Class of 2007 Abstract / Objectives: This retrospective analysis compared the prescribing rates of typical versus atypical oral antipsychotics in the treatment of schizophrenia for 6 months before versus 6 months after the publication of the Phase 1 CATIE trial on September 22, 2005. Methods: Prescription and membership databases from COPE Behavioral Services in Tucson, AZ were utilized for determining prescribing rates of typical and atypical antipsychotics for pre- versus post-publication of the CATIE trial. Comparisons were made for gender, court order treatment, hospitalizations and length of stay, costs of services (case management, inpatient, lab, and other services), total number of prescriptions and number of tablets/capsules of typical and atypical antipsychotics, and cost of antipsychotic prescriptions. Results: There was no significant difference in prescribing rates for oral atypical and typical antipsychotics, cost of services, or hospitalization rates in the pre-publication (N=316) versus post-publication (N=336) groups. Atypical antipsychotics accounted for approximately 77% of antipsychotic prescriptions and for 98% of the total costs for antipsychotic therapy in the two time periods. During the 12-month study, the amount paid for atypical antipsychotic prescriptions was $ 1,026,004 versus $ 22,671 for typical antipsychotics. Conclusions: Prescribing patterns of oral typical and atypical antipsychotics for the treatment of schizophrenia did not change during the first six months after the publication of the phase I CATIE trail in this outpatient population. Atypical antipsychotics accounted for the majority of prescriptions and for the highest cost compared to other services provided despite similar efficacy to typical antipsychotics in the treatment of schizophrenia.

Thesis (Msc.(Med.)(Pharmacy))--University of Limpopo, 2009. / Background: The study was conducted in primary healthcare facilities in Vhembe district in Limpopo province, South Africa. Seeing that the National Drug policy was implemented in 1996 and followed by the Standard Treatment Guidelines, it was necessary to investigate if PHC facilities are prescribing according to the guidelines. Although the data collected was from five clinics, iinformation on antimicrobial prescribing patterns is necessary for a constructive approach to the challenges that arise from the vast number of antibiotics that are available in the market and the occurrence of resistance. Objectives: The aim of the study was to investigate whether prescribers at Primary Health Care (PHC) facilities in Vhembe district adhered to the Standard Treatment Guidelines/Essential Drug List (STG/EDL) when prescribing antimicrobials. Method: Five hundred antimicrobial prescribing patterns and patient demographics were recorded from five PHC facilities (100 prescriptions in each) in the Vhembe District, Limpopo Province over a two weeks period. In all PHC facilities, data collection of prescriptions focused on the period from 01 August 2007 until the required number of 100 prescriptions was reached. x Results: Conditions where prescriptions complied to STG/EDL were skin infections and wound 91.67% (22/24), upper respiratory tract infection 86.49% (32/37), bronchitis 80% (4/5), ear/eye infections 75% (3/4), otitis media 57.14% (4/7), sore throat/tonsillitis 56.57% (56/99), urinary tract infection 37.5% (3/8), sexual transmitted infections 37.25% (19/51), bites 33.33% (1/3), and abscesses 25% (1/4). All other remaining 18 conditions that were listed as diagnosis did not comply at all. On overall only 29.2% (146/500) of prescriptions that were evaluated complied. Conclusion: Antimicrobial prescribing patterns adhering to the EDL/STD were low. Attention needs to be given to the prescribing of antimicrobials.

