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Inappropriate prescription

Caroline Daly, Eve Griffin, Darren M Ashcroft, Roger T Webb, Ivan J Perry, Ella Arensman
Background: Intentional drug overdose (IDO) is the most common form of hospital-treated self-harm, yet no national study has systematically classified the range of drugs involved using a validated system. We aimed to determine the profile of patients engaging in overdose, to identify drugs frequently used and to quantify the contributions of multiple drug use and alcohol involvement. Methods: Between 2012 and 2014, the National Self-Harm Registry, Ireland recorded 18 329 presentations of non-fatal IDO to Irish emergency departments...
March 12, 2018: European Journal of Public Health
Ray O'Connor, Jane O'Doherty, Andrew O'Regan, Colum Dunne
BACKGROUND: Antimicrobial resistance is an emerging global threat to health and is associated with increased consumption of antibiotics. Seventy-four per cent of antibiotic prescribing takes place in primary care. Much of this is for inappropriate treatment of acute respiratory tract infections. AIMS: To review the published literature pertaining to antibiotic prescribing in order to identify and understand the factors that affect primary care providers' prescribing decisions...
March 12, 2018: Irish Journal of Medical Science
Philippe Martin, Cara Tannenbaum
Context: Interprofessional communication is an effective mechanism for reducing inappropriate prescriptions among older adults. Physicians' views about which elements are essential for pharmacists to include in an evidence-based pharmaceutical opinion for deprescribing remain unknown. Objective: To develop a prototype for an evidence-based pharmaceutical opinion that promotes physician-pharmacist communication around deprescribing. Methods: A standardized template for an evidence-based pharmaceutical opinion was developed with input from a convenience sample of 32 primary care physicians and 61 primary care pharmacists, recruited from conferences and community settings in Montreal, Canada...
March 2018: Canadian Pharmacists Journal: CPJ, Revue des Pharmaciens du Canada: RPC
Janelle Guirguis-Blake, Gina A Keppel, John Holmes, Rex W Force, William Kriegsman, Laura-Mae Baldwin
Background: Patients with chronic kidney disease (CKD) are at high risk for adverse drug events related to medication dosing errors and prescriptions for relatively contraindicated medications, such as non-steroidal anti-inflammatory drugs (NSAIDs). Objectives: To examine the scope of and variation in prescribing relatively contraindicated medications and medications above the recommended dose levels among patients with stage III/IV CKD in primary care practice...
February 26, 2018: Family Practice
Roberto W Dal Negro, Alessandro Zanasi, Paola Turco, Massimiliano Povero
Background: Influenza and influenza-like syndromes (I-LSs) are infectious diseases occurring on a seasonal basis which can lead to upper (URTI) and lower respiratory tract illness (LRTI) of different severity. The approach to these disorders is unfortunately not uniform. Aim of the study was to investigate real-life people beliefs, the attitude to their prevention and treatment, and their impact in general population. Methods: A cross-sectional survey via Computer Assisted Telephone Interview (CATI) was carried out using a specific questionnaire investigating influenza episode rates, subjects behavior in case of influenza and I-LSs, and prescribed therapy...
2018: Multidisciplinary Respiratory Medicine
Farshid Hajati, Evan Atlantis, Katy J L Bell, Federico Girosi
OBJECTIVES: We examine the extent to which the adult Australian population on lipid-lowering medications receives the level of high-density lipoprotein cholesterol (HDL-C) testing recommended by national guidelines. DATA: We analysed records from 7 years (2008-2014) of the 10% publicly available sample of deidentified, individual level, linked Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) electronic databases of Australia. METHODS: The PBS data were used to identify individuals on stable prescriptions of lipid-lowering treatment...
March 8, 2018: BMJ Open
Amina Delpeuch, Marc Ruivard, Armand Abergel, Olivier Aumaitre, Stéphane Boisgard, Sandrine Bagel, Valérie Sautou
Background Intravenous (IV) iron preparations bypass the difficulties (malabsorption and side effects) associated with oral iron for the treatment of iron deficiency anaemia (IDA). Ferric carboxymaltose (FCM) can be administered as a single infusion over short periods of time but is more expensive than iron sucrose (IS) when the patients are hospitalized. Objectives To evaluate the appropriateness of FCM prescriptions and to establish the economic impact of this management (including disease coding) compared to the use of IV IS...
