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Prescribing Physician (prescribing + physician)
Selected AbstractsRecombinant human interferon beta in relapsing,remitting multiple sclerosis: a review of the major clinical trialsEUROPEAN JOURNAL OF NEUROLOGY, Issue 4 2000M. Chofflon The beneficial effects of interferon beta (IFN-,) on disease activity in relapsing,remitting multiple sclerosis (RRMS) have been confirmed in several clinical trials. Three IFN-, products are currently available and licensed for use in RRMS at different dosages and with different routes of administration. For the prescribing physician, therefore, questions remain about the effect these differences may have on the success of therapy. This paper reviews the four large placebo-controlled clinical trials that have been conducted with IFN-, in patients with RRMS. The evidence available indicates that optimal results are likely to be achieved with the highest tolerable dosage of IFN-,. Furthermore, as inflammatory brain lesions in MS have been shown to exhibit more extensive and early axonal damage than previously suspected, early treatment may be advisable in order to delay disease progression in RRMS. [source] Migraine Prevention: What Patients Want From Medication and Their Physicians (A Headache Specialty Clinic Perspective)HEADACHE, Issue 5 2006Todd D. Rozen MD Objective.,To document the results of a migraine patients survey, from a headache specialty clinic, in which patients were asked to rank, in order of importance, certain characteristics of migraine preventive treatment. Methods.,A 10-question survey was completed by 150 patients (114 females and 36 males) with a history of migraine who presented to the Michigan Head Pain & Neurological Institute. The patients were asked to rank, in order of importance, characteristics of migraine preventive treatment. Each characteristic was rated individually on a 1 to 10 scale (1 being of little importance and 10 being extremely important). The mean rating of each characteristic was then calculated and the results analyzed. Results/Discussion.,From this migraine preventive treatment survey, the most important thing to migraineurs, from a headache specialty clinic population, is that the prescribing physician involves them in the decision making of choosing a preventive agent. The physician taking time to explain the possible medication side effects is the second most highly ranked characteristic. Migraine preventives with published efficacy in the medical literature are also deemed very important. Migraineurs do not mind using more than 1 preventive agent at one time if greater efficacy can be achieved. Agents that may affect weight and /or cause sedation may be important factors as to why patients (especially females) may not want to take a preventive medication. Natural therapies and once-daily dosing are ranked lower overall but still are important characteristics of preventive treatment. Some gender differences are noted in the ranking of migraine preventive characteristics. [source] Frequency and nature of drug,drug interactions in a Dutch university hospitalBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 2 2009Jeannette E. F. Zwart-van Rijkom WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT , Drug,drug interactions (DDIs) may lead to often preventable adverse drug events and health damage. , In Dutch community pharmacies approximately 6% of all prescriptions generate a DDI alert. , Hospitalized patients may be especially at risk, as they are more severely ill and multiple medications may be prescribed simultaneously; however, only limited data are available on the frequency and nature of DDIs during hospitalization. WHAT THIS STUDY ADDS , In a Dutch university hospital 10% of all prescriptions generated a DDI alert; overall 25% of patients encountered at least one potential DDI. , Besides the risk of decreased effectiveness (25% of the DDIs), the most frequently occurring potential clinical consequence of the DDIs was an increased risk of side-effects, such as an increased bleeding risk (22% of DDIs), hypotension (15%) and nephrotoxicity (13%). , Almost half of the DDIs could be managed by monitoring laboratory values. AIM Drug,drug interactions (DDIs) may lead to often preventable adverse drug events and health damage. Especially within hospitals, this might be an important factor, as patients are severely ill and multiple medications may be prescribed simultaneously. The objective of this study was to measure the frequency and nature of DDI alerts in a Dutch university hospital. METHODS All patients hospitalized in the University Medical Centre Utrecht in 2006 who were prescribed at least one medication were included. The frequency of DDIs was calculated as: (i) the percentage of patients experiencing at least one DDI, and (ii) the percentage of prescriptions generating a DDI alert. Based on the national professional guideline, DDIs were classified into categories of potential clinical outcome, management advice, clinical relevance (A,F) and available evidence (0,4). RESULTS Of the 21 277 admissions included, 5909 (27.8%) encountered at least one DDI. Overall, the prescribing physician received a DDI alert in 9.6% of all prescriptions. The most frequently occurring potential clinical consequence of the DDIs was an increased risk of side-effects such as increased bleeding risk (22.0%), hypotension (14.9%), nephrotoxicity (12.6%) and electrolyte disturbances (10.5%). Almost half (48.6%) of the DDIs could be managed by monitoring laboratory values. CONCLUSIONS Computerized DDI alerts may be a useful tool to prevent adverse drug events within hospitals, but they may also result in ,alert fatigue'. The specificity of alerts could significantly improve by the use of more sophisticated clinical