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PubMed2005

Use of prescription drugs: rising or declining?

Prescribing practices are a reflection of health professionals' abilities to discriminate among the various choices of drugs and determine the ones that will most benefit their patients. As selective as practitioners must be, they cannot limit themselves to knowing only those drugs that fit within the dominant paradigm of acute care. They must broaden their exposure to incorporate knowledge of drugs that permeate clients' lives through media and self-administration. Health promotion drug use is just emerging as a prescriptive activity, but it will become more significant in the future. Primary and secondary prevention drug uses are in flux, and tertiary prevention drug use is likely to overwhelm our system, particularly with the baby boom generation, until our society can switch its focus to more health promotion and disease prevention. It is imperative that health professionals develop shared decision-making capabilities for client education and appropriate prescribing. Only when the health care system exhibits a true client-provider partnership will the "five rights"-right drug, right dose, right route, right time, right client-be accurately applied. With the increasing and overwhelming costs of prescription drugs, health practitioners cannot afford to sit idle; as professionals and stakeholders, they must engage health policy makers and persuade these entities to share their concerns and views, and help their clients, the profession, and themselves.

Cooperative Behavior↗
PubMed2006

Nonmedical use of prescription stimulants in the United States.

OBJECTIVE: This study estimated prevalences and correlates of stimulant diversion in the United States and examined relationships between diversion and measures of abuse or dependence. METHODS: We conducted descriptive and multivariate analysis of data from the National Survey on Drug Use and Health. Key measures were nonmedical use (misuse) of any prescription stimulant, any stimulant other than methamphetamine, and stimulants indicated for attention-deficit/hyperactivity disorder (ADHD). RESULTS: Lifetime stimulant misuse included some misuse of longer-acting ADHD drugs. The majority of past-year misuse involved drugs other than methamphetamine, particularly for youth aged 12-17. Past year misuse was more prevalent among persons aged 12-25, compared with older adults, and among Whites, compared with other groups. Prevalences in large metropolitan areas were lower than or similar to those in less populated areas. About 13% of past-year stimulant misusers met the survey criteria for dependence or abuse, as did about 10% of persons aged 12-25 who misused only nonmethamphetamine stimulants. CONCLUSIONS: Most stimulant misuse in the United States (particularly among youth) involved prescription drugs other than methamphetamine. The problem is not limited to metropolitan areas.

Adolescent↗
PubMed2006

Infrequent use of antidepressants in depressed individuals (an interview and prescription database study in a defined Swedish population 2001-2002).

PURPOSE: To investigate whether antidepressants are over-used, under-used, or misused, by determining to what extent the depressed individuals in a defined population are treated with antidepressant medication and, from the other end, to what extent prescribed antidepressants are aimed for the treatment of depression. SUBJECTS AND METHOD: From an individual based prescription database in the County of Jämtland, 2048 individuals representative for the general population were selected. The presence of current depression in these individuals was screened by a mailed self-screening questionnaire. Individuals with depression according to the questionnaire were interviewed by a psychiatrist using a structured interview (SCAN) to confirm the diagnosis. Their use of antidepressants was obtained from the prescription database. RESULTS: Sixty-two (4.5%) out of 1375 were diagnosed with depression and 17 (27%) of these were taking an antidepressant. In addition 44 individuals, currently not depressed, were taking antidepressants. Twenty-five of these were interviewed per telephone and it was found that the indications for 18 of them were continuation treatment of depression, and for seven of them pain, sleep disturbance or anxiety. CONCLUSION: Antidepressants appear to be under-used in the population. Only one in four of the depressed individuals was treated with antidepressant medication. Those who had antidepressant medication without being currently depressed had, with few exceptions, either continuation treatment for depression in remission or treatment on other approved indications.

Adolescent↗
PubMed2005

Usefulness of coadministration of bucolome in warfarin therapy: pharmacokinetic and pharmacodynamic analysis using outpatient prescriptions.

