

Exercise performance is determined by the interaction of many systems. Cardiac disease, non-cardiovascular pathology, physical training, and the hemodynamic response to the type of exercise the patient wants to perform should all be considered when developing an exercise prescription. There are two stages for deriving a complete exercise prescription, determination of optimal exercise intensity from an exercise test and adoption of the recommendation to include other forms of exercise. The recommendation is usually based on a target oxygen consumption or a target heart rate derived from a treadmill test, but both of these methods may be of limited effectiveness. Ventilatory measurements during exercise, which reflect metabolic changes, are a useful adjunct. The exercise prescription must be individualized to the patient's needs, and may have to be modified so that exercise intensity remains within acceptable limits.

Cardiac Output↗
PubMed1993

Low-dose aspirin in pregnancy: changes in patterns of prescription in The Netherlands.

OBJECTIVE: To describe patterns of prescription in the Netherlands of low-dose aspirin in pregnancy. DESIGN: Anonymous written inquiry in 1989 and 1991. SUBJECTS: Gynecologists in the Netherlands (619 in 1989 and 618 in 1991), practicing in training and non-training hospitals. MAIN OUTCOME MEASURES: Prescription rates for prevention of pregnancy-induced hypertension and fetal growth retardation, or for intention to treat. RESULTS: The response rates were 52% in 1989 and 58% in 1991, covering approximately 61% and 62%, respectively, of the practicing gynecologists in the Netherlands. The use for prevention increased from 53% to 79% and for therapeutic intentions from 25% to 48%. CONCLUSION: The prescription rate for low-dose aspirin increased markedly from 1989 to 1991, without evidence for its benefit from the literature published in the same time period.

Aspirin↗
PubMedDate not supplied

Drug use behavior under the constraints of a Medicaid prescription cap.

Limiting the number of prescriptions reimbursed per month is a cost-containment measure used by state Medicaid programs. The purpose of this study was to identify and examine the strategies used by patients who exceed the limits of the cap. Nineteen patients identified by community pharmacists as meeting this criterion were interviewed in their homes by a member of the project team. The sample consisted predominantly of women. Seven of the 19 individuals reported that they had altered the way they took their medication, primarily by reducing the frequency of dosing, to make the medication last longer. Eight individuals reported that, at some time during the past year, they did not obtain a prescribed medication because of the prescription cap. These medications were prescribed for a variety of conditions, including diabetes, asthma, and congestive heart failure. Patients made the purchase/nonpurchase decision based primarily on importance of the condition for which the medication was prescribed. What was deemed important, however, could change over time as a result of changing symptoms. Patients obtained some help from friends, family, and health care professionals in coping with the constraints of the prescription cap. However, the cap forced a significant group of patients into noncompliance, and thus placed them at risk for poor health outcomes.

Adaptation, Psychological↗
PubMed1993

Concurrent utilization of chiropractic, prescription medicines, nonprescription medicines and alternative health care.

This study examines the use of chiropractic, prescription medicines, nonprescription medicines and alternative health care for two independent samples representative of the population of Edmonton, Alberta, Canada in 1979 (n = 439) and again in 1988 (n = 464). While the usage of prescription medicines was unchanged from 1979 to 1988, utilization of nonprescription medicines, chiropractic and alternative health care increased. Users of chiropractic tended to be concurrent users of the conventional health care system, although they were also more likely to utilize alternative health care. This study shows that Edmontonians tend to select their health care concurrently from various health care modalities including both prescription and nonprescription medicines and conventional and alternative health care.

Adolescent↗
PubMed1985

Aluminum intake from non-prescription drugs and sucralfate.

The use of non-prescription antacids to control hyperphosphatemia has been implicated as a primary cause of aluminum intoxications in patients with reduced renal function. Additional reports suggest that oral aluminum intake may have adverse effects on mineral metabolism of patients with normal renal function. The non-prescription drugs that contain substantial quantities of aluminum salts include some antacids, buffered aspirins, antidiarrheals, and vaginal douches. Sucralfate, an anti-ulcer drug available by prescription, is the aluminum salt of sucrose sulfate. If taken as directed, the daily aluminum intake from the antacids can be as much as 5,000 mg. When aluminum buffered aspirins are used as part of the drug therapy for rheumatoid arthritis, aluminum intake can be elevated by 700 mg/day. Although aluminum intoxications have been reported among patients with reduced renal function, existing reports are not sufficient to estimate whether the chronic elevation of aluminum intake from drugs is causing adverse health effects among other patient populations.

Aluminum↗
PubMed2004

[Drug prescription in the post-percutaneous coronary interventions period: results of the ECART study].

Among 1000 French cardiologists, the ECART study investigated drug prescription in 1041 patients with coronary heart disease, before and after percutaneous coronary interventions. The baseline drug prescription rate CAD patients were the following: beta-blockers 96%, antiplatelets agents 85%, statines 56%, nitrates 36%, calcium blockers 26% and ACE inhibitors 8.7%. The main changes in patients having undergone PCI were: a significant increase in antiplatelets agents (to 97%), ACE inhibitors (to 29%) and statins (to 94%), a significant decrease in nitrates (to 23%). The calcium blockers rate remains unchanged at 26%. Those results are discussed in the field of evidence based medicine and are compared with data from previous drug prescription studies in post myocardial infarction or in secondary prevention.

Adrenergic beta-Antagonists↗
PubMed2006

Pectinase production by solid fermentation from Aspergillus niger by a new prescription experiment.

The Ordos Plateau in China is covered with up to 300,000 ha of peashrub (Caragana) which is the dominant natural vegetation and ideal for fodder production. To exploit peashrub fodder, it is crucially important to optimize the culture conditions, especially culture substrate to produce pectinase complex. In this study, a new prescription process was developed. The process, based on a uniform experimental design, first optimizes the solid substrate and second, after incubation, applies two different temperature treatments (30 degrees C for the first 30 h and 23 degrees C for the second 42 h) in the fermentation process. A multivariate regression analysis is applied to a number of independent variables (water, wheat bran, rice dextrose, ammonium sulfate, and Tween 80) to develop a predictive model of pectinase activity. A second-degree polynomial model is developed which accounts for an excellent proportion of the explained variation (R(2)=97.7%). Using unconstrained mathematical programming, an optimized substrate prescription for pectinase production is subsequently developed. The mathematical analysis revealed that the optimal formula for pectinase production from Aspergillus niger by solid fermentation under the conditions of natural aeration, natural substrate pH (about 6.5), and environmental humidity of 60% is rice dextrose 8%, wheat bran 24%, ammonium sulfate ((NH(4))(2)SO(4)) 6%, and water 61%. Tween 80 was found to have a negative effect on the production of pectinase in solid substrate. With this substrate prescription, pectinase produced by solid fermentation of A. niger reached 36.3 IU/(gDM). Goats fed on the pectinase complex obtain an incremental increase of 0.47 kg day(-1) during the initial 25 days of feeding, which is a very promising new feeding prospect for the local peashrub. It is concluded that the new formula may be very useful for the sustainable development of arid and semiarid pastures such as those of the Ordos Plateau.

Animal Feed↗