Benzodiazepine drugs in Australia: associated mortality and morbidity.

The use of benzodiazepine drugs in Australia results not only in widespread therapeutic benefits but also in harmful outcomes at both an individual and societal level. Accurate measurement of the level of harm has been precluded by a lack of robust data relating to the use of these drugs and to the resulting adverse consequences. This paper examines existing mortality and morbidity data, comments upon the available data sources and recommends areas where research is needed in order to clarify the relationship between the use of benzodiazepines and associated adverse effects.

Clinical trials in an Australian teaching hospital: problems and procedures.

Clinical trials conducted in Australia's hospitals need to satisfy certain scientific, technical, ethical and legal standards. Difficulties have been experienced in complying with these requirements. This paper defines problems encountered at the Queen Victoria Medical Centre and procedures adopted to overcome them.

Psychotropic drugs in Australia: consumption patterns.

This paper reviews studies of psychotropic drug use in Australia, analyses results from the Australian Health Surveys and compares the findings with those from other countries. It identifies subpopulations with high rates of drug use, which may consequently be at greater risk of drug-related harm. The levels of consumption of psychotropic agents in Australia were estimated from the results of studies conducted in community and institutional settings between 1970 and 1986. In the absence of more recent data national prevalence rates were derived from analysis of data provided by the Australian Health Surveys (AHS) of 1977-1978 and 1983-1984, and comparisons were made with rates available from other countries. While the prevalence of current and frequent use of drugs for nervous conditions was found to have decreased in most age groups over this period, it was consistently higher in females than in males, and increased with age. An analysis of the 1983-1984 AHS data revealed that the consumption of "medicines for nervous conditions" fell by 35% but that no change occurred in the prevalence of persons taking sleeping medicines. This fall appeared to occur in both rural and urban populations. Further analysis of data relating to the consumption of hypnotic agents revealed that changes occurred in the patterns of use within age and gender subgroups. Significant differences were observed between Australian States in consumption rates of sleeping medicines (chi 2 = 282.2; df = 7; P less than 0.01) and of medicines for nervous conditions (chi 2 = 289.7; df = 7; P less than 0.01). There were high rates of use of medicines for sleep in South Australia and of medicines for nervous conditions in Queensland. The prevalence of use of both drugs for sleep (rs = 0.71; P less than 0.05) and drugs for nervous conditions (rs = 0.77; P less than 0.05) was related to the rate of consultations with doctors. Preliminary surveys of various non-British subpopulations including Aborigines were inconclusive. These results have implications for reducing the harm associated with the use of psychotropic agents, particularly hypnotics and drugs for nervous conditions, in Australia.

Drug bulletins: effectiveness in modifying prescribing and methods of improving impact.

Little research has been conducted into the impact of drug bulletins in modifying prescribing and containing costs. The authors review published reports of bulletin effectiveness in institutional and community settings, pointing out the apparent enhanced usefulness of drug bulletins combined with other informational strategies and products. They offer guidelines for boosting bulletin effectiveness through content and design of decisions.

Improving patient care and pharmacy management: the effect of hospital formularies.

A study of the organizational features and implementation procedures associated with formulary use in major acute-care hospitals throughout Australia was undertaken. Data were collected via a questionnaire mailed to 57 directors of pharmacy. An 86-percent response was obtained. A high proportion of formularies was found to rate poorly in terms of organizational features (e.g., content, compilation methods, format) and process variables (e.g., effectiveness as a communication document, prescribing aid, or management tool). Methods of improving formulary effectiveness are outlined in the context of practical and normative research, including improving the quality of drug therapy, use of formularies in cost control, and improving user acceptance. The results confirm previous research showing that methods of improving organizational features and implementation procedures associated with formulary compilation and use are neither widely applied nor widely known. There is an urgent need to reassess the usefulness of formularies and improve their effectiveness by adopting recommendations resulting from past research.

Trends in licit opioid use in Australia, 1984-1998: comparative analysis of international and jurisdictional data.

