Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: OBJECTIVE The aim of this study is to establish the frequency of unlicensed and off label drug use in infants admitted to the neonatal intensive care unit (NICU) in Tygerberg Hospital. METHOD This was a prospective descriptive survey conducted over 3 consecutive months (September 2011-November 2011) of all medicine charts of neonates admitted during this time period to the NICU. Data collected included demography, diagnoses, medicines prescribed according to dose, frequency, route of administration and indication. Medicine use was defined as unlicensed, licensed or off label use according to the latest South African Medicines Formulary (2012) and the manufacturer’s package insert. Unlicensed drug use is per definition a drug not registered with South African Medicine Control Council (SA MCC) for children and off label drug use is where the use is outside of its authorized license with SA MCC. RESULTS There were 112 neonates enrolled in the study, of whom 51% were preterm and 49% term infants. The most common diagnoses on admission for the preterm babies were hyaline membrane disease (33%) and sepsis (21%), while it was hypoxic ischemic encephalopathy (42%) and post-operative care (22%) for term infants. There were 759 drug events of which 37% were licensed and followed all the licensing terms, 51% were prescribed in an off label manner and the remaining 12% were of unlicensed drugs. The most common reasons off label drug use were for weight (74%), followed by age (44%), frequency (44%), indication (21%), or a route not described in the licensing terms (13%). There was a lack of pediatric data for 9% of the drugs prescribed. In 203 drug events (27%) a drug was used in an off label manner for more than one reason. Sixty one percent of the drugs used had no information on the use of the drug in neonates. CONCLUSION This is the first study conducted in an African NICU, according to our knowledge and the results are similar to studies conducted in Europe and America. Neonates are exposed to a significant proportion of unlicensed and off label drugs. Neonatal clinical trials should be conducted to address the need for proven safe and efficacious treatment for neonates.

本文透過健保資料精神疾病歸人檔，擷取1997～2004年門診中之精神分裂症患者，針對其中701位精神科專科醫師對患者的精神分裂症一、二代藥物之處方行為進行研究。迴歸結果顯示醫師性別對處方選擇沒有特別的影響，同儕效果在相當程度上對醫師產生蠻大的改變。藥價調整前，教學醫院的醫師會受到周遭醫師開藥行為影響，其受影響程度大於非教學醫院。藥價調整後，教學醫院醫師幾乎不受同儕影響，相對的，非教學醫院比起藥價變動前，更易受到同僚行為而改變其行為。不過大體而言當周遭醫師容易開新藥（舊藥）時，醫師本身也會較容易開第二代（第一代）藥物。

<p>This study aimed to identify barriers to the availability of essential drugs at health facilities, to identify implementable solutions to those barriers, to develop a monitoring system for tracking implementation of solutions and for tracking drug supply.</p>

BACKGROUND: Concern has increased worldwide with regard to the over-prescribing of antibiotics, as well as the fact that more bacteria strains are developing resistance to antibiotics. According to research, a great deal of this use is for what has been called “non-pharmacological” reasons. The reduction of unnecessary antibiotic use and exploration of the reasons for ”irrational prescribing” has become a public health priority. OBJECTIVE: To study the reasons cited by Icelandic general practitioners for their “non-pharmacological” prescribing of antibiotics. DESIGN: A qualitative interview-study with research dialogues guided by the Vancouver School of doing phenomenology. SETTING: General practice. PARTICIPANTS: 16 general practitioners: 11 in the maximum variety sample and 5 in the theoretical sample. RESULTS: The most important reasons for prescribing antibiotics in situations with low pharmacological indications (non-pharmacological prescribing) were an unstable doctor-patient relationship due to lack of continuity of care, patient pressure in a stress-loaded society, the doctor’s personal characteristics, particularly zeal and readiness to serve, and finally, the insecurity and uncertainty of the doctor who falls back upon the prescription as a coping strategy in a difficult situation. CONCLUSION:The causes of non-pharmacological prescribing of antibiotics are highly varied, and relational factors in the interplay between the doctor and the patient are often a key factor. Therefore, it is of great importance for the general practitioner to know the patient and to become better equipped to resist patient pressure, in order to avoid the need to use the prescription as a coping strategy. Continuity of medical care and a stable doctor-patient relationship may be seen as the core concepts in this study and the most important task for the GPs is to promote the patients’ trust. / <p>ISBN 91-7997-091-5</p>

