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Medication Prescribing (medication + prescribing)
Selected AbstractsDiscontinuing Medications: A Novel Approach for Revising the Prescribing Stage of the Medication-Use ProcessJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2008Kevin T. Bain PharmD Thousands of Americans are injured or die each year from adverse drug reactions, many of which are preventable. The burden of harm conveyed by the use of medications is a significant public health problem, and therefore, improving the medication-use process is a priority. Recent and ongoing efforts to improve the medication-use process have focused primarily on improving medication prescribing, and not much emphasis has been put on improving medication discontinuation. A formalized approach for rationally discontinuing medications is a necessary antecedent to improving medication safety and improving the nation's quality of care. This article proposes a conceptual framework for revising the prescribing stage of the medication-use process to include discontinuing medications. This framework has substantial practice and research implications, especially for the clinical care of older persons, who are particularly susceptible to the adverse effects of medications. [source] Using explicit criteria to evaluate the quality of prescribing in elderly Italian outpatients: a cohort studyJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 2 2010V. Maio PharmD MS MSPH Summary Background and objective:, Inappropriate prescribing in the elderly population is a well-recognized problem in public health. The Beers criteria have been widely used to evaluate the quality of prescribing for the elderly. However, because the Beers criteria were developed in the United States, they are not fully applicable in Italy. The purpose of this study was to establish explicit criteria for potentially inappropriate medication prescribing (PIP) for the elderly and assess the prevalence of and factors associated with PIP among elderly residents in the Local Health Unit of Parma, Italy according to the developed criteria. Methods:, A nine-member expert panel was convened to identify a list of inappropriate medications reflecting the Italian prescribing habits. The panel decided to refine and update the 2002 Beers criteria. Consensus through a Nominal Group Technique was reached to classify the identified 23 inappropriate medications into three categories: 17 medications to be always avoided, three medications rarely appropriate, and three medications with some indications but often misused. A retrospective cohort study using the 2006 Parma Local Health Unit automated outpatient prescriptions database was conducted. The cohort comprised 91 741 elderly individuals ,65 years with at least one prescription medication. PIP was defined as having a prescription claim for at least one inappropriate medication. Results and discussion:, A total of 23 662 elderly in the cohort (25·8%) had at least one PIP. Of these, 14·1% received prescriptions for two medications of concern, and 2·0% for three or more. Using the expert panel's categories, 59·2% of the elderly receiving PIP had prescriptions for drugs that should always be avoided, 33·9% for rarely appropriate drugs, and 19·1% for drugs that have some indications but are often misused. Non-steroidal anti-inflammatory drugs (35·7% of subjects) were the most frequently occurring PIP, followed by ticlopidine (17·6%), doxazosin (15·5%), and amiodarone (13·6%). Female, older age, overall number of drugs prescribed, greater number of chronic conditions were factors associated with greater odds of receiving PIP. Conclusion:, Via the developed criteria, the study corroborates that PIP among elderly outpatients is a substantial issue in Parma Local Health Unit, Italy. Knowledge of the prevalence of PIP and associated factors should gear efforts to develop strategies to reduce PIP in outpatient settings in Italy. [source] Pharmaceutical company influences on medication prescribing and their potential impact on quality use of medicinesJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 5 2008G. J. Kyle BPharm MClinPharm Summary Background:, Pharmaceuticals are big business, reporting strong market growth year after year. The ,gatekeepers' of this market are prescribers of medicines, who are the major target of pharmaceutical companies, utilizing direct and indirect influences. Methods:, This paper draws on previous research investigating pharmaceutical company prescribing influences to develop a qualitative model demonstrating the synergism between commercial influences on prescribing. The generic model was used to explore a realistic but hypothetical scenario to ascertain the applicability of the model. Results and Discussion:, A generic influence model was developed. The model was readily able to be adapted to reflect a realistic practice scenario. Conclusion:, Prescriber awareness of the linkages between various seemingly separate marketing techniques could potentially improve medicines usage in an evidence-based practice paradigm. [source] Therapeutic approaches to fibromyalgia in the Netherlands: a comparison between 1998 and 2005JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2008Mariëlle E. A. L. Kroese MSc Abstract Rationale, In this study, information was gathered from five disciplines on their usual management methods for fibromyalgia (FM) in order to asses whether treatment regimens have changed in the Netherlands during a period of 6 years. In addition, insight was gained into the therapeutic motives of the professionals. Method, A questionnaire was sent to a sample of 150 persons per discipline: general practitioners (GPs), rheumatologists (RMTs), rehabilitation specialists (RS), physical therapists and psychologists. Results, The overall response rate was 40.4%. The referral behaviour changed (significantly), especially between GPs and RMTs. An increased choice for aerobic exercise (RS: P = 0.023) and multidisciplinary therapy (RMT: P = 0.046) was found. RMTs and RS showed decreased medication prescribing (RMT: P = 0.024). Preferences of treatment for FM differ per discipline. The choice is principally made on the basis of subjective, professional group-bound factors. Particularly for GPs, dynamic patient factors are an important motive in the management of FM. Conclusions, Despite the fact that most changes found are in conformity with the literature, the absolute application percentages of recommended therapies are still very low. The differences in practice between the several disciplines seem explicable on the basis of the factors that have a prominent role in the choice of a therapy for FM. This study underlines the need for further research into methods and processes of the management of FM, and their clinical effectiveness. An effective way of dissemination, especially of guidelines, is essential. [source] | ||||||||||