Yes / Background In the United Kingdom, nurses and pharmacists who have undertaken additional post-registration training can prescribe medicines for any medical condition within their competence (non-medical prescribers, NMPs), but little is known about patients' experiences and perceptions of this service. Objective to obtain feedback from primary care patients on the impact of prescribing by nurse independent prescribers (NIPs) and pharmacist independent prescribers (PIPs) on experiences of the consultation, the patient–professional relationship, access to medicines, quality of care, choice, knowledge, patient-reported adherence and control of their condition. Design Two cross-sectional postal surveys. Setting and participants Patients prescribed for by either NIPs or PIPs in six general practices from different regions in England. Results 30% of patients responded (294/975; 149/525 NIPs; 145/450 PIPs). Most said they were very satisfied with their last visit (94%; 87%), they were told as much as they wanted to know about their medicines (88%; 80%), and felt the independent prescriber really understood their point of view (87%; 75%). They had a good relationship with (89%; 79%) and confidence in (84%; 77%) their NMP. When comparing NMP and doctor prescribing services, most patients reported no difference in their experience of care provided, including access to it, control of condition, support for adherence, quality and safety of care. Discussion and conclusions Patients had positive perceptions and experience from their NMP visit. NMPs were well received, and patients' responses indicated the establishment of rapport. They did not express a strong preference for care provided by either their non-medical or medical prescriber. / Policy Research Programme in the Department of Health

BACKGROUND:Clinicians often encounter information about drug-drug interactions (DDIs) during clinical practice. This information is found within product information (hardcopy and electronic) and various electronic systems. Prescribers may receive medication-related communications in practice that are distributed by facsimile (fax), mail, or telephone from pharmacies and pharmacy benefit managers (PBMs). The purpose of this study was to determine if near-real time fax alerts for potential drug-drug interactions (PDDIs) would influence prescribing.METHODS:A prospective study, in cooperation with a pharmacy benefit manager (PBM), was conducted targeting 18 clinically important PDDIs. Fax alerts included an individualized letter to the prescriber with a list of the interacting drugs, PDDI evidence summaries with citations, and recommended clinical management strategies. Among the 18 PDDIs, 13 PDDIs could be assessed for prescription therapy changes using pharmacy claims data. A prospective cohort design was used to evaluate changes in prescription dispensing 90-days following a PDDI fax alert.RESULTS:A total of 8,075 fax alerts were sent to prescribers and there were 4,712 alerts for the 13 PDDIs that could be assessed for change using pharmacy claims data. There were 2,019 patients (interventions) for which fax alerts were sent to their prescribers who were matched with a control group consisting of patients with the same PDDIs but for whom no fax alert was sent. Overall, this study found 154 (7.6%) of patients in the fax alert group compared to 132 (6.5%) in the control group had changes in therapy (p=0.177).CONCLUSIONS:This fax alert intervention program observed no statistically significant differences in prescribing with a fax alert compared to the control group. If PBMs chose to send individualized, evidence-based information to clinicians regarding drug-drug interactions, this study suggests it may not be an effective intervention to mitigate harm.

Registered nurses entering a Nurse Prescriber programme participated in a mixed methods case study to explore the extent of their bioscience knowledge and the confidence with which that knowledge was held. Forty two Nurse Prescriber students, aged 26 – 55 years, from a range of job roles were recruited. Using questionnaires and interviews, both quantitative and qualitative data were obtained. An examination of the Nurse Prescribers’ views of pre-registration nursing demonstrated that the knowledge gained had been related to practice but had been both superficial and lacking in breadth. The bioscience in pre-registration programmes had not sufficiently prepared the participants for their roles as registered nurses. The importance of experiences gained as a registered nurse in the practice setting in the learning of bioscience was strongly emphasised. Participants reported greater learning of bioscience by informal methods such as work experience, use of books and the Internet and discussion with colleagues than from experiences in the classroom. Interviewees placed particularly strong emphasis on the importance of learning from medical colleagues. The role of post-registration programmes emerged as important in learning bioscience because it related to the job role. Post-registration courses also emerged as significant in giving confidence to the registered nurse. Confidence increased not just in terms of the knowledge held, but also in terms of nurses’ ability to communicate with patients, relatives, and doctors, their ability to understand nursing skills, and their willingness to admit when something was not known.

