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PubMed1999

Prescription data as a tool in pharmacotherapy audit (II). The development of an instrument.

In many countries, prescription data are used as an instrument to provide feedback on prescribing. This article describes the development and implementation of a computer program as a tool for pharmacotherapy audit meetings and it illustrates the possibilities of such a program. The program was developed to support the optimisation of prescribing in the various stages of behavioural change. It enables pharmacists to make sophisticated overviews of prescribing by physicians in their audit group and furthermore, pharmacists can conduct drug utilisation studies or pharmaco-epidemiological studies in their own patient population. Forty percent of Dutch pharmacies have purchased the computer program since its introduction; it was distributed together with a technical handbook and a course book, which elaborated on the types of graphs available and their interpretation. An educational course was developed regarding the optimal selection and interpretation of graphs. Examples of prescription data as a tool to support various aims of audit meetings are given. The program is acknowledged as a welcome contribution to pharmacotherapy audit and to the pharmacists' advisory role in pharmacotherapy.

Attitude of Health Personnel↗
PubMed1997

The association of prescription status, patient age, patient gender, and patient question asking behavior with the content of pharmacist-patient communication.

PURPOSE AND METHODS: Data from 358 pharmacist-patient encounters in 12 community pharmacies were used to investigate the association of prescription status, patient age, patient gender, and patient question asking with the content of pharmacist-patient communication. RESULTS: There was an association between prescription status and the provision of five types of information, patient age and gender were associated with the provision of the same two types of information, and patient question asking was associated with the provision of eight types of information. CONCLUSIONS: An important cue for improvement of pharmacist-patient communication was patient question asking. Thus, it is imperative to find ways to increase question asking by patients and understand why some patients are reluctant to ask their pharmacist questions.

Adolescent↗
PubMed2003

What happens to patients' psychotropic prescriptions after discharge from a state psychiatric hospital?

Continuity of pharmacotherapy was examined between a state psychiatric hospital and an urban community mental health center. Anecdotal reports from administrators as well as limited empirical research suggested that there would be breaks in the continuity of pharmacotherapy across the two agencies and that the high cost of newer medications would contribute to poor continuity. Clinical chart reviews of 242 discharges over a 5-year period revealed that less than 11% of atypical prescriptions and less than 20% of all psychotropic prescriptions were altered beyond dosage level changes after discharge from a state hospital. Analysis of reasons given (reported) for altering the medication regimen revealed a consistent pattern of changes based on clinical evidence or consumer choice.

Adult↗
PubMed2004

Direct-to-consumer communication on prescription only medicines via the internet in the Netherlands, a pilot study. Opinion of the pharmaceutical industry, patient associations and support groups.

OBJECTIVE: Investigation of the current application of direct-to-consumer (DTC) communication on prescription only medicines via the Intemet in the Netherlands. METHOD: Questionnaires were sent by e-mail to 43 Dutch innovative pharmaceutical industries and 130 Patient Association and Support Groups (PASGs). RESULTS: In this pilot study, the response of the pharmaceutical industry was rather low but the impression is that they were willing to invest in DTC communication. The majority of the websites of PASGs did not link to websites of pharmaceutical companies. The PASGs had no opinion whether patients can make a good distinction between DTC advertising and information on websites of the pharmaceutical industry nor about the quality. PASGs did not think unambiguously about the impact on the patient-doctor relationship. CONCLUSION: The impact of DTC communication on prescription only medicines via the internet is not yet clear in the Netherlands.

Advertising↗
PubMedDate not supplied

Antibiotic prescription for acute dental conditions in the primary care setting.

To determine the pattern of antibiotic prescribing (source and type) for acute dental conditions in the emergency setting, a prospective cross-sectional study was undertaken of 500 consecutive new patients attending the examination and emergency clinic of the Cardiff Dental Hospital in May 1994. The source and type of antibiotics prescribed, the nature of complaint and type of antibiotic prescribed in the primary care and dental hospital setting were recorded. Antibiotic prescription was a feature of the treatment of 30% (149/500) of patients. The 60 patients who had received emergency treatment prior to attending the hospital emergency clinic had been prescribed a total of 14 different types of antibiotics; 41% of these patients had sought treatment from general medical practitioners. Antibiotics were frequently prescribed without generally accepted criteria and there was wide variation in prescribing. Overall, only seven different types of antibiotics were prescribed in the dental hospital setting. The use of second generation antibiotics was more common in general practice than in the dental hospital. The results suggest that many patients with dental pain may seek treatment from medical practitioners, prior to, or in place of, definitive dental treatment. In summary, rationalisation of antibiotic prescription and the provision of emergency dental treatment is needed.

