Nonadherence to prescribed medication is associated with increased morbidity and mortality as well as the increased use of health services. The main objective of our study was to assess the incidence of prescription-filling and medication adherence in patients discharged from the emergency department (ED).
This was a prospective, observational study carried out at a Canadian tertiary care ED with an annual census of 69 000. We enrolled a convenience sample of patients being discharged with a prescription. We queried a provincial prescription-dispensing database 2 weeks later to determine whether prescriptions had been filled. We used a standardized follow-up interview to assess adherence and whether or not the patient experienced an adverse drug-related event (ADRE) or an unplanned revisit to an ED or clinic.
Of the 301 patients who agreed to participate, follow-up was successful for 258 (85.7%). Fifty-one patients (19.8%, 95% confidence interval [CI] 15.4%-25.1%) failed to fill their discharge prescriptions and 104 (40.3%, 95% CI 34.5%-46.4%) did not adhere to 1 or more medications. Antibiotics were associated with a lower odds ratio (OR) of nonadherence (OR 0.21, 95% CI 0.08-0.52). There was a trend toward increasing nonadherence in patients who reported an ADRE (OR 1.84, 95% CI 0.98-3.48) or had 2 or more medications coprescribed (OR 1.71, 95% CI 0.95-3.09). There was also a trend toward a higher risk of a revisit to an ED or clinic in nonadherent patients (OR 1.75, 95% CI 0.94-3.25).
Approximately 4 in 10 patients discharged from the ED did not adhere to his or her prescribed medication. Our results suggest that patients who are prescribed antibiotics are more likely to be adherent, and that further evaluation of the associations between nonadherence, ADREs, the coprescription of 2 or more medications and the use of health services is warranted.
The authors attempted to compare the value of two strategies--an educational (antibiotic handbook) and a control (perioperative pre-printed physician order form, which contained antibiotic orders)--in modifying physicians' patterns of antibiotic prophylaxis for preventing infection in patients who undergo elective surgery. They reviewed the charts of 240 such patients on five different surgical services in one teaching hospital. Use of the antibiotic handbook (educational strategy) increased overall compliance with the recommended regimens from 11% to 18% (p = 0.06). The control strategy (perioperative pre-printed physician order form) increased compliance from 17% to 78% (p less than 0.01).
It takes time for a GP to acquire sufficient experience of a new drug to be able to prescribe competently. This article describes a project studying the use of computerized records to afford a group of GP's swift feedback on recently introduced drugs of special interest. In the south-east of Sweden a network of primary health care centers has been created in two neighboring counties. The pharmacies of the region are also taking part. When new drugs of particular interest are introduced, each participating GP will automatically see a pop-up menu, asking questions pertaining to each computer-assisted prescription. In the pharmacies, patients are given a questionnaire regarding their expectations with respect to the drug. In this way it will be possible to provide the individual GP swift feedback from a large number of colleagues and patients concerning the drug's effectiveness in clinical practice. We have now been studying the COX-2 inhibitors rofecoxib (Vioxx) and celecoxib (Celebrex). Results show that a pop-up menu used in this way provides the general practitioner quick feed-back on prescribing behavior as well as drug effectiveness in clinical practice.
The proper management of drug treatment is essential, since adverse drug reactions are common reasons of hospitalisations. Expenditure on drug therapy has also been growing faster than any other aspect of health care in many countries. Savings and quality improvements in drug treatment could be achieved with computerised prescribing. In this paper, the architecture of an electronic prescription system is described in the light of software certification and registration. An electronic prescription system is an example of a system supporting shared care and therefore it should be person based, integrated, secure and confidential and data should be shared among health care institutions. The system architecture shares the idea of a virtual patient record and a smart card will be used as a key to prescription data located on the network. The certification and registration of medical software is a difficult and costly procedure. Ensuring the quality of software can be based on; certification of development process, voluntary evaluation, and post-market surveillance. Voluntary evaluation practice would be a precious tool for both the customers and software developers, and it would also be an invaluable source of information in terms of developing new software.
To assess the appropriateness of nonsteroidal anti-inflammatory drug (NSAID) use relative to recent osteoarthritis treatment guidelines from the Second Canadian Consensus Conference.
Observational study of self-reported practice in a cohort of physicians from the Canadian Osteoarthritis Rx (CANOAR) study.