March 8, 2018: International Journal of Clinical Pharmacy
Yi-Jen Wang, Shu-Chiung Chiang, Pei-Chen Lee, Yu-Chun Chen, Li-Fang Chou, Yueh-Ching Chou, Tzeng-Ji Chen
Objectives: Target populations with persistent polypharmacy should be identified prior to implementing strategies against inappropriate medication use, yet limited information regarding such populations is available. The main objectives were to explore the trends of excessive polypharmacy, whether transient or persistent, at the individual level. The secondary objectives were to identify the factors associated with persistently excessive polypharmacy and to estimate the probabilities for repeatedly excessive polypharmacy...
2018: Frontiers in Pharmacology
Abdul Aziz Al Wazzan, Eline Tommelein, Katrien Foubert, Stefano Bonassi, Graziano Onder, Annemie Somers, Mirko Petrovic, Koen Boussery
BACKGROUND: Renal function progressively worsens with age. Potentially inappropriate prescribing (PIP) of renally excreted active drugs (READs) is common in older adults, leading to an increased rate of iatrogenic illness. The Ghent Older People's Prescription community Pharmacy Screening (GheOP3 S-) tool is an effective, explicit instrument that was developed for community pharmacists (CPs) to detect PIP. So far, this tool does not assess PIP of the frequently used READs in older patients with renal impairment...
March 5, 2018: Drugs & Aging
Sergio I Prada, Victoria E Soto, Tatiana S Andia, Claudia P Vaca, Álvaro A Morales, Sergio R Márquez, Alejandro Gaviria
Background: High pharmaceutical expenditure is one of the main concerns for policymakers worldwide. In Colombia, a middle-income country, outpatient prescription represents over 10% of total health expenditure in the mandatory benefits package (POS), and close to 90% in the complementary government fund (No POS). In order to control expenditure, since 2011, the Ministry of Health introduced price caps on inpatient drugs reimbursements by active ingredient. By 2013, more than 400 different products, covering 80% of public pharmaceutical expenditure were controlled...
2018: Cost Effectiveness and Resource Allocation: C/E
Franca Benini, Emanuele Castagno, Egidio Barbi, Sabrina Congedi, Antonio Urbino, Paolo Biban, Lucia Calistri, Rossella Letizia Mancusi
AIM: The Pain Practice in Italian Paediatric Emergency Departments assessed how appropriately analgesic drugs were being used by Italian clinicians, based on national paediatric pain guidelines. METHODS: This was a retrospective study that involved 17 Italian members of the Pain In Pediatric Emergency Rooms group. It comprised patients up to the age of 14 years who came to hospital emergency departments with pain and were treated with paracetamol, ibuprofen or opioids, such as codeine, tramadol and morphine...
March 5, 2018: Acta Paediatrica
Elvis Dzelamonyuy Chem, Damian Nota Anong, Jane-Francis K T Akoachere
BACKGROUND: Inappropriate use of antibiotics is a global public health challenge and has been associated with antibiotic resistance. WHO reports show that efforts to promote rational antibiotic use in developing countries are poor. With the growing number of infections with antibiotic resistant bacteria, rational drug use becomes imperative and studies that promote rational drug use are highly necessary. Considering this, we investigated prescribing patterns and predictors of antibiotic prescription in primary health care facilities in Kumbo East (KE) and Kumbo West (KW) health districts in North West Cameroon, to contribute data which could influence policy on antibiotic use...
2018: PloS One
Lies De Bock, Eline Tommelein, Hans Baekelandt, Wim Maes, Koen Boussery, Annemie Somers
For the majority of Belgian hospitals, a pharmacist-led full medication review process is not standard care and, therefore, challenging to introduce. With this study, we aimed to evaluate the successes and barriers of the implementation of a pharmacist-led full medication review process in the geriatric ward at a local Belgian hospital. To this end, we carried out an interventional study, performing a full medication review on older patients (≥70 years) with polypharmacy (≥5 drugs) who had an unplanned admission to the geriatric ward...
February 28, 2018: Pharmacy (Basel, Switzerland)
Khalid Al Khaja, Husain Ahmed Isa, Sindhan Veeramuthu, Reginald P Sequeira
OBJECTIVES: The aims of the study were to evaluate: a) the prevalence and types of potentially inappropriate prescribing in older adults with hypertension or diabetes mellitus and hypertension; and b) whether or not the differences in training of primary care physicians was associated with the PIP. MATERIALS AND METHODS: Primary care prescriptions issued by family physicians and general practitioners were audited using Screening Tools of Older Person's Prescriptions criteria (version 1) with 18 out of 65 applicable criteria...
