SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
AIMS: To examine the nature, frequency and determinants of prescription modifications in Dutch community pharmacies. METHODS: A prospective case-control study comparing modified prescriptions with nonmodified prescriptions was carried out in 141 Dutch community pharmacies. 2014 modified prescriptions (cases), collected in the selected pharmacies on a predetermined day in a specific period (25th February until 12th March 1999) and 2581 nonmodified prescriptions (controls) randomly selected on the same day were studied. The nature and frequency of prescription modifications and patient, drug and prescriber related determinants for a modified prescription were assessed. RESULTS: The overall incidence of prescription modifications was 4.3%, with a mean of 14.3 modifications per pharmacy per day. For prescription only medicines (POM) the incidence was 4.9%. The majority of POM modifications concerned a clarification (71.8%). In 22.2% a prescription could potentially have had clinical consequences when not altered; in more than half of the latter it concerned a dose error (13.7% of all cases). POM prescriptions of patients of 40-65 years had a significantly lower chance of modification compared with those of younger people (OR = 0.74 [0.64-0.86]). With respect to medication-class, we found a higher chance of POM modifications in the respiratory domain (OR = 1.48 [1.23-1.79]) and a decreased chance for nervous system POMs (OR = 0.71 [0.61-0.83]). With regard to prescriber-related determinants modifications were found three times more often in non printed prescriptions than in printed ones (OR = 3.30 [2.90-3.75]). Compared with prescriptions by the patient's own GP, prescriptions of specialists (OR = 1.82 [1.57-2.11]), other GP's (OR = 1.49 [1.02-2.17]) and other prescribers such as dentists and midwives (OR = 1.95 [1.06-3.57]) gave a higher probability of prescription modifications. When a GP had no on-line access to the computer of the pharmacy the chance of a modification was also higher (OR = 1.61 [1.33-1.94]). Multivariate analysis revealed that a nonprinted prescription was the strongest independent determinant of prescription modifications (OR = 3.32 [2.87-3.84]), remaining so after adjustment for GP computer link to the pharmacy and for type of prescriber. CONCLUSIONS: At least 30% of Dutch community pharmacies corrected 2.8 POM prescriptions per pharmacy per working day, which could potentially have had clinical consequences if not altered. If the study sample is representative for The Netherlands, Dutch community pharmacies correct a total of approximately 4400 of these prescriptions per working day. Using computerized systems to generate prescriptions is an important strategy to reduce the incidence of prescription errors.
OBJECTIVE: This study augments existing literature by examining characteristics associated with prescription drug utilization and makes an in-depth assessment of family prescription drug economic burden within the United States. The objective of this study was to examine differences in prescription drug use and prescription drug characteristics among elderly and nonelderly families. METHODS: A measure of out-of-pocket prescription drug burden associated with family prescription drug utilization was constructed using data from the 1996 Medical Expenditure Panel Survey (MEPS). Families were designated as the unit of analysis and further divided by age (<65 and e 65 years) of the reference person. The 1996 MEPS database provides medical expenditure data on a national sample of 8,917 families (22,601 individuals) and 147,308 drug episodes, i.e., prescription procurement. The ratio of family prescription out-of-pocket expenditures to family income was used to assign families to economic burden rank-ordered quintiles, each representing 20% of U.S. families in 1996. RESULTS: Prescription size, price, and drug use were higher among elderly families. Their proportion of generic use was higher compared to nonelderly families. Additionally, out-of-pocket prescription expenditures represented 23.7% and 45.6% of the total out-of-pocket medical care burden for nonelderly and elderly families, respectively. The average prescription drug burden (total prescription out-of-pocket costs/family income) was 0.4% for nonelderly and 1.9% for elderly households. CONCLUSION: The study results demonstrate an ability to identify populations with high economic burden for prescription medications. The presumption is that persons age 65 or older, lacking purchasing leverage, are more likely to pay full retail price and, consequently, higher prices. Our findings suggest that high prescription drug burden was a function of prescription size and cost per prescription, with prescription size showing more drastic differences between the high and low prescription drug burden subgroups. Future studies should continue to assess factors influencing families. prescription drug economic burden, and the information derived from these studies should be used by benefit planners in designing drug benefits within health insurance plans.