Acute Disease↗
PubMed1997

Antibiotics prescription for indigent patients in primary care.

OBJECTIVE: A drug use evaluation focusing on prescribed antibiotics among Greek indigent and Social Security patients. METHOD: Four hundred and forty-six indigent patients insured by Social Care and 332 patients insured under Social Security Funds were interviewed and their prescription records reviewed. RESULTS: Although 88.5% of indigent patients stated that they had received instructions on antibiotic use and had understood these instructions, only 45.9% could correctly repeat these instructions. Only 9.9% read the enclosed leaflets and 59.4% reported asking the pharmacist for advice, 54.1% of these patients were unaware of the dosage of their medication, and the length of treatment was only written in 13% of cases. The most common diseases among indigent patients were respiratory infection (11.7%) and dental problems (10.1%). The latter ranked 11th among the insured patients (3.7%). Tuberculosis (3.3%) was still one of the most common diseases among the indigent patients. Overall, 30.9% of the prescribed daily defined dose (DDD) of medication for the indigent patients were for cardiovascular drugs (16.9% of the cost), 19.5% were for nervous system drugs (8.9% of the cost), 13.5% for gastrointestinal tract drugs (14.1% of the cost) and only 4.3% were antibiotics (but 16.9% of the cost). The most frequently prescribed antimicrobials were penicillins (45.6%), cephalosporins (19.7%), macrolides (12.6%) and quinolones (9.6%). Antituberculous agents made up 13.7% of the antibiotic prescriptions. The most widely prescribed antibiotics were amoxycillin + clavulanate (19.3%), amoxycillin (7.9%), cefaclor (5.6%), clarythromycin (5.1%) and rifampicin + isoniazid (6.3%). CONCLUSION: The present study emphasizes the need for more information on drug use among indigent patients and their information needs.

Adolescent↗
PubMed2001

Adherence with naltrexone prescription advice in hospital outpatient alcohol rehabilitation programme.

BACKGROUND: The anti-craving drug, naltrexone, is used as a pharmacotherapeutic adjunct in the treatment of alcohol dependence. In addictive disorders, compliance issues remain central. There are limited data on compliance with naltrexone treatment regimens within formalized rehabilitation programs and even less data that identifies factors that have an impact on this. OBJECTIVE: To study patient adherence to naltrexone medication regimens and examine whether patients' reported pre-treatment alcohol use, dependence severity and measures of psychological health are predictive of medication compliance. METHOD: Fifty outpatients meeting DSM IV criteria for alcohol dependence enrolled in a 12-week rehabilitation programme. This included cognitive behavioural therapy (CBT) and naltrexone, 50 mg orally daily. Measures included: pharmacy prescription pick-up including number of tablets dispensed, programme attendance and patient pre-treatment alcohol use variables. Measures of psychological health included somatic symptoms, anxiety, social dysfunction and depression as measured by the General Health Questionnaire (GHQ-28). RESULTS: Classifying the sample into compliant (> or = 90% medication pick-up) and less compliant groups, 66% of subjects were naltrexone-compliant. Pre-treatment alcohol use variables were not predictive of compliance. Although social dysfunction and depression tended towards poorer prescription filling, measures of psychological distress (GHQ-28) did not identify factors predictive of medication non-compliance. One patient withdrew from treatment because of naltrexone-induced dysphoria. CONCLUSION: Patients with alcohol dependence demonstrated high levels of anti-craving medication compliance, good rehabilitation programme participation and favourable outcomes. Naltrexone was well tolerated. Medication compliance in this study group compared well with those of other hospital populations with chronic disorders. Factors predictive of anti-craving medication compliance in alcohol dependence require further study.

Adult↗
PubMed2002

Variation in pharmacy prescription refill adherence measures by type of oral antihyperglycaemic drug therapy in seniors in Nova Scotia, Canada.