Acne is a very common disease affecting approximately 85% of people in some stage of their life (Wolff et al., 2005:2). The systemic drug isotretinoin is the only acne drug which has an influence on all the pathophysiological factors of this highly prevalent disease and is considered as the most effective treatment for acne, although it should be limited to the treatment of severe acne. Isotretinoin prescribing is under the largest risk-minimisation programme (called iPLEDGE) ever implemented for a drug in the United States of America, due to concerns with pregnancies during isotretinoin treatment (Honein et al., 2007:11). In comparison South Africa has no equal managing programme to regulate isotretinoin prescribing and the need to identify certain prescribing patterns is deemed necessary. The general objective of this study was to analyse the prescribing patterns of isotretinoin, including aspects of cost, in a section of the private healthcare sector of South Africa. A quantitative, retrospective drug utilisation review was performed to evaluate the prescribing patterns and cost of isotretinoin containing products claimed through a pharmacy benefit management organisation, over the study period of 2005 and 2006. Data were analysed by using the Statistical Analysis System, 9.1 (SAS). The information of prescriber, age, gender, and cost of isotretinoin usage were considered and evaluated. A total number of 6 427 and 6 927 patients claimed 18 589 and 20 232 isotretinoin prescriptions respectively during 2005 and 2006. Isotretinoin total costs contributed to 34.4% (n = R6 810 090) and 36.3% (n = R6 533 241) of the total identified acne medicine costs for 2005 and 2006 respectively. Isotretinoin represented the highest percentage of total costs in relation to any other acne product identified in both study years. Average costs of R314.82 ± 205.92 per prescribed isotretinoin item in 2005 and R277.63 ± 192.63 in 2006 were recorded in comparison to the total database medicine item cost of R95.33 ± 192.21 in 2005 and R95.33± 227.99 in 2006. The generic products of isotretinoin were claimed at a lower ratio (generic vs. innovator product ratio of 1.8:1 in 2005 and 2.2:1 in 2006) in relation to the total database (generic ratio of 3:1 in both years). Dermatologists prescribed 68.2% and 65.7% of isotretinoin prescriptions and general practitioners 27.5% and 29.7%. General practitioners were more likely to prescribe the generic equivalents of isotretinoin (68.9% in 2005 and 72.1% in 2006) in comparison to dermatologists (59.7% in 2005 and 63.4% in 2006). The teenage group 12 to 19 years received 48.4% (n = 8 989) and 47.7% (n = 9 656) of isotretinoin prescriptions claimed respectively at an estimated cost of R275 000 and R260 000 per 10 000 beneficiaries in this age group respectively for 2005 and 2006. There were 71 patients identified over both study years in the age group younger than 12 years, in which isotretinoin use is not recommended. Female patients received 56.2% (n = 10 450) and 57.4% (n = 11 610) of the total number of isotretinoin prescriptions claimed respectively for 2005 and 2006. The average cost per isotretinoin prescription claimed for male patients was higher (R406.36 ± 233.76 and R358.69 ± 218.29 respectively for 2005 and 2006) in relation to female patients (R335.15 ± 209.98 and R296.36 ± 197.74 respectively for 2005 and 2006). The median ages for female and male patients were 21 years and 18 years respectively. The concern, however, was the high number of female patients of child-bearing potential identified (2 892 and 3 201 female patients respectively for 2005 and 2006), claiming their isotretinoin prescriptions. Systemic isotretinoin occurred alone in 70.8% and 69.3% of prescriptions claimed respectively for 2005 and 2006. Oral contraceptives occurred in combination with isotretinoin in only 8.6% and 9.2% of isotretinoin prescriptions claimed. The contra-indicated use of a systemic tetracycline in combination with systemic isotretinoin occurred in 139 (0.75%) and 130 (0.64%) prescriptions. It can be concluded that the use of isotretinoin increased. Dermatologists played the major role in prescribing isotretinoin. The number of female isotretinoin users (especially of child-bearing potential) could be a concern, although pregnancy prevalence should be identified in South Africa. It is recommended that further studies be conducted in South Africa regarding the usage and control of isotretinoin, including the extension of regulating programmes, with special reference to age and gender. Effective management of the increasing popularity of this ultimately successful acne treatment is of utmost importance to ensure the effective and safe usage of isotretinoin. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