decision support systems taking into account, for example, laboratory values. [source] Educational strategy to reduce medication errors in a neonatal intensive care unitACTA PAEDIATRICA, Issue 5 2009Ainara Campino Abstract Objective: We aimed to evaluate the effect of a comprehensive preventive educational strategy on the number and type of drug errors in the prescription process in a regional neonatal intensive care unit (NICU). Design: Medication errors during prescription were recorded in a 41 bed, level III regional neonatal unit by a pharmacist. Data were retrieved from handwritten doctor's orders and introduced at bedsite into an e-database. Each prescription, not related to enteral and parenteral nutrition and blood products, was evaluated for dosage, units, route and dosing interval. The study was developed in three phases: pilot phase to know the baseline drug error rate and estimate sample size; pre-intervention (4182 drug orders reviewed); and post-intervention seven months after a comprehensive preventive educational intervention consisting sessions about drug errors and study's aims was implemented. Results: After the preventive educational intervention was implemented, the prescription error rate and the percentage of registers with one or more incident decreased significantly from 20.7 to 3% (p < 0.001) and from 19.2 to 2.9% (p < 0.001), respectively. Simultaneously, an improvement in correct identification of the prescribing physician was registered (from 1.3 to 78.2%). The rest of items analysed were similar in both periods. Conclusion: The implementation of a structured preventive educational intervention for health professionals in a regional NICU reduced the medication error rate, possibly by the dissemination of a patient safety culture. [source] Physician peer assessments for compliance with methadone maintenance treatment guidelinesTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2007Carol Strike PhD Abstract Introduction: Medical associations and licensing bodies face pressure to implement quality assurance programs, but evidence-based models are lacking. To improve the quality of methadone maintenance treatment (MMT), the College of Physicians and Surgeons of Ontario, Canada, conducts an innovative quality assurance program on the basis of peer assessments. Using data from this program, we assessed physician compliance with MMT guidelines and determined whether physician factors (e.g., training, years of practice), practice type, practice location, and/or caseload is associated with MMT guideline adherence. Methods: Secondary analysis of methadone practice assessment data collected by the College of Physicians and Surgeons of Ontario, Canada. Assessment data from methadone prescribing physicians who completed their first year of methadone practice were analyzed. We calculated the mean percentage compliance per guideline per physician and global compliance across all guidelines per physician. Linear regression was used to assess factors associated with compliance. Results: Data from 149 physician practices and 1,326 patient charts were analyzed. Compliance across all charts was greater than 90% for most areas of care. Compliance was less than 90% for take-home medication procedures; urine toxicology screening; screening for hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), tuberculosis, other sexually transmitted infections, and completion of a psychosocial assessment. Mean global compliance across all charts and guidelines per physician was 94.3% (standard deviation = 7.4%) with a range of 70% to 100%. Linear regression analysis revealed that only year of medical school graduation was a significant predictor of physician compliance. Discussion: This is the first report of MMT peer assessments in Canada. Compliance is high. Few countries conduct similar assessment processes; none report physician-level results. We cannot quantify the contribution of peer assessment, training, or self-selection to the compliance rates, but compared to other areas of practice these rates suggest that peer assessment may exert a significant effect on compliance. A similar assessment process may in other areas of clinical practice improve physician compliance. [source] ThiaZolidineDiones and the Influence of Media Adverse Reporting on Prescribing Attitudes in PraCTice (TZD-IMPACT) StudyCARDIOVASCULAR THERAPEUTICS, Issue 2 2009Jacob George Prescribing behavior may be linked to media influence rather than to scientific evidence. Recently, the oral diabetic drug class of thiazolidinedione has been under the spotlight because of concerns over their cardiovascular safety. We have therefore conducted an electronic questionnaire survey among prescribing physicians in Tayside, Scotland to evaluate the prescribing attitudes and knowledge of the available evidence regarding the cardiovascular safety of thiazolidinedione use. Nationally representative prescribing data thoughout Scotland and Tayside from the IMS Health RSA dataset were also examined. Prescriptions for rosiglitazone alone or in combination with metformin have steadily decreased since the publication of a meta-analysis suggesting harm from rosiglitazone. This was mirrored by a gradual increase in prescriptions of pioglitazone. However, when questioned, the majority of doctors rate the level of information received regarding drug safety information on thiazolidinediones to be low with 68% of respondents scoring 5 or less (scale 1,10) on the level of information received. The source of information regarding drug safety warning was highly varied ranging from journals (21%), scientific meetings (19%) and the news media (15%). The findings of this study clearly show a need to disseminate reliable drug safety information more effectively to prescribers. [source] | ||||||||||