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PubMed1989

Ingestion of prescription drugs by children: an epidemiologic study.

Although the Poison Prevention Packaging Act of 1970 has resulted in a 65% decline in ingestion of products packaged in child-resistant containers, ingestion of prescription drugs by children has declined by only 36%. Since ingestion of solid prescription drugs remains an important cause of ingestion-related morbidity in children, this descriptive epidemiologic study of cases reported to a poison control center was done with the hope of identifying factors responsible for this continuing problem. The study provides an epidemiologic perspective of this unnecessary risk to child health, and also proposes interventions targeted to high-risk caregivers.

Age Factors↗
PubMed1999

Adequacy of prenatal care and prescription of zidovudine to prevent perinatal HIV transmission.

In 1994, data were published on the effectiveness of zidovudine in preventing perinatal transmission of HIV infection. Using data from surveillance projects in San Antonio, Dallas, and Houston, Texas, U.S.A., we linked records of children born from 1987 through 1996 with records of their HIV-infected mothers. Prenatal care was measured by Kotelchuck's Adequacy of Prenatal Care Utilization (APNCU) Index. We examined the association between adequacy of prenatal care and four measures of zidovudine prescription: prenatal, intrapartum, neonatal, and the complete regimen. Inclusion criteria was that the mother's HIV infection was diagnosed before a live birth; 221 mother-infant pairs were included in the analysis. Overall, 68% received inadequate or no prenatal care. Over time, the proportion of mother-infant pairs with adequate prenatal care doubled (24%-48%; relative risk [RR], 2.0; 95% confidence interval [CI], 1.3-3.0), and the proportion prescribed prenatal zidovudine tripled (20%-67%; RR, 3.4; 95% CI, 2.4-4.9). In logistic regression, APNCU (adjusted odds ratio [aOR], 2.6; 95% CI, 1.1-6.2) and time period (aOR, 19.9; 95% CI, 8.1-48.7) were associated with prenatal prescription of zidovudine. The benefits of prenatal care, including HIV testing and zidovudine treatment, underscore the urgent need to improve access to and use of prenatal care services.

Adult↗
PubMed2006

Estimated costs of prescription opioid analgesic abuse in the United States in 2001: a societal perspective.

OBJECTIVES: This study estimates the costs to society of prescription opioid analgesic (RxO) abuse in the United States. METHODS: Costs associated with RxO abuse were grouped into healthcare, criminal justice, and workplace categories. Costs were estimated by either (1) a quantity method that multiplies the number of RxO abusers derived from various national surveys by the estimated per abuser cost, or (2) an apportionment method that starts with overall (ie, prescription and nonprescription) drug abuse costs for a cost component (eg, police protection) and apportions the share of costs based on the prevalence of RxO abuse relative to overall drug abuse. Medical costs in excess of those for otherwise similar nonabusers were based on an analysis of a large administrative claims database for an employed population using multivariate regression methods. RESULTS: A lower bound estimate of the costs of RxO abuse in the United States was 8.6 billion dollars in 2001 (or 9.5 billion dollars in 2005 dollars). Of this amount, 2.6 billion dollarswere healthcare costs, 1.4 billion dollars were criminal justice costs, and 4.6 billion dollars were workplace costs. CONCLUSIONS: The costs of RxO abuse represent a substantial economic burden. Rising trends of RxO abuse suggest an escalating economic and public health burden in coming years in the United States, and potentially, elsewhere.

Analgesics, Opioid↗
PubMedDate not supplied

Prescription analgesic and antidepressant utilization and cost among elderly Medicaid beneficiaries before and after nursing home admission.