This Issue Brief closely examines expenditures on prescription drugs, and discusses their potential to substitute for other types of health care services. In addition, it describes employer coverage of prescription drugs, direct-to-consumer advertising of prescription drugs, and potential legislation affecting the prescription drug market. Prescription drug expenditures grew at double-digit rates during almost every year since 1980, accelerating to 14.1 percent in 1997. In contrast, total national health expenditures, hospital service expenditures, and physician service expenditures growth rates decreased from approximately 13 percent in 1980 to less than 5 percent in 1997. Private insurance payments for prescription drugs increased 17.7 percent in 1997, after growing 22.1 percent in 1995 and 18.3 percent in 1996. This growth in prescription drug payments compares with 4 percent or less overall annual growth in private insurance payments for each of those three years. From 1993 to 1997, the overwhelming majority of the increases in expenditures on prescription drugs were attributable to increased volume, mix, and availability of pharmaceutical products. In 1997, these factors accounted for more than 80 percent of the growth in prescription drug expenditures. A leading explanation for the sharp growth in drug expenditures is that prescription drugs are a substitute for other forms of health care. While it is difficult to determine the extent to which this substitution occurs, various studies have associated cost savings with the use of pharmaceutical products in treating specific diseases. Evidence suggests that more appropriate utilization of prescription drugs has the potential to lower total expenditures and improve the quality of care. Also, some studies indicate the U.S. health care system needs to improve the way patients use and physicians prescribe current medications. Prescription drug plans offered by employers are likely to undergo changes to ensure that only the most efficacious drugs are covered. Anecdotal evidence suggests that copayments for prescriptions are going to increase. Some health plans are including prescription drug costs in their capitated payments to physicians. Furthermore, prescription drug plans are expected to use formularies more aggressively. In 1996, an average 5.47 outpatient prescriptions were written for those ages 55-64, compared with more than eight for those age 65 and older. Inevitably, this translated to significantly more spending for prescription drugs by the elderly. In 1994-1995, the average elderly individual (age 65 or older) spent $558 on prescription drugs, while the average 55-64-year-old spent $355. While prescription drugs are showing sharp price increases, they are also becoming more important in the treatment of many diseases. Consequently, both employers and policymakers must carefully balance the design and cost of a drug benefit so that continual innovation is preserved and the benefit can remain affordable and effective.
BACKGROUND AND OBJECTIVES: Duplicate prescription pads are used in many family practice residency programs to monitor prescribing patterns and detect errors in the actual prescription-writing process. This study looked at whether the review of duplicate prescriptions could be enhanced by adding the patient's diagnosis to the prescription. METHODS: The prescription-writing errors of Shaughnessy and Nickel were revised to include prescription-writing markers. These markers were defined as either an indication of use or a duration of therapy that differed from current medical literature or manufacturers' recommendations. Duplicate prescriptions of first-year family practice residents were reviewed for prescription-writing errors and markers before and after an in-service training regarding prescription writing. RESULTS: Following the in-service training, the number of prescriptions containing the patient's diagnosis increased significantly (20% to 61%). Nineteen percent of all prescriptions contained prescription-writing errors. Eight percent of the prescriptions with the patient's diagnosis contained prescription-writing markers. CONCLUSIONS: The addition of the patient's diagnosis to the prescription enhanced the review of duplicate prescriptions. It permitted the evaluation of not only the prescription-writing process but also the decision-making process that led to writing the prescription. It also permitted a more thorough evaluation of appropriate drug use.
