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1.
Pharmacoepidemiol Drug Saf ; 18(1): 36-43, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19040199

RESUMO

PURPOSE: Doctor-shopping (simultaneous use of several physicians by a patient) is one of the most frequent ways of diversion for prescription drugs. A specific method was used to assess the evolution of doctor-shopping for High Dosage Buprenorphine (HDB) in a French region from 2000 to 2005 and the impact of a prescription monitoring program for HDB implemented in 2004. METHODS: Data from eight periods (semesters of years 2000, 2002, 2004, and 2005) were extracted from a prescription database. Three quantities (the delivered, the prescribed, and the doctor-shopping quantity) were computed for each patient. The total doctor-shopping quantity and the doctor-shopping ratio (percentage of buprenorphine obtained through doctor-shopping) were used to evaluate the diversion of HDB among the population. The total prescribed quantity and the number of patients treated regularly were used as indicators of the access to treatment. RESULTS: The doctor-shopping ratio increased from 1st semester 2000 to 1st semester 2004 (from 14.9 to 21.7%) and then decreased to 16.9% in 2nd semester 2005. The total doctor-shopping quantity followed the same evolution. The number of patients treated remained stable from 1st semester 2000 to 2nd semester 2005. The prescribed quantity increased from 1st semester 2000 to 2nd semester 2002, decreased in 1st semester 2004 (4163 g) and then remained stable. CONCLUSIONS: After a four-year increase of the diversion through doctor-shopping for buprenorphine the beginning of the prescription monitoring program was concomitant with a marked decrease of doctor-shopping indicators without notable impact on the access to treatment.


Assuntos
Buprenorfina/administração & dosagem , Entorpecentes/administração & dosagem , Padrões de Prática Médica/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Buprenorfina/efeitos adversos , Bases de Dados Factuais , França/epidemiologia , Acessibilidade aos Serviços de Saúde/normas , Humanos , Entorpecentes/efeitos adversos , Relações Médico-Paciente , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
2.
Addict Behav ; 30(1): 187-91, 2005 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-15561460

RESUMO

In France, since 1996, any general practitioner (GP) can prescribe high-dosage buprenorphine maintenance treatment (BMT) for opioid-dependent patients. The health authorities initially provided mandatory specific training, but since 1998, such training is only delivered by specialized networks and the pharmaceutical industry. Among a random sample of GPs from southeastern France (N=345), we found that many untrained GPs, as well as a significant minority of trained GPs, were likely to prescribe an ineffective dosage of buprenorphine or a potentially dangerous treatment (BMT+a short half-life benzodiazepine). These results highlight the necessity to edit clear guidelines, especially concerning situations of polyaddiction and psychiatric comorbidity, and to extend and improve BMT training in France with a renewed involvement of health authorities for quality control of such training. They even suggest that GPs' participation to specialized training sessions should become a mandatory prerequisite for prescribing BMT.


Assuntos
Buprenorfina/administração & dosagem , Educação Médica Continuada/normas , Medicina de Família e Comunidade/educação , Transtornos Relacionados ao Uso de Opioides/reabilitação , Adulto , Atitude do Pessoal de Saúde , Prescrições de Medicamentos/normas , Feminino , França , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Médicos de Família/psicologia , Guias de Prática Clínica como Assunto , Receptores Opioides mu/agonistas , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Inquéritos e Questionários
3.
J Addict Dis ; 24(3): 7-22, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16186080

RESUMO

This study investigated attitudes toward buprenorphine maintenance treatment (BMT) among general practitioners (GPs) and their maintained patients' propensity to turn to several prescribers (doctor shopping), among a sample of 345 GPs prescribing BMT in South-Eastern France. Survey data were anonymously matched to administrative data that provided information about GPs' patients. A simultaneous equation model suggests that GPs' attitude influenced doctor shopping, not the reverse. Doctor shopping was lower among GPs who reported inducting BMT with 8 mg of buprenorphine per day or more, and was higher for GPs endorsing a stringent attitude toward patients. Thus doctor shopping should not be understood exclusively as a deviant behaviour. It is partially physician-driven, and further research is needed to assess whether it reflects patients' dissatisfaction toward inappropriate care supply and the difficulty to establish a good therapeutic relationship between an opiate-dependent patient and a general practitioner.


Assuntos
Atitude do Pessoal de Saúde , Buprenorfina , Prescrições de Medicamentos/estatística & dados numéricos , Antagonistas de Entorpecentes , Médicos de Família/psicologia , Encaminhamento e Consulta/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Buprenorfina/uso terapêutico , Análise por Conglomerados , Estudos Transversais , Feminino , França , Humanos , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Antagonistas de Entorpecentes/uso terapêutico , Relações Médico-Paciente , Médicos de Família/estatística & dados numéricos , Medição de Risco/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/psicologia
4.
Pharmacoepidemiol Drug Saf ; 15(7): 494-503, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16700077

