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Prescribing Patterns (prescribing + pattern)

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Medical Sciences	100%

Selected Abstracts

Persistent Nonmalignant Pain and Analgesic Prescribing Patterns in Elderly Nursing Home Residents

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2004
(See editorial comments by Dr. Debra Weiner on pp 1020, 1022)
Objectives: To determine the prevalence of analgesics used, their prescribing patterns, and associations with particular diagnoses and medications in patients with persistent pain. Design: Cross-sectional study. Setting: Nursing homes from 10 U.S. states. Participants: A total of 21,380 nursing home residents aged 65 and older with persistent pain. Measurements: Minimum Data Set (MDS) assessments on pain, analgesics, cognitive, functional, and emotional status were summarized. Logistic regression models identified diagnoses associated with different analgesic classes. Results: Persistent pain as determined using the MDS was identified in 49% of residents with an average age of 83; 83% were female. Persistent pain was prevalent in patients with a history of fractures (62.9%) or surgery (63.6%) in the past 6 months. One-quarter received no analgesics. The most common analgesics were acetaminophen (37.2%), propoxyphene (18.2%), hydrocodone (6.8%), and tramadol (5.4%). Only 46.9% of all analgesics were given as standing doses. Acetaminophen was usually prescribed as needed (65.6%), at doses less than 1,300 mg per day. Nonsteroidal antiinflammatory drugs (NSAIDs) were prescribed as a standing dose more than 70% of the time, and one-third of NSAIDs were prescribed at high doses. Conclusion: In nursing home residents, persistent pain is highly prevalent, there is suboptimal compliance with geriatric prescribing recommendations, and acute pain may be an important contributing source of persistent pain. More effective provider education and research is needed to determine whether treatment of acute pain could prevent persistent pain. [source]

Prescribing pattern of anti-epileptic drugs in an Italian setting of elderly outpatients: a population-based study during 2004,07

BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 4 2010
Alessandro Oteri
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT , In the last years there has been a growing trend in anti-epileptic drug (AED) use, particularly in elderly patients, but few data concerning indication of use are available in general practice. , Various AEDs, including newer agents, have been approved for indications other than epilepsy and are increasingly also used for unlicensed indications. , No data about the impact of re-imbursement restrictions on the choice of anti-epileptic drugs in general practice are available. WHAT THIS STUDY ADDS , In general practice, a rapid increase of AED prescriptions in the elderly was observed, principally due to the use of newer AEDs for indications other than epilepsy. , Re-imbursement restrictions influenced newer AED use, particularly pregabalin and gabapentin prescriptions. , Phenobarbital, accounting for more than 50% of total AED volume, was the most prescribed medication during the entire study period. This finding should be considered in light of the potential risks associated with phenobarbital use in the geriatric population. AIMS The aims of the study were to assess the trend of older and newer anti-epileptic drugs (AEDs) in the elderly population and to analyze the effects of a health-policy intervention with regard to AED use in general practice in a setting in Southern Italy. METHODS Data were extracted from the ,Caserta-1' Local-Health-Unit Arianna database in the years 2004,07. Patients aged over 65 years, receiving at least one AED prescription and registered in the lists of 88 general practitioners, were selected. The use of older and newer AEDs was calculated as 1 year prevalence and incidence of use and defined daily dose (DDD) per 1000 inhabitants day,1. Sub-analyses by gender, age and indication of use were performed. RESULTS Most of AED users were treated because of neuropathic pain (64.8%). However, the main indication of use for older AEDs (57.8%) was epilepsy, whereas newer AEDs (79.5%) were used for neuropathic pain. Prevalence and incidence of newer AED use increased until 2006, followed by a reduction in 2007. Newer AEDs, particularly gabapentin and pregabalin, were used in the treatment of more patients than older AEDs. However phenobarbital, accounting for more than 50% of total AED volume, was the most prescribed medication during the entire study period. CONCLUSIONS An increasing use of AEDs has been observed during 2004,07, mostly due to the prescription of newer compounds for neuropathic pain. The fall in the use of newer AEDs during 2007 coincides with revised re-imbursement criteria for gabapentin and pregabalin. The large use of phenobarbital in the elderly should be considered in the light of a risk of adverse drug reactions. [source]

