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Adherence to emergency department discharge prescriptions.

https://arctichealth.org/en/permalink/ahliterature152169
Source
CJEM. 2009 Mar;11(2):131-8
Publication Type
Article
Date
Mar-2009
Author
Corinne M Hohl
Riyad B Abu-Laban
Jeffrey R Brubacher
Peter J Zed
Boris Sobolev
Gina Tsai
Patricia Kretz
Kevin Nemethy
Jan Jaap Bijlsma
Roy A Purssell
Author Affiliation
Department of Emergency Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada. chohl@interchange.ubc.ca
Source
CJEM. 2009 Mar;11(2):131-8
Date
Mar-2009
Language
English
Publication Type
Article
Keywords
Adult
British Columbia
Drug Prescriptions - standards
Emergency Service, Hospital - standards
Female
Follow-Up Studies
Guideline Adherence
Humans
Male
Middle Aged
Patient Compliance - statistics & numerical data
Patient Discharge - standards
Prospective Studies
Abstract
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.
PubMed ID
19272214 View in PubMed
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[Administration of medications. Joint charts for prescription--transcription and dispensing errors].

https://arctichealth.org/en/permalink/ahliterature178572
Source
Ugeskr Laeger. 2004 Aug 9;166(33):2800-3
Publication Type
Article
Date
Aug-9-2004
Author
Henning K Nielsen
Maren-Lis Larsen
Jette Ratchke
Birgit Svendsen
Niels Obel
Birte Hansen
Author Affiliation
Randers Centralsygehus, Medicinsk Afdeling. HKN@rc.aaa.dk
Source
Ugeskr Laeger. 2004 Aug 9;166(33):2800-3
Date
Aug-9-2004
Language
Danish
Publication Type
Article
Keywords
Denmark
Documentation - standards
Drug Prescriptions - standards
Humans
Medication Errors - prevention & control
Medication Systems, Hospital - standards
Safety
Software
Notes
Comment In: Ugeskr Laeger. 2004 Sep 6;166(37):321915384381
PubMed ID
15344860 View in PubMed
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Antibiotic handbook and pre-printed perioperative order forms for surgical antibiotic prophylaxis: do they work?

https://arctichealth.org/en/permalink/ahliterature228303
Source
Can J Surg. 1990 Oct;33(5):385-8
Publication Type
Article
Date
Oct-1990
Author
M J Girotti
S. Fodoruk
J. Irvine-Meek
O D Rotstein
Author Affiliation
Department of Surgery, Toronto Hospital Corporation, University of Toronto, Ont.
Source
Can J Surg. 1990 Oct;33(5):385-8
Date
Oct-1990
Language
English
Publication Type
Article
Keywords
Anti-Bacterial Agents - therapeutic use
Canada
Drug Prescriptions - standards
Education, Medical, Continuing - methods
Humans
Premedication - standards
Abstract
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).
PubMed ID
2224658 View in PubMed
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[A pop-up menu linked to a computerized drug prescribing system. Prescribing pattern's feedback via a simple and quick method].

https://arctichealth.org/en/permalink/ahliterature191941
Source
Lakartidningen. 2001 Dec 12;98(50):5772-6
Publication Type
Article
Date
Dec-12-2001
Author
I. Ovhed
J. Berglund
S. Oistämö
K. Lenhoff
H. Odeberg
Author Affiliation
Lyckeby vårdcentral. ovhed_i@blekingefou.pp.se
Source
Lakartidningen. 2001 Dec 12;98(50):5772-6
Date
Dec-12-2001
Language
Swedish
Publication Type
Article
Keywords
Attitude of Health Personnel
Clinical Pharmacy Information Systems
Community Health Centers - statistics & numerical data
Decision Making, Computer-Assisted
Drug Prescriptions - standards
Family Practice - statistics & numerical data
Feedback
Humans
Patient satisfaction
Product Surveillance, Postmarketing - methods
Questionnaires
Software
Sweden
Abstract
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.
PubMed ID
11789101 View in PubMed
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Approaches for certification of electronic prescription software.

https://arctichealth.org/en/permalink/ahliterature206219
Source
Int J Med Inform. 1997 Dec;47(3):175-82
Publication Type
Article
Date
Dec-1997
Author
J. Niinimäki
J. Forsström
Author Affiliation
Health Care Informatics Centre of Excellence, Satakunta Hospital District, Pori, Finland.
Source
Int J Med Inform. 1997 Dec;47(3):175-82
Date
Dec-1997
Language
English
Publication Type
Article
Keywords
Certification
Computer Security - legislation & jurisprudence - standards
Drug Prescriptions - standards - statistics & numerical data
Evaluation Studies as Topic
Finland
Humans
Software - legislation & jurisprudence - standards
Abstract
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.
PubMed ID
9513006 View in PubMed
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Appropriateness of NSAID and Coxib prescribing for patients with osteoarthritis by primary care physicians in Ontario: results from the CANOAR study.