Bucolome, a nonsteroidal anti-inflammatory drug, has often been coadministered to patients who take warfarin as an anticoagulant. This combination increases the anticoagulant effect, which is most likely due to the interaction of bucolome with the pharmacokinetics (PK) or pharmacodynamics (PD) of warfarin. More than 30 years ago the mechanism of this interaction was reported to be inhibition of warfarin protein binding by bucolome, and the inhibition of warfarin metabolism by bucolome was also recently reported. Here, we examined daily doses of warfarin and its anticoagulant effect (thrombo-test, TT) in outpatient prescriptions in five hospitals to elucidate the drug interaction and the usefulness of this drug combination. Among the warfarin prescriptions, 78 were for patients also taking bucolome and 99 were for patients not taking bucolome. The daily dose of warfarin in patients taking bucolome was significantly lower than those without bucolome (ca. 40%). TT in patients taking bucolome was significantly lower as compared to those not taking bucolome. Control of the anticoagulant effect was greater with coadministration of bucolome and warfarin than with warfarin alone. PK and PD analysis of our results suggests that the improved therapeutic effect resulting from coadministration of warfarin with bucolome was due to lower and less patient-to-patient variation of intrinsic hepatic clearance (CL(int)) of warfarin, since bucolome decreased the high CL(int) but did not have a great effect on the low CL(int). In conclusion, administration of bucolome in warfarin therapy is useful to control the anticoagulant effect of warfarin. Attention should also be paid to the enzymatic inhibition by bucolome on the PK of coadministered drugs.

Adult↗
PubMed2005

Aspirin use in older patients with heart failure and coronary artery disease: national prescription patterns and relationship with outcomes.

OBJECTIVES: We sought to determine patterns of aspirin use and the relationship between aspirin prescription and outcomes in patients with coronary artery disease (CAD) and heart failure (HF). BACKGROUND: Because of the potential for exacerbating hypertension or renal insufficiency and possible interactions with angiotensin-converting enzyme (ACE) inhibitors, the use of aspirin for secondary prevention of coronary events is controversial in patients with HF. METHODS: We studied a national sample of Medicare beneficiaries > or =65 years old after hospitalization for HF with CAD and without aspirin contraindications between April 1998 and June 2001. We assessed factors associated with aspirin prescription and the relationship between aspirin and outcomes in regression models accounting for differences in patient, physician, and hospital characteristics and for clustering of patients by hospital. RESULTS: Of the 24,012 patients, 54% received aspirin. Treated patients had lower unadjusted rates of death (31% vs. 39% for those not receiving aspirin, p < 0.001). In multivariable analyses, aspirin remained associated with a lower risk of death (risk ratio [RR] 0.94; 95% confidence interval [CI] 0.90 to 0.99). This association was similar regardless of hypertension, renal insufficiency, or treatment with ACE inhibitors (p for all interactions > 0.2). Aspirin also was associated with lower risks of death or all-cause readmission (RR 0.98; 95% CI 0.97 to 0.99) and of death or readmission for HF (RR 0.98; 95% CI 0.96 to 0.99). CONCLUSIONS: Almost one-half of patients with CAD hospitalized for HF in the U.S. are not treated with aspirin. This study found no evidence of harm from aspirin in this population and suggests a treatment benefit. Withholding aspirin based upon theoretical concerns about adverse effects appears to be unjustified.

Age Factors↗
PubMed2005

Diagnosis of chronic pain caused by osteoarthritis and prescription of analgesics in patients with cognitive impairment.

