This study set out to review and analyse aspects of antidepressant prescribing in children and adolescents in a section of the private health care sector of South Africa. The research was conducted in two phases, namely a literature review and an empirical investigation. The aim of the literature review was to provide background to the study by conceptualising antidepressants. The empirical review followed a retrospective, descriptive, observational design. The data employed in the study was obtained from the medicine claims database of a South African Pharmaceutical Benefit Management (PBM) company. The study population consisted of 3 611 children and adolescents receiving ≥1 antidepressants from 1 January 2010 to 31 December 2010. Basic descriptive statistics, such as frequency, prevalence, average, weighted average, standard deviation, weighted standard deviation, median, effect sizes, prescribed daily dosages and DU95% methodology were used to characterise the study sample, and were calculated using the Statistical Analysis System SAS® for Windows 9.3® program. The data were used to determine the prescribing patterns of antidepressants with regard to age, gender, geographic area, type of prescriber, the comparison of prescribed daily dosages vs. recommended daily dosages, and the prevalence of potential drug-drug interactions. Potential drug-drug interactions were identified and compiled by using various interaction compendia, whereas recommended daily dosages were identified by cross-referencing various dosage compendia. The study population consisted of 1 850 girls and 1 761 boys. The mean age of girls was 13.7 ± 3.9 years, vs. 12.3 ± 3.8 years for boys (d = 0.4). A total of 11 735 prescriptions containing 12 272 antidepressants were documented in 2010. Results of the study furthermore showed that the average number of prescriptions claimed per patient increased with age, from an average of 1.0 ± 0.28 among those up to the age of 2 years, to an average of 3.4 ± 3.21 among those 16 to 18 years of age. Prescribing with regard to age groups differed, rising gradually from birth and peaking at middle childhood for boys, whereas antidepressant use in girls increased from birth up to 6 years of age, reaching a plateau and increases again from age 13 and onward. Approximately 25% (n = 12 272) of antidepressants prescribed were either not indicated in children, or the dosages were deemed too high. More than 50% (n = 12 272) of antidepressants prescribed were in the Gauteng province. The SSRIs (selective serotonin re-uptake inhibitors) and the TCAs (tricyclic antidepressants) were the most prescribed antidepressants in both gender groups. The male-to-female ratio for the selective serotonin re-uptake inhibitors was 0.9, compared to 1.2 for the tricyclic antidepressants. The top three antidepressants prescribed were imipramine (21.8%), citalopram (15.3%) and escitalopram (14.7%, n = 12 272). Potential DDIs were observed on 284 (2.4%) (n = 11 743) prescriptions. The drug pairs with potential drug-drug interactions prescribed most, were imipramine with methylphenidate [43 cases (15.1%)] and valproic acid [38 cases (13.4%)], and followed by methylphenidate in combination with fluoxetine and sertraline [both documenting 32 cases (11.3%), respectively. The TCAs accounted for 182 (64.1%) cases of possible DDIs (drug-drug interactions), whereas combination therapy of SSRIs and TCAs accounted for 21.4% of potential DDIs. In conclusion, this study determined that there were a number of differences with regard to antidepressant prescribing in children and adolescents. Recommendations for future studies were made. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

The aim of the study was to evaluate type 2 diabetes mellitus (DM) medicine management in Government Clinics in Maseru, Lesotho. A two-dimensional research method was employed, consisting of a literature review and an empirical investigation. The objective of the literature review was to provide information on the pathophysiology, signs and symptoms, diagnosis, treatment and clinical management of DM. The empirical investigation consisted of a descriptive pharmacoepidemiological study, in which data for analysis was collected retrospectively from patients‘ medical records (―bukanas‖) at dispensing points, a using data collection tool. The selected study sites were Domiciliary Health Center, Mabote, Likotsi, and Qoaling filter clinics in Maseru district of Lesotho. Data on costs of antidiabetic agents was collected from purchase invoices provided by the pharmacy department of Domiciliary Health Center. Results showed that the