OBJECTIVES: The objectives of this study were to describe changes in prescription analgesic and antidepressant medications and to track the costs associated with these medication changes when elderly Medicaid beneficiaries move from the community to a nursing home setting. DESIGN: Retrospective analysis of Medicaid long-term care and drugs claims data for fiscal year 2000 from three different states. SETTING: Long-term care facilities in three different states. PARTICIPANTS: We studied 1321 elderly Medicaid beneficiaries newly admitted to a nursing home during the study period. MEASUREMENTS: Pain medications were grouped into four different categories and all antidepressants were grouped into one category. For each medication category, we obtained the number of unique patients for whom it was prescribed, the number of days it was prescribed, and the amount paid by Medicaid. We then calculated the percentage of subjects prescribed and the amount paid per day for each medication class before and after nursing home admission. RESULTS: Except for skeletal muscle relaxants, 21% to 39% of beneficiaries already had claims linked to each medication class while still living in the community. After nursing home admission, the percentage of beneficiaries exposed to each medication class increased by 2% to 33%. Cost per day of therapy increased by 10% to 83%. There was significant variation among the states in utilization and cost per day of therapy. CONCLUSIONS: We draw three major conclusions: (1) community-dwelling elderly Medicaid beneficiaries in this study use more prescription analgesics and antidepressants than community-dwelling elders in prior studies; (2) there is a significant increase in medication utilization and cost on nursing home admission; and (3) significant variability in medication use and cost exists among the three states examined. Further investigation to elucidate the reasons for these differences could assist legislators in formulating sound public policy to contain Medicaid expenditures without sacrificing patient care.

Aged↗
PubMed2006

Refill adherence to repeat prescriptions of cancer drugs to ambulatory patients.

The objective was to study the refill adherence among ambulatory patients with prescribed cancer drugs. The study was based on copies of repeat prescriptions, which were collected at three large Swedish pharmacies during the last 3 months of 2004. Copies of 141 repeat prescriptions were analysed. There was no statistical significant difference between the number of patients with undersupply of cancer drugs (i.e. <80% of prescribed cancer drugs) and that of patients with undersupply of all other drugs, or between the number of patients with oversupply of cancer drugs (>120% of prescribed cancer drugs) and that of patients with oversupply of all other drugs. Undersupply of drugs was found among 14% of the patients. The median treatment gap for these patients was 39 (range 29-49 days) per 98-100 days of prescribed treatment time, meaning that the undersupply leads to treatment gaps that may jeopardize their therapeutic outcome. It is reasonable to expect that more seriously ill patients would be adherent to prescribed medication, and consequently that cancer patients would have high adherence. However, our data show that cancer patients on oral long-term treatment have a non-adherence similar to that of patients in general.

Ambulatory Care↗
PubMed1990

The use of prescription drugs among elderly Finnish men.

The extent and factors that influence drug use were studied in two rural cohorts of Finnish men. The men aged between 65 and 84 years belonged to the Finnish study population of the 25-year follow-up of the 'Seven Countries Study'. Of the original 1,711 men in 1959, 766 were still alive in 1984. The participation rate in the follow-up was 93%. Of the non-institutionalized men (n = 675), 66% had used prescription drugs, and 36% non-prescription drugs, while 25% had not used any drugs during the week preceding the study. The number of drugs in use was highly dependent on the time period covered in the assessment. The number of prescribed drugs was associated with the number of symptoms experienced (P less than 0.001) and the use of OTC-drugs (P less than 0.05). Drug use was not associated with socio-economic variables. Standardized measurement methods are needed in the assessment of drug use to obtain more reliable and comparable results in different populations.

Aged↗
PubMed1992

A survey of prescription label preferences among community pharmacy patrons.

Fifty-five randomly selected community pharmacy patrons were surveyed regarding their preferences between four different prescription labels. The variables displayed on the four labels were: (i) laser printed, (ii) dot-matrix printed, (iii) glossy surface, and (iv) matt surface. The study population was stratified by age and gender. Statistical analysis of the results indicated a clear preference by all groups for the laser printed labels (P less than 0.001), and the only other statistically significant finding was the preference for the matt surface (P less than 0.05) of females between the ages of 16 and 39. The implications for these differences on label readability are discussed, and recommendations are offered for the use of improved laser technology for computer-generated prescription labels.

Adolescent↗
PubMed1990

Diabetes mellitus in north Sweden: prevalence assessed from prescriptions for anti-diabetic agents.