OBJECTIVE: Evaluation of the ability to detect symptoms of osteoarthritis and prescription of analgesics in older adults with different degrees of cognitive impairment. SETTING AND PATIENTS: Patients consecutively admitted to a Geriatric Evaluation and Rehabilitation Unit (GERU) for disability due to orthopedic, neurological, or cardiopulmonary diseases, after a surgical intervention, or for behavioral disturbances of dementia. Subjects with a recent orthopedic intervention were excluded. Eight hundred eighty-eight patients were analyzed (mean age 78.4 +/- 7.2 years, 69.5% female) and divided into 4 groups according to cognitive impairment: severe (Mini-Mental State Examination, MMSE 0-12), moderate (MMSE 13-18), mild (MMSE 19-24), or absent (MMSE 25-30). METHODS: Patients underwent a geriatric multidimensional assessment; the diagnosis of musculoskeletal pain was based on patients' direct report, objective signs (inflammatory signs around the joints), and "pain behaviors" (reductions in activity, social withdrawal, self-protective maneuvers, increased alterations in facial expressions or body postures, observable displays of distress). Analgesic drugs were registered on discharge in subjects with symptomatic osteoarthritis. RESULTS: Of the patients admitted to GERU, 16.8% (n = 149) had osteoarthritis; this percentage is different according to cognitive impairment (MMSE 0-12: 1%, MMSE 13-18: 8%, MMSE 19-24: 17.4%, MMSE 24-30: 34.1%, P < .001). If patients admitted for osteoarthritis are excluded, the new diagnoses of pain due to osteoarthritis are 306 (41.4%), without differences between cognitive status groups. On discharge, analgesic drugs are prescribed to 28.8% of patients with symptomatic arthritis (n = 131); the percentage is lower in patients with severe cognitive impairment in comparison with subjects with better cognitive functions. CONCLUSION: There is a poor attention to chronic pain due to osteoarthritis in community-dwelling elders with cognitive impairment. In a rehabilitative setting, an accurate evaluation of objective signs allows the diagnosis of symptomatic osteoarthritis. However, the link between the diagnosis and the treatment is not direct, since the prescription of analgesics is lower in patients with a more severe cognitive impairment.

Activities of Daily Living↗
PubMed2006

Reconstruction of the inventory of materia medica used by members of the Jewish community of medieval Cairo according to prescriptions found in the Taylor-Schechter Genizah collection, Cambridge.

The Taylor-Schechter (T-S) collection at Cambridge University Library is the biggest of all Cairo Genizah collections in the world. The importance and the potential of research into the medical aspects of the Genizah documents were clear to researcher since the early 1960s. A few works have been published since, usually focusing on one subject, or even important single manuscripts. The current research concerned mainly with one aspect of the history of medicine of the Jewish community of Cairo (as a reflection of Eastern medieval societies), namely the practical uses of natural substances for medicine. The most interesting and original information is undoubtedly to be found in the 141 prescriptions, as they reflect the medical reality that actually existed. And indeed, 242 substances were recorded in the prescriptions identified: 195 substances of plants origin (80.6%), 27 inorganic materials (11.2%) and 20 substances of animal origin (8.2%) were recorded as being in practical used for medicinal purposes. The most frequently mentioned substances were the rose, myrobalan, sugar, almonds, and endive. The most prevalent ailments: eye diseases, headache, constipations (purgative), cough, skin diseases, stomach, fever, gynaecological problems, haemorrhoids, liver ailments, lice, swellings, dental trouble, ulcers, and problems of the urinary tract.

Cough↗
PubMed2004

Cancer patients' share in a population's use of opioids. A linkage study between a prescription database and the Danish Cancer Registry.

The aim of this study was to 1) assess cancer patients' share in a population's use of opioids and how much it influences the total use, and 2) analyze trends in the population's use of "weak" and "strong" opioids during a five-year period. Person-identifiable data on opioid prescriptions and cancer diagnoses from a Danish county (n approximately 470,000) were retrieved from a prescription database, OPED, and The Danish Cancer Registry from 1993-1997 (identifying 23,843 cancer patients). In a given year, 14% of the population's opioid users were cancer patients, and they received 23% of the total opioid consumption. Over time, the number of patients using weak opioids increased and the number using strong opioids decreased among both cancer patients and non-cancer patients. Cancer patients' consumption of strong opioids increased dramatically in 1996-1997, almost accounting for the entire increase in the whole population's consumption of strong opioids.

Data Collection↗
PubMed2004

Office visits and analgesic prescriptions for musculoskeletal pain in US: 1980 vs. 2000.