OBJECTIVES: The authors sought to evaluate the impact of computerised chemotherapy prescription on the reduction of medication errors. The purpose of this study was to assess the incidence of errors present in electronic versus manual prescription. MATERIAL AND METHODS: The data gathered from computerised chemotherapy prescription sheets were submitted to a prospective analysis as cases of the intervention groups. The control group was comprised of the handwritten chemotherapy prescription sheets. Chemotherapy prescriptions for consecutive oncology patients were analysed by 2 independent examiners, who investigated errors of omission, commission, interpretation of dates, abbreviations and illegible handwriting. The proportion of treatment prescriptions containing one or more errors and the median of errors were calculated in order in both groups. RESULTS: At least one error was detected in 100% of the manual prescriptions and in 13% of computerised prescriptions (p < 0.001). The median of errors per computerised prescription was 0 (range: 0- 1), whereas in manual prescriptions the median was 5 (range: 1-12) (p < 0.001). Errors of omission were predominant in manual prescriptions. Errors of commission were limited to 1 case of unjustified cytostatic agent infra-dosage in a computerised prescription. This error was present in 3 cases in handwritten prescriptions and, in addition, 1 case of premedication drug substitution was detected. Errors of interpretation of the date, use of abbreviations and illegible handwriting were frequent among manual prescriptions and were absent from computerised prescriptions. CONCLUSIONS: Electronic chemotherapy prescription is a powerful tool. In this study it has been shown to decrease chemotherapy-related medication errors and ensure that safe chemotherapy practices were followed.
The goal of the National Medical Care Utilization and Expenditure Survey (NMCUES) of 1980 was to improve the understanding of the ways in which Americans use and pay for health care. This report is one in a series of descriptive reports based on NMCUES data. This report provides data regarding prescription drugs obtained on an outpatient basis by noninstitutionalized elderly people who reported being covered by Medicare in 1980. The results presented are based on NMCUES data collected about the civilian noninstitutionalized persons in the NMCUES national household sample who at any time during the survey year of 1980: (1) were 65 years of age or over, and (2) reported having been covered by Medicare hospital insurance (HI) or Medicare supplementary medical insurance (SMI) or both. These results include the number of prescriptions obtained during the survey year, the total charges for these prescriptions, the amounts paid by various sources, and the types of drugs obtained. Noninstitutionalized aged Medicare beneficiaries obtained an estimated 288 million prescriptions during 1980 and spent an estimated $2.3 billion for prescription drugs. Four of five beneficiaries used prescription drugs during the year. Although aged Medicare beneficiaries represented only 10.9 percent of the U.S. population during 1980, they accounted for 28.6 percent of all prescriptions and 30.2 percent of total prescription drug charges. The average aged beneficiary during the year purchased 12.1 prescriptions and incurred $98 of expenditures, about three times the average of those under 65 years of age. The average charge per prescription was $8.05. Prescription drug charges accounted for 5.5 percent of an estimated $42 billion spent by aged Medicare beneficiaries for health care during 1980, excluding charges for institutional care. Prescription drug use and expenditures were lower among people 65-69 years of age than among people 70-74 or 75-79 years of age. On average, women used more prescriptions and incurred higher charges than did men. Regionally, the average number of prescriptions that were filled per beneficiary was highest in the South and lowest in the West. People who perceived their health status to be poor had approximately four times as many prescriptions filled per person and incurred four times the average annual charge of people who perceived their health status to be excellent. Approximately 68 percent of the total dollars spent by aged Medicare beneficiaries for prescription drugs was paid out-of-pocket, 13.9 percent was paid by private health insurance, and 10.8 percent was paid by Medicaid. The remaining charges were distributed among other payers.(ABSTRACT TRUNCATED AT 400 WORDS)
This final rule implements the provisions of the Social Security Act (the Act) establishing and regulating the Medicare Prescription Drug Benefit. The new voluntary prescription drug benefit program was enacted into law on December 8, 2003 in section 101 of Title I of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108-173). Although this final rule specifies most of the requirements for implementing the new prescription drug program, readers should note that we are also issuing a closely related rule that concerns Medicare Advantage organizations, which, if they offer coordinated care plans, must offer at least one plan that combines medical coverage under Parts A and B with prescription drug coverage. Readers should also note that separate CMS guidance on many operational details appears or will soon appear on the CMS website, such as materials on formulary review criteria, risk plan and fallback plan solicitations, bid instructions, solvency standards and pricing tools, plan benefit packages. The addition of a prescription drug benefit to Medicare represents a landmark change to the Medicare program that will significantly improve the health care coverage available to millions of Medicare beneficiaries. The MMA specifies that the prescription drug benefit program will become available to beneficiaries beginning on January 1, 2006. Generally, coverage for the prescription drug benefit will be provided under private prescription drug plans (PDPs), which will offer only prescription drug coverage, or through Medicare Advantage prescription drug plans (MA PDs), which will offer prescription drug coverage that is integrated with the health care coverage they provide to Medicare beneficiaries under Part C of Medicare. PDPs must offer a basic prescription drug benefit. MA-PDs must offer either a basic benefit or broader coverage for no additional cost. If this required level of coverage is offered, MA-PDs or PDPs, but not fallback PDPs may also offer supplemental benefits through enhanced alternative coverage for an additional premium. All organizations offering drug plans will have flexibility in the design of the prescription drug benefit. Consistent with the MMA, this final rule also provides for subsidy payments to sponsors of qualified retiree prescription drug plans to encourage retention of employer-sponsored benefits. We are implementing the drug benefit in a way that permits and encourages a range of options for Medicare beneficiaries to augment the standard Medicare coverage. These options include facilitating additional coverage through employer plans, MA-PD plans and high-option PDPs, and through charity organizations and State pharmaceutical assistance programs. See sections II.C, II.J, and II.P, and II.R of this preamble for further details on these issues. The proposed rule identified options and alternatives to the provisions we proposed and we strongly encouraged comments and ideas on our approach and on alternatives to help us design the Medicare Prescription Drug Benefit Program to operate as effectively and efficiently as possible in meeting the needs of Medicare beneficiaries.
