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Abstract Non-benzodiazepine drugs such as zopiclone and zolpidem are alternatives to treatment of insomnia, but are recommended only for short-term treatment. The objectives of the study were to evaluate the prescribing patterns and usage of these drugs. Method: Data was collected from Clicks Rosebank Pharmacy. One hundred (100) patients presenting with prescriptions for either zolpidem or zopiclone were followed over a period of seven months and data was collected regarding: demographic characteristics of patients; drug and dose distribution; ICD10 codes; prescriber characteristics; period of use; and whether use was continuous or as needed (uninterrupted or interrupted). All data was collected from the Unisolv computer system. Over a period of one year, total prescriptions received for all drugs were compared to the total number of zopiclone/zolpidem prescriptions received to gauge whether there was any seasonal variation in hypnotic use. Results: In each age group, excluding 20 years and below, the number of females was greater than males. The mean age of all patients between the ages of 21 and 80 years was 53.1 years. Out of 100 patients, 85 (85%), used either zolpidem 10mg or zopiclone 7.5mg, which are the standard doses. The most common ICD 10 code observed was G47.0, Disorders of initiating and maintaining sleep [insomnias], occurring in 52 (52%) of 100 prescriptions. Of the 100 initial prescriptions, 68 (68%) were prescribed by General Practitioners, while 32 (32%) were prescribed by Specialists. Thirty of the 100 patients (30%) used one of the drugs for the full seven months; twenty two patients (22%) used one of the drugs for a period of one month or less; and the remaining 48 patients (48%) used a hypnotic for a total of two to six months. The number of patients who used a hypnotic in an interrupted manner, with each period of use of one month or less duration, was 34 (34%). The number of patients who used a hypnotic for at least one uninterrupted period of more than 1 month s duration was 66 (66%). Over a period of 12 months, prescriptions for either zolpidem or zopiclone represented 3.17% of total prescriptions. There was no significant seasonal fluctuation in hypnotic use. Conclusion: The majority of patients used one of the two hypnotics in an uninterrupted manner, and over a long term as well. Despite numerous cautions in the literature, these medications are still being prescribed and used in a manner contrary to existing guidelines.

In recent years health care personnel have seen changes to their roles and responsibilities. A number of reports both from within the occupation and from government have recommended changes in the roles of community pharmacists so that they become more active in the provision of health care. The new roles and services suggested have become known as "extended roles" and include health promotion, treatment of minor ailments, provision of advice on prescribed medicines to the public and to other health care personnel. The aim of this study was to investigate the factors affecting the extended roles of the community pharmacist. The investigation initially took an exploratory approach and used unstructured interviews with pharmacists to ascertain influences on every day practice which could have implications on implementation of extended roles. The findings from the initial qualitative stage were incorporated into a national survey of community pharmacists. A number of interrelated factors were found to be important including work practices, financial considerations, people's expectations, relationships with GPs and pharmacists' own definitions of their roles. These findings are explained in terms of the progressive division of labour in the market for the provision of health care. Recommendations are made for extending the role of the community pharmacist

Class of 2014 Abstract / Specific Aims: The aim of this study was to examine the appropriateness of antibiotic use in the first 48 hours of being admitted to the emergency department in a tertiary care medical center. The purpose was to identify inappropriate usage patterns of antibiotics to limit future misuse and prevent the unintended consequences of overuse of antibiotics. Methods: Patients 18 years and older who were admitted to the emergency department at University of Arizona Medical Center – University Campus who were administered imipenem within 48 hours of admission were included. All antibiotics received by included patient were recorded and assessed for appropriateness by two pharmacists with specialized infectious disease training. Inappropriate use of carbapenems or other antibiotics in conjunction with carbapenems was identified and the acquisition cost of the misused antibiotics was calculated. Main Results: Imipenem use was considered inappropriate in 35/52 (71.1%) of patients included in this study. The direct cost of inappropriate antibiotic prescribing was $914.77. Multiple β-lactam antibiotics were used in 24/52 (46.1%) patients while 18/52 (34.6%) of patients received four or more antibiotics within the first 48 hours of admission. Conclusion: Imipenem was frequently used empirically for in cases did not fit the predetermined criteria of use within 48 hours of admission emergency department of the University of Arizona Medical Center – University Campus, resulting in unnecessary direct costs to the medical center.

No / Background: Non-medical prescribing is well established within the British health service, with increasing numbers of nurses practicing within children’s hospices. Aim: To identify the context of non-medical prescribing in children’s hospices in the UK, focusing on the perceived benefits and challenges. Method: Internet-based questionnaires were sent to 55 UK children’s hospices, exploring the practice and context of prescribing. Results: Of the 55 invited, 20 children’s hospices responded to the questionnaire, 14 of which employed a total of 39 non-medical prescribers (NMPs). Sixteen individual NMPs responded, of which half (50%) prescribed to enable the continuation of existing medicines, 37.5% prescribed independently surrounding symptom management and control and 31.3% in end-of-life care. Perceived benefits of prescribing included timely access to medicines, increased efficiency and accuracy in the admissions process and medicine reconciliation and the increased ability to offer choice in the place of palliative and hospice care. Perceived barriers to prescribing surrounded opportunities to develop confidence, defining the scope of practice and the time required to assess, diagnose and treat. Conclusion: NMPs are making a significant contribution to the prescribing workforce within hospices; however, a number of challenges need to be addressed to enable hospices to realise the benefits.

