Drug utilization review on high blood pressure and diabetes mellitus in St. Vincent and the Grenadines - abstract

The Eastern Caribbean Drug Service (ECDS) conducted a Drug Utilization Review (DUR) of patients with hypertension and diabetes mellitus in St. Vincent and the Grenadines between August, 1993 and August, 1994. The goal of this study was to assess prescribing practices and initiate appropriate education intervention aimed at enhancing prescribing behaviour. One thousand and sixty-two (1062) prescriptions were collected from both public and private sector pharmacies on a patient quota basis. Four (4) times as many patients were treated with antihypertensives (66 percent) as were treated with antidiabetics (15 percent), while 18 percent of subjects were treated with both. The most commonly used anti-hypertensive drug, bendrofluazide, was most often prescribed at the conventional 5 mg daily dose; however, almost one-third of prescriptions were for the recommended daily dose of 2.5 mg. Methyldopa and chlorpropamide were often used in higher than recommended doses. Few drug incompatibles were documented, as evidenced by the occasional concomitant use of two (2) sulphonylureas. Physicians in St. Vincent appeared to be very conservative in their drug choices and are moving towards currently recommended low doses. They also appear to be cost-conscious, for very few of the newer, higher-cost drugs were used, even in private practice. Significant cost savings could, however, be realised by educating patients in the multiple use of insulin syringes (AU)

Drug utilization review on high blood pressure and diabetes mellitus in St. Lucia - abstract

During a three-month period in 1991, the Eastern Caribbean Drug Service conducted a drug utilization review of hypertension and diabetes mellitus in St. Lucia. The survey was designe to assess the prescribing trends of drugs for these two highly prevalent diseases with emphasis on ther resulting medical and financial consequences. This prospective study utilized a quota sampling technique whereby an equal number of prescriptions were drawn from selected private and public clinics. One thousand, four hundred and eighteen prescriptions were collected. The percentage of women (68.3 percent) treated was more than double that of the men (31.7 percent). Seventy-three per cent (73 percent) of patient visits were for the treatment of hypertension, while the remaining twenty-seven per cent (27 percent) were for diabetes mellitus. As many as 10.4 percent of all prescriptions were for patients with co-existing hypertension and diabetes mellitus. The most commonly prescribed anti-hypertensive drug was bendrofluazide, which is inexpensive and highly effective in black populations. However, the traditional daily dose of 5 mg or more was usually given rather than the current recommended lower dose of 2.5 mg. Chlorpropamide was the most frequently prescribed hypoglycaemic agent (50 percent). It was surprising that metformin, useful in the treatment of obese diabetics, accounted for only 4 percent of all diabetic prescriptions. For a population of only 140,000, the Government issued 130,000 insulin syringes. The Ministry of Health could realise significant savings if patients who self-administer insulin reuse the syringe, and by conducting sharing the cost of health care with the private sector (AU)

Drug prescribing for diabetes mellitus in primary care: a comparison of public and private practice in three Caribbean countries - abstract

Examining the appropriateness of drug prescribing for people with diabetes mellitus in Caribbean countries is important because of the high cost of drug treatment, the potential for improved control of the disease and the possibility of reducing adverse side effects of treatment. This study examined patterns of drug prescribing for diabetes mellitus in public and private sector primary care settings in three Caribbean countries. The sample included 690 patients in Barbados (BDS, 24 percent private), 791 in Trinidad and Tobago (TT, 13 percent private) and 180 in Tortola (BVI, 31 percent private). Patients treated in public health care facilities were prescribed significantly more drugs than those treated in private practice. Few patients had diabetes mellitus managed by diet alone (8 percent public, 15 percent private). Metformin was rarely used as single agent therapy (3 percent public, 6 percent private). Most patients were treated with sulfonylurea drugs alone or in combination with metformin (75 percent public, 67 percent). The proportion of sulfonylurea prescriptions for chlorpropamide varied (Public: BVI 80 percent, TT 60 percent, BDS 10 percent; Private: BVI 41 percent, TT 28 percent, BDS 7 percent) as did prescriptions for gliclazide and glipizide (Public: BDS 41 percent, BVI 3 percent, TT 1 percent; Private: BVI 51 percent, BDS 46 percent, TT 19 percent). A high proportion of patients were treated for hypertension (public 49 percent, private 40 percent). In private practice, ACE inhibitors and diuretics were the most frequently prescribed drugs. In the public sector, Brinderin accounted for 53 percent of prescriptions in TT while thiazides, methyldopa, betablockers and ACE inhibitors were the most frequently prescribed drugs in BDS and BVI. These variations in prescribing practice among countries of the region suggest that factors other than patients' needs or the cost effectiveness of treatment are important in determining prescribing practices. Individual countries should examine how efficiency and effectiveness of drug use could be improved (AU)

Inappropriate secretion of antidiuretic hormone induced by chlorpropamide

A patient with diabetes mellitus treated with the sulfonylurea chlorpropamide developed the syndrome of inappropriate secretion of antidiuretic hormone. The mode of clinical presentation was one suggesting a central nervous system disorder. A clinical study of the patient's response to chlorpropamide was carried out. Headache, systolic hypertension, serum hypo-osmality, hyponatremia, urine hyperosmolality, fall in urinary output and continued renal excretion of sodium were demonstrated, confirming the initial diagnosis (AU)