Abstract Non-benzodiazepine drugs such as zopiclone and zolpidem are alternatives to treatment of insomnia, but are recommended only for short-term treatment. The objectives of the study were to evaluate the prescribing patterns and usage of these drugs. Method: Data was collected from Clicks Rosebank Pharmacy. One hundred (100) patients presenting with prescriptions for either zolpidem or zopiclone were followed over a period of seven months and data was collected regarding: demographic characteristics of patients; drug and dose distribution; ICD10 codes; prescriber characteristics; period of use; and whether use was continuous or as needed (uninterrupted or interrupted). All data was collected from the Unisolv computer system. Over a period of one year, total prescriptions received for all drugs were compared to the total number of zopiclone/zolpidem prescriptions received to gauge whether there was any seasonal variation in hypnotic use. Results: In each age group, excluding 20 years and below, the number of females was greater than males. The mean age of all patients between the ages of 21 and 80 years was 53.1 years. Out of 100 patients, 85 (85%), used either zolpidem 10mg or zopiclone 7.5mg, which are the standard doses. The most common ICD 10 code observed was G47.0, Disorders of initiating and maintaining sleep [insomnias], occurring in 52 (52%) of 100 prescriptions. Of the 100 initial prescriptions, 68 (68%) were prescribed by General Practitioners, while 32 (32%) were prescribed by Specialists. Thirty of the 100 patients (30%) used one of the drugs for the full seven months; twenty two patients (22%) used one of the drugs for a period of one month or less; and the remaining 48 patients (48%) used a hypnotic for a total of two to six months. The number of patients who used a hypnotic in an interrupted manner, with each period of use of one month or less duration, was 34 (34%). The number of patients who used a hypnotic for at least one uninterrupted period of more than 1 month s duration was 66 (66%). Over a period of 12 months, prescriptions for either zolpidem or zopiclone represented 3.17% of total prescriptions. There was no significant seasonal fluctuation in hypnotic use. Conclusion: The majority of patients used one of the two hypnotics in an uninterrupted manner, and over a long term as well. Despite numerous cautions in the literature, these medications are still being prescribed and used in a manner contrary to existing guidelines.

No description available.

Background. Little is known about longitudinal prescribing practices for psychoactive medications for individuals with intellectual disabilities and developmental disabilities (IDDD) who are living in community settings. Methods. Computerized pharmacy records were accessed for 2344 community-based individuals with IDDD for whom a total of 3421 prescriptions were written during a 17-month period of study. Forty-two psychoactive medications were rank ordered in terms of prescription frequency. Results. Fifty-two per cent (52%) of all prescriptions written during the study period were for psychoactive medications. Anticonvulsant, antipsychotic and antidepressant medications were the most commonly filled prescriptions among psychoactive medications. Sixty per cent (62%) of the study population was given prescriptions for more than one psychoactive medication and 36% received three or more psychoactive medications. During the study period there was a statistically significant increase in prescriptions filled for olanzapine, risperidone, valproic acid, and clonazepam whereas prescriptions filled for thioridazine, haloperidol, and benzotropine showed a significant decline (P < 0.05-0.001). Distribution of psychoactive drug class by age showed that the majority of prescriptions were filled for individuals between 20 and 50 years with the exception of prescriptions for psychostimulants which peaked for individuals prior to 20 years. Conclusions. (1) Analysis of pharmacy billing records provides a method for assessing prescribing patterns of psychoactive medications in community-based individuals with IDDD. (2) Polypharmacy for psychoactive medications is prevalent in this setting. (3) The second-generation antipsychotic medications are prominently represented by an increasing number of filled prescriptions during the study period.

Background: People with intellectual disability are more likely than the general population to be prescribed psychotropic agents. The most common indications include treatment of a psychiatric disorder and management of behaviours that challenge. Aim: The study aimed to assess the prescribing patterns of psychotropic medication to outpatients with intellectual disability at a psychiatric hospital. Setting: Alexandra hospital outpatient clinic, Cape Town. Methods: This was a retrospective folder and prescription chart review. Folders of all new patients (103) seen between January 2018 and August 2019 were examined at two points, the initial appointment and again at six months. The information was examined against the World Psychiatric Association (WPA) and the National Institute for Health and Care Excellence (NICE) guidelines for prescribing in people with intellectual disability. Results: psychotropic medication was prescribed to 88% of patients. Antipsychotics accounted for more than 56% of the medication prescribed and was used mainly to manage behaviours that challenge. Clinicians at Alexandra hospital followed prescribing guidelines to some extent; however, more still needs to be done to ensure best practice and care. Conclusion: This review revealed a few shortcomings in meeting prescribing guidelines by clinicians at Alexandra hospital. Measures to address these shortcomings could be the inclusion of medication review schedules and standardised forms for clerking and monitoring of side effects in patient files, the use of behavioural strategies as the primary management of behaviours that challenge, and the performance of regular clinical practice audits.