Prescribing patterns of antiparkinsonian agents in Europe,

MOVEMENT DISORDERS, Issue 8 2010
Mário Miguel Rosa MD
Abstract In the 1990s, previous knowledge and randomized controlled trials supported the establishment of today's therapeutic recommendations in Parkinson's disease (PD). Scientific evidence allows different options for the treatment of PD. Patterns of use of antiparkinsonian agents (APA) across European countries may thus reflect these options. We wanted to describe patterns of use of APA in Europe and characterize the changes in prescription habits between 2003 and 2007. We investigated APA outpatient sales in 26 European countries where all commercially available APA were studied. Data for molecules and brand names were collected through IMS Health. Treatment per 1000 inhabitants daily (DID) was obtained from the WHO defined daily dose. Prescription pattern changes were evaluated by market share. Prescription patterns varied widely. In most countries, levodopa/dopamine agonists accounted for half of the drug use; whereas in others, anticholinergics, MAO inhibitors and amantadine prevailed. The greatest increase occurred with monoamine oxidase inhibitors and levodopa. There was an increase in dopamine agonists and a decrease in anticholinergics. For a 6.8% dose consume increase, there was a 41.1% sales increase (in euros). We showed an increase in the consumption of APA over 5 years. There was significant heterogeneity in the use of APA in Europe, suggesting differences in drug treatment. Costs of medication increased more than did dose consume, implying an increase in the cost of individual patient treatment. Published evidence does not explain the observed differences in the prescribing of APA. © 2010 Movement Disorder Society [source]

Antimicrobial prescribing trends in primary care: implications for health policy in Bahrain,,

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2008
Khalid A. J. Al Khaja PhD
Abstract Purpose To evaluate antimicrobial prescribing pattern by primary care physicians. Methods A nation-wide, retrospective, multi-centric prescription-audit was carried out in primary care health centres in Bahrain. Results Systemic antimicrobials ranked the fourth most common class of drugs prescribed. Amoxycillin, cephalexin, erythromycin, ciprofloxacin and cotrimoxazole were prescribed by general practitioners (GPs) more often than by family physicians (FPs) (p,<,0.05). With respect to prescribing of other antimicrobials and anthelmintic mebendazole, the differences between GPs and FPs were nonsignificant. Seventy-seven per cent of systemic antimicrobials prescribed were for respiratory tract infections (RTIs). Topical antimicrobial preparations for ear and eye infections were prescribed by GPs in a rate significantly higher than by FPs (p,<,0.05); of these, chloramphenicol and Locacorten vioform® (flumethasone,+, clioquinol) ear drops and sulphacetamide eye drops were more often prescribed by GPs (p,<,0.05). There were no significant differences in prescribing between GPs and FPs as regards topical antimicrobials used for oropharyngeal, skin and vulvovaginal infections. Conclusion Antimicrobials were extensively used in primary care, mainly for treating RTIs. The general practitioners were more avid prescribers of antimicrobials compared to the FPs. Rational use of antimicrobials in primary care should be encouraged and the reasons for the observed differences in prescribing of antimicrobials between the GPs and FPs need further evaluation. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Comparison of nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 (COX-2) inhibitors use in Australia and Nova Scotia (Canada)

BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 1 2009
Nadia Barozzi
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT , Cyclo-oxygenase-2 (COX-2) inhibitors were marketed aggressively and their rapid uptake caused safety concerns and budgetary challenges in Canada and Australia. WHAT THIS STUDY ADDS , The study showed that there were similarities in the anti-inflammatory prescribing pattern between Australia and Nova Scotia; however, volumes of both ns-NSAIDs and COX-2 inhibitors prescribed were higher in Australia in the study period. The remarkable increase observed in Australia in NSAIDs use was essentially due to the much higher COX-2 inhibitor use. Differences in regulatory and marketing practices, as well as cultural and historical differences might be some of the reasons for differences in the NSAID prescribing between Australia and Nova Scotia. AIMS Cyclooxygenase-2 (COX-2) inhibitors were marketed aggressively and their rapid uptake caused safety concerns and budgetary challenges in Canada and Australia. The objectives of this study were to compare and contrast COX-2 inhibitors and nonselective nonsteroidal anti-inflammatory drug (ns-NSAID) use in Nova Scotia (Canada) and Australia and to identify lessons learned from the two jurisdictions. METHODS Ns-NSAID and COX-2 inhibitor Australian prescription data (concession beneficiaries) were downloaded from the Medicare Australia website (2001,2006). Similar Pharmacare data were obtained for Nova Scotia (seniors and those receiving Community services). Defined daily doses per 1000 beneficiaries day,1 were calculated. COX-2 inhibitors/all NSAIDs ratios were calculated for Australia and Nova Scotia. Ns-NSAIDs were divided into low, moderate and high risk for gastrointestinal side-effects and the proportions of use in each group were determined. Which drugs accounted for 90% of use was also calculated. RESULTS Overall NSAID use was different in Australia and Nova Scotia. However, ns-NSAID use was similar. COX-2 inhibitor dispensing was higher in Australia. The percentage of COX-2 inhibitor prescriptions over the total NSAID use was different in the two countries. High-risk NSAID use was much higher in Australia. Low-risk NSAID prescribing increased in Nova Scotia over time. The low-risk/high-risk ratio was constant throughout over the period in Australia and increased in Nova Scotia. CONCLUSIONS There are significant differences in Australia and Nova Scotia in use of NSAIDs, mainly due to COX-2 prescribing. Nova Scotia has a higher proportion of low-risk NSAID use. Interventions to provide physicians with information on relative benefits and risks of prescribing specific NSAIDs are needed, including determining their impact. [source]

GP prescribing of nicotine replacement and bupropion to aid smoking cessation in England and Wales

ADDICTION, Issue 11 2004
Andy McEwen
ABSTRACT Aims Prescribing nicotine replacement therapy (NRT) or bupropion for smoking cessation is of considerable importance to public health but little is known about prescribing practices. This paper examines general practitioners' (GPs') prescribing patterns in Britain where these drugs are reimbursed. The results have implications for other health-care systems considering introducing reimbursement. Design, participants and setting Postal survey conducted in 2002 of a random sample of 1088 GPs in England and Wales, of whom 642 (59%) responded. Measures Number of requests GPs reported having received from patients for NRT and bupropion over the past month, the number of prescriptions they reported issuing and ratings of attitudes to these medications. Findings GPs reported receiving an average of 4.3 requests for NRT and 1.9 for bupropion in the previous month. They reported issuing 3.5 prescriptions for NRT and 1.2 for bupropion. Almost all GPs accepted that NRT (95%) and bupropion (97%) should be reimbursable on National Health Service (NHS) prescription. However, a significant minority of those who received requests for prescriptions did not issue any (8% for NRT and 26% for bupropion). This was related to whether they thought these products should be available on NHS prescription for both NRT and bupropion (OR = 0.66, P < 0.05), which in turn was related to beliefs about whether smokers should have to pay for treatment themselves, the cost-effectiveness of NRT/bupropion and the low priority they would give NRT/bupropion in the drug budget. For bupropion, concern about side-effects independently predicted not prescribing [odds ratio (OR) = 1.46, P < 0.03]. Conclusion In the British health-care system, which has a well-established system for technology assessment and professionally endorsed guidelines, a significant minority of GPs decline all patient requests for stop-smoking medicines. [source]

5-Aminosalicylic acid (mesalazine) use in Crohn's disease: A survey of the opinions and practice of Australian gastroenterologists