The treatment of pain has received increasing attention over the past decade promoted by national guidelines, the 'pain as the 5th vital sign' campaign and direct-to-consumer advertising. We examined national trends in office visits and analgesic treatment for musculoskeletal pain in the office setting, comparing data from 1980 and 2000. We analysed the National Ambulatory Medical Care Survey (NAMCS)--a nationally representative survey of visits to office-based physicians--using data from 1980-81 (n=89,000 visits) and 1999-2000 (n=45,000 visits). During this time, NSAID prescriptions increased for both acute (19 vs. 33%, RR=1.74; 95% CI, 1.52-1.95) and chronic (25 vs. 29%, RR=1.16; 95% CI, 0.97-1.35) musculoskeletal pain visits. In 2000, one-third of the NSAID prescriptions were for COX II agents. Opioids increased for acute pain (8 vs. 11%, RR=1.38; 95% CI, 0.92-1.83) and doubled for chronic pain (8 vs. 16%, RR=2.0; 95% CI, 1.52-2.48). The use of more potent opioids (hydrocodone, oxycodone, morphine) for chronic musculoskeletal pain increased from 2 to 9% of visits (RR=4.5; 95% CI, 2.18-6.87). This corresponds to 5.9 million visits where potent opioids were prescribed in 2000--an increase of 4.6 million visits from 1980 (assuming the total number of outpatient visits was constant at the 2000 level). In spite of the increased attention to pain treatment, there has not been an increase in office visits for musculoskeletal pain complaints. The threshold for prescribing NSAIDS and opioids, however, has dropped.

Adolescent↗
PubMed2005

Palatal perforation associated with intranasal prescription narcotic abuse.

BACKGROUND: Palatal perforation resulting from insufflation of cocaine has been well documented. In comparison, reports of destructive orofacial lesions resulting from intranasal abuse of prescription narcotics are rare. We present the clinical and histologic findings in a case of palatal perforation arising in a patient abusing a prescription opioid drug. The patient denied any history of cocaine use but admitted to habitually crushing and snorting a hydrocodone/acetaminophen preparation. Study design The patient presented to our clinic seeking resolution of speech difficulties associated with an oroantral fistula. Surgical repair of the defect had been attempted unsuccessfully in the past. In addition to blood and chemistry panels, endoscopic examination was conducted, with removal of several biopsy specimens for histologic evaluation and flow cytometry. Biopsy specimens included both lesional and perilesional tissue from within the oral and nasopharyngeal cavities. Culture and cytology for fungal organisms were also performed. RESULTS: Histopathologic examination revealed normal mucosa with diffuse and focal inflammatory changes and no evidence of malignancy. Polarizable foreign material was noted in the specimens. The absence of lymphoid neoplasia was confirmed by flow cytometric analysis. The toxicology panel was positive for the presence of opiates in the blood. Culture and cytology were positive for candidal organisms. A palatal obturator was fabricated for the patient, producing significant improvement in the quality of speech. CONCLUSIONS: This may represent a case of palatal perforation resulting from abuse of a drug other than cocaine. The potential for drugs other than cocaine to produce destructive orofacial lesions should be considered.

Administration, Intranasal↗
PubMed2005

Prescription-only anthelmintics--a questionnaire survey of strategies for surveillance and control of equine strongyles in Denmark.

In 1999, legislation in Denmark made anthelmintic drugs available only by prescription, and prohibited their use for routine, prophylactic treatment. A questionnaire survey was conducted in 2004 to determine current strategies for surveillance and control of equine strongyles used in Danish equine veterinary practices. Eighty-seven of 170 (51.2%) registered equine veterinary practices responded. Ninety seven percent of the respondents used faecal egg counts for diagnosis and surveillance, and 41% used larval cultures. Logistic regression revealed that the use of larval cultures was positively correlated with numbers of employees (P = 0.013) and the proportion of equine caseload in the practice (P < 0.000). Performing faecal egg counts and treating horses was most frequent during spring, summer and early autumn. Veterinary practices made treatment decisions based on cut-off values ranging from 20 to 500 eggs per gram (EPG) faeces. Ages of horses, clinical suspicions of parasitic disease, or requests by the owners were the most important factors in the strategies for faecal sampling. Less commonly, sampling strategies included all horses on the premises and random sampling. Ninety five percent of the respondents reported treating certain groups of horses without prior faecal analysis, including horses with clinical signs of parasitic disease (77%), foals (84%), horses less than 3 years of age (52%), and pregnant mares (51%). The respondents regarded the cyathostomin group as the most prevalent cause of parasitic disease and ill-thrift, followed by large strongyles and Parascaris equorum. Sixty seven percent rotated regularly between drugs, while 11% performed routine screening for anthelmintic resistance. Results of this survey suggest that limiting equine anthelmintics to prescription-only availability has increased the level of strongyle surveillance. Veterinary practitioners play a central role in equine parasite management with indications of a lowered intensity of treatment. However, screening for anthelmintic resistance remains uncommon.

Age Factors↗
PubMed1987

Prescription drug use before and during pregnancy in a Medicaid population.

This study describes prescription drug use before and during pregnancy and is based on data obtained from the paid Medicaid claims of 18,886 Michigan women aged 15 to 44 years who were delivered of a live infant. Rates of exposure to drugs within 15 therapeutic categories are presented for each of five 90-day periods preceding delivery. Overall dispensed drug use (excluding vitamins) decreased during pregnancy; however, there was still substantial exposure to drugs including drugs that are contraindicated during pregnancy. During the gestational period, study mothers received an average of 3.1 prescriptions for nonvitamin drugs. Black mothers received more exposure to drugs other than vitamins than did white mothers. Black mothers had higher rates of exposure to analgesics, ampicillin, codeine, and vaginal preparations. Similarities between black and white mothers in the use of vitamins with and without other drugs suggest there is no racial difference in attaining prenatal care within the Medicaid system, but that black mothers may have more medical problems that warrant the use of other medications in addition to vitamins during pregnancy.

Adolescent↗
PubMed1998

Mortality hazard associated with prescription hypnotics.

BACKGROUND: The American Cancer Society's Cancer Prevention Study II was a large survey designed primarily to examine cancer risks such as cigarette smoking. From the same survey and methods, data on usage of "prescription sleeping pills" in 1982 were examined. METHODS: Standardized mortality ratios were computed. Because sleeping pill use could be a proxy for other risk factors, cox proportional hazards models were computed to control for possible confounding factors as extensively as the data permitted. RESULTS: Men and women who reported taking prescription sleeping pills 30+ times in the past month had standardized mortality ratios of 3.18 and 2.82, respectively; controlling for 10-year age groups (p < 0.001). The standardized mortality ratios for usage 1-29 times/month were 1.8 and 1.48, respectively (p < 0.001). In proportional hazards models that controlled for 30 other risk factors and comorbidities simultaneously, the excess mortality risk associated with usage 30+ times per month remained significant, but hazard ratios were reduced to 1.35 for men and 1.22 for women. CONCLUSIONS: Use of hypnotics was associated with excess mortality. This methodology could not determine if hypnotic compounds caused the risks associated with their use, nor could the risks of individual compounds be determined. Since millions of Americans are currently taking hypnotics, long-term controlled trials are urgently needed to further guide both patients and physicians.

Adult↗
PubMedDate not supplied

[Prescription of psychotropic drugs in paediatry: approved indications and therapeutic perspectives].

In France, psychotropic drugs may be classified in four categories according to their official data. The first category corresponds to psychotropic drugs with an approved indication available in paediatry. Theyare old agents (e.g. haloperidol, amitriptyline, benzodiazepines...) with the exception of methylphenidate (hyperactivity). The second one corresponds to pharmacological agents approved for some indications obtained with adults but not for a1l (i.e. restricted indication: e.g. sertraline approved in paediatry only for OCD but not for depression, risperidone approved only for the treatment of disruptive behaviors in children with subaverage IQs). For the third category, the psychotropic agent is either contraindicated or unadvised under the age of 15 or 18 years, by lack of data (e.g. most of SSRI or atypical antipsychotic drugs). For the last category, official data available in brief summaries offer no information on paediatric use and consequently their administration does not appear possible. Up to now, no approved use has been delivered to injection route (IM or IV) in France, except for an IM formulation of zuclopenthixol. Prescribing psychotropic drug has to respect good practices including close psychological and somatic monitoring that associates the young patient and his relative (psycho-education program). Particular key-points should be taken into consideration (i.e. pharmacokinetic and physiological specificities, risk of false passage under the age of 6 years with capsules or tablets, presence of alcohol in some oral solution or bitter aroma...). Beside these official data, many studies have been published but must be carefully interpreted according to their level of pertinence. Meta-analysis gather all randomised controlled trials published or not, analyse their specific pertinence and thus provide clinically relevant elements. Randomised controlled trials present clinical interest but key-points in study design must be checked (e.g. number of patients, inclusion and exclusion criteria, length of the study and clinical relevance of clinical scales...). Other studies like open trials or clinical cases do not offersufficient guarantees. Some randomised controlled trials of clinical relevance have been carried out in this population with new pharmacological classes (eg SSRI, atypical antipsychotic drugs) and may lead to extended indications in children and adolescents. According to bibliographic and official data, the main criteria in the prescribing choice may take into consideration the following sis stressing a poor benefit/risk ratio. SSRI may offer better prospects but their use has not been approved in this indication, until now. In OCD, sertraline shows great interest to enhance clinical response and represents the molecule of reference. No drug has been approved for mood disorders in children or adolescent, in France, contrary to USA where lithium can be administered over the age of 12 years. In addition, antiepileptic drugs like carbamazepine or divalproate have conducted to clinical improvement in some studies. Benzodiazepines, hydroxyzine and meprobamate use should be strictly restricted in case of anxiety symptoms but are the only agents approved in this indication despise promising results obtained with SSRI. Transitory insomnia may take advantage of alimemazine prescription (approved use over the age of 36 months). Some typical neuroleptics are indicated in tics or in behaviour disorders associated to autism or related syndromes but present clinical limitations and poor tolerability. Promising clinical trials (randomised or not) have been conducted with new atypical antipsychotic drugs like risperidone. In conclusion, present data available for paediatric use of psychotropic agents emphasizes that safety and effectiveness are not always well established in particular for the treatment of chronic disorders (long term tolerability assessment). Moreover, studies should be carried out to specify factors promoting adherence and quality of life for this young population in order to optimise clinical benefit of drug prescription.

Adolescent↗
PubMed2000

Telephoning the patient's pharmacy to assess adherence with asthma medications by measuring refill rate for prescriptions.

OBJECTIVE: To determine whether a prescription refill history obtained by telephoning patients' pharmacies identifies poor adherence with asthma medications more frequently than physician assessment. METHODS: The study population consisted of 116 children with persistent asthma who were Medicaid recipients; patients who received medication samples were excluded. During a clinic visit pulmonologists interviewed patients, caretakers, or both and estimated adherence on a checklist. A nurse asked the caretakers where they obtained medications and telephoned 66 identified pharmacies for refill histories. The maximum possible adherence was calculated as the number of doses refilled/number of doses prescribed x 100 for a mean duration of 163 days (range, 63 to 365 days). The accuracy of the refill information was determined from Medicaid reimbursement records. RESULTS: Information provided by pharmacies was 92% accurate. The mean (95% CI) of maximum potential adherence was 72% (65%,77%) for theophylline, 61% (55%,68%) for inhaled corticosteroids, and 38% (23%,53%) for cromolyn; only cromolyn and theophylline were significantly different. Physicians were able to identify 21 (49%) of 43 patients who refilled </=50% of prescribed doses of long-term symptom controllers and only 3 (27%) of 11 patients who used albuterol excessively. CONCLUSIONS: Physicians often were unable to identify patients with very poor adherence. Checking prescription refills is an accurate and practical method of identifying such patients.

Anti-Asthmatic Agents↗
PubMed2003

Prescription of adrenaline auto-injectors for potential anaphylaxis--a population survey.

OBJECTIVE: To assess the quality of training provided to parents of children prescribed adrenaline auto-injector devices, adherence to the Chief Medical Officer's recommendation regarding specialist referral, and effect of allergies on quality of life. SETTING: Middlesbrough, Redcar and Cleveland districts in North-east England. DESIGN: Postal questionnaire to parents of all children prescribed an auto-injector in the area (n = 154). RESULTS: One hundred and seven parents replied. General practitioners were the source of initial prescription for 30 children. Fifty-one children were not referred to a specialist allergy clinic. Four parents said that they had received no training in the use of the device. Dummy auto-injectors were not used to train 51 parents. Forty-six families were not given the opportunity to retrain. Eleven parents had low or very low confidence in the use of the device, and 13 parents were unsure when to use it. Quality of life was significantly affected. Sixteen children were bullied as a result of their allergy. Thirty parents felt that their child could not do something they really enjoyed as a result of the allergy, and 39 parents felt that their own lifestyle was affected. CONCLUSION: The impact of the prescription of auto-injector devices should not be underestimated. National guidelines regarding specialist referral were often not followed, and this needs to be addressed by primary care organizations. Quality of training issues needed to be addressed and this has led to re-organization of services in our district.

Anaphylaxis↗
PubMed1988

Prevalence of angina as assessed by a survey of prescriptions for nitrates.

Prescriptions for nitrates issued during a 6-month period in the Nottingham Health District were used to estimate the prevalence of patients thought to have angina who might potentially require specialist investigation and treatment. The 15,451 prescriptions issued were for 6856 patients. Of these, only 435 were known to hospitals. The general practitioner records of 499 patients identified from a 10% sample of general practitioners showed that in 96% the general practitioner had prescribed a nitrate for the treatment of angina. The records of five large practices with some form of diagnostic register suggested, however, that the survey detected only 73% of patients thought to have angina. With these estimates of specificity and sensitivity the prevalence of angina in Nottingham was calculated to be 1.5%. Few of the patients identified had been investigated in detail, and only 26% had attended hospital in the 3 years before the survey. There is clearly a very large potential demand for hospital resources for the investigation and treatment of angina.

Aged↗
PubMed1999

Prescription of transdermal nicotine patches for smoking cessation in general practice: evaluation of cost-effectiveness.

BACKGROUND: The 1998 UK government White Paper Smoking Kills emphasises that normal practice should be for general practitioners (GPs), practice nurses, and others to offer advice and support to smokers in their efforts to stop. However, GPs are not allowed to write NHS prescriptions for nicotine-replacement therapy, even though this is the only effective pharmaceutical treatment available in the UK. We estimated the cost-effectiveness, for the NHS, of allowing GPs to prescribe transdermal nicotine patches for up to 12 weeks. METHODS: We used data from a randomised, placebo-controlled efficacy trial of nicotine patches and a survey of associated resource use in 30 GP surgeries in 15 English counties. We calculated the health benefit of nicotine-patch treatment in number of life years that would be saved by stopping smoking at various ages, and used an abstinence-contingent treatment model to calculate the incremental cost per life year saved by GP counselling with nicotine-patch treatment over GP counselling alone. Cost effectiveness was assessed on the basis that GPs would provide repeat NHS prescriptions for up to 12 weeks if the treatment was proving successful. FINDINGS: If GPs were allowed to prescribe transdermal nicotine patches on the NHS, for up to 12 weeks, the incremental cost per life year saved would be: Pound Sterling 398 per person younger than 35 years; Pound Sterling 345 for those aged 35-44 years; Pound Sterling 432 for those aged 45-54 years; and Pound Sterling 785 for those aged 55-65 years. INTERPRETATION: The low cost per life year saved would make GP intervention against smoking a cost-effective life-saving treatment. The priniciples of the government White Paper could be cost-effectively extended into general practice to reduce smoking and smoking-related illnesses.

Administration, Cutaneous↗