Acne is a very common disease affecting approximately 85% of people in some stage of their life (Wolff et al., 2005:2). The systemic drug isotretinoin is the only acne drug which has an influence on all the pathophysiological factors of this highly prevalent disease and is considered as the most effective treatment for acne, although it should be limited to the treatment of severe acne. Isotretinoin prescribing is under the largest risk-minimisation programme (called iPLEDGE) ever implemented for a drug in the United States of America, due to concerns with pregnancies during isotretinoin treatment (Honein et al., 2007:11). In comparison South Africa has no equal managing programme to regulate isotretinoin prescribing and the need to identify certain prescribing patterns is deemed necessary. The general objective of this study was to analyse the prescribing patterns of isotretinoin, including aspects of cost, in a section of the private healthcare sector of South Africa. A quantitative, retrospective drug utilisation review was performed to evaluate the prescribing patterns and cost of isotretinoin containing products claimed through a pharmacy benefit management organisation, over the study period of 2005 and 2006. Data were analysed by using the Statistical Analysis System, 9.1 (SAS). The information of prescriber, age, gender, and cost of isotretinoin usage were considered and evaluated. A total number of 6 427 and 6 927 patients claimed 18 589 and 20 232 isotretinoin prescriptions respectively during 2005 and 2006. Isotretinoin total costs contributed to 34.4% (n = R6 810 090) and 36.3% (n = R6 533 241) of the total identified acne medicine costs for 2005 and 2006 respectively. Isotretinoin represented the highest percentage of total costs in relation to any other acne product identified in both study years. Average costs of R314.82 ± 205.92 per prescribed isotretinoin item in 2005 and R277.63 ± 192.63 in 2006 were recorded in comparison to the total database medicine item cost of R95.33 ± 192.21 in 2005 and R95.33± 227.99 in 2006. The generic products of isotretinoin were claimed at a lower ratio (generic vs. innovator product ratio of 1.8:1 in 2005 and 2.2:1 in 2006) in relation to the total database (generic ratio of 3:1 in both years). Dermatologists prescribed 68.2% and 65.7% of isotretinoin prescriptions and general practitioners 27.5% and 29.7%. General practitioners were more likely to prescribe the generic equivalents of isotretinoin (68.9% in 2005 and 72.1% in 2006) in comparison to dermatologists (59.7% in 2005 and 63.4% in 2006). The teenage group 12 to 19 years received 48.4% (n = 8 989) and 47.7% (n = 9 656) of isotretinoin prescriptions claimed respectively at an estimated cost of R275 000 and R260 000 per 10 000 beneficiaries in this age group respectively for 2005 and 2006. There were 71 patients identified over both study years in the age group younger than 12 years, in which isotretinoin use is not recommended. Female patients received 56.2% (n = 10 450) and 57.4% (n = 11 610) of the total number of isotretinoin prescriptions claimed respectively for 2005 and 2006. The average cost per isotretinoin prescription claimed for male patients was higher (R406.36 ± 233.76 and R358.69 ± 218.29 respectively for 2005 and 2006) in relation to female patients (R335.15 ± 209.98 and R296.36 ± 197.74 respectively for 2005 and 2006). The median ages for female and male patients were 21 years and 18 years respectively. The concern, however, was the high number of female patients of child-bearing potential identified (2 892 and 3 201 female patients respectively for 2005 and 2006), claiming their isotretinoin prescriptions. Systemic isotretinoin occurred alone in 70.8% and 69.3% of prescriptions claimed respectively for 2005 and 2006. Oral contraceptives occurred in combination with isotretinoin in only 8.6% and 9.2% of isotretinoin prescriptions claimed. The contra-indicated use of a systemic tetracycline in combination with systemic isotretinoin occurred in 139 (0.75%) and 130 (0.64%) prescriptions. It can be concluded that the use of isotretinoin increased. Dermatologists played the major role in prescribing isotretinoin. The number of female isotretinoin users (especially of child-bearing potential) could be a concern, although pregnancy prevalence should be identified in South Africa. It is recommended that further studies be conducted in South Africa regarding the usage and control of isotretinoin, including the extension of regulating programmes, with special reference to age and gender. Effective management of the increasing popularity of this ultimately successful acne treatment is of utmost importance to ensure the effective and safe usage of isotretinoin. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