INFLAMMATORY BOWEL DISEASES, Issue 8 2007
Richard B. Gearry MD
Abstract Background: The use of 5-aminosalicylate (5-ASA) drugs in Crohn's disease (CD) is controversial, with their continuing apparent widespread use despite high-level evidence indicating marginal benefit at best and international guidelines recommending limited indications. Methods: In order to understand how clinicians translate the evidence base into clinical practice, we surveyed a cross-section of Australian gastroenterologists to determine opinions and prescribing patterns of 5-ASA drugs in CD. Results: In all, 42% of 285 gastroenterologists who were sent a questionnaire by e-mail responded. Five (4%) never use 5-ASA drugs in CD. The drugs are most commonly prescribed for patients with colonic (96%) or ileocolonic (92%) disease location, inflammatory disease behavior (80%), and mild disease activity (97%). The majority (64%) use a dose of 1,3 g/day, but only 6% use over 4.5 g/day. Less than one-half use 5-ASA drugs as maintenance following surgical resection, but most use it for inducing remission alone (70%) or in combination with other drugs (90%), and continue its use for maintenance. Side effects are thought to be infrequent (62%) or rare (20%) and few common side effects are believed to be serious. Respondents estimated that over 90% of patients were nonadherent to prescribed 5-ASA regimens at least 50% of the time. While 84% believed that 5-ASA drugs were effective in CD, only 58% believed that they were cost-effective. Conclusions: In Australia 5-ASA drugs are extensively prescribed for CD at relatively low doses without expectation of patient adherence. Current evidence and guidelines has had little apparent impact on clinical practice. The cost implications are considerable. (Inflamm Bowel Dis 2007) [source]

BRIEF COMMUNICATIONS: A quantity survey of intravenous administration of metronidazole in its different forms in a tertiary teaching hospital

INTERNAL MEDICINE JOURNAL, Issue 8 2010
L. L. Lee
Abstract The aim of this paper is to examine the prescribing patterns and cost of various formulations of metronidazole in a hospital setting over a 3-month period. Oral metronidazole has high bioavailability (98.9%) with peak plasma concentrations averaged at 2.3 h after dosing. Despite the high bioavailability of oral metronidazole, many patients continue to receive metronidazole intravenously when they are suitable for oral preparation. An audit of 120 consecutive patients prescribed metronidazole was conducted at the Liverpool Hospital, NSW, from March to July 2005. There were 65 men and 55 women (age 18,93). Of the 120 patients, 16 were on oral, 1 on rectal and 103 were on intravenous metronidazole. Treatment was initiated based on clinical diagnoses. Potential pathogens were subsequently identified on only 21 occasions. The use of metronidazole as an oral preparation was contraindicated in 27 patients (22.5%) who were nil-by-mouth. Of these, rectally administered metronidazole was contraindicated in only eight patients. The average course of intravenous metronidazole was 8.0 ± 9.7 days (mean ± SD). The total number of intravenous metronidazole treatment days was 824. Oral metronidazole would have been possible in 618 out of the 824 days. The estimated cost to administer each dose of oral, suppository and intravenous forms of metronidazole is $A0.11, $A1.34 and $A6.09 respectively. Thus, substantial savings could be achieved if oral metronidazole were to be administered whenever possible. The early use of oral or rectal metronidazole should be encouraged when there are no clinical contraindications. [source]

Comparison of medication-prescribing patterns for patients in different social groups by a group of doctors in a general practice

INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 4 2005
Mrs. Jenifer Anne Harding Primary care pharmacist
Objective This study was designed to compare medication-prescribing patterns of five general practitioners (GPs) who served patients living in two different communities, one of which is more economically deprived. Method The study focused on cardiovascular and antibiotic prescribing. Practice population data including history of cardiovascular disease and records of medication prescribed were considered with public health and socio-economic statistics for each community. Setting The study practice serves 8300 patients in two clinics, Tipton and Gornal, 4 miles apart. Each has similar numbers of registered patients. Tipton is in one of England's most deprived areas, ranked 16 out of 354 in the Indices of Multiple Deprivation 2004, compared with Gornal which is situated in an area ranked 109. Key findings For each Tipton patient, mean prescribing costs were 37% higher and mean number of prescription items were 16% higher over the study period compared with Gornal. Although a higher incidence might be expected in Tipton, little difference in identified cardiovascular disease (CVD) was found between Tipton and Gornal, and prescribing rates of aspirin and statins were similar. Tipton patients with CVD were less likely to be prescribed antihypertensives especially calcium channel blockers (P = 0.003) and diuretics (P = 0.02). Tipton patients received on average 3.27 different cardiovascular drugs compared with 3.80 in Gornal (P = 0.004). In those aged 65 years and over, this reduced to 3.08 in Tipton compared with 3.82 in Gornal (P = 0.001). Tipton patients generally, and children specifically, were significantly more likely to receive antibiotic prescriptions (P <0.0001). Conclusion This study suggested that some prescribing patterns differed at the two clinics, which may reflect different behaviours by the GPs when prescribing in the two communities of different population need. [source]