overall ratio of males to females was 1.3. There were no statistical difference in DM prevalence between males and females in the different clinics (p = 0.48). The mean age of males and females was 57.5 ± 14.2 years and 58.6 ± 11.3 years, respectively (Cohen‘s d = 0.07). DM was more prevalent in patients 59 to 69 years for both males and females, with the exception of Mabote and Qoaling filter clinics, where DM was more prevalent in patients 49 to 59 years. These differences in prevalence were not statically significant. Overall, 20% (n = 69) of the study sample had DM alone, while 80.0% of patients had DM concurrently with hypertension. The odds ratio implicated that women were 1.7 times more likely to have hypertension concurrently with Type 2 Diabetes Mellitus. The mean blood glucose level at 95% confidence interval for females and males were 10.1 ± 5.9 mmol/L (95% CI: 10.1–11.7) and 10.9 ± 6.2 mmol/L (95% CI: 11.0–14.0) respectively. The difference in the mean blood glucose levels of males vs. females was not statistically significant (p = 0.07). In both males and females there were outliers as high as 33.3 mmol/L. Metformin 850 mg given three times, metformin 500 mg three times a day, glibenclamide 10 mg daily and glibenclamide 5 mg twice daily are oral hypoglycaemic agents that were first, second, third and fourth choice treatment of DM at all four study sites at a frequency of 54.2% (n = 160), 27.7% (n = 82), 4% (n = 12) and 2.7% (n = 27), respectively. Actraphane® 20 units in the morning and 10 units in the evening was prescribed at a frequency of 11.6% (n = 432) in comparison to other Actraphane®-containing regimens. The frequencies of prescribing metformin and Actraphane® as combination therapies represented 10.6% (n = 40), 7.1% (n = 27), and 6.6% (n = 25), respectively, for Actraphane® 20 units in the morning and 10 units in the evening, plus metformin 500 mg three times per day; Actraphane® 20 units in the morning and 10 units in the evening plus metformin 850 mg three times per day; and Actraphane® 30 units in the morning and 15 units in the evening plus metformin 850 mg three times per day. The combination therapy of metformin and glibenclamide were prescribed at frequencies of 24.6% (n = 172), 22.9% (n = 160), and 13.4% (n = 94) respectively for glibenclamide 10 mg daily plus metformin 850 mg three times per day, glibenclamide 5 mg daily plus metformin 850 mg three times per day, and glibenclamide 5 mg once a day plus metformin 500 mg three times per day as first, second and third choice treatments at all study sites. The total cost incurred for all the oral drugs prescribed alone within different regimens was M75.6 with the weighted average cost per patient of M0.81 ± 2.06 per day compared to the cost of Actraphane® which was M40 660.52 per month at a weighted average daily cost of M21.43 ± 6.23 per patient. The overall cost of Actraphane® and metformin combination therapy amounted to M50 676.50, at an average cost per patient of M21.77 ± 6.80 per day. The cost of combination therapy consisting of metformin and glibenclamide amounted to M377.10, at a weighted average cost amounting to M0.49 ± 0.16 per patient, per day. Based on the results of this study some conclusions were reached on the prevalence of DM, prescribing patterns and the cost of antidiabetic agents. Recommendations pertaining to the clinics and further research were made. / MPham (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

This study set out to review and analyse aspects of antidepressant prescribing in children and adolescents in a section of the private health care sector of South Africa. The research was conducted in two phases, namely a literature review and an empirical investigation. The aim of the literature review was to provide background to the study by conceptualising antidepressants. The empirical review followed a retrospective, descriptive, observational design. The data employed in the study was obtained from the medicine claims database of a South African Pharmaceutical Benefit Management (PBM) company. The study population consisted of 3 611 children and adolescents receiving ≥1 antidepressants from 1 January 2010 to 31 December 2010. Basic descriptive statistics, such as frequency, prevalence, average, weighted average, standard deviation, weighted standard deviation, median, effect sizes, prescribed daily dosages and DU95% methodology were used to characterise the study sample, and were calculated using the Statistical Analysis System SAS® for Windows 9.3® program. The data were used to determine the prescribing patterns of antidepressants with regard to