A prescription inventory was performed over a period of 3 months in all pharmacies in Sweden's northernmost province. Norrbotten, in order to assess the prevalence of diabetes treated with insulin and oral anti-diabetic agents. A total of 4869 prescriptions were collected from 3482 individuals, of whom 1746 (50.1%) were men. The prevalence of drug-treated diabetes was thus 13.27/1000 inhabitants (95% confidence interval (CI) 12.8-13.7) in the province. Nearly half (47.9%) of all drug-treated diabetics were treated with insulin and the majority (74%) were over 55 years of age, with only 449 (13%) being less than 40 years old. The prevalence of diabetes was highest in individuals aged 75-84 years; in this age group it was 55.47/1000 (95% CI 50.9-58.7). There was considerable regional variation in the prevalence of diabetes in Norrbotten, with a mean prevalence of 23.84/1000 (95% CI 22.1-25.6) in the municipalities in the Torneå Valley, compared to 13.08/1000 (95% CI 1.19-1.28) for the remainder of Norrbotten. While there was no difference in the prevalence of drug-treated diabetes between men and women in the province as a whole, a slightly higher prevalence was found in women (27.41 vs. 24.73/1000) in the Torneå Valley. The prevalence of diabetes mellitus in individuals over 40 years of age was 36.62/1000 (95% CI 3.73-4.36) in The Torneå Valley, 24.38/1000 (95% CI 22.8-24.7) in the remainder of Norrbotten, and 27.88/1000 (95% CI 2.50-2.68) in the province as a whole. The estimated prevalence of diabetes mellitus in Norrbotten, including patients treated by diet alone, was of the order of 20.21/1000, with a prevalence of 40.00/1000 in subjects over the age of 40 years. Thus the prevalence of diabetes appears to be higher in the Torneå Valley than in the rest of Norrbotten, while it is apparently lower than has been reported in North Finland.

Adolescent↗
PubMed2005

Factors related to prescription dosage in Japanese psychiatric hospitals.

A point prevalence study of prescription dosage was made among psychiatric inpatients in Japan with the following aims: (i) to analyze whether total chlorpromazine equivalent dose was related to patient characteristics or hospital and physician characteristics; and (ii) to analyze whether the usage of the two major categories of antipsychotics, butyrophenone and phenothiazine, were related to their expected pharmacological reactions. A comprehensive database of prescription contents and characteristics of patients, physicians and hospitals was developed from a survey of 1674 patients in 18 psychiatric hospitals. Using the tree-based model analysis, factors related to the total chlorpromazine equivalent dose were analyzed. Factors included hospital ownership, staffing levels, physician specialty and patient length of stay, symptoms etc. The same analysis was then done for the two major categories of antipsychotics, in order to evaluate whether their expected pharmacological reactions were related to their usage. Factors related to the total chlorpromazine equivalent dose were age of patient, presence of hallucination, age of first psychiatric hospitalization, and change(s) in attending physician (while hospitalized). For the chlorpromazine equivalent dose of the butyrophenone category, the clinical factors related were abnormality in thought and hallucination, and for the phenothiazine category, it was bizarre behavior. Total chlorpromazine equivalent doses had no relationship with hospital or physician characteristics, and appeared to be determined by patient age and psychiatric symptoms. Doses in the butyrophenone category were related to pathological experiences and that in the phenothiazine category to behavioral aspects.

Adult↗
PubMed2005

Perceived discrimination and reported delay of pharmacy prescriptions and medical tests.

BACKGROUND: Access to health care varies according to a person's race and ethnicity. Delaying treatment is one measure of access with important health consequences. OBJECTIVE: Determine whether perceptions of unfair treatment because of race or ethnicity are associated with reported treatment delays, controlling for economic constraints, self-reported health, depression, and demographics. DESIGN: Cross-sectional, observational study. PARTICIPANTS: A randomly selected community sample of 181 blacks, 148 Latinos, and 193 whites in Durham County, NC. MEASUREMENTS: A phone survey conducted in 2002 to assess discrimination, trust in medical care, quality of care, and access to care. Treatment delays were measured by whether or not a person reported delaying or forgoing filling a prescription and delaying or forgoing having a medical test/treatment in the past 12 months. Perceived discrimination was measured as unfair treatment in health care and as racism in local health care institutions. RESULTS: The odds of delaying filling prescriptions were significantly higher (odds ratio (OR)=2.02) for persons who perceived unfair treatment, whereas the odds of delaying tests or treatments were significantly higher (OR=2.42) for persons who thought racism was a problem in health care locally. People with self-reported depression and people who reported not working had greater odds of delaying both types of care. CONCLUSIONS: A prospective cohort study with both personal and macro measures of discrimination, as well as more refined measures of treatment delays, would help us better understand the relationship between perceived discrimination and treatment delays.

Adult↗
PubMed1992

Prevalence and predictors of regularly scheduled prescription medications of newly admitted nursing home residents.