The South African national drug policy (NDP) was implemented in 1994 to ensure the availability and accessibility of essential drugs to all citizens. The NDP also hoped to ensure the safety, efficacy and quality of drugs as well as to promote the concepts of individual responsibility for health, preventative care and informed decision making. However, drug utilisation studies performed after the implementation of the national drug policy showed that South Africa's pharmaceutical sector was characterised by indiscriminate and irrational drug use, high drug prices and polypharmacy. A retrospective study that was done in 2001 in the clinics supplied by Evander Hospital showed that only 11.9% of prescriptions for acid-related disorders complied with the standard treatment guidelines (STG). It became evident that there was need for an intervention. The general objective of this study was to determine the effect of an education intervention, implemented in 2003, on the prescribing patterns of drugs for acid-related disorders in the Govan Mbeki municipal clinics serviced by Evander Hospital. An empirical pre-intervention and post-intervention study using primary data obtained from patient files at the clinics was done. A quantitative survey of the use of the drugs included in the study (magnesium trisilicate, aluminium hydroxide/magnesium trisilicate combination tablets, cimetidine or omeprazole) was conducted. To determine a baseline, all prescriptions where the drugs selected for this study were prescribed from 1 July 2001 to 31 December 2001 were collected. For the period I January 2002 to 31 December 2002 retrospective data was collected in the form of all prescriptions where the relevant drugs were prescribed. Additional retrospective data was collected for the period January 2002 to 30 June 2003 to determine the outcome of treatment given. The phi coefficient was calculated, and although statistical correlation could not be proven, important tendencies could be detected in the data. Only 8% of the prescriptions adhered to the STG before the presentation of the face to face education intervention. In the first six months following the intervention, STG compliance increased to 15.2%. In the following six-month period, the STG compliance decreased to 14.1 %. The assumption was made that patients were cured if they did not return with the same complaint. Based on this assumption the conclusion was drawn that, before the intervention, 50.2% of the patients were cured. In the first six months after the intervention had taken place the percentage patients who did not return increased from 50.2% to 60.6%. In the second six months after the intervention the percentage of patients who did not return increased to 70.7%. It may be concluded that compliance with the STG improved as a result of the face to face education intervention. Moreover, it was found that cost efficiency improved in parallel and the cure rate seemed to be positively affected by the intervention. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2007.

Introduction: Propotion of older people is rapidly increasing in the world population. Elderly represents a specific, heterogenous population which is because of many reasons more vulnerable to some adverse drug events. Many explicit criteria of potentially inappropriate medication used in the elderly have been developed in order to improve the quality and safety of geriatric pharmacotherapy. These criteria represent basic tools, defining fundamental prescribing rules for the evaluation of appropriate choice and dosing of medications in the old age and for the evaluation of potentially inappropriate prescriptions in older patiens. The aim of the diploma thesis was to compare advantages and disadvantages of explicit criteria published until the end of 2015 year and to summarizea list of allpotentially inappropriate medications in the elderly (regardless of diagnoses and concomitantly used medications), applicable in the epidemiological studies of the EU COST Action 1402project and in subsequent studies. Methods: Using systematic literature search in PubMed dataset, conducted in the period 04/2015 - 12/2015, all explicit and explicit- implicit criteria (published in the foreign peer- reviewed scientific journals bythe end of year 2015 and validated by expert panels) have been identified. Information...

Syfte: Syftet var att belysa den äldre kvinnans erfarenheter i samband med förskrivning, användning och uppföljning av urininkontinenshjälpmedel i öppenvården. Metod: Kvalitativ intervjustudie med innehållsanalys. Baserad på 12 enskilda semistrukturerade intervjuer i deltagarnas hem. Resultat: Ur analysen framkom att flertalet av deltagarna saknade information om tillvägagångssättet och användningen av urininkontinenshjälpmedel. Trots detta är mer än hälften av deltagarna nöjda med sin förskrivning. Vidare visar analysen att hemtjänsten är en viktig arbetsgrupp för att uppföljning och utprovning sker. Flertalet av deltagarna upplever att uppföljningsansvaret låg på dem själva. Nästan alla deltagare i intervjustudien är mycket nöjda med bemötandet från vården. Slutsats: Föreliggande studie visar att det fanns ett behov av bättre information från förskrivaren, där det tydligt framgår vilka urininkontinenshjälpmedel som kan erbjudas och hur hjälpmedlet används samt uppföljning av hjälpmedlet. Vidare visade föreliggande studie att hemtjänsten var en viktig arbetsgrupp för deltagarna, för att hemtjänsten ser till att det fungerar med urininkontinenshjälpmedel i det dagliga livet även om det inte var korrekt utprovat. Samtliga deltagare i föreliggande studie uttrycker en känsla av att det inte var något märkvärdigt att använda urininkontinenshjälpmedel. / Aim: The aim was to elucidate the older woman's experiences in connection with prescription, use and follow-up of urinary incontinence aids in outpatient care. Method: Qualitative interview study with content analysis. Based on 12 individual semi-structured interviews in the home of the participants. Results: The analysis showed that most of the participants lacked information about the approach and use of urinary incontinence aids. Despite this, more than half of the participants are satisfied with their prescription. Furthermore, the analysis showed that home care services are an important working group for monitoring and testing incontinence aids. Most of the participants feel that the follow-up responsibility lay on themselves. Almost all participants in the interview study are very satisfied with how they were treated. All participants have accepted their situation in using urinary incontinence aids. Conclusion: The present study shows that there was a need for better information from the prescriber, where it is clear which urinary incontinence aids can be offered and how the device is used and follow-up of the aid. Furthermore, the present study showed that home care was an important working group for the participants, because the home care service ensures that it works with urinary incontinence aids in daily life even though it was not properly tested. All participants in the present study express the feeling that using urinary incontinence aids was not remarkable.