age, gender, geographic area, type of prescriber, the comparison of prescribed daily dosages vs. recommended daily dosages, and the prevalence of potential drug-drug interactions. Potential drug-drug interactions were identified and compiled by using various interaction compendia, whereas recommended daily dosages were identified by cross-referencing various dosage compendia. The study population consisted of 1 850 girls and 1 761 boys. The mean age of girls was 13.7 ± 3.9 years, vs. 12.3 ± 3.8 years for boys (d = 0.4). A total of 11 735 prescriptions containing 12 272 antidepressants were documented in 2010. Results of the study furthermore showed that the average number of prescriptions claimed per patient increased with age, from an average of 1.0 ± 0.28 among those up to the age of 2 years, to an average of 3.4 ± 3.21 among those 16 to 18 years of age. Prescribing with regard to age groups differed, rising gradually from birth and peaking at middle childhood for boys, whereas antidepressant use in girls increased from birth up to 6 years of age, reaching a plateau and increases again from age 13 and onward. Approximately 25% (n = 12 272) of antidepressants prescribed were either not indicated in children, or the dosages were deemed too high. More than 50% (n = 12 272) of antidepressants prescribed were in the Gauteng province. The SSRIs (selective serotonin re-uptake inhibitors) and the TCAs (tricyclic antidepressants) were the most prescribed antidepressants in both gender groups. The male-to-female ratio for the selective serotonin re-uptake inhibitors was 0.9, compared to 1.2 for the tricyclic antidepressants. The top three antidepressants prescribed were imipramine (21.8%), citalopram (15.3%) and escitalopram (14.7%, n = 12 272). Potential DDIs were observed on 284 (2.4%) (n = 11 743) prescriptions. The drug pairs with potential drug-drug interactions prescribed most, were imipramine with methylphenidate [43 cases (15.1%)] and valproic acid [38 cases (13.4%)], and followed by methylphenidate in combination with fluoxetine and sertraline [both documenting 32 cases (11.3%), respectively. The TCAs accounted for 182 (64.1%) cases of possible DDIs (drug-drug interactions), whereas combination therapy of SSRIs and TCAs accounted for 21.4% of potential DDIs. In conclusion, this study determined that there were a number of differences with regard to antidepressant prescribing in children and adolescents. Recommendations for future studies were made. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

Thesis (M. Tech.) -- Central University of Technology, Free State, 2007 / Multi-agent systems (MAS) consist of a number of autonomous agents that communicate among themselves to coordinate their activities in order to solve collectively a complex problem that cannot be tackled by any agent individually. These kinds of systems are appropriate in many domains where problems that are complex, distributed and heterogeneous require communication and coordination between separate autonomous agents, which may be running on different machines distributed over the Internet and are located in many different places. In the health care domain, MAS have been used for distributed patient scheduling, organ and tissue transplant management, community care, decision support, training and so on. One other promising area of application is in the prescription of antiretroviral and antiTB drugs. The drugs used to treat the two diseases have many and similar side effects that complicate the prescription process. These factors have to be considered when prescribing medication to a person coinfected with HIV and tuberculosis. This is usually done manually using drug recommendation tables, which are complicated to use and require a great deal of decisionmaking. The design and implementation of a multiagent system that assists health care staff in carrying out the complex task of combining antiretroviral and antiTB drugs in an efficient way is described. The system consists of a number of collaborating agents requiring the communication of complex and diverse forms of information between a variety of clinical and other settings, as well as the coordination between groups of health care professionals (doctors, nurses, counsellors, etcetera.) with very different skills and roles. The agents in the system include: patient agents, nurse agents, lab agents, medication agents and physician agents. The agents may be hosted on different machines, located in many different places distributed over the Internet. The system saves time, minimises decision errors and increases the standard of health care provided to patients.