Ontario primary care physicians were recruited from the top 10% of NSAID prescribers based on the number of NSAID prescriptions filled per year. Physicians were asked to record office visits on a 1-page data collection form from November 2000 to December 2001.
Of 1400 physicians invited, 185 were enrolled and 119 registered office visits. Data were analyzed for the first visits of 5459 patients for whom a prescribed NSAID was identified, of whom 60% were female and 46% were older than 65 years. Coxibs were prescribed for 56% of study patients and were more commonly used by those with recent gastrointestinal (GI) events (85%), those receiving warfarin sodium therapy (79%), and those with congestive heart failure (68%). Coxib use increased with increasing global assessment of OA severity, but not patient age. Overall, 58% of prescriptions were considered appropriate given patient GI risk factors.
Most coxib and NSAID prescriptions were consistent with the guidelines, but there was considerable underuse of coxibs in at-risk patients and some overuse of coxibs and of gastroprotective agents with NSAIDs in patients with no identified GI risk factors. Increased recognition of relationships between patient age and NSAID-related GI risk would likely promote more appropriate use of traditional NSAIDs, coxibs, and gastroprotective agents in osteoarthritis patients.
Poor concordance exists between medications that receive a priority review in Canada and those given an expeditious review in the United States. The objectives of this study were to obtain an evaluation of the clinical significance of new drugs approved in both countries from expert clinical pharmacologists, and to examine the concordance of their aggregate assessment with whether or not the product received an expeditious review in either country. Five experts assessed 146 new medications approved in both Canada and the United States between 1996 and early 2002. Overall, the concordance between the experts' assessments was poor and there was large variation in products considered to be of sufficient importance for priority status. Nevertheless, the experts' evaluations suggested that several priority-reviewed products did not warrant such a review. Regulatory agencies select new medications of potential clinical significance to receive shorter review times to minimize the delay in access to them, but, in Canada, only a low proportion of priority-status products had review times within Health Canada's performance target. The large variation in the assessment of clinical significance suggests that a more appropriate strategy in Canada is to devote sufficient resources to reviewing all medications in a timely manner.
This study measured the validity of a new instrument, the Assessment Instrument for Drug Detailing (AIDD), used by doctors to score the quality of drug detailing provided by pharmaceutical representatives in their offices. Five pharmaceutical representatives provided "good, medium, and poor" details to 135 family doctors in their offices, who were blinded to the quality of the details. A "reference standard group" constructed the details and trained the representatives. An "assessment group" trained family physicians to use the AIDD to score the details. Physicians discriminated between different quality details in all but one domain, nomenclature (P
To evaluate the concurrent validity of three European sets of drug-specific indicators of prescribing quality
In 200 hip fracture patients (=65?years), consecutively recruited to a randomized controlled study in Sahlgrenska University Hospital in 2009, quality of drug treatment at study entry was assessed according to a gold standard as well as to three drug-specific indicator sets (Swedish National Board of Health and Welfare, French consensus panel list, and German PRISCUS list). As gold standard, two specialist physicians independently assessed and then agreed on the quality for each patient, after initial screening with STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) and START (Screening Tool to Alert to Right Treatment).
According to the Swedish, French, and German indicator sets, 82 (41%), 54 (27%), and 43 (22%) patients had potentially inappropriate drug treatment. A total of 141 (71%) patients had suboptimal drug treatment according to the gold standard. The sensitivity for the indicator sets was 0.51 (95% confidence interval: 0.43; 0.59), 0.33 (0.26; 0.41), and 0.29 (0.22; 0.37), respectively. The specificity was 0.83 (0.72; 0.91), 0.88 (0.77; 0.94), and 0.97 (0.88; 0.99). Suboptimal drug treatment was 2.0 (0.8; 5.3), 1.9 (0.7; 5.1), and 6.1 (1.3; 28.6) times as common in patients with potentially inappropriate drug treatment according to the indicator sets, after adjustments for age, sex, cognition, residence, multi-dose drug dispensing, and number of drugs.
In this setting, the indicator sets had high specificity and low sensitivity. This needs to be considered upon use and interpretation.
Cites: Pharmacoepidemiol Drug Saf. 2013 Jul;22(7):719-2723585247