BACKGROUND: The nonmedical use of prescription medications among young people has escalated substantially in recent years. Certain subgroups of adolescents are at greater risk than others, including rural youth, however this has yet to be adequately quantified in Canada, and risk and protective factors in rural communities remain understudied. OBJECTIVES: The first objective of this thesis was to characterize the nonmedical use of prescription drugs in Canadian youth by age, gender, socioeconomic, immigrant and geographic statuses. The second objective was to examine time-use patterns among rural young people as they may relate to their risk of using prescription drugs recreationally. METHODS: Data were obtained from 10,429 youth in grades 9 and 10 across Canada who participated in the 2009/2010 Cycle of the Health Behaviour in School-aged Children survey. Participants documented information about their nonmedical use of opioid pain relievers, stimulants and sedative or tranquilizer medications in the past year. Cross-tabulations and multi-level regression analyses were used to determine proportions and estimate risk by demographic subgroups, and among 2393 rural youth, to examine associations with time-use patterns RESULTS: Females were 1.25 times more likely to report recreational use of pain relievers (95% CI: 1.04-1.51). Lower SES students were 2.41 times more likely to report recreational use of any type of medication (95% CI: 1.94-2.99). Pain reliever use was highest among rural youth living in close proximity to urban centres. Frequent peer time after school and in the evenings was associated with a 1.73 (95% CI: 1.10-2.73) and 2.16 times (95% CI: 1.30-3.60) increased risk of using prescription drugs recreationally, however associations were attenuated when adjusted for other risk factors. Non-participation in extracurricular activities was associated with a 50% increase in risk for nonmedical use of prescription drugs, even when adjusted for other risk factors. CONCLUSIONS: Females, those of low SES and some rural youth, especially those who do not participate in extracurricular activities, are at increased risk for using prescription drugs recreationally. Results from this thesis point to priority areas for public health and education in reducing harms associated with nonmedical use of prescription drugs. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2013-10-01 22:39:42.815

Class of 2012 Abstract / Specific Aims: To evaluate the effect on the incidence and nature of pharmacists’ drug utilization review (DUR) interventions of including patient diagnosis on electronic prescription (e-prescription) orders. Methods: This prospective pre-post evaluation was conducted in the outpatient pharmacy of a federally funded community health center over two consecutive four-week periods. During the pre-phase, a clinical pharmacist in the clinic’s onsite pharmacy prospectively reviewed the e- prescriptions received from the clinic’s primary care providers using a standard prospective DUR process and recorded all therapy-related interventions. In the post-phase, providers added a diagnosis on each e-prescription. Interventions were documented using a standard intervention form that has been used in previous research. Chi square and t-tests were used to assess the nominal and interval data, respectively (α=0.05). The Institutional Review Boards of the two collaborating universities approved the study. Main Results: Pharmacist intervention rates on problematic e-prescription orders significantly decreased (4% pre vs. 1% post, p<0.001). Drug-drug interactions (17.5% pre vs. 20% post) and missing information (15% pre vs. 20% post) were the most frequently cited problems that prompted the need for the pharmacist’s intervention. The medication classes most frequently involved in interventions were antibiotics (53% pre vs. 50% post) and central nervous system agents (17% pre vs. 10% post). After receiving clarification, the pharmacist most often dispensed the prescription (33.3% pre vs. 38.4% post) and educated the patient regarding their treatments (18.8% pre vs. 7.7% post). Conclusions: In this small pilot project, including the patient’s diagnosis on e-prescription orders significantly reduced the incidence of pharmacists’ DUR-related interventions. If duplicated in larger studies, our results suggest that providing pharmacists with additional targeted clinical information could reduce confusion and uncertainty thereby decreasing the number of unnecessary pharmacist contacts with prescribers and improving workflow and efficiency for both.

Class of 2009 Abstract / OBJECTIVES: The purpose of this work is to evaluate the effectiveness of an educational intervention, regarding prescription errors, amongst pharmacy technician students. METHODS: Pharmacy technician students over the age of 18 years attending Apollo College in Tucson, Arizona were eligible to participate. Pretests were given to students to assess baseline knowledge of medication errors. Posttests consisting of questions regarding medication errors were administered to students following a PowerpointTM presentation to assess the effectiveness of the presentation. RESULTS: Pretests and posttests were completed by 18 women and 14 men. Test scores improved significantly from 5.652 to 8.13 out of 10 in the morning class (P< 0.01), 5.8 to 8 in the evening class (P< 0.01), and 5.697 to 8.091 for both classes combined (p< 0.01). Differences in scores based on gender and general employment status did not reach statistical significance (p> 0.05). CONCLUSIONS: An educational intervention is effective in improving pharmacy technician student knowledge about prescription errors.