The aim of the study was to evaluate type 2 diabetes mellitus (DM) medicine management in Government Clinics in Maseru, Lesotho. A two-dimensional research method was employed, consisting of a literature review and an empirical investigation. The objective of the literature review was to provide information on the pathophysiology, signs and symptoms, diagnosis, treatment and clinical management of DM. The empirical investigation consisted of a descriptive pharmacoepidemiological study, in which data for analysis was collected retrospectively from patients‘ medical records (―bukanas‖) at dispensing points, a using data collection tool. The selected study sites were Domiciliary Health Center, Mabote, Likotsi, and Qoaling filter clinics in Maseru district of Lesotho. Data on costs of antidiabetic agents was collected from purchase invoices provided by the pharmacy department of Domiciliary Health Center. Results showed that the overall ratio of males to females was 1.3. There were no statistical difference in DM prevalence between males and females in the different clinics (p = 0.48). The mean age of males and females was 57.5 ± 14.2 years and 58.6 ± 11.3 years, respectively (Cohen‘s d = 0.07). DM was more prevalent in patients 59 to 69 years for both males and females, with the exception of Mabote and Qoaling filter clinics, where DM was more prevalent in patients 49 to 59 years. These differences in prevalence were not statically significant. Overall, 20% (n = 69) of the study sample had DM alone, while 80.0% of patients had DM concurrently with hypertension. The odds ratio implicated that women were 1.7 times more likely to have hypertension concurrently with Type 2 Diabetes Mellitus. The mean blood glucose level at 95% confidence interval for females and males were 10.1 ± 5.9 mmol/L (95% CI: 10.1–11.7) and 10.9 ± 6.2 mmol/L (95% CI: 11.0–14.0) respectively. The difference in the mean blood glucose levels of males vs. females was not statistically significant (p = 0.07). In both males and females there were outliers as high as 33.3 mmol/L. Metformin 850 mg given three times, metformin 500 mg three times a day, glibenclamide 10 mg daily and glibenclamide 5 mg twice daily are oral hypoglycaemic agents that were first, second, third and fourth choice treatment of DM at all four study sites at a frequency of 54.2% (n = 160), 27.7% (n = 82), 4% (n = 12) and 2.7% (n = 27), respectively. Actraphane® 20 units in the morning and 10 units in the evening was prescribed at a frequency of 11.6% (n = 432) in comparison to other Actraphane®-containing regimens. The frequencies of prescribing metformin and Actraphane® as combination therapies represented 10.6% (n = 40), 7.1% (n = 27), and 6.6% (n = 25), respectively, for Actraphane® 20 units in the morning and 10 units in the evening, plus metformin 500 mg three times per day; Actraphane® 20 units in the morning and 10 units in the evening plus metformin 850 mg three times per day; and Actraphane® 30 units in the morning and 15 units in the evening plus metformin 850 mg three times per day. The combination therapy of metformin and glibenclamide were prescribed at frequencies of 24.6% (n = 172), 22.9% (n = 160), and 13.4% (n = 94) respectively for glibenclamide 10 mg daily plus metformin 850 mg three times per day, glibenclamide 5 mg daily plus metformin 850 mg three times per day, and glibenclamide 5 mg once a day plus metformin 500 mg three times per day as first, second and third choice treatments at all study sites. The total cost incurred for all the oral drugs prescribed alone within different regimens was M75.6 with the weighted average cost per patient of M0.81 ± 2.06 per day compared to the cost of Actraphane® which was M40 660.52 per month at a weighted average daily cost of M21.43 ± 6.23 per patient. The overall cost of Actraphane® and metformin combination therapy amounted to M50 676.50, at an average cost per patient of M21.77 ± 6.80 per day. The cost of combination therapy consisting of metformin and glibenclamide amounted to M377.10, at a weighted average cost amounting to M0.49 ± 0.16 per patient, per day. Based on the results of this study some conclusions were reached on the prevalence of DM, prescribing patterns and the cost of antidiabetic agents. Recommendations pertaining to the clinics and further research were made. / MPham (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

Submitted in fulfillment of the Masters degree in Technology: Community Health Nursing, Durban University of Technology, 2013. / Background One of the major challenges for the Department of Health in South Africa today is inequity and the need to provide quality integrated health care for all its citizens. Primary Health Care (PHC) has been declared as the way to achieve this goal, through the District Health System. Standard Treatment Guidelines (STGs) and the Essential Medicines List (EML) have been developed and are used at PHC clinics and hospitals. This study explored the use of STGs and the EML by professional nurses at PHC clinics in the UMgungundlovu District, KwaZulu-Natal, South Africa. Methods A quantitative descriptive research design was used. Questionnaires were used to collect data from respondents at the PHC clinics. A retrospective review of facility registers kept by the respondents on the rational use of drugs was also carried out by the researcher. Results The findings of the study revealed that the respondents had a good understanding of the use of the STGs and the EML. There was no evidence of polypharmacy, and medications were prescribed according to guidelines. Areas that were suboptimal were related to prescription writing in writing of schedules and routes of medication as indicated in facility records. The results further showed that training on the use of the STGs and EML were inadequate, which implies the need for strengthening of training programmes.

This study evaluated the benefits and the problems of implementing the World Trade Organization's decision on the implementation of Paragraph 6 of the Doha Declaration by developing country members.