RESUMO

PURPOSE: This study proposes to complete declarative studies by describing the prescriptions of anxiolytics, hypnotics, and antidepressants dispensed to adolescents in a French region in 2002. METHODS: This cross-sectional study analyzes all the hypnotic, anxiolytic, and antidepressant prescriptions (ATC codes beginning with N05B, N05C, and N06A, respectively) sent by adolescents (aged 13-17 years) to the French Health Insurance system of the study region for reimbursement during one year (2002). It was performed in a southern France area with 120,908 adolescents covered by this insurance scheme. Adverse drug reactions (ADRs) recorded in the Pharmacovigilance database were also studied. RESULTS: Three thousand two hundred and eighty-six adolescents (2.7% of adolescent population) had at least one prescription of the studied drugs. This prevalence increased with age and female sex, leading to a maximum of 6.3% for the 17-year-old girls. Two thousand four hundred and thirty-one of adolescents were dispensed anxiolytics, 935 antidepressants, and 548 hypnotics. The most dispensed drugs were zolpidem, zopiclone, and niaprazine for hypnotics; hydroxyzine, etifoxine, and bromazepam for anxiolytics; and paroxetine, sertraline, and fluoxetine for antidepressants. Zolpidem, hydroxyzine, and paroxetine accounted, respectively, for 82.9%, 57.1%, and 59.8% of the prescriptions. 75.5% of hypnotics users had only one prescription, 77.4% for anxiolytics, and 57.4% for antidepressants. Three ADRs were reported. CONCLUSIONS: This study confirms the large use of psychotropics in French adolescents and the influence of age and sex. Also, the results underline treatment for most adolescents is short, which may be beneficial for hypnotics and anxiolytics but not for antidepressants.


Assuntos
Ansiolíticos/uso terapêutico , Antidepressivos/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Adolescente , Sistemas de Notificação de Reações Adversas a Medicamentos , Ansiolíticos/efeitos adversos , Antidepressivos/efeitos adversos , Estudos Transversais , Prescrições de Medicamentos , Uso de Medicamentos , Feminino , França , Humanos , Hipnóticos e Sedativos/efeitos adversos , Masculino , Estações do Ano , Fatores de Tempo
5.
Pharmacoepidemiol Drug Saf ; 13(7): 473-81, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15269931

RESUMO

PURPOSE: To assess the extent of doctor-shopping for buprenorphine maintenance therapy in a French region with a specific indicator. METHODS: Use of a quasi-exhaustive prescription database in a French region (information system of the French General Health Insurance Scheme). Extraction of all buprenorphine prescriptions between September 1999 and December 2000. Definition and calculation of three quantities for each patient: delivered, prescribed and doctor-shopping quantity. The calculation of these three quantities is done by an automated and reproducible method determining the overlaps in prescription periods of different physicians for a given patient. Calculation of the corresponding daily dose was done for each quantity. RESULTS: A total of 64 326 prescriptions of buprenorphine by 1313 physicians to 3259 patients were extracted. Quantities and doses were calculated for 2587 patients. The total doctor-shopping quantity represented 18.6% of the delivered quantity. Doctor-shopping involved a minority of patients and was highly concentrated: 87 patients with doctor-shopping doses superior to 16 mg/day were responsible for 45.4% of the total doctor-shopping quantity. CONCLUSIONS: Doctor-shopping appears to be an important problem for buprenorphine maintenance treatment in France but may be resolved by regulatory interventions. The use of adequate indicators on prescription databases may help to limit the effects of such interventions on legitimate care. The method presented here may be used with slight adaptations for other medications to assess their abuse potential.


Assuntos
Buprenorfina/administração & dosagem , Entorpecentes/administração & dosagem , Programas Nacionais de Saúde/organização & administração , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Bases de Dados Factuais , França/epidemiologia , Humanos , Padrões de Prática Médica , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
6.
Ann Med Interne (Paris) ; 154 Spec No 1: S7-14, 2003 Jun.
Artigo em Francês | MEDLINE | ID: mdl-12910029

RESUMO

Several reports have focused on prescription of high-dose buprenorphine using data electronically transmitted to the French health reimbursement system. This study deals with high-dose buprenorphine prescriptions in the Bouches-du-Rhone region between 1999 and 2001. We determined the number of maintained patients followed by practitioners (either short- or long-term care), the doses administered, and the associated prescription of psychotropic treatments. The number of general practitioners involved in 84% of the prescriptions of high-dose buprenorphine grew with a high turnover (20%). More than 25% of the general practitioners in the region prescribed this drug, but only 38% of them were involved in long-term follow-up of more than one maintained patient. The number of maintained patients and the mean daily treatment dose delivered (13.4 mg/d during 2001) increased. The associated prescriptions of benzodiazepines concerned 47% of the patients during 2001 (on the rise), but the associated prescription of flunitrazepam tended to decrease (29% of the subjects during 2001 versus 32% during 2000). This study shows a tendency for deviant behaviors to increase, constituting a public health concern.


Assuntos
Buprenorfina/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Antagonistas de Entorpecentes/uso terapêutico , Adulto , Algoritmos , Buprenorfina/efeitos adversos , Feminino , França , Humanos , Masculino , Antagonistas de Entorpecentes/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Estudos Retrospectivos , Estatísticas não Paramétricas
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