ABSTRACT All members registered on the managed care database for the chronic condition Rheumatoid Arthritis (RA), for the period 01 January 2003 to 30 June 2003, were evaluated to determine the prescribing pattern of the cyclo-oxygenase (COX) II inhibitors and non-selective non-steroidal anti-inflammatory (NSAIDs). A total of 2818 members were registered on the managed care database of the chronic condition RA and 1372 members were identified as using COX II inhibitors and 827 members were using nonsteroidal anti-inflammatory (NSAIDs). The prescribing frequency determined for the COX II inhibitors were 48.60% and 29.35% for the NSAIDs. The members identified as either using a COX II inhibitor or a NSAIDs were divided into two groups. The prescribing patterns of each group such as age, gender, co-morbid conditions, concomitant medication use and frequency were analysed and compared to the national institute of clinical excellence (NICE) and the South African Rheumatism and Arthritis Association (SARAA) guidelines for the appropriate prescribing of the COX II inhibitors. Celecoxib was the most frequently prescribed COX II inhibitor accounting for 46% of all the COX II inhibitors identified and diclofenac was the most frequently prescribed NSAID accounting for 34% of all the NSAIDs prescriptions. COX II inhibitors were prescribed more frequently to females with a mean age of 55 years than males. A similar prescribing trend was found with the NSAIDs. The COX II inhibitors were frequently prescribed to patients over the age of 56 with co morbid gastro-oesophageal disease and concomitant warfarin and steroid use. The prescribing patterns found in the managed care environment were similar to those recommended by the NICE and SARAA guidelines. The managed care data showed that the COX II inhibitors, which are supposed to have less gastric adverse side effects, were frequently used in combination with gastroprotective agents (GPA’s). This study indicates that even though COX II inhibitors were prescribed more frequently than NSAIDs in the managed care environment the recommended clinical guidelines and protocols employed by the managed care environment were adhered to. However, there v is a need to closely monitor patients on concomitant GPA’s treatment and COX II inhibitors. This study helped to evaluate the current prescribing patterns of COX II inhibitors in the managed health care environment. This study confirmed that guidelines and protocols were adhered to. These are excellent tools to be used in the managed health care environment to ensure effective and appropriate prescribing.

Atualmente, uns dos assuntos mais discutidos na medicina quando se trata de erros é a prescrição médica. Estes erros podem causar grandes danos à saúde dos pacientes, e um dos grandes causadores destes erros é a prescrição feita de forma manual, ou seja, de forma escrita manuscrita pelos médicos. Outro problema decorrente é o fato que nos modelos existentes não contemplam todas as informações necessárias para a correta prescrição. A prescrição médica é um documento que deve conter dados do paciente e de seu tratamento, como medicamentos, doses, periodicidade e, entre outras informações. Como na maioria das vezes quem realiza a infusão dos medicamentos nos pacientes não são os mesmos médicos que os prescreveram, a escrita manuscrita pode dificultar a leitura e o entendimento para quem for realizar o procedimento no paciente. Assim, os problemas proporcionados pela prescrição médica manuscrita como a falta de informações, escrita ilegível, rasuras e informações incompletas, podem ocasionar interpretações errôneas por parte dos profissionais de saúde que os leem, provocando sérios prejuízos diretos aos pacientes. Como atualmente é inevitável à introdução da tecnologia da informação (T.I.) na medicina, houve a iniciativa de criar um questionário eletrônico com perguntas sobre quais informações devem contemplar uma prescrição eletrônica, a fim de não haver falta e nem excesso de informações no modelo de prescrição eletrônica evitando possíveis problemas. Foi criado um questionário contendo 24 questões de múltiplas escolhas, com respostas do tipo SIM ou NÃO. Os questionários foram enviados aos associados da Sociedade Brasileira de Oncologia Clínica. Foram 215 questionários respondidos, sendo que das 24 questões 17 tiveram 80% ou mais de respostas sim, onde significa que estas informações devem fazer parte do modelo de prescrição, que foi desenvolvido a partir destas informações. / Nowadays, one of the most discussed subjects in medicine when it comes to errors, is medical prescription. These errors can cause great harm to patients, and one of the great causes of these errors is the prescription made manually, that is, in handwritten by doctors. Another problem is the fact that in the existing models it is not include all the information necessary for the correct prescription. The medical prescription is a document that should contain data about the patient and their treatment, such as medications, doses, periodicity among other information. As most of the time those who infuse the drugs are not the same doctors who prescribed them, handwriting may make it difficult to read and understand for those who perform the procedure. Thus, the problems provided by medical prescription such as lack of information, illegible writing, erasures and incomplete information, can lead to misinterpretations by health professionals who read them, causing serious harm to patients. As it is currently unavoidable the introduction of informatics technology (IT) in medicine, there was the initiative to create an electronic questionnaire with questions about what information should contemplate an electronic prescription. In order to avoid lack or excess of information in the prescription model, avoiding possible problems, a questionnaire containing 24 multiple choice (YES or NO) questions was created. The questionnaires were sent to the members of the Brazilian Society of Clinical Oncology. There were 215 questionnaires answered, and of the 24 questions, 17 had 80% or more answers, which means that this information should be part of the prescription model.