Persistent Nonmalignant Pain and Analgesic Prescribing Patterns in Elderly Nursing Home Residents

Prescribed medications and pharmacy interventions for acute respiratory tract infections in Swiss primary care

JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 4 2009
K. E. Hersberger PhD
Summary Background and objectives:, Symptomatic medications are often not considered in clinical studies assessing interventions to reduce prescribing of antibiotics for acute respiratory tract infections (ARTI). Our study objectives were to examine prescribing patterns of antibiotics and symptomatic medications for ARTI in Swiss primary care and to monitor pharmacists' interventions during the prescription-dispensing process. Methods:, Medical records of 695 patients participating in a clinical trial which was designed to reduce use of antibiotics for ARTI in primary care, were linked to their prescriptions. Matching of prescribed and dispensed medications enabled the assessment of interventions by community pharmacists. Results:, On average, 2·4 different drugs were prescribed per patient (in total 142 antibiotics, 1599 symptomatic medications, and 56 non-ARTI-medication). Most patients (80%) were treated only with symptomatic medications. Most frequently prescribed symptomatic ARTI-medications were nasal decongestants (39%), cough suppressants (36%), and mucolytics (31%). Patients with prescribed antibiotics received significantly fewer symptomatic medications (odds ratio, 0·24; 95% confidence interval 0·16,0·37). Over 20% of prescriptions prompted at least one intervention by a pharmacist in the dispensing process. A discrepancy between prescribed and dispensed medications was seen in 19% of patients. Conclusions:, Prescription rates of antibiotics for ARTI in this trial were low and patients were treated mainly with non-antibiotic symptomatic medications. Efforts to reduce antibiotic prescribing may induce higher rates of use of medications for intensive symptomatic treatment. Considerable differences between prescribed and dispensed medications were noted. [source]

Vitamin K prescribing patterns and bone health surveillance in UK children with cystic fibrosis

JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 6 2007
D. S. Urquhart
Abstract Background, Bone disease has become an increasingly recognized complication of cystic fibrosis (CF). Although causes of CF bone disease are multifactorial, there has been recent interest in the role of vitamin K in CF bone disease. Aims,and,methods, A questionnaire survey of all UK paediatric CF centre dietitians and centre directors was carried out to ascertain current practice with regard to vitamin K prescribing and bone health surveillance. Results, The survey had a 97% response rate representing 3414 CF children. Twenty-three centre directors and 19 dietitians responded, and at least moderate agreement was noted with kappa scores >0.41 for all but one question assessed. Ninety-three per cent centres report that >90% pancreatic insufficient patients receive vitamins A, D and E, yet only 18% centres routinely supplement vitamin K. The majority (60%) report that <10% of their CF patients receive vitamin K, whilst vitamin K dosage varied from 0.3,0.5 to 10 mg day,1. Only one centre undertook no bone health surveillance, and vitamin D levels are measured in 89%, calcium intake assessed in 82% and dual-energy X-ray absorptiometry scans performed in 61% centres. Discussion, Heterogeneity in both vitamin K prescribing practices and bone health surveillance in CF across the UK were noted, underlining the need for a national consensus on bone health management, as well as acting as a call for longitudinal research into the clinical effectiveness of vitamin K therapy in CF. [source]

Evaluation of antifungals in the surgical intensive care unit: a multi-institutional study

MYCOSES, Issue 3 2006
Kevin W. Garey
Summary In the USA, >50% of candidemia episodes occur in medical or surgical intensive care units (SICU). However, studies focused on patterns and rationale for antifungal use are lacking. The objective of this study was to evaluate systemic antifungal usage in SICU patients. Retrospective audit of SICU patients receiving antifungal therapy from four American hospitals. Medical records were reviewed for demographics, hospital variables, microbiology results, antifungal regimens and indications for therapy. A total of 2411 patient-days of antifungal use were evaluated in 225 patients. Fluconazole was the most frequently prescribed antifungal (1846 patient-days) followed by amphotericin B deoxycholate (251 patient-days), lipid formulations of amphotericin B (201 patient-days), itraconazole (71 patient-days), and caspofungin (42 patient-days). Antifungals were prescribed empirically (44%), for preemptive therapy in critically ill patients colonised with Candida (43%), or for candidiasis (12%). Candida species were recovered from 98% of patients with positive fungal cultures most commonly from pulmonary (53%) or urinary sources (17%). Fluconazole is the most frequently prescribed antifungal agent in SICUs and is most often prescribed for empiric or preemptive indications. Research efforts to identify patients who warrant preemptive antifungal therapy for invasive candidiasis could dramatically change antifungal prescribing patterns in the SICU. [source]