Introduction: Medication errors are a major cause of illness and hospitalization of patients throughout the world. This study examines the situation regarding medication errors in the Armed Forces Hospital, Kuwait since no literature exists of any such studies for this country. Several types of potential errors were studied by physicians, nurses and pharmacists. Their attitudes to the commission of errors and possible consequences were surveyed using questionnaires. Additionally, patient medical records were reviewed for possible errors arising from such actions such as the co-administration of interacting drugs. Methods: This study included direct observations of physicians during the prescribing process, pharmacists while they dispensed medications and nurses as they distributed and administered drugs to patients. Data were collected and compiled on Microsoft Excel spreadsheet and analyses were performed using SPSS. Where applicable, results were reported as counts and/ or percentages of error rates. Nurses, pharmacists and physicians survey questionnaires: From the 200 staff sent questionnaires a total of 149 respondents comprising nurses (52.3%), physicians (32.2%) and pharmacists (16.1%) returned the questionnaires a total response rate of 74.5%. All responses were analyzed and compared item-by-item to see if there were any significant differences between the three groups for each questionnaire item. All three groups were most in agreement about their perception of hospital administration as making patient safety a top priority with regard to communicating with staff and taking action when medication errors were reported (all means 3.0 and p > 0.05). Pharmacists were most assured of administration support when an error was reported whereas nurses were least likely to see the administration as being supportive ( p < 0.001), and were more afraid of the negative consequences associated with reporting of medication errors (p = 0.026). Although nurses were generally less likely to perceive themselves as being able to communicate freely regarding reporting of errors compared to pharmacists there was no significant difference between the two groups. Both however were significantly different from physicians (p< 0.001). Physicians had the most favorable response to perceiving new technology as helping to create a safer environment for patients and to the full utilization of such technologies within the institution in order to help prevent medical errors. Scenario response - Responses to two scenarios outlining possible consequences, should a staff member commit a medication error, tended to be very similar among the three groups and followed the same general trend in which the later the error was discovered and the more grievous the patient harm, the more severe would be the consequences to the staff member. Interestingly, physicians saw themselves as less likely to suffer consequences and nurses saw themselves as more likely to suffer consequences should they have committed a medication error. All three groups were more likely to see themselves as facing dismissal from their job if the patient were to die. RESULTS OF ALL THREE OBSERVATIONS: Result of Nursing observations: For 1124 doses studied, 194 resulted in some form of error. The error rate was 17.2% and the accuracy was 82.8%. The commonest errors in a descending order were: wrong time, wrong drug, omission, wrong strength/ dose, wrong route, wrong instruction and wrong technique. No wrong drug form was actually administered in the observational period. These were the total number of errors observed for the entire month period of the study. IV Result of Pharmacist observations: A total of 2472 doses were observed during the one month period. Observations were done for 3 hours per day each day that the study was carried out. The study showed that there were 118 errors detected which were in the following categories respectively: 52 no instructions, 28 wrong drug/unordered, 21 wrong strength/dose, ignored/omission 13, shortage of medication 3 and expired date 1. Result of Prescribers in Chart review for drug-drug interactions: The analysis of the drug-drug interactions showed that out of a total of 1000 prescriptions, 124 had drug-drug interactions. None were found to fall into the highest severity rating i.e. 4 (contraindicated). Only twenty-one interactions were rated 3 (major), 87 interactions were rated moderate and 15 interactions were rated minor according the modified Micromedex scale. Patient education: All health care such as physician, pharmacist, and nurses have a responsibility to educate patient about their medication use and their health conditions to protecting them from any error can occur by wrong using drugs. Conclusion This study has contributed to the field of medication errors by providing data for a Middle Eastern country for the very first time. The views and opinions of the nurses, pharmacists and physicians should be considered to enhance the systems to minimize any errors in the future.