OBJECTIVE: To examine the association between pharmacy prescription refill adherence by type of oral antihyperglycaemic medications used in seniors in Nova Scotia, Canada. RESEARCH DESIGN AND METHODS: Pharmacy and health care utilization data from April 1993 to March 1996 for Nova Scotia Seniors' Pharmacare beneficiaries treated with 1st and 2nd generation sulphonylureas and biguanides was analysed. Refill adherence was quantified by two proportions: number of days beneficiaries had a medication surplus compared with the total period of observation and gaps in treatment compared with the total period of observation. Analysis examined association of type of oral antihyperglycaemic agent and dosing on refill adherence, after adjustment for age, gender and hospital use. RESULTS: A total of 3358 beneficiaries met the study criteria. The mean refill adherence rate [continuous multiple-interval measure of medication availability (CMA)] was 86 +/- 0.4% SE and continuous measure of medication gaps (CMG) was 16 +/- 0.4% SE. Use of biguanides was associated with lower odds of having a medication surplus. The use of 2nd generation sulphonylureas and biguanides, and use of agents with a dosage frequency of more than one dose per day was associated with medication gaps. CONCLUSIONS: Many beneficiaries taking antihyperglycaemic agents adhered well to prescribed therapy. The proportion of days not covered by medications averaged 16%. Beneficiaries taking medications once a day were more likely to have good refill adherence. Further work is needed to compare prescription refill adherence rates with other adherence measures and clinical outcomes. These methods are useful for establishing baseline adherence, monitoring the success of programmes designed to improve adherence, and determining cost-effectiveness of drug regimens.

Administration, Oral↗
PubMed1997

Do drug costs affect physicians' prescription decisions?

OBJECTIVE: To study the impact of the cost of pharmaceuticals on physicians' decisions about drug prescription. DESIGN: A simulation protocol for the treatment of two patients, one with mild and the other with a severe form of urinary tract infection (UTI), was designed. Thirty family physicians in outpatient clinics and 30 physicians in the internal medicine wards of a Community Hospital participated in the project. They had to prescribe treatment for the patients twice: at phase I, when the drug cost was unknown, and at phase II, after 2 months, when the price of the drugs was brought to their attention. The physicians selected the medication from a list of drugs commonly used for the treatment of UTIs. RESULTS: Analysis of the findings indicates that an awareness of drug costs affects prescription decisions among physicians in hospital wards, whereas family physicians showed a preference for less expensive drugs even before they were informed about drug costs. An extrapolation of the results shows that knowledge about the cost of the drugs usually administered for treatment of UTI, could save at least IS 112,883 ($34,207) a month to Kupat Holim Klalit (KHK) the health insurance institution to which the outpatient clinics and the hospital belong. CONCLUSIONS: When economic aspects of healthcare are considered, information on drug costs may be an important factor in physicians' decision-making processes and for saving pharmaceutical expenses.

Anti-Bacterial Agents↗
PubMed1996

Quality assurance of clinical transfusion practice by implementation of the privilege of blood prescription and computerized prospective audit of blood requests.

Guidelines, algorithms and recommendations have been issued in the attempt to ensure appropriateness of transfusion practice, but the results are less than satisfactory, mainly due to the difficulty to turn paper procedures into actual practice. In our hospital we have tried to overcome this difficulty through the implementation of a quality assurance programme which includes giving the privilege of nonurgent blood prescription to a limited number of physicians and a computerized prospective audit of blood requests. The latter is performed through verification of the compliance of blood requests, which are designed to include a patient's laboratory and clinical data, with hospital guidelines for the proper use of blood. In the 12 months since implementation of the computerized prospective audit the transfusion service has evaluated 7884 requests. Of these, 63.4% (n = 4998) were for red blood cells, 21.1% (n = 1664) for platelets and 15.5% (n = 1222) for fresh frozen plasma. The prospective audit showed that 96.8% and 98.1% of requests for red units and platelets were appropriate, respectively. Conversely, approximately 27% of plasma requests did not comply with guidelines, mainly because the evidence of coagulopathy was missing. However, inappropriateness of plasma requests for elective general surgery decreased from 39% at the onset of the programme to 14% in the last trimester considered. Moreover, the evaluation by retrospective audit of the proportion of patients transfused with both red blood cells and plasma in the perioperative period out of those transfused with red blood cells only, as an indicator of unwanted reconstitution of whole blood, showed that this proportion decreased from 47.6% (320/672) in the 12 months before implementation of computerized audit to 37.8% (244/646) in the following 12 months (difference = -9.8%, 95% confidence interval of the difference from -4.5% to -15.1%; P < 0.005 by chi 2 test). Our initial experience, together with the present system, shows that (1) the restriction of nonurgent blood prescription to a group of clinicians more educated in transfusion medicine than average clinicians practicing in a large multispecialty hospital is feasible; (2) prospective audit is a useful tool for assuring the quality of blood requesting.

