Thesis (Msc.(Med.)(Pharmacy))--University of Limpopo, 2009. / Background: The study was conducted in primary healthcare facilities in Vhembe district in Limpopo province, South Africa. Seeing that the National Drug policy was implemented in 1996 and followed by the Standard Treatment Guidelines, it was necessary to investigate if PHC facilities are prescribing according to the guidelines. Although the data collected was from five clinics, iinformation on antimicrobial prescribing patterns is necessary for a constructive approach to the challenges that arise from the vast number of antibiotics that are available in the market and the occurrence of resistance. Objectives: The aim of the study was to investigate whether prescribers at Primary Health Care (PHC) facilities in Vhembe district adhered to the Standard Treatment Guidelines/Essential Drug List (STG/EDL) when prescribing antimicrobials. Method: Five hundred antimicrobial prescribing patterns and patient demographics were recorded from five PHC facilities (100 prescriptions in each) in the Vhembe District, Limpopo Province over a two weeks period. In all PHC facilities, data collection of prescriptions focused on the period from 01 August 2007 until the required number of 100 prescriptions was reached. x Results: Conditions where prescriptions complied to STG/EDL were skin infections and wound 91.67% (22/24), upper respiratory tract infection 86.49% (32/37), bronchitis 80% (4/5), ear/eye infections 75% (3/4), otitis media 57.14% (4/7), sore throat/tonsillitis 56.57% (56/99), urinary tract infection 37.5% (3/8), sexual transmitted infections 37.25% (19/51), bites 33.33% (1/3), and abscesses 25% (1/4). All other remaining 18 conditions that were listed as diagnosis did not comply at all. On overall only 29.2% (146/500) of prescriptions that were evaluated complied. Conclusion: Antimicrobial prescribing patterns adhering to the EDL/STD were low. Attention needs to be given to the prescribing of antimicrobials.

No description available.

Introduction: Potentially inappropriate prescriptions (PIPs) have been defined as the prescribing of medications where the risk of adverse outcomes outweighs the benefit to patients. Some medications pose a greater risk than others. Nonsteroidal anti-inflammatory drugs (NSAIDs), antiplatelets, and anticoagulants are among the top offenders for preventable drug-related ER visits, hospitalizations and deaths. Methods: Data were collected through a retrospective electronic/paper chart review for all patients prescribed a target medication in two family medicine clinics in Winnipeg, Manitoba from June 2012 to June 2013. Results: The presence of at least one PIP was identified in 198 of 567 patients (35%). The most common PIP was the use of an oral NSAID with one or more gastrointestinal bleed risk factor without adequate gastro-protection. Conclusion: With over one-third of patients using NSAIDs, antiplatelets, and anticoagulants potentially inappropriately, a greater focus on improving prescribing practices with these higher-risk medications is warranted.

No description available.

Chronic obstructive pulmonary disease (COPD) is expected to become the third most common cause of mortality in the world (GOLD Committee, 2009). COPD management continues to play a large role in everyday medical practice and inhalation therapy will continue to be a mainstay of COPD treatment. Very little is known about how prescribers choose drug-delivery devices for their clients with COPD. This study examined the current practice related to COPD inhalation devices among physicians working in a small rural community hospital. . Results showed that the most frequently prescribed device for patients was a DPI in the community setting and that nebulizers are most commonly prescribed in the emergency department. Physicians reported various factors that they consider when prescribing an inhalation device; ease of use for the patient, disease severity, cost to the patient, and therapeutic response. Physicians expressed that disease severity as the most important factor.