The prescriptive authority for psychologists (RxP) movement contends that psychologists who receive specialized training should attain licensure to prescribe psychotropic medication. The RxP movement has presently culminated in psychologists in the United States prescribing at both the state and federal levels. However, the RxP movement remains contentious, and both supporters and opponents continue to disagree over its validity as a professional movement. Division 17 of the American Psychological Association, the counseling psychology specialty’s professional organization, has not officially discussed the RxP movement since 1994. Given the developments within the RxP movement since then, this study endeavored to investigate the current perceptions of prescriptive authority among the Executive Board leadership of Division 17. Researchers conducted semi-structured interviews with current and former members of the Executive Board and then used a consensual qualitative research (CQR) methodology to qualitatively generate findings across participants’ responses. Participants shared qualified support of prescriptive authority, despite indicating no interest in prescribing themselves, and they reported that they saw prescriptive practice as consistent with the professional identity of counseling psychology. Participants also suggested that Division 17 could proceed with the RxP movement by developing a Special Task Group (STG) to investigate prescriptive authority among its members. These conclusions indicate that members of the Executive Board are well positioned to lead Division 17 forward in addressing prescriptive authority by creating a STG to further explore the issue for counseling psychology.

Increased opioid analgesic (OA) prescribing has been associated with increased risk of prescription opioid diversion, misuse, and abuse. States established prescription drug monitoring programs (PDMPs) to collect and analyze electronic records for dispensed controlled substances to reduce prescription drug abuse and diversion. PDMP data can be used by prescribers for tracking patient’s history of controlled substance prescribing to inform clinical decisions. The studies in this dissertation are focused on the less utilized potential of the PDMP data to enhance public health surveillance to monitor OA prescribing and co-prescribing and association with opioid overdose mortality and morbidity. Longitudinal analysis of OA prescribing and evaluation of the effect of recent policies and opioid prescribing guidelines require consensus measures for OA utilization and computational tools for uniform operationalization by researchers and agencies. Statistical macros and computational tools for OA utilization measures were developed and tested with Kentucky PDMP data. A set of covariate measures using mortality and morbidity surveillance data were also developed as proxy measures for prevalence of painful conditions justifying OA utilization, and availability of heroin and medication treatment for opioid use disorder. A series of epidemiological studies used the developed OA measures as outcomes, and adjusted for time-varying socio-demographic and health care utilization covariates in population-averaged statistical models to assess longitudinal trend and pattern changes in OA utilization in Kentucky in recent years. The first study, “Trends and Patterns of OA Prescribing: Regional and Rural-Urban Variations in Kentucky from 2012 to 2015,” shows significant downward trends in rates of residents with OA prescriptions. Despite the significant decline over time, and after accounting for prevalence of injuries and cancer, the rate of dispensed OA prescriptions among residents in Kentucky Appalachian counties remained significantly higher than the rest of the state. The second study, “Population-Level Measures for High-Risk OA Prescribing: Longitudinal Trends and Relationships with Pain-Associated Conditions,” shows significant reduction in high-risk OA prescribing (e.g., high daily dosage, long-term use, concurrent prescriptions for OA and benzodiazepines) from 2012 to 2016, significantly positive associations between high-risk OA prescribing and cancer mortality rates with no substantial change in the association magnitude over time, and declining strengths of positive associations between high-risk OA prescribing and acute traumatic injuries or chronic non-cancer pain over the study period. The third study, “A Reciprocal Association between Longitudinal Trends of Buprenorphine/Naloxone Prescribing and High-Dose OA Prescribing,” indicates a significant reciprocal relationship between high-dose OA prescribing and buprenorphine/ naloxone prescribing, and a clinically meaningful effect of buprenorphine/naloxone prescribing on reducing OA utilization. The results from the studies advanced the understanding of the epidemiology of opioid use and misuse in Kentucky, and identified actionable risk and protective factors that can inform policy, education, and drug overdose prevention interventions. The developed operational definition inventory and computational tools could stimulate further research in Kentucky and comparative studies in other states.

Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2007.