Algorithms↗
PubMed2001

Finasteride and tamsulosin used in benign prostatic hypertrophy: a review of the prescription-event monitoring data.

OBJECTIVE: To review the results of non-interventional observational cohort studies of 14 772 patients treated with finasteride and 12 484 patients treated with tamsulosin, both studies being of national proportions and undertaken in general medical practice in England. METHODS: Both studies were undertaken by prescription-event monitoring (PEM), whereby the exposure data are derived from information provided in strict confidence by the Prescription Pricing Authority of the National Health Service. The outcome data are derived from 'green form' questionnaires completed by the prescribing general practitioners (GPs). Additional data are obtained by medical follow-up with the attending practitioners. Adverse experience was measured in three ways; as reports of events which the doctors considered to represent adverse drug reactions; as reports of reasons for stopping the drug; and by studying the incidence density of each reported event. For these purposes a computerized dictionary containing 1430 higher level terms was used. The duration of exposure in the finasteride study was approximately 1 year and was approximately 6 months in the tamsulosin study. RESULTS: The outcome data on the 14 772 and 12 484 patients treated in the finasteride and tamsulosin studies were derived from the 63% and 57.4% of the green forms sent out and returned, respectively. The finasteride cohort included two women and the tamsulosin cohort 70 women. The mean (SD) age of the men in the two cohorts was, respectively, 69.0 (9.2) and 66.2 (11.7) years. Both drugs were well tolerated on long-term therapy and 69.6% (10 274 patients) of the total finasteride and 62.0% (7739 patients) of the total tamsulosin cohort were still receiving the drug at the end of 6 months. In the finasteride study, impotence or ejaculatory failure was reported in 2.0% of the patients still receiving the drug; there were reports of decreased libido in 1.0% and gynaecomastia was reported whilst the drug was still being prescribed in 39 patients (0.3% of the cohort). With tamsulosin, uncommon cases of dizziness, headache, malaise and hypotension (89 reports in 12 484 patients, i.e. 0.7% of the cohort) were common to the findings of reported adverse reactions, reasons for stopping the drug and events of highest incidence density. None of the deaths which occurred in either of these large cohorts was attributed by either the reporting GPs or the PEM medical staff to the drugs examined. Conclusion The GPs rated the drugs effective in most patients; tolerance and adverse experience was consistent with the known pharmacology of the two drugs. No serious, unexpected adverse effects were identified.

Adrenergic alpha-Antagonists↗
PubMedDate not supplied

Using stated preference modeling to forecast the effect of medication attributes on prescriptions of alcoholism medications.

OBJECTIVE: The objective of this study was to forecast physicians' preferred rate of prescriptions of alcoholism medications given different medications attributes (i.e., efficacy, side effects, compliance, price, mode of administration, method of action). METHODS: Stated preference modeling was used. Data came from a survey of 1388 physicians specializing in addiction medication (65% response rate). Physicians were given four hypothetical scenarios, each in which they were asked to choose between prescribing one of two hypothetical alcoholism medications with given attributes or prescribing no medication. RESULTS: Prescribing decisions were elastic with respect to the efficacy of the medication (1.35 and 1.65 using two efficacy measures). A 10% increase in the percentage of patients who would remain abstinent on the medication would lead to a 13.5% increase in the percentage of patients prescribed the medication. Prescribing decisions were inelastic with respect of nonserious side effects (-0.24), compliance (0.80), and price (-0.25). The market share of alcoholism medications with extremely favorable characteristics (i.e., 80% abstinence rate, a 95% no heavy drinking rate, a 10% side effect rate, a 80% compliance rate, and a price of US dollars 0.25) was predicted to be 53%, and 47% of the population would not be prescribed a medication to prevent alcoholism. CONCLUSIONS: The market share of new medications to treat alcoholism among addiction specialists could surpass the low usage rates of existing medications if those medications have better attributes. However, prescription levels may not reach that expected for treatment of other diseases.