Since 1994 there have been considerable additions to the range of health care professionals (HCPs) that can prescribe in the United Kingdom (UK). These HCPs include nurses, pharmacists, radiographers, physiotherapists, podiatrists, chiropodists and optometrists. After a period of specific prescribing training these HCPs are often referred to as non-medical prescribers (NMPs). There has been a limited amount of research that has investigated the influences on the prescribing behaviour of NMPs. Additional research with NMPs would be beneficial to contribute to the currently limited understanding of the prescribing behaviour of NMPs. Knowledge about the influences on NMPs' decisions will also provide further insight into the training and support requirements of these HCPs. A programme of research was conducted to explore the influences on the prescribing behaviour of nurse and pharmacist independent and/or supplementary prescribers working in primary and community care. The research utilised a range of qualitative data collection techniques including interviews, semi-structured interviews, focus groups and the critical incident technique. The Q-method was also used. This allowed perspectives amongst NMPs about prescribing influences to be identified. In total, 104 NMPs took part in this research. This included 31 pharmacist prescribers and 73 nurse prescribers. NMPs were mainly recruited via their primary care trust prescribing lead but pharmacist prescribers were also contacted using the details they provided to their professional body. NMPs in this research occupied a wide range of roles and had diverse demographic characteristics. Relevant ethical approval was obtained before conducting this research. NMPs were motivated by their desire to feel safe, keep it simple and fit in with prescribing culture when prescribing. They also had a code of practice which underlined their rejection of some influences, such as patient pressure and logistical influences, and their acceptance of others, such as guidelines and formularies. The research found that the influences on NMPs' prescribing decisions can be best understood through identifying how and in what circumstances NMPs take responsibility for issuing prescriptions and making prescribing decisions. As well as providing insights into the training and support requirements of NMPs the findings of this research are important to others that may want to research the prescribing influences on NMPs in the future.

Yes / The role of non-medical prescribers working in palliative care has been expanding in recent years and prescribers report improvements in patient care, patient safety, better use of health professionals’ skills and more flexible team working. Despite this, there is a lack of empirical evidence to demonstrate its clinical and economic impact, limiting our understanding of the future role of non-medical prescribers within a healthcare system serving an increasing number of people with palliative care needs. We developed a unique methodology to establish the level of non-medical prescribers’ activity in palliative care across England and consider the likely overall contribution these prescribers are making at a national level in this context in relation to medical prescribing. All prescriptions for 10 core palliative care drugs prescribed by general practitioners, nurses and pharmacists in England and dispensed in the community between April 2011 and April 2015 were extracted from the Prescribing Analysis Cost Tool system. The data were broken down by prescriber and basic descriptive analysis of prescription frequencies by opioid, non-opioids and total prescriptions by year were undertaken. To evaluate the yearly growth of non-medical prescribers, the total number of prescriptions was compared by year for each prescribing group. Non-medical prescribers issued prescriptions rose by 28% per year compared to 9% in those issued by medical prescribers. Despite this, the annual growth in non-medical prescribers prescriptions was less than 1% a year in relation to total community palliative care prescribing activity in England. Impact on medical prescribing is therefore minimal.

Background: Hospital drug formularies are developed in order to support safe, effective and cost-effective prescribing. Their utilisation is based on the assumption that prescribers and other users will follow guidance outlined within them. The role of formulary users’ attitudes has been largely overlooked in the research literature. The nature and impact of attitudes to formularies on influencing prescribing practice have not been fully investigated. This study seeks to address this issue through a local practice based research project. Objectives: To determine the attitudes and experiences of users and key stakeholders with the utilisation of a new formulary at a local hospital trust. Methodology: Semi-structured interviews were conducted exploring the views of doctors, pharmacists and non-medical prescribers. An online self-completion questionnaire was sent to all key stakeholders. In addition prescribing data was also extracted from the Pharmacy computer system to assess impact of the new formulary. Data collection was thus split into two phases with modifications made to the formulary based on preliminary findings and emerging themes. Results: The local formulary symbolises a ‘critical split’ in the approach to resource management and patient care. Pharmacists are ‘closely bound’ to the formulary, relying on it for retrospective decision-support and ultimately seen to improve pharmacists’ autonomy while prescribers consider it to be over-rationalisation eroding their professional autonomy. Although the quantitative data in this study demonstrates a statistically significant improvement in doctors’ perceptions of using the formulary, the distinct divide between doctors’ and pharmacists’ attitudes towards the formulary remained. Prescribing data extracted showed no significant impact of the formulary on prescribing practice. Conclusion: The study confirms the existence of deeper sociological constructs, particularly concerning autonomy and professionalism. Doctors claim an ability to manage uncertainty during patient consultations while pharmacists claim to be drug ‘experts’. The monopoly on drug knowledge is therefore contested ground. This study concludes that both the formulary and the pharmacy profession need to be more influential, and embrace a more ‘humanised-bureaucracy.’ It is recommended that pharmacists build on a new philosophical union with the formulary and focus on asserting their claim and dominance on the monopoly of drug knowledge.