Chronic non-terminal pain (CNTP) is defined as pain lasting longer than three months, serves no functional role in healing, lasts beyond normal tissue recovery time and is unresolved despite appropriate treatment. CNTP triggers a complex set of central nervous system responses and a decline in social function. Opioids have been used to treat moderate to severe pain when non-opioid analgesics have not been sufficient. Multiple factors have led to increased use and higher prescribing dosages of opioids to manage CNTP in primary care. Higher dosages of opioids are associated with higher risk of adverse events, including death. Nationally, between 1999 and 2011, opioid related deaths rose over 300%. In Arizona, 41% of drug mortality is attributed to opioids and in 2011, the state ranked fifth in the nation for opioid prescribing rates. Statewide, a multi-professional, multi-agency strategy has been initiated to address this problem. The impact evaluation of the prescribing initiative led by the Arizona Criminal Justice Commission has been positive but little information exists regarding prescribers' practice patterns, prescribers' knowledge of evidence based recommendations synthesized in the guidelines, or the barriers to safe opioid prescribing in Arizona. The Statewide Interprofessional Practice-Based Research Network (IP PBRN) identified chronic pain management as a top research priority during their planning conference in 2012. The purpose of this project was to create and formalize a survey, eliciting responses that describe current practice patterns and identify implementation barriers to evidence-based recommendations for prescribing and monitoring opioids for patients with CNTP in Arizona primary care settings.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

This cross-sectional study used a weighted sample of ED visits contained in the 2010-2015 years of the National Hospital Ambulatory Care Survey-Emergency Department (NHAMCS-ED) dataset. The purpose of this study was to: 1) identify differences in predisposing, enabling, and need characteristics, and ED use and medication prescribing characteristics between homeless and nonhomeless ED users; 2) assess the association between housing status and medication prescribing at ED discharge, and identify variables contributing to the disparity in medication prescribing between homeless and nonhomeless ED users; and 3) assess the predisposing, enabling, need, and ED use characteristics that predict medication prescribing at ED discharge among homeless ED users. This research is guided by the Andersen-Gelberg Behavioral Model for Vulnerable Populations. There were a total of 502,614,359 visits to EDs located within a MSA made by homeless and nonhomeless adults 18 years of age and older. About 0.9% of these visits were made by homeless individuals. Age, mental health diagnosis, substance use diagnosis, primary payer, and patient-reported pain differed significantly between homeless and nonhomeless ED users. A significantly greater proportion of homeless ED users arrived to the ED via ambulance, and was seen in the last 72 hours. Homeless ED users tended to have longer ED visits, and ED disposition differed significantly between homeless and nonhomeless ED users. A significantly smaller proportion of homeless ED users were prescribed a medication at ED discharge, and an opioid medication at ED discharge. There was no difference in the likelihood of medication prescribing at ED discharge between homeless and nonhomeless ED users after controlling for predisposing, enabling, need, and ED use characteristics. ED diagnosis was the greatest contributor to the disparity in medication prescribing at ED discharge between homeless and nonhomeless ED users. Among homeless ED users, visits covered by Medicare and other payers were significantly more likely to result in medication prescribing at ED discharge compared to nonhomeless ED users covered by private insurance. Homeless ED users with no substance use condition diagnosis were significantly more likely to be prescribed a medication at ED discharge compared to those with a substance use condition diagnosis.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal