This study represents the first national survey of optometrists in Canada. A mailed questionnaire was designed and implemented in order to discover how optometrists have reacted to the introduction of diagnostic pharmaceutical agent (DPA) legislation in Canada and to determine what variables are important predictors of DPA use. The data collected were also used to test the null hypothesis that DPA legislation does not affect the use of mydriatic/cycloplegic agents by optometrists. A stratified random sampling procedure was used to select 230 optometrists (roughly 10% of the practicing profession) for inclusion in the study. Over 90% of the subjects completed and returned the questionnaire. A statistically significant and important association was found between mydriatic/cycloplegic drug use and legislation (p less than 0.05 and odds ratio = 2.18). Legislation, type of practice, age, and optometry school attended were all found to be associated with DPA use.
Historically substance misuse has been relatively common in western countries, but comparatively few Finns report drug use. The Drugs 2020 study aimed at foreseeing changes in the drug situation in Finland by the year 2020.
The Delphi method was used, utilizing drug experts of the EU national network in Finland.
Marked growth was foreseen in drug use, especially in synthetic designer drugs and misuse of medicinal drugs. Significant increase was also expected in growing cannabis at home. However, the control of drug market was expected to shift more into the hands of organized crime. No consensus was reached on how drug prices will develop in the time period. Drug use is likely to remain punishable although the use and possession of cannabis may be treated less severely. It seems likely that health and social services resources will be directed towards medicinal treatment.
Foresight can be utilized in preparing for the future; desirable developments can be fostered, and measures can be taken to curb probable but undesirable lines of development. Based on the results of this study, the experts' view is that it is highly likely that the Finnish society will have to prepare for an increase in the demand for drug-related care, both in terms of content of the care and financing the services. Also, the forecasted increase in the role of legal prescription medicine used as intoxicants will call for efforts not only in changing prescription practices but in border and police control measures, as well. Parallel developments have been foreseen in the UK and Sweden, and it is likely that similar trends will actualize also in other western countries.
Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada. mlaw@chspr.ubc.ca
Granting dispensing pharmacists the authority to prescribe has significant implications for pharmaceutical and health human resources policy, and quality of care. Despite the growing number of jurisdictions that have given pharmacists such privileges, there are few rigorous evaluations of these policy changes. This study will examine a January 2009 policy change in British Columbia (BC), Canada that allowed pharmacists to independently adapt and renew prescriptions. We hypothesize this policy increased drug utilization and drug costs, increased patient adherence to medication, and reduced total healthcare resource use.
We will study a population-based cohort of approximately 4 million BC residents from 2004 through 2010. We will use data from BC PharmaNet on all of the prescriptions obtained by this cohort during the study period, and link it to administrative billings from physicians and hospital discharges. Using interrupted time series analysis, we will study longitudinal changes in drug utilization and costs, medication adherence, and short-term health care use. Further, using hierarchical modelling, we will examine the factors at the regional, pharmacy, patient, and prescription levels that are associated with prescription adaptations and renewals.
In a recent survey of Canadian policymakers, many respondents ranked the issue of prescribing privileges as one of their most pressing policy questions. No matter the results of our study, they will be important for policymakers, as our data will make policy decisions surrounding pharmacist prescribing more evidence-based.
Over two decades of rather restrictive regulations have kept the availability of methadone treatment (MT) at low levels in the province of Ontario, Canada. Regulatory changes in the Province of Ontario in the mid-1990s relaxed relevant authorization and treatment practice guidelines. Subsequently, the number of physicians authorized for methadone treatment and treatment spots increased substantially. A large number of the newly authorized physicians are general/local medical practitioners. This study reports on the results of a survey conducted with the majority of MT prescribing physicians in Ontario authorized at the time of study. Physicians were surveyed on their attitudes and practices with regards to the MT authorization system, treatment approaches, requirements and workload, patient 'stability', additional opiate substitution treatment needs, and with regards to general issues and concerns about the new MT governance system. The article also discusses patterns and differences that were found between physicians when comparing their geographic location, whether they see themselves practicing under a 'harm reduction' or an 'abstinence' approach, and whether they received MT authorization under the old or the new guidelines. It is concluded that the liberalized regulations and the increased incorporation of local physicians seems to provide for an overall more desirable system of governance of MT. However, some relevant concerns about the current system exist and are discussed.
A retrospective analysis of all prescriptions for hypersensitive drugs was undertaken at a pharmacy serving 20 general practitioners and 17 temporarily employed doctors. The analysis was carried out in 1992 over two three-month periods separated by an interval of five months. The Governmental regulations aimed at promoting use of the "cheapest synonymous drug" apparently had little impact on the doctors' prescriptions. During the 11 months concerned, the prescribed antihypersensitive drugs contained an increasing share of expensive alternatives with no documented ability to reduce cardiovascular morbidity or mortality.
Our aim was to determine current usage patterns of intravenous heparin for patients with acute ischemic stroke.
A survey was undertaken of 280 neurologists from the United States and 270 neurologists from Canada. Brief vignettes were presented for the following 5 scenarios: stroke in evolution, atrial fibrillation-related stroke (A FIB), vertebrobasilar stroke, carotid territory stroke, and multiple transient ischemic attacks. The effect of medicolegal factors was also ascertained. Statistical comparisons were done with chi-squared testing.
US neurologists were significantly more likely than Canadian neurologists to use intravenous heparin for patients with stroke in evolution (51% versus 33%, P