Purpose: The purpose of this study is to examine the adoption of e-prescribing by primary care physicians in the Cowichan Valley Community of Practice (COP) who use the same commercial EMR product (Med Access EMR) and to make suggestions on improving adoption. Methods: This study employed a multi-method study design to compare the ideal state of e-prescribing (i.e., the desired e-prescribing features in an EMR) with the possible state (i.e., what the EMR can offer) and the current state of e-prescribing (i.e., what physicians are actually using in practice).The ideal state of e-prescribing was determined using a literature search in MEDLINE, a personal collection, and reference mining.The possible state for e-prescribing was assessed by (1) reviewing the EMR user documentation and (2) reviewing provincial conformance specifications for EMRs (from Physician Information Technology Office (PITO)) and (3) interviewing an EMR vendor representative to confirm features. Based on this review, an e-prescribing assessment tool was then developed and piloted with physicians.The current state of e-prescribing was examined by interviewing physicians using the aforementioned e-prescribing assessment tool and an EMR Adoption Survey. A discussion group then took place to share the study findings and provide feedback on how to improve use of the EMR for prescribing. Results: For the ideal state of e-prescribing, 10 papers were included in the literature search as a part of the search strategy. In total, 104 e-prescribing features were identified in these papers relating to the following categories: patient Information, identification, and data access, current medications/medication history, medication selection, prescribing safety, patient education, monitoring, repeat (renewal) prescribing, computer-user interface, transparency and accountability, security and confidentiality, and interoperability and communication.For the possible state of e-prescribing, the EMR product met 27 of the 33 PITO e-prescribing requirements partially or fully, relating to the following PITO subcategories: generating prescriptions, processing prescriptions, transmitting prescriptions, viewing medications, managing renewals, drug formularies, interaction checking, medication profiles, and reference support. Data pertaining to the current state of e-prescribing adoption were collected from interviews with 12 primary care physicians who represent 17% of the total sample population. On average, the physicians reported using 75% (n=21.7/29) of the e-prescribing features available in the EMR. The e-prescribing features least used were “drug search by class”, “check for patient coverage”, “drug to procedure interaction checking”, and “use of drug monographs”. The average EMR Adoption score for physicians was 3.1 out of 5. A discussion group with six study participants was conducted to validate the findings of the current state and recommendations. Conclusions/ Recommendations: Recruited physicians from the Cowichan Valley COP are using most of the e-prescribing and EMR features available in the Med Access EMR. However, there are several gaps between the ideal, possible, and current state of e-prescribing. These gaps have been addressed through physician-level, policy-related, and technology-related recommendations to (1) help physicians improve use of the EMR for prescribing to achieve the possible state of e-prescribing and (2) guide vendor design and development of e-prescribing features in the EMR to achieve the ideal state of e-prescribing. / Graduate / 0723 / 0566 / 0984 / gurprit@uvic.ca

Yes / Medication errors involving insulin in hospital are common, and may be particularly problematic at the point of transfer of care. Our aim was to improve the safety of insulin prescribing on discharge from hospital using a continuous improvement methodology involving cycles of iterative change. A multidisciplinary project team formulated locally tailored insulin discharge prescribing guidance. After baseline data collection, three ‘plan-do-study-act’ cycles were undertaken over a 3-week period (September/ October 2018) to introduce the guidelines and improve the quality of discharge prescriptions from one diabetes ward at the hospital. Discharge prescriptions involving insulin from the ward during Monday to Friday of each week were examined, and their adherence to the guidance measured. After the introduction of the guidelines in the form of a poster, and later a checklist, the adherence to guidelines rose from an average of 50% to 99%. Qualitative data suggested that although it took pharmacists slightly longer to clinically verify discharge prescriptions, the interventions resulted in a clear and helpful reminder to help improve discharge quality for the benefit of patient safety. This project highlights that small iterative changes made by a multidisciplinary project team can result in improvement of insulin discharge prescription quality. The sustainability and scale of the intervention may be improved by its integration into the electronic prescribing system so that all users may access and refer to the guidance when prescribing insulin for patients at the point of discharge.