Asthma is a chronic disease of the airways and affects many people regardless of their age, gender, race and socioeconomic status. Since asthma is recognised as one of the major causes of morbidity and mortality in people and especially in South Africa, the prescribing patterns, prevalence and medication cost of asthma in South Africa are saliently important and need to be investigated. A non-experimental, quantitative retrospective drug utilisation review was conducted on medicine claims data of a pharmaceutical benefit management company in a section of the private health care sector of South Africa. The study period was divided into four annual time periods (1 January 2008 to 31 December 2008, 1 January 2009 to 31 December 2009, 1 January 2010 to 31 December 2010 and 1 January 2011 to 31 December 2011). The prescribing patterns and cost of asthma medication were investigated and stratified according to province, age and gender. Patients were included if the prescriptions which were provided by the health care practitioners matched the Chronic Disease List (CDL) of South Africa and the International Classification of Disease (ICD-10) coding for asthma and chronic obstructive pulmonary disease (COPD). Data analysis was conducted by means of the SAS 9.3® computer package. Asthma patients were divided according to different age groups (there were five different age groups for this study), gender and geographical areas of South Africa. The study indicated a steady increase in the prevalence of asthma patients from 0.82% (n = 7949) in 2008 to 1.18% (n = 15 423) in 2009 and reached a minimum of 0.79% (n = 8554) in 2011. Analysis of the prevalence regarding geographical areas in South Africa suggested that Gauteng had the highest number [n = 17 696, (0.85%)] of asthma patients throughout the study period, followed by KwaZulu Natal [n = 8 628, 1.16%)] and the Western Cape [(n = 8513, 0.97%) (p < 0.05)]. The prevalence of asthma in female patients [0.89% (n = 26 588)] was higher than in their male counterparts [0.79% (n = 19 244)] (p > 0.05). The results showed that asthma was not as common chronic disease in children. The total number of asthma patients younger than 7 years represented 0.64% (n = 2 909). It was found that patients over 65 years of age showed the highest prevalence of the five age groups [1.94% (n = 13 403) (p < 0.05)]. The average number of asthma prescriptions per patient per year was 8.28 (95% CI, 8.16- 8.40) and 5.15 (95% CI, 5.06-5.23) in 2008 and 2011, respectively. The number of asthma items per prescription varied from 1.55 (95% CI, 1.55-1.56) in 2008 to 1.40 (95% CI, 1.39- 1.40) in 2011. Medication from the MIMS® pharmacological group (anti-asthmatics and bronchodilators) was used to identify asthma medication. The top three asthma medication with the highest prevalence in the study period were the anti-inflammatory inhaler of fluticasone (n = 39 721) followed by the single item combination product of budesonide/ formoterol (n = 25 121) and salbutamol (n = 24 296). The influence of COPD on asthma treatment and the costimplication thereof were investigated. Medication from the MIMS® pharmacological group (anti-asthmatics and bronchodilators) was used to identify COPD medication. This study also showed that COPD had an influence in the economic burden of the South African asthma population. The cost of medication is responsible for the single largest direct cost involved in the economic burden of asthma. This study showed that asthma represented 0.88% of the direct medication cost in the study (excluding hospitalisation and indirect cost). The average cost per prescription and average cost per asthma item both increased throughout the study period. The prescribing patterns for the different medication used in the treatment of asthma were investigated and recommendations for further research in this field of study were made. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

Background: Accrual of continuing medical education credits is part of licensure in family medicine but opinions are mixed as to whether the training has an impact on clinical practice. Literature does suggest that practice change is most likely when training involves multiple interactive exposures, and when the benefit to patients is apparent. Aim: To determine whether an interactive peer-lead educational intervention for General Practitioners in British Columbia, the Practice Support Program Mental Health Module, resulted in measureable change in clinical practice of the Vancouver Island participants. Method: Administrative information from British Columbia Ministry of Health databases was obtained for analysis regarding physician billing and prescribing, and hospitalizations on Vancouver Island. Paired t-tests were used to compare physician-patient interactions among module participants before and after the training regarding a) initiation of antidepressants and anti-anxiety medication, and b) use of the mental