BACKGROUND: There is concern regarding the irrational production, prescription and use of drugs in India. This study aimed to describe the quality of prescriptions by medical practitioners, including both the layout of the prescription and the type and number of drugs prescribed. MATERIALS AND METHODS: A survey of all prescriptions dispensed at a busy pharmacy in the state of Goa, India, was carried out over a consecutive seven-day period. Each prescription was rated on the basis of a priori and pilot-tested variable list. The prescriptions by private practitioners were compared with those from practitioners in the public healthcare system. RESULTS: Nine hundred and ninety prescriptions were collected. The majority (83.9%) were from private practitioners. The quality of the layout of the prescriptions was unsatisfactory: information to identify the practitioner was incomplete in more than a third of the prescriptions and information to identify the patient was incomplete in more than half. Clarity of written instructions on how to take the medicines was unsatisfactory in the majority of prescriptions. Polypharmacy was the norm, with more than half (52.7%) the prescriptions containing at least 3 medicines. Forty per cent of prescriptions included a vitamin or tonic preparation and a quarter of the prescriptions included an antibiotic and an analgesic. Over 90% of prescriptions contained only branded medicines. Private practitioners prescribed significantly greater number of medicines and were more likely to prescribe vitamins and antibiotics, and branded medicines. DISCUSSION: This study confirms that the quality of prescriptions, both in terms of layout and the content of the drugs prescribed, is inadequate. There is a need to standardize the format of prescriptions in India so that all essential information is included. There is a need to strengthen an independent mechanism for continuing professional development of practitioners to ensure that patients are always given evidence-based, cost-effective treatments.
OBJECTIVE: To study the pattern of prescriptions in outpatient clinics in a teaching hospital in Southwestern Saudi Arabia. METHODS: A total of 3796 prescriptions from outpatient clinics of Aseer Central Hospital, Abha, Kingdom of Saudi Arabia were screened randomly and systemically over one-year period (April 2000 to April 2001). The prescriptions were analyzed for the essential elements of the prescription order, and for the number and classes of drugs prescribed, source of prescription and appropriateness of prescription to the diagnosis. RESULTS: The source of prescriptions was not provided in 61.5% of prescriptions. The diagnosis was missing in 15.1% and not readable in 18.9% of prescriptions. Upper respiratory tract infection (URTI) was the most frequent diagnosis and was included in 21.6% of prescriptions. The average number of drugs per prescription was 2.1 +/- 1.05 (Mean +/- SD), with 90.8% of prescriptions containing 3 or fewer drugs. The most frequently prescribed drugs were nonsteroidal anti-inflammatory drugs (NSAIDs), including paracetamol which were included in 51.2% of prescriptions, followed by antibacterial agents (33.2%). Only 46.4% of prescriptions were appropriate to the diagnosis, while 11.1% were partially appropriate and 5.3% were inappropriate. For the rest (37.2%), it was difficult to evaluate appropriateness due to deficient information. General practitioners and specialists were more likely to prescribe appropriately than emergency room physicians (64.6% and 60.4% versus 35.7%). None of the prescriptions for antiplatelet and anticoagulant drugs and antihypertensive agents were inappropriate. CONCLUSION: These results emphasize the need for continuing medical education on rational prescribing, and for periodic monitoring of physicians habits on drug utilization.