March 1, 2018: Medical Principles and Practice: International Journal of the Kuwait University, Health Science Centre
Jonathan Brett, Andrea Schaffer, Timothy Dobbins, Nicholas A Buckley, Sallie-Anne Pearson
PURPOSE: To evaluate the impact of 2 policy changes on quetiapine dispensing in Australia: removal of prior authorisation for prescribing (policy 1: July 2007) and removal of repeat prescriptions for 25-mg quetiapine (policy 2: January 2014). METHODS: We performed an interrupted time series analysis using Pharmaceutical Benefits Scheme claims data (July 2005 to December 2015). We assessed the impact of both policies on monthly quetiapine dispensing (25 mg and >25 mg) and the impact of policy change 2 on monthly rates of 25-mg discontinuation and switching from 25 mg to other quetiapine strengths...
February 28, 2018: Pharmacoepidemiology and Drug Safety
Vanessa Elaine Muirhead, Zahidul Quayyum, Donal Markey, Sally Weston-Price, Annette Kimber, Wayne Rouse, Cynthia M Pine
OBJECTIVES: To assess the number of parents who visited community pharmacies in London seeking pain medications for their children's pain and specifically for oral pain, to identify which health services parents contacted before their pharmacy visit and to estimate the cost to the National Health Service (NHS) when children with oral pain who visit pharmacies also see health professionals outside dentistry. DESIGN: A cross-sectional study. SETTING: 1862 pharmacies in London in November 2016-January 2017...
February 28, 2018: BMJ Open
David R M Smith, F Christiaan K Dolk, Koen B Pouwels, Morag Christie, Julie V Robotham, Timo Smieszek
Objectives: To assess the appropriateness of prescribing systemic antibiotics for different clinical conditions in primary care, and to quantify 'ideal' antibiotic prescribing proportions in conditions for which antibiotic treatment is sometimes but not always indicated. Methods: Prescribing guidelines were consulted to define the appropriateness of antibiotic therapy for the conditions that resulted in antibiotic prescriptions between 2013 and 2015 in The Health Improvement Network (THIN) primary care database...
February 1, 2018: Journal of Antimicrobial Chemotherapy
Timo Smieszek, Koen B Pouwels, F Christiaan K Dolk, David R M Smith, Susan Hopkins, Mike Sharland, Alastair D Hay, Michael V Moore, Julie V Robotham
Objectives: To identify and quantify inappropriate systemic antibiotic prescribing in primary care in England, and ultimately to determine the potential for reduction in prescribing of antibiotics. Methods: Primary care data from 2013-15 recorded in The Health Improvement Network (THIN) database were used. Potentially inappropriate prescribing events in the database were identified by: (i) comparing prescribing events against treatment guidelines; (ii) comparing actual proportions of consultations resulting in prescription for a set of conditions with the ideal proportions derived from expert opinion; and (iii) identifying high prescribers and their number of prescriptions above an age- and body-system-specific benchmark...
February 1, 2018: Journal of Antimicrobial Chemotherapy
Sally C Davies
Antibiotics are indispensable for treating bacterial infections, but their effectiveness is threatened by the emergence and spread of antibacterial resistance. Antibiotics are unique among drugs since the more they are used, the less effective they become because bacterial resistance is likely to develop. In response to this threat, the UK government aims to reduce inappropriate antibiotic prescribing in humans by 50% by 2020. A team at Public Health England has found that at least 20% of antibiotic prescriptions in primary care in England were inappropriate, which, if correct, implies that antibiotic prescribing nationally needs to be reduced by 10% by 2020...
February 27, 2018: Journal of Antimicrobial Chemotherapy
Cathal A Cadogan, Cristín Ryan, Caitriona Cahir, Colin P Bradley, Kathleen Bennett
AIMS: To examine prescribing trends for benzodiazepines and Z-drugs to General Medical Services (GMS) patients in Ireland. METHODS: A repeated cross-sectional analysis of the national pharmacy claims database was conducted for GMS patients aged ≥16 years from 2005-2015. Prescribing rates per 1000 eligible GMS population were calculated with 95% confidence intervals (CIs). Negative binomial regression was used to determine longitudinal trends and compare prescribing rates across years, gender and age groups...
February 28, 2018: British Journal of Clinical Pharmacology
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