OBJECTIVES: (1) To assess prescribers' ability to recognize clinically significant DDIs, (2) to examine demographic and practice factors that may be associated with prescribers' DDI knowledge, and (3) to evaluate prescribers' perceived usefulness of various DDI information sources.METHODS: This study used a mailed questionnaire sent to a national sample of prescribers based on their past history of DDI prescribing which was determined using data from a pharmacy benefit manager covering over 50 million lives. The survey questionnaire included 14 drug-drug pairs that tested prescribers' ability to recognize clinically important DDIs and five 5-point Likert scale-type questions that assessed prescribers' perceived usefulness of DDI information provided by various sources. Demographic and practice characteristics were collected as well. Rasch analysis was used to evaluate the knowledge and usefulness questions.RESULTS: Completed questionnaires were obtained from 950 prescribers (overall response rate: 7.9%). The number of drug pairs correctly classified by the prescribers ranged from zero to thirteen, with a mean of 6 pairs (42.7%). The percentage of prescribers who correctly classified specific drug pairs ranged from 18.2% for warfarin-cimetidine to 81.2% for acetaminophen with codeine-amoxicillin. Half of the drug pair questions were answered "not sure" by over one-third of the respondents; among which, two were contraindicated. Rasch analysis of knowledge and usefulness questions revealed satisfactory model-data fit and person reliability of 0.72 and 0.61, respectively. A multiple regression analysis revealed that specialists were less likely to correctly identify interactions as compared to prescribers who were generalists. Other important predictors of DDI knowledge included the experience of seeing a harm caused by DDIs and the extent to which the risk of DDIs affected the prescribers' drug selection. ANOVA with the post-hoc Scheffe test indicated that prescribers considered DDI information provided by "other" sources to be more useful than that provided by computerized alert system. CONCLUSIONS: This study suggests that prescribers' DDI knowledge may be inadequate. The study found that for the drug interactions evaluated, generalists performed better than specialists. In addition, this study presents an application of IRT analysis to knowledge and attitude measurement in health science research.

Background: Mannitol has been used in the past for the prevention of cisplatin-induced nephrotoxicity. Studies on its efficacy have conflicting results. An educational newsletter was designed for local oncologists on the conflicting data of mannitol use in preventing cisplatin-induced nephrotoxicity. Purpose: The purpose of this study was to determine whether a pharmacist-created newsletter intervention led to changes in the mannitol prescribing practices of local oncologists. Methods: A newsletter describing the paucity of evidence to support mannitol use to prevent cisplatin-induced nephrotoxicity was distributed via e-mail to local oncologists in October 2010. Mannitol prescribing rates were retrospectively evaluated before and after newsletter distribution. The Mann-Whitney U test was used to compare nonparametric continuous data. The chi-square test was used for nominal data. Descriptive statistics were performed for baseline demographics, and odds ratios were calculated for possible risk factors for acute kidney injury (AKI). The primary endpoint was a change in mean mannitol dose before and after the newsletter intervention. The secondary endpoint was the difference in the rate of AKI before and after the intervention. Data were collected for 67 patients with various malignancies. Results: There was a difference in the average mannitol dose before and after newsletter intervention (P = .02). The rates of AKI before and after newsletter were similar. Conclusion: A pharmacist-led newsletter intervention was associated with significantly decreased rates of mannitol usage after intervention.

Introduction: Medication errors are a major cause of illness and hospitalization of patients throughout the world. This study examines the situation regarding medication errors in the Armed Forces Hospital, Kuwait since no literature exists of any such studies for this country. Several types of potential errors were studied by physicians, nurses and pharmacists. Their attitudes to the commission of errors and possible consequences were surveyed using questionnaires. Additionally, patient medical records were reviewed for possible errors arising from such actions such as the co-administration of interacting drugs. Methods: This study included direct observations of physicians during the prescribing process, pharmacists while they dispensed medications and nurses as they distributed and administered drugs to patients. Data were collected and compiled on Microsoft Excel spreadsheet and analyses were performed using SPSS. Where applicable, results were reported as counts and/ or percentages of error rates. Nurses, pharmacists and physicians survey questionnaires: From the 200 staff sent questionnaires a total of 149 respondents comprising nurses (52.3%), physicians (32.2%) and pharmacists (16.1%) returned the questionnaires a total response rate of 74.5%. All responses were analyzed and compared item-by-item to see if there were any significant differences between the three groups for each questionnaire item. All three groups were most in agreement about their perception of hospital administration as making patient safety a top priority with regard to communicating with staff and taking action when medication errors were reported (all means 3.0 and p > 0.05). Pharmacists were most assured of administration support when an error was reported whereas nurses were least likely to see the administration as being supportive ( p < 0.001), and were more afraid of the negative consequences associated with reporting of medication errors (p = 0.026). Although nurses were generally less likely to perceive themselves as being able to communicate freely regarding reporting of errors compared to pharmacists there was no significant difference between the two groups. Both however were significantly different from physicians (p< 0.001). Physicians had the most favorable response to perceiving new technology as helping to create a safer environment for patients and to the full utilization of such technologies within the institution in order to help prevent medical errors. Scenario response - Responses to two scenarios outlining possible consequences, should a staff member commit a medication error, tended to be very similar among the three groups and followed the same general trend in which the later the error was discovered and the more grievous the patient harm, the more severe would be the consequences to the staff member. Interestingly, physicians saw themselves as less likely to suffer consequences and nurses saw themselves as more likely to suffer consequences should they have committed a medication error. All three groups were more likely to see themselves as facing dismissal from their job if the patient were to die. RESULTS OF ALL THREE OBSERVATIONS: Result of Nursing observations: For 1124 doses studied, 194 resulted in some form of error. The error rate was 17.2% and the accuracy was 82.8%. The commonest errors in a descending order were: wrong time, wrong drug, omission, wrong strength/ dose, wrong route, wrong instruction and wrong technique. No wrong drug form was actually administered in the observational period. These were the total number of errors observed for the entire month period of the study. IV Result of Pharmacist observations: A total of 2472 doses were observed during the one month period. Observations were done for 3 hours per day each day that the study was carried out. The study showed that there were 118 errors detected which were in the following categories respectively: 52 no instructions, 28 wrong drug/unordered, 21 wrong strength/dose, ignored/omission 13, shortage of medication 3 and expired date 1. Result of Prescribers in Chart review for drug-drug interactions: The analysis of the drug-drug interactions showed that out of a total of 1000 prescriptions, 124 had drug-drug interactions. None were found to fall into the highest severity rating i.e. 4 (contraindicated). Only twenty-one interactions were rated 3 (major), 87 interactions were rated moderate and 15 interactions were rated minor according the modified Micromedex scale. Patient education: All health care such as physician, pharmacist, and nurses have a responsibility to educate patient about their medication use and their health conditions to protecting them from any error can occur by wrong using drugs. Conclusion This study has contributed to the field of medication errors by providing data for a Middle Eastern country for the very first time. The views and opinions of the nurses, pharmacists and physicians should be considered to enhance the systems to minimize any errors in the future.

Yes / Direct oral anticoagulants (DOACs) uptake for stroke prevention in atrial fibrillation has been slow.[1] This study aimed to profile the prescribing of DOACs over three years to identify factors associated with DOAC prescribing in a Clinical Commissioning Group (CCG) without restrictions to DOACs use. The objectives were to identify: - Characteristics of patients prescribed oral anticoagulant (OAC) in a sample of general practices; - Who initiated the prescribing of OAC; - Recorded reasons for prescribing a DOAC rather than warfarin;