PURPOSE: The impact of cost-containment strategies on prescription drug utilization and costs in an ambulatory care safety-net-provider setting was studied, along with the impact of these strategies on patient out-of-pocket expenditures. METHODS: Aggregate monthly prescription drug cost and utilization data were obtained from a health system's outpatient pharmacy computer system for the targeted clinic. The data represented approximately 42,000 patient visits over 38 months. Univariate and multivariate statistics were used to evaluate the influence of copayment increases and changes in prescription drug sample policies on prescription drug costs, prescription drug utilization, and patient expenditures. RESULTS: Prescription drug copayment increases were associated with significant decreases in prescription drug utilization and costs. An average per visit prescription drug copayment increase of $5 was associated with a significant reduction in prescription drug utilization per visit and a $26.07 reduction in prescription drug expenditures per visit per month. Removal of samples from the clinic did not result in a significant decrease in either prescription drug costs or utilization. The presence of samples, however, was associated with a significant reduction in per visit patient expenditures by an amount similar to the copayment for one brand-name prescription drug per visit. CONCLUSION: An increase in patient copayments was associated with reductions in a clinic's drug expenditures and prescription drug utilization per visit. Removal of prescription drug samples had no effect except increasing patients' out-of-pocket drug costs.
BACKGROUND: The Drug Programs Information Network (DPIN), Manitoba's (Canada) new electronic prescription database, is a valuable data source for pharmacoepidemiologic research. Pharmacies are required to submit to the DPIN all prescriptions for Pharmacare, the province's drug insurance plan, but submission of prescriptions for social assistance recipients and treaty status Indians is discretionary. OBJECTIVE: The completeness of the DPIN prescription database was assessed to determine whether treaty status Indians and social assistance recipients were underrepresented. DESIGN: Prescriptions dispensed during March 13-17, 1995, in a stratified sample of Manitoba pharmacies were linked to DPIN by prescription number to determine the proportions submitted for Indian Affairs, Social Services, and Pharmacare recipients. Pharmacare records in the DPIN were compared with original pharmacy records to evaluate data accuracy. RESULTS: Of 2196 Indian Affairs and 1879 Social Services prescriptions dispensed in 58 pharmacies, a corresponding prescription was found in the DPIN for 79.7% (98% CI 78.0% to 81.4%) and 90.1% (98% CI 88.8% to 91.4%) of prescriptions, respectively. These proportions were significantly lower than the estimated proportion of Pharmacare prescriptions submitted (93%, 98% CI 92.4% to 93.6%). Ninety-two percent of 8012 DPIN Pharmacare prescriptions matched the original prescription on the drug name, quantity, and days' supply. CONCLUSIONS: This study established that the DPIN is a valid and reliable data source for studying prescription use among the majority of Manitoban residents. However, the DPIN database has differential validity and underrepresents prescriptions dispensed for the aboriginal population.
Unclaimed prescriptions, that is, those filled but not obtained by the patient, may influence patient care and pharmacy operations. The authors' objectives were to 1) describe characteristics of unclaimed prescriptions and the patients for whom these prescriptions were written, and 2) compare and contrast characteristics of prescriptions never dispensed with those that were eventually dispensed. During the 8-week study, 180 patients with 224 unclaimed prescriptions were identified at the University of Michigan Hospital's Ambulatory Care Pharmacy. The most frequent categories of unclaimed prescriptions were skin/mucous membrane, central nervous system, and anti-infective medications. In 25.9% of cases of unclaimed prescriptions, they were telephoned in by a healthcare professional as new prescriptions. Overall, 64.3% were new, rather than refill, prescriptions. Approximately two thirds of the unclaimed prescriptions were eventually dispensed. Of the characteristics evaluated for differences between unclaimed prescriptions eventually dispensed and those never dispensed, only new versus refill prescriptions and class of medication were significantly different. Most unclaimed prescriptions were eventually dispensed after a delay. However, the types of medications involved suggest that these delays from initially unclaimed prescriptions could have resulted in problems.