OBJECTIVE: The purpose of this study was to identify the prevalence and predictors of commonly prescribed regularly scheduled medications. DESIGN: Data were collected on the first day following nursing home admission in this non-experimental study. SETTING: A stratified, proportional probability sample of eight nursing homes in a large Mid-South city participated in this study. PARTICIPANTS: A consecutive sample of 574 new and readmitted nursing home residents who did not refuse participation. INTERVENTIONS: None. MAIN OUTCOME MEASURE(S): Data were collected on regularly scheduled prescription medications and resident and nursing home characteristics. RESULTS: Residents without a diagnosis of dementia were more likely to receive cardiovascular medications (Odds Ratio = 2.34; 95% CI = 1.56-3.49), and white residents were more likely to receive cardiovascular medications (Odds Ratio = 1.74; 95% CI = 1.19-2.53) or central nervous system medications (Odds Ratio = 1.72; 95% CI = 1.18-2.51). Older residents were less likely to receive central nervous system medications (Odds Ratio = 0.97 per year; 95% CI = 0.96-0.99), and females were more likely to receive cardiovascular medications (Odds Ratio = 1.89; 95% CI = 1.30-2.75). CONCLUSIONS: Resident characteristics were the most important predictors for cardiovascular and central nervous system medication prescriptions of new and readmitted nursing home residents.

Adult↗
PubMed1993

Alcoholism and prescription drug abuse in the elderly: St. Louis University grand rounds.

This Grand Rounds will review the problem of alcoholism and prescription drug abuse in the elderly. Several case vignettes will be presented. The pharmacology of alcohol and potentially addictive prescription medications will be reviewed. The clinical presentation of and psychiatric symptoms associated with these disorders will be discussed. The process of addiction and issues regarding the clinical evaluation of the elderly addict will be discussed. The medical complications of these disorders will be reviewed, followed by a discussion of guidelines for the appropriate use of these drugs in the elderly. The grand rounds will conclude with a discussion of the treatment of patients with these disorders.

Aged↗
PubMed2006

Will the Medicare prescription drug benefit eliminate cost barriers for older adults with diabetes mellitus?

OBJECTIVES: To determine the proportion of older people with diabetes mellitus (DM) eligible to enroll in the standard Medicare Part D drug benefit who will exceed the initial $2,250 coverage limit and to determine the effect of hypoglycemic choice on risk of exceeding the coverage limit. DESIGN: Cross-sectional survey. SETTING: Nationally representative sample of adults living in United States households participating in the 2001 Medical Expenditure Panel Survey (MEPS). PARTICIPANTS: Individuals aged 65 and older with a diagnosis of DM eligible to enroll in the standard Medicare Part D drug benefit. MEASUREMENTS: Prescription medication use and expenditures adjusted to 2006 U.S. dollars as reported in the MEPS prescribed medicine file. Survey-weighted logistic regression models were used to estimate the odds of annual medication expenditures exceeding $2,250, controlling for hypoglycemic type, sociodemographic characteristics, chronic conditions, and health status. RESULTS: Of the estimated 3.2 million elderly people with DM eligible for the standard drug benefit filling a prescription in 2001, approximately 64% had medication expenditures in excess of $2,250 in 2006 adjusted dollars. The proportion exceeding the initial coverage limit varied by type of hypoglycemic drug used from 60% of those using traditional hypoglycemics to more than 75% of those using novel hypoglycemics. Patients with more comorbidities and poorer health status were at greater risk of exceeding the initial coverage limit. CONCLUSION: A large proportion of older adults with DM may exceed the initial coverage limit under the standard Medicare Part D drug benefit and incur significant out-of-pocket spending.

Aged↗
PubMed1995

Estimate of parkinsonism prevalence through drug prescription histories in the Province of Rome, Italy.

INTRODUCTION: The objective of the study was to estimate the prevalence of parkinsonism in the Province of Rome using antiparkinsonian prescription histories from 1986 to 1991. METHODS: A subject was defined as a case of parkinsonism if he/she had received "specific" and "consistent" antiparkinsonian therapy in the study period. RESULTS: In November 1990, 6,572 patients were defined as prevalent cases of parkinsonism. The crude prevalence ratio, for the total population of the Province of Rome, is 173.5 per 100,000 inhabitants (165.9 per 100,000 in men and 180.5 per 100,000 in women). The method was validated by record-linkage with clinical records of all patients visited during 1990 at the Department of Neurological Sciences of the University of Rome "La Sapienza". The sensitivity of the prevalence study was 83.6%. CONCLUSIONS: The use of a computerized data base of all prescription data, routinely collected for administrative purposes, enabled us to obtain a prevalence estimate based on a very large population, with low costs and in a relatively short time.