health plan billing code, used to support patients who struggle with activities of daily living. In addition, mental health hospitalizations among participants' patients before and after training were used to measure its impact on patient outcomes. Results: One-hundred and ninety-seven General Practitioners on Vancouver Island completed the mental health module between 2008 and 2011. While no significant difference was found in the numbers of mental health patients seen during the pre- and post- periods (M=142.06, SD=97.45) and (M=144.44, SD=103.00); t(196)=-0.679, p=0.498, α=.05, the change in the proportion of new prescriptions between pre-period mean (M=0.0796, SD=.06527) and post-period means (M=.0530, SD=.03877); t(195)=6.668, p<0.001 was found to be significant and indicative of a relative decrease between 31.2 and 33.4%. The change in the proportion of mental health plans was also found to be significant between pre-period (M=0.1142, SD=.018598) and post-period means (M=.1674, SD=.23973); t(180)=-3.586, p<0.001. This indicated a relative increase between 42.0 and 46.6%. No significant change in patient hospitalizations was found between the pre- and post-period means: (M=0.039, SD=.0612) and (M=.0392, SD=.0978); t(192)=-0.055, p=0.956. Conclusion: This educational intervention appears to have resulted in significant changes in the practice patterns of the physician participants. Future research using better indicators may reveal more about the impact of physician training on patient outcomes. / Graduate

Os medicamentos são um recurso terapêutico que vêm ganhando cada vez mais importância no tratamento dos pacientes, o que tem levado várias instituições nacionais e internacionais a implementarem esforços no sentido de estimularem boas práticas de prescrição. Entretanto, várias influências têm levado médicos ao redor do mundo a adotarem práticas irracionais de prescrição, levando a custos cada vez mais elevados e riscos para a saúde dos doentes. Este estudo teve por objetivos descrever as práticas de prescrição de uma amostra de médicos de Curitiba, Paraná, a partir de respostas dadas a um questionário auto-aplicado, bem como investigar se médicos atuando na Estratégia Saúde da Família (ESF) prescrevem de forma diferente dos que atuam em Unidades Básicas de Saúde (UBS) e em outros serviços e explorar o uso de um questionário auto aplicado para este fim. Trata-se de um estudo transversal com uma amostra de conveniência. Foram entrevistados 17 indivíduos nas unidades da ESF, 22 em UBS, 5 no Hospital Universitário Cajuru e 5 no Centro Clínico Nossa Saúde através de um questionário sobre dados demográficos e com 20 questões em uma escala Likert de 5 pontos que explorava ideias a respeito da prescrição de fármacos. O escore resultante destas questões foi comparado aos dados demográficos e foi constatado que médicos sem especialidade, médicos de família e comunidade, médicos da ESF, que atuam em apenas um local de trabalho, que se encontram nas faixas etárias entre 25 e 34 anos e entre 40 e 59 anos de idade e que se formaram entre os anos de 1985 a 1994 e entre 2005 e 2012 obtiveram escores maiores. Estes resultados permitem levantar a hipótese de que médicos na cidade de Curitiba com este perfil prescrevem de forma mais racional do que seus pares. / Medicines are therapeutic options which are gaining more and more importance in the treatment of patients, leading several national and international institutions to efforts in order to stimulate good prescribing practices. However, many influences have led physicians around the world to adopt irrational prescribing practices, leading to increasingly high costs and risks to patients\' health. This study aimed to describe the prescribing practices of a sample of doctors from Curitiba, Paraná, from responses to a self-administered questionnaire as well as to investigate if doctors working in the Family Health Strategy may prescribe differently of those working in Basic Health Units and in other services and to explore the use of a self-applied questionnaire for this purpose. This is a cross-sectional study with a convenience sample. 17 individuals were interviewed in Family Health Units, 22 in Basic Health Units, 5 in the Cajuru University Hospital and 5 in the Nossa Saúde Clinical Center through a questionnaire on demographic data and 20 questions in a 5-point Likert scale that explored ideas concerning drug prescription. The resulting score from these questions was compared to demographic data and it was found that doctors with no medical specialty, family and community physicians, those working in Family Health Units, those working in just one workplace, who are in the age groups between 25 and 34 years and between 40 and 59 years of age and who graduated between the years 1985 to 1994 and between 2005 and 2012 had higher scores. These results raise the hypothesis that physicians in the city of Curitiba with this profile prescribe more rationally than their peers.