Alcohol Deterrents↗
PubMed1999

Direct-to-consumer prescription drug advertising and the public.

OBJECTIVE: Drug manufacturers are intensely promoting their products directly to consumers, but the impact has not been widely studied. Consumers' awareness and understanding of, attitudes toward, and susceptibility to direct-to-consumer (DTC) drug advertising were examined. DESIGN: Random-digit dialing telephone survey with a random household member selection procedure (completion and response rates, 58% and 69%, respectively). SETTING: Respondents were interviewed while they were at their residences. PARTICIPANTS: Complete data were obtained from 329 adults in Sacramento County, California. MEASUREMENTS AND MAIN RESULTS: Outcome measures included awareness of advertisements for 10 selected drugs, misconceptions about DTC advertising, attitudes toward DTC ads, and behavioral responses to such promotions. The influence of demographic characteristics, health status, attitudes, beliefs, and media exposure on awareness and behaviors was examined. On average, respondents were aware of advertisements for 3.7 of the 10 drugs; awareness varied from 8% for Buspar (buspirone) to 72% for Claritin (loratadine). Awareness was associated with prescription drug use, media exposure, positive attitudes toward DTC advertising, poorer health, and insurance status. Substantial misconceptions were revealed; e.g., 43% thought that only "completely safe" drugs could be advertised. Direct-to-consumer advertisements had led one third of respondents to ask their physicians for drug information and one fifth to request a prescription. CONCLUSIONS: Direct-to-consumer advertisements are reaching the public, but selectively so, and affecting their behaviors. Implications for public policy are examined.

Adult↗
PubMed2000

Pregnancy outcome following prescription for sumatriptan.

BACKGROUND: Some 2.5% of fertile Danish women use sumatriptan, and the drug is also taken during pregnancy. Although sumatriptan reacts selectively in brain vessels, the possibility of reactions with placental blood flow and uterotonic activity cannot be ruled out. The aim of our study was to examine the association between sumatriptan exposure during pregnancy and the risk of preterm delivery and low birth weight. METHODS: Data from the Pharmaco-Epidemiological Prescription Database of North Jutland county regarding all women who had given birth in the county of North Jutland from 1991 to 1996 were linked to the Danish Medical Birth Registry. Women who were exposed to sumatriptan during pregnancy were identified (n = 34), and using logistic regression models their pregnancy outcome was compared with two groups of pregnant women: (1) healthy women (n = 15 955) and (2) migraine controls (n = 89), defined as migraine patients who did not redeem prescriptions for migraine treatment during pregnancy. RESULTS: The risk of preterm delivery was elevated among women exposed to sumatriptan compared with migraine controls (odds ratio [OR] 6.3, 95% confidence interval [CI] 1.2-32.0) and healthy women (OR 3.3, 95% CI 1.3-8.5). The odds ratio for having a newborn with a low birth weight was increased (OR 3.0, 95% CI 1.3-7.0) for all migraine patients who delivered at term (n=115) compared with the outcome of healthy pregnancies. CONCLUSIONS: We found that sumatriptan exposure during pregnancy was associated with an increased risk of preterm delivery and low birth weight. These findings may be due to drug exposure, but they may also reflect the impact of disease severity rather than the treatment itself, or confounding, or chance.

Adult↗
PubMed2003

Patients discharged with a prescription for acetaminophen-containing narcotic analgesics do not receive appropriate written instructions.

To determine whether patients given prescriptions for acetaminophen-containing narcotic analgesics receive appropriate discharge instructions to reduce their intake of or stop taking other acetaminophen-containing products, we evaluated discharge instructions given by an urban, tertiary-care emergency department from September 1 to September 18, 2001 to find patients discharged while taking narcotic-analgesic compounds containing acetaminophen. We evaluated these discharge instructions to determine whether they included instructions to reduce or discontinue the use of acetaminophen compounds. Among the 1,505 discharge instructions evaluated, we found that 108 patients were discharged with a narcotic-analgesic combination product containing acetaminophen. Of these 108 patients, none of those given a prescription for such an acetaminophen-containing product was instructed to reduce or discontinue the use of other acetaminophen products. Emergency physicians, during the specified study period, did not explain to their patients the need to reduce the use of other acetaminophen-containing products when prescribing acetaminophen-containing medications. Further inquiry into this potentially dangerous activity is warranted.

