Objective: To determine the readiness of registered nurses (RNs) who provide care for patients with diabetes in a primary care setting for RN prescribing. Setting: Canadian provinces and territories. Participants: Canadian RNs working in primary care settings who provide care to patients with diabetes. Methods: A cross-sectional survey design was used to examine the readiness of RNs by measuring the attributes of readiness (value, confidence and willingness). The survey included questions on the demographic profile of participants including their age, education level and whether or not they had obtained additional certifications. This data was used to describe the sample and to determine whether there were differences between RNs who were ready to prescribe and RNs who were not ready to prescribe. Results: Almost 75% of the respondents were "ready" for RN prescribing. There were high positive correlations between "value" and "confidence", "value" and "willingness", and "confidence" and "willingness". There were no statistically significant differences in age, level of education and certifications for respondents who were ready to prescribe compared to those who were not ready to prescribe. Conclusions: The results of the present study indicate that RNs who provide care for patients with diabetes in a primary care setting are ready for prescribing. This practice has the potential to make more effective use of health human resources, allowing RNs to work to their full potential and increase accessibility to care for patients with diabetes.

Objective: To determine the readiness of registered nurses (RNs) who provide care for patients with diabetes in a primary care setting for RN prescribing. Setting: Canadian provinces and territories. Participants: Canadian RNs working in primary care settings who provide care to patients with diabetes. Methods: A cross-sectional survey design was used to examine the readiness of RNs by measuring the attributes of readiness (value, confidence and willingness). The survey included questions on the demographic profile of participants including their age, education level and whether or not they had obtained additional certifications. This data was used to describe the sample and to determine whether there were differences between RNs who were ready to prescribe and RNs who were not ready to prescribe. Results: Almost 75% of the respondents were "ready" for RN prescribing. There were high positive correlations between "value" and "confidence", "value" and "willingness", and "confidence" and "willingness". There were no statistically significant differences in age, level of education and certifications for respondents who were ready to prescribe compared to those who were not ready to prescribe. Conclusions: The results of the present study indicate that RNs who provide care for patients with diabetes in a primary care setting are ready for prescribing. This practice has the potential to make more effective use of health human resources, allowing RNs to work to their full potential and increase accessibility to care for patients with diabetes.

Objective: To determine the readiness of registered nurses (RNs) who provide care for patients with diabetes in a primary care setting for RN prescribing. Setting: Canadian provinces and territories. Participants: Canadian RNs working in primary care settings who provide care to patients with diabetes. Methods: A cross-sectional survey design was used to examine the readiness of RNs by measuring the attributes of readiness (value, confidence and willingness). The survey included questions on the demographic profile of participants including their age, education level and whether or not they had obtained additional certifications. This data was used to describe the sample and to determine whether there were differences between RNs who were ready to prescribe and RNs who were not ready to prescribe. Results: Almost 75% of the respondents were "ready" for RN prescribing. There were high positive correlations between "value" and "confidence", "value" and "willingness", and "confidence" and "willingness". There were no statistically significant differences in age, level of education and certifications for respondents who were ready to prescribe compared to those who were not ready to prescribe. Conclusions: The results of the present study indicate that RNs who provide care for patients with diabetes in a primary care setting are ready for prescribing. This practice has the potential to make more effective use of health human resources, allowing RNs to work to their full potential and increase accessibility to care for patients with diabetes.

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Class of 2009 Abstract / OBJECTIVES: To measure the attitudes of Arizona e-prescribing clinicians regarding (1) the importance of key criteria that may be used in the selection of an e-prescribing system; and (2) their satisfaction with key criteria as implemented within their current e- prescribing system. METHODS: This study utilized a print-based questionnaire. The questionnaire was faxed weekly to clinicians who were registered office-based e-prescribers in Arizona until either a response was received or three fax cycles were completed. Clinicians were asked to rate the importance of each e-prescribing feature on a five-point scale, where 1 was not at all important and 5 was extremely important. For each e-prescribing feature, clinicians were asked to rate their satisfaction with their current e-prescribing system on a seven-point scale, where -3 was very dissatisfied and +3 was very satisfied. Demographic data were collected on practice size, practice type, prescription entry, e-prescribing software vendor and system used, year e-prescribing started, and comments. RESULTS: Questionnaires were completed and returned by 114 clinicians. The overall mean for feature importance and satisfaction was 4.22 and 4.92, respectively. Of the 39 criteria, 9 were categorized as having high importance with low satisfaction; and 14 were categorized as having high importance with high satisfaction. The nine criteria with high importance but low satisfaction were related to vendor support, system cost, lack of e-prescribing features, and unrealized benefits. CONCLUSIONS: Arizona e-prescribers are moderately satisfied with the basic functions provided by their electronic prescribing systems. Their dissatisfaction with electronic prescribing systems may be due to vendor support and system costs.