Adolescent↗
PubMed1995

The prescription of psychotropic drugs in primary health care.

We followed the prescription of psychotropic drugs by primary health care physicians over a 3-year period. The material consisted of 1000 randomly selected adult primary health care patients. At least one psychotropic drug was prescribed to one third (n = 307) of the sample during the follow-up period. The most commonly used drug category was that of benzodiazepines, which was prescribed to 24% of the sample. An antidepressive was prescribed to 8%, a neuroleptic to 2% and "other psychotropic drugs" to 10% of the sample. The most important predictor for prescribing psychotropic drugs was recognition of mental problems at the initial survey, but age and marital status also had an association with the prescription. No gender difference was found after controlling for mental problems. Psychotropic medication was also prescribed to 13% of the patients who had no sign of mental disorder.

Adolescent↗
PubMed2007

Antithrombotic drug prescription in atrial fibrillation and its rationale among general practitioners, internists and cardiologists in The Netherlands--The EXAMINE-AF study. A questionnaire survey.

The objective of the EXAMINE-AF study was to record and compare antithrombotic treatment in patients with atrial fibrillation (AF) in daily clinical practice of general practitioners, internists and cardiologists in the Netherlands. Eighty-six general practitioners, 93 internists and 99 cardiologists responded to postal questionnaires and enrolled 1596 patients: 365, 351 and 880 respectively. A cardiologist was indicated to be the main treating physician for AF in 82% of all patients; current antithrombotic treatment was initiated in 80% by a cardiologist. Of all patients, 84% were at high risk for stroke and therefore were eligible for oral anticoagulation treatment, but only 64% actually received this. Cardiologists instituted appropriate antithrombotic treatment best, compared with general practitioners and internists (70% vs. 58% and 55%; p < 0.001). Positive predictive factors for oral anticoagulation prescription were previous stroke/transient ischaemic attack (OR, 2.31; 95% CI, 1.33-4.02) and heart failure (OR, 1.72; 95% CI, 1.23-2.42). Contraindications for oral anticoagulation (OR, 0.46; 95% CI, 0.32-0.68), treatment by a general practitioner (OR, 0.29; 95% CI, 0.20-0.42) or internist (OR, 0.24; 95% CI, 0.15-0.39) were important factors for withholding treatment. Antithrombotic treatment in AF patients is well instituted in primary and secondary care in the Netherlands. Cardiologists play a key role in the diagnosis and management of the majority of AF patients, even in those regularly attending other physicians. Factors for oral anticoagulation prescription are heart failure, physician specialty and contraindications. Availability of guidelines seems instrumental for application of appropriate antithrombotic treatment.

Adolescent↗
PubMedDate not supplied

Preparing for prescriptive privileges: a standard for the psychiatric-mental health preceptorship.

TOPIC: Establishing a standard for preparation for prescriptive authority for advanced practice psychiatric nurses. PURPOSE: To outline a best practice standard for the clinical and prescriptive authority preceptorship. SOURCES: NACNS and NONPF competencies and practice guidelines. CONCLUSIONS: The authors recommend a clinical preceptorship with planned faculty monitoring, clinical logs, case studies, and group supervision to prepare the psychiatric-mental health advanced practice nurse to serve within the expanded prescribing role.

Clinical Competence↗
PubMed1978

Exercise prescription--North American experience.

The principles of exercise prescription are reviewed with respect to North American experience. The required regimen must be safe, therapeutically effective, and ensure a high rate of compliance. Precautions to increase the safety of exercise are discussed. Cardiac emergencies are sufficiently rare events (less than 1 in 200,000 hours even in post-coronary classes) that the need for immediate medical supervision of a well-designed programme can be questioned. The prime determinant of the response to training is the intensity of effort relative to the individual's initial fitness. Post-coronary patients often have a great potential for training due to their previous inactivity, but this will not be realised if the prescribed exercise is of insufficient intensity. Exercise programmes are plagued by a high 'drop-out' rate; 50% of normal middle-aged volunteers are lost in 6 months, and even with post-coronary programmes losses can be 60--70% over 4 years. Simple suggestions are made for improving compliance with the required exercise prescription.

Adult↗