Toward Evidence-Based Prescribing at End of Life: A Comparative Analysis of Sustained-Release Morphine, Oxycodone, and Transdermal Fentanyl, with Pain, Constipation, and Caregiver Interaction Outcomes in Hospice Patients

PAIN MEDICINE, Issue 4 2006
BCPS, Douglas J. Weschules PharmD
ABSTRACT Objective., The primary goal of this investigation was to examine selected outcomes in hospice patients who are prescribed one of three sustained-release opioid preparations. The outcomes examined include: pain score, constipation severity, and ability of the patient to communicate with caregivers. Patients and Settings., This study included 12,000 terminally ill patients consecutively admitted to hospices and receiving pharmaceutical care services between the period of July 1 and December 31, 2002. Design., We retrospectively examined prescribing patterns of sustained-release morphine, oxycodone, and transdermal fentanyl. We compared individual opioids on the aforementioned outcome markers, as well as patient gender, terminal diagnosis, and median length of stay. Results., Patients prescribed a sustained-release opioid had similar average ratings of pain and constipation severity, regardless of the agent chosen. Patients prescribed transdermal fentanyl were reported to have more difficulty communicating with friends and family when compared with patients prescribed either morphine or oxycodone. On average, patients prescribed transdermal fentanyl had a shorter length of stay on hospice as compared with those receiving morphine or oxycodone. Conclusion., There was no difference in observed pain or constipation severity among patients prescribed sustained-release opioid preparations. Patients receiving fentanyl were likely to have been prescribed the medication due to advanced illness and associated dysphagia. Diminished ability to communicate with caregivers and a shorter hospice course would be consistent with this profile. Further investigation is warranted to examine the correlation between a patient's ability to interact with caregivers and pain control achieved. [source]

Variations in prescribing atypical antipsychotic drugs in primary care: cross-sectional study

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2002
Darren M. Ashcroft
Abstract Background Side-effects from conventional antipsychotic drugs, in particular extrapyramidal side-effects, limit their use for some patients, lead to non-compliance and may adversely affect the quality of life of others. Newer, more expensive, ,atypical' antipsychotics have been developed in attempts to address these problems, although debate about the most appropriate role for these medications remains. Objectives To examine variations in prescribing of the ,atypical' antipsychotics in primary care, over a 5-year period. Setting All 13 health authorities within the West Midlands region. Method Cross-sectional analysis of prescribing analysis and cost (PACT) data for atypical antipsychotic drugs (amisulpride, clozapine, olanzapine, risperidone, sertindole, and zotepine) was performed using one-way analysis of variance. To test whether the differences reflected variation in local population need, the prescribing data were adjusted using Mental Illness Needs Index scores. Regression analysis was used to examine the relationship between the overall levels of prescribing and local population need. Results The total volume of prescribing of atypical antipsychotic drugs in primary care increased nearly six-fold from 1996/97 to 2000/01 in the West Midlands region. Olanzapine was the most commonly prescribed drug during 1999/2000, accounting for 45% of defined daily doses, while risperidone accounted for 38% of the total. In 1996/97, a four-fold variation in rates of atypical antipsychotic prescribing between health authorities was found, compared with a three-fold variation in 2000/01, after adjusting for measures of local population need. Conclusions There has been a substantial increase in the prescription of atypical antipsychotics in primary care over the last 5 years, but the rate of increase has varied widely between health authorities. Further studies are needed to determine the factors that have led to these differences in uptake, and the likely impact of national guidance on future prescribing patterns. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Prescriptions for Schedule II Opioids and Benzodiazepines Increase after the Introduction of Computer-generated Prescriptions

ACADEMIC EMERGENCY MEDICINE, Issue 6 2009
Genevieve McGerald DO
Abstract Background:, Prescriptions for controlled substances decrease when regulatory barriers are put in place. The converse has not been studied. Objectives:, The objective was to determine whether a less complicated prescription writing process is associated with a change in the prescribing patterns of controlled substances in the emergency department (ED). Methods:, The authors conducted a retrospective nonconcurrent cohort study of all patients seen in an adult ED between April 19, 2005, and April 18, 2007, who were discharged with a prescription. Prior to April 19, 2006, a specialized prescription form stored in a locked cabinet was obtained from the nursing staff to write a prescription for benzodiazepines or Schedule II opioids. After April 19, 2006, New York State mandated that all prescriptions, regardless of schedule classification, be generated on a specialized bar-coded prescription form. The main outcome of the study was to compare the proportion of Schedule III,V opioids to Schedule II opioids and benzodiazepines prescribed in the ED before and after the introduction of a less cumbersome prescription writing process. Results:, Of the 26,638 charts reviewed, 2.1% of the total number of prescriptions generated were for a Schedule II controlled opioid before the new system was implemented compared to 13.6% after (odds ratio [OR] = 7.3, 95% confidence interval [CI] = 6.4 to 8.4). The corresponding percentages for Schedule III,V opioids were 29.9% to 18.1% (OR = 0.52, 95% CI = 0.49 to 0.55) and for benzodiazepines 1.4% to 3.9% (OR = 2.8, 95% CI = 2.4 to 3.4). Conclusions:, Patients were more likely to receive a prescription for a Schedule II opioid or a benzodiazepine after a more streamlined computer-generated prescription writing process was introduced in this ED. [source]

The Centers for Medicare and Medicaid Services (CMS) Community-Acquired Pneumonia Core Measures Lead to Unnecessary Antibiotic Administration by Emergency Physicians

ACADEMIC EMERGENCY MEDICINE, Issue 2 2009
Bret A. Nicks MD
Abstract Objectives:, The objectives were to assess emergency physician (EP) understanding of the Centers for Medicare and Medicaid Services (CMS) core measures for community-acquired pneumonia (CAP) guidelines and to determine their self-reported effect on antibiotic prescribing patterns. Methods:, A convenience sample of EPs from five medical centers in North Carolina was anonymously surveyed via a Web-based instrument. Participants indicated their level of understanding of the CMS CAP guidelines and the effects on their prescribing patterns for antibiotics. Results:, A total of 121 EPs completed the study instrument (81%). All respondents were aware of the CMS CAP guidelines. Of these, 95% (95% confidence interval [CI] = 92% to 98%) correctly understood the time-based guidelines for antibiotic administration, although 24% (95% CI = 17% to 31%) incorrectly identified the onset of this time period. Nearly all physicians (96%; 95% CI = 93% to 99%) reported institutional commitment to meet these core measures, and 84% (95% CI = 78% to 90%) stated that they had a department-based CAP protocol. More than half of the respondents (55%; 95% CI = 47% to 70%) reported prescribing antibiotics to patients they did not believe had pneumonia in an effort to comply with the CMS guidelines, and 42% (95% CI = 34% to 50%) of these stated that they did so more than three times per month. Only 40% (95% CI = 32% to 48%) of respondents indicated a belief that the guidelines improve patient care. Of those, this was believed to occur by increasing pneumonia awareness (60%; 95% CI = 52% to 68%) and improving hospital processes when pneumonia is suspected (86%; 95% CI = 80% to 92%). Conclusions:, Emergency physicians demonstrate awareness of the current CMS CAP guidelines. Most physicians surveyed reported the presence of institutional protocols to increase compliance. More than half of EPs reported that they feel the guidelines led to unnecessary antibiotic usage for patients who are not suspected to have pneumonia. Only 40% of EPs believe that CAP awareness and expedient care resulting from these guidelines has improved overall pneumonia-related patient care. Outcome-based data for non,intensive care unit CAP patients are lacking, and EPs report that they prescribe antibiotics when they may not be necessary to comply with existing guidelines. [source]