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

M.Sc. (Med), Faculty of Health Sciences,University of the Witwatersrand, 2011 / Background: Many factors affect the prescribing of medication to patients with schizophrenia including variables that relate to physicians and may result in marked variance in the choice of drugs, dosages, drug combinations, route of administration and the use of antipsychotic, anticholinergic, sedative and other adjuvant drugs. Clinical practice guidelines were developed to address this variance and for other reasons, including the management of side-effects, drug innovation, rising costs, information overload, changes in treatment goals and the management of medication non-adherence. There are advantages and disadvantages to using clinical practice guidelines including those pertaining to context and cultural norms, but they remain the best method of assessing prescribing quality. Many guidelines are based on the results of randomised clinical trials (with a single drug) or are the consensus of experts in the field. Despite the development and publication of these guidelines over the past two decades, they are frequently not adhered to resulting in much variance in treatment. Aims and objectives: The aim of the study was to determine to what extent the prescribing of psychotropic drugs in the treatment of schizophrenia was consistent with the most recent version of each of five guidelines that originate outside South Africa (two from the United States and one each from Canada, the United Kingdom, and Australia and New Zealand); and one that was developed locally. Methodology: A retrospective, cross-sectional prescription chart review with data sampling at three time points (on hospital admission, at fourteen days thereafter and on hospital discharge) was undertaken. A sample population was drawn over a three year period during which the patients’ physician had access to the same drug formulary. Seventy patients met the study selection criteria in terms of age, diagnosis and receipt of antipsychotic medication during hospital stay and on discharge. Seventy patients met the study selection criteria, and their prescriptions for psychotropic medication (exclusively) were examined for a number of parameters including: drug class, drug name, dose, route of administration and whether the medication was to be administered routinely or ‘as needed’. Findings and discussion: As compared with the recommendations made in some or all of the guidelines, first generation antipsychotic agents were over-prescribed especially early on in the patients’ hospital stay, whereas second generation antipsychotics were under-prescribed. The profile changed after fourteen days and on discharge there were more patients on second generation drugs than on the older drugs. More patients were discharged on depot antipsychotic treatment than were admitted which is considered a favourable finding, however, many patients receiving the depot form continued to be prescribed the oral drug on a routine basis and for an indefinite period, resulting in antipsychotic polypharmacy. Anticholinergic drugs were prescribed as prophylaxis for the extra-pyramidal side-effects of the first generation antipsychotic drugs and more than a quarter of the sample received these drugs on discharge, after which they were to be taken routinely and indefinitely. A similar finding was made with the use of benzodiazepine sedatives, where nearly a quarter of patients received these drugs on discharge - again to be taken routinely and for an unspecified period. Sodium valproate was given increasingly to many patients in the sample and was prescribed to over a quarter of those upon discharge, without an indication of duration. Limitations: The study was retrospective in design, without the benefit of the patients’ clinical histories and treatment progress, and the findings were compared with guidelines whose age spanned more than a decade and some of which had become redundant. Conclusions: The study demonstrated some prescribing habits that were not in accord with the guidelines used for comparison in the study. The extent of the disagreement reveals the need for a prospective pilot study that will include the patients’ clinical progress in the study design which will provide greater insight into why specific medication parameters were chosen by the physician for the individual patient. If the findings justify it, then a programme promoting better adherence to the most current guidelines should be commenced.

Introduction: Prescribing by non medical personnel (NMP) has been introduced in the UK. The objectives of this study were to a) describe pharmacist discharge prescription transcription service (PDPTS) provided in UK hospitals prior to NMP, b) investigate the implementation of supplementary prescribing (SP) by pharmacists in England, c) explore patient opinions on development of pharmacists and nurses as independent prescribers (IP). Methods: Two postal questionnaires were undertaken, one of hospital clinical pharmacy managers (Q1) and one of PCTPs and CPs (Q2). Depth interviews with patients were also used. Ethics approval was obtained. Key Findings: For Q1 the response rate was 66% (135/206). PDPTS was offered by 49/135 (36%) of hospitals and was the most common prescribing activity undertaken. The majority of pharmacists wrote