Florida is one of two states that do not allow ARNPs to prescribe controlled substances. The Florida Legislature has expressed concern regarding the safety of ARNPs prescribing controlled substances. The purpose of this study was to compare malpractice rates of ARNPs and physicians in states with and without controlled substance prescribing. The design was a direct comparison of malpractice rates in states with and without ARNP controlled substance prescriptive authority. Comparison of malpractice claims was made between physicians (MDs and DOs collectively) and ARNPs in the United States and by state ARNP prescribing authority. Comparison of malpractice claims was also made between Florida and states that were demographically similar. The results showed that ARNPs have significantly less malpractice than physicians in the United States. In addition, there were no significant differences in malpractice, whether or not the ARNP was allowed to prescribe controlled substances. Finally, ARNPs working in states that are demographically similar to Florida, but allowed to prescribe controlled substances had no significant increase in malpractice. This study showed that there is no increase in malpractice rates in states where ARNPs prescribe controlled substances, either fully or partially, supporting the hypothesis.

Independent and supplementary prescribing are the two main forms of non-medical prescribing (NMP) that have been practised in the UK since 2006. Most available studies have qualitatively investigated the impact of NMP, especially in primary care. This may be due to the fact that prescriptions are issued mainly by general practitioners in primary care. This PhD thesis aimed at investigating the clinical effectiveness of independent pharmacist and diabetes specialist nurse (DSN) prescribers in the management of patients with type 2 diabetes at outpatient clinics in hospitals. A literature review was firstly conducted to explore the current research on NMP around the world and the UK. A systematic review of the previously published randomised control trials (RCT) and non-RCT studies that focused on prescribing interventions of nurses and pharmacist was also conducted to explore the impact of their prescribing interventions in treating type 2 diabetes using HbA1c level as the primary outcome. A programme of work of three retrospective comparative database analytical studies was then carried out to investigate the impact of independent NMPs in type 2 diabetes care. This programme of work used electronic medical records of patients attending outpatient clinics of diabetes centres in two teaching hospitals in Manchester; one employed an independent pharmacist and the other employed DSN prescribers. A group of subjects seen by an NMP in place of a doctor during the study period were the study group and the control group were those who seen only by doctors. The primary outcome was the average yearly change of HbA1c amongst the two groups. Secondary outcomes were yearly change of total cholesterol, blood pressure and serum creatinine as well as body mass index. Five statistical models, which included multivariable regression, propensity score matching and sensitivity analyses, were utilised to control for confounding effects, and the nature of selection bias in the retrospectively comparative effectiveness research using secondary database resources. A total of 330 patients seen by a team including a pharmacist versus 975 by doctors only between January 2006 and January 2013 at one site; and 656 by a team including DSNs versus 3,746 patients seen by doctors only between January 2007 to December 2013 at the other. The studies found both prescribing pharmacists and DSNs are capable of achieving at least non-inferior improvements in diabetes outcome compared to doctors. The pharmacist achieved a mean 0.01% reduction in HbA1c level versus doctors who achieved slight increase (p<0.4). DSNs also achieved a mean 0.07% reduction compared to doctors. However, after adjustment with multivariate and propensity score as well as with propensity score matching, there were no significant differences between the two groups. These findings were consistent with the findings in the systemic review. Although an RCT is the only method that by definition would produce unbiased treatment effects, the use of propensity score methods here, have reduced the potential for bias that may remain unaccounted for in multivariate models without propensity scores. Adjusting for propensity scores using two different methods also gives more confidence that the results are as unbiased as possible. Nonetheless, caution in generalising the results is necessary because of the retrospective nature of the studies and deficiencies in the database used.

The objectives of this study were to investigate the hypotheses that: (1) Job satisfaction is related to medical specialty, the physician's nationality, and length of tenure. (2) The physician's attitude toward the Drug Utilization Review (DUR) program is related to medical specialty, the place of residency training, length of tenure, and job satisfaction. (3) The quality of drug prescribing is related to medical specialty, the place of residency training, length of tenure, job satisfaction, and the physician's attitude toward the DUR program. The results indicated a significant relationship between the physician's nationality and job satisfaction (P = 0.001), and between job satisfaction and the physician's attitude toward the DUR program (P 0.001). Medical specialty was a strong independent predictor of the quality of drug prescribing (P = 0.002). However, the other independent variables of the locale of residency training, length of tenure, job satisfaction, and the physician's attitude toward the DUR program were not related to drug prescribing.

No description available.