Oral antineoplastics (OAs) have become an emerging and rapidly growing field in cancer treatment. As with any chemotherapeutic agent, clinicians must be aware of potential drug interactions. Drug information databases are a common resource utilized to check for interactions between OAs and patient’s home medications. A major concern with OAs is that they are usually taken at home as well as picked up at a pharmacy by the patient themselves. The objective of this study was to determine the reliability of these databases for identifying potential interactions with OAs in a real-world setting. Hospital records were used to identify patients with common malignancies (leukemia, sarcoma, colon, lung, thyroid, prostate, kidney and liver cancers) treated with OAs from 2013 to 2014. To be included patients must have started an OA during the study period and have adequate records to evaluate OA use as well as home medications. The patient’s regimen is then entered into Drugs.com and Lexicomp™ interaction databases. In addition to documenting the number of interactions flagged by both databases, the severity of the interaction and disagreements between databases were analyzed. A major interaction was defined as either a “D” or “X” by Lexicomp™ and “major” by Drugs.com. As of this preliminary analysis, 407 of 876 subjects have been screened. Of the 407 screened, 9 patients (one patient with 3 different OAs) have been enrolled. Lexicomp™ flagged 34 interactions, of which 10 were major interactions. Drugs.com flagged 34 interactions, of which 6 were major interactions. Between the 2 databases there was only 60% agreement in flagging major interactions. These discrepancies are of concern in that clinicians hope resources they utilize are congruent with one another and allow them to practice in the safest manner in terms to avoid clinically significant drug interactions OA.

Direct-to-Consumer Advertising (DTCA) of prescription drugs has been a consistent controversial topic extensively debated in scholarly work by many authors. This thesis compares the arguments made by the proponents and opponents of this debate and comes to a conclusion that there is less justification in claims that DTCA benefits society. The thesis goes further in assessing the benefits from normative ethical principles, including using Rawls difference principle as a guide, to evaluate which side of the debate conforms more logically along the teachings of ethical philosophy. At the end it is apparent that the least advantaged members of society do not benefit from this aggressive marketing strategy. It concludes that the pharmaceutical industry makes exaggerated claims of providing the public increased autonomy when, in reality, it is trying to further its own cause of making huge profits for its shareholders. This thesis also reaches the conclusion that the industry uses patients as a means to achieve its own end, that end being unreasonable levels of profit.

The purpose of this study was to examine the obstacles and problems prescribers of exercise on prescription (EoP) in primary care in Bollnäs and Söderhamn experience when using the method. It also aimed at examining if the barriers identified in previous studies also will be found in Bollnäs and Söderhamns municipalities. A qualitative study was made and four interviews with the managers of health centers in Bollnäs and Söderhamns municipalities were completed. The only inclusion criteria was that it would be a licensed health care professional at the clinic who work with, and prescribe the EoP. A content analysis was performed, which categorized the statements made according to their content. The results of the study showed that prescribers experienced obstacles and problems with the method. The main reason was lack of time, particularly insufficient time to provide information on adequate physical activity. Another obstacle was difficulties to motivate patients to become more physically active, as well as interoperability issues with politicians and complicated prescription forms. The study confirmed previous research regarding the barriers identified. The basis for the study was small and it is therefore not possible to generalize from the results obtained.

Texte remanié de: Thèse de doctorat--Droit romain--Paris 2, 2001. / Bibliogr. p. 305-320. Index.

The use of prescription opioids for chronic non-cancer pain is complex. Opioids have the potential to alleviate discomfort and increase ones overall ability to function but, long term use also has potential physical and psychological impacts. The purpose of this study was to explore the lived experience of adults who use prescription opioids to manage chronic non-cancer pain. Nine participants were recruited and interviewed. Participants were asked to describe how using prescription opioids had affected their lives. Interviews were recorded, transcribed and analyzed thematically using Interpretative phenomenological analysis (IPA). Eight themes emerged from the data: the process of decision making, physical effects of using opioids, social consequences of using opioids, Guilt, fears, ambivalence, self-protection, and acceptance. Using opioids made pain more manageable and improved function for most of the participants. Nevertheless, using opioids was also associated with stigma, guilt, fears and ambivalence about their future as persons with chronic pain.