Acetaminophen↗
PubMed1991

Prescription and intake patterns in long-term and ultra-long-term benzodiazepine treatment in primary care practice.

Pharmacoepidemiological data show that long-term treatment accounts for a considerable part of benzodiazepine prescriptions in primary care practice. Prescription and intake patterns were, therefore, investigated in a study of 196 patients who had been treated with benzodiazepines for longer than six months by internists or general physicians in private practice. Patients were 64 years of age on average, half of them being 65 years or older. Females were in the majority (73.5%). The average duration of tranquilizer or hypnotic intake was 11.0 years, or 5.3 years for the current benzodiazepine medication. The mean daily dose was 9 mg diazepam equivalent. All benzodiazepine hypnotics and 61% of benzodiazepine tranquilizers had been prescribed solely for night-time use. Only 6% of the patients were taking benzodiazepines as single medication: on average they were taking 3.1 additional types of medication for other conditions, these being predominantly cardiac and antirheumatic/analgesic in nature. One in five patients was taking additional psychotropic medication. The compliance coefficient was on average 0.8, showing that patients did not tend to abuse benzodiazepines, with noncompliance generally being similar to noncompliance with other forms of medication.

Adult↗
PubMed2001

Changing the status of drugs from prescription to over-the-counter availability.

The availability of drugs on an over-the-counter basis, including those previously available only by prescription, provides patients with improved access to effective therapies. Removal of the requirement for prescriptions saves both the health care professional and the patient time. However, the overall effect on health care costs is complex. One such effect may be that costs shift from third-party payers to patients. In addition, short-term cost savings may be offset over the long term by problems due to inappropriate use or suboptimal therapy. Optimal therapy with an over-the-counter drug requires that the consumer diagnose the underlying condition correctly and use the drug in a manner that minimizes risk. Assessment of the ability of patients to use drugs in this manner is a critical component of the regulatory review of over-the-counter drugs. The available data arouse the concern that without the supervision of a health care professional, some patients may not be able to use over-the-counter drugs appropriately for certain diagnoses or chronic conditions or in high-risk situations. On the other hand, the widespread use of over-the-counter aspirin on a long-term basis for cardiovascular-risk reduction illustrates the potential value of increased drug availability for long-term therapy. Advances in technology may facilitate the growth of over-the-counter drug therapy. For example, the wide availability and acceptance of reliable methods for measuring serum cholesterol in nonmedical settings may eventually contribute to the safety and effectiveness of over-the-counter treatments for hyperlipidemia. Thus, the future promises increases in the number of drugs available over the counter and in the variety of indications for their use.

Drug Approval↗
PubMed2003

Prescription, over-the-counter, and herbal medicine use in a rural, obstetric population.

OBJECTIVE: The purpose of this study was to identify the medications that are consumed by a rural obstetric population during pregnancy. STUDY DESIGN: Over a period of 26 months, pregnant women were interviewed about medication use. Interviews on subsequent visits provided a longitudinal study of medication usage and discontinuation. Trend differences were analyzed according to the number of medications, the trimester of use, and insurance status. RESULTS: Five hundred seventy-eight participants had 2086 interviews. The compilation of the interviews showed that 95.8% of the participants took prescription medications, 92.6% of the participants self-medicated with over-the-counter medications, and 45.2% of the participants used herbal medications. Over time, consumption of over-the-counter medications exceeded prescription medication use. Fifteen percent of the pregnant women took ibuprofen at some point during the pregnancy (5.7% in the third trimester). Eight percent of the women were noncompliant and 20% incompletely compliant with prenatal vitamin and mineral formulations. CONCLUSION: Medication use was substantial in this population. Medications (eg, ibuprofen) that are contraindicated in pregnancy were used at unexpectedly high rates. Of the three medication classes, over-the-counter medications were used most frequently.

Adult↗