https://arctichealth.org/en/permalink/ahliterature176815
Source
Am J Manag Care. 2004 Nov;10(11 Pt 1):742-50
Publication Type
Article
Date
Nov-2004
Author
Rolf J Sebaldt
Annie Petrie
Charles H Goldsmith
Michael A Marentette
Author Affiliation
Centre for Evaluation of Medicines, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada. sebaldt@mcmaster.ca
Source
Am J Manag Care. 2004 Nov;10(11 Pt 1):742-50
Date
Nov-2004
Language
English
Publication Type
Article
Keywords
Aged
Antacids - therapeutic use
Anti-Inflammatory Agents, Non-Steroidal - adverse effects - contraindications - therapeutic use
Cohort Studies
Cyclooxygenase Inhibitors - contraindications - therapeutic use
Drug Prescriptions - standards
Drug Utilization - standards - statistics & numerical data
Family Practice - standards
Female
Gastrointestinal Diseases - chemically induced
Gastrointestinal Hemorrhage - chemically induced
Guideline Adherence - statistics & numerical data
Humans
Male
Observation
Ontario
Osteoarthritis - drug therapy
Physician's Practice Patterns - standards - statistics & numerical data
Practice Guidelines as Topic
Risk factors
Abstract
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.
PubMed ID
15623264 View in PubMed
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Assessing prescription medications for priority regulatory review.

https://arctichealth.org/en/permalink/ahliterature174776
Source
Regul Toxicol Pharmacol. 2005 Jun;42(1):70-6
Publication Type
Article
Date
Jun-2005
Author
Nigel S B Rawson
Author Affiliation
Center for Health Care Policy and Evaluation, Eden Prairie, MN, USA. nigel.s.rawson@gsk.com
Source
Regul Toxicol Pharmacol. 2005 Jun;42(1):70-6
Date
Jun-2005
Language
English
Publication Type
Article
Keywords
Canada
Drug Approval - legislation & jurisprudence - methods
Drug Evaluation - legislation & jurisprudence - methods - standards
Drug Prescriptions - standards
Humans
Pharmaceutical Preparations - classification - standards
Time Factors
United States
Abstract
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.
PubMed ID
15896445 View in PubMed
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Assessing the quality of drug detailing.

https://arctichealth.org/en/permalink/ahliterature188127
Source
J Clin Epidemiol. 2002 Aug;55(8):825-32
Publication Type
Article
Date
Aug-2002
Author
William Molloy
David Strang
Gordon Guyatt
Joel Lexchin
Michel Bédard
Sacha Dubois
Rosalie Russo
Author Affiliation
Geriatric Research Group, McMaster University, Hamilton Health Sciences, Henderson Site, 711 Concession Street, Ontario, Canada. molloy@mcmaster.ca
Source
J Clin Epidemiol. 2002 Aug;55(8):825-32
Date
Aug-2002
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Attitude of Health Personnel
Canada
Chi-Square Distribution
Drug Industry - standards
Drug Information Services - standards
Drug Prescriptions - standards
Family Practice - standards
Female
Humans
Male
Physicians - psychology
Professional Competence
Quality of Health Care
Abstract
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
PubMed ID
12384198 View in PubMed
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Association between drug-specific indicators of prescribing quality and quality of drug treatment: a validation study.

https://arctichealth.org/en/permalink/ahliterature273921
Source
Pharmacoepidemiol Drug Saf. 2015 Sep;24(9):906-14
Publication Type
Article
Date
Sep-2015
Author
Susanna M Wallerstedt
Björn Belfrage
Johan Fastbom
Source
Pharmacoepidemiol Drug Saf. 2015 Sep;24(9):906-14
Date
Sep-2015
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Drug Prescriptions - standards
Drug-Related Side Effects and Adverse Reactions - diagnosis - epidemiology - prevention & control
Female
France - epidemiology
Germany - epidemiology
Hip Fractures - drug therapy - epidemiology
Humans
Inappropriate Prescribing - prevention & control - trends
Male
Sweden - epidemiology
Abstract
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.
Notes
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PubMed ID
26147790 View in PubMed
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149 records – page 1 of 15.