OBJECTIVES: To examine trends from 1984 to 1998 in licit opioids used in Australia compared with nine other developed countries, and in New South Wales compared with other Australian jurisdictions. DESIGN: Poisson regression analysis of annual rates of national and jurisdictional consumption of methadone, morphine and pethidine. MAIN OUTCOME MEASURES: All drug data were standardised to defined daily doses per 1000 population per day. RESULTS: Methadone consumption increased by, on average, 12% per year (RR, 1.12; 95% CI, 1.08-1.17), with Australia in the first rank of countries. Morphine use increased by 5% per year (RR, 1.05; 95% CI, 1.02-1.09), with Australia ranking equal second with three other countries behind Denmark. Consumption of pethidine in all 10 countries was unchanged (RR, 0.99; 95% CI, 0.97-1.00), with Australia equal first. In Australia, use of methadone syrup increased by 17% per year (RR, 1.17; 95% CI, 1.16-1.17) and by 11% per year for methadone tablets (RR, 1.11; 95% CI, 1.10-1.12). Consumption of methadone syrup in NSW was more than double that of any other jurisdiction. Consumption of methadone tablets was 2.4 times higher in South Australia (RR, 2.35; 95% CI, 2.09-2.65) than NSW. The Northern Territory, Tasmania and Queensland also had significantly higher consumption than NSW. From 1991 to 1998, controlled-release morphine consumption increased by 27% per year nationally (RR, 1.27; 95% CI, 1.24-1.30). The NT had 2.6 times more supply of morphine (RR, 2.63; 95% CI, 1.71-4.03) and Tasmania 58% more supply than NSW (RR, 1.58; 95% CI, 1.11-2.25). CONCLUSIONS: Australia's consumption of licit opioids ranked high internationally. There were diverse trends in the supply of licit opioids to Australia's jurisdictions, resulting in a heterogeneous pattern throughout the country.

Standards of antimicrobial prescribing for prophylaxis in selected surgical operations: A study conducted in a teaching hospital.

A study of the prescribing habits of the surgeons of Fremantle Hospital for antimicrobial prophylaxis was conducted in the period from July to October, 1979. In selected operations, an assessment of use was made according to generally accepted principles of prophylaxis. In 109 "clean" surgical operations and in 38 cholecystectomies, antimicrobial agents were rarely used for prophylaxis. It was concluded that there was no overusage of prophylactic antimicrobial agents in surgery. In 58 operations on the appendix and large bowel, it was found that administration of the antimicrobial agents was started either too late or the choice of agent was illogical in 15 cases. In 12 total hip replacements, the prescribing was satisfactory, but, in 21 Richards' pin-and-plate operations and in 35 minor orthopaedic implants, prophylaxis was continued for longer than 48 hours in 33 of 41 courses of therapy. The mean duration of a course was 6.5 days for pin-and plate and 6.7 days for minor implants. In only seven of 30 hysterectomies were patients covered for Bacteroides fragilis infection at the time of operation, the mean duration of a course was 5.5 days. It is suggested that a reduction in costs and increase in quality of care are most likely to be achieved by surgical teams adopting a protocol in operations where prophylaxis is of proven value.

Quality assurance of drug therapy in hospitals: patient serum creatinine values used by ward pharmacists in checking dosage regimens.

A programme for the systematic adjustment of drug dosage in hospital patients with impairment of renal function is described. This programme involves the efficient identification of patients with elevated serum levels of creatinine, the checking of dosage regimens for these patients in terms of known pharmacokinetic data, and advising of medical officers when dosage regimens are in excess of those recommended, or where contraindicated drugs have been prescribed. The procedure, which has been shown to be both workable and effective in a large teaching hospital over a period of more than two years, serves as a model for quality assurance of an aspect of drug treatment with existing staff and with no additional capital costs.

Impact of a drug bulletin on prescribing oral analgesics in a teaching hospital.

The impact of a drug bulletin on prescribing oral analgesics in a teaching hospital was studied. Using an abbreviated time-series design, prescriptions for oral analgesics for all inpatients were surveyed one, three, and five weeks before and one, three, five, and seven weeks after the distribution of one of the hospital's regular drug bulletins. This bulletin contained guidelines for the treatment of minor, moderate, and severe pain. The 493 patients included in the study were classified by drug category, pain severity, and timer period. The drug categories were: (1) propoxyphene, (2) aspirin or acetaminophen alone or with codeine 8 mg or less, and (3) codeine alone or in combination products with more than codeine 8 mg, or other oral narcotic drugs. Each patient's pain severity was determined by interviewing attendant nursing staff; the validity of this approach was confirmed by correlating nurse and physician perception of pain at one time point. Multivariate contingency table analysis revealed that the drug bulletin significantly (p less than or equal to 0.05) reduced the prescribing of propoxyphene hydrochloride across both the minor and moderate pain categories. An increased use of aspirin and acetaminophen was significant three weeks after the release of the drug bulletin. This effect, however, was not significant at other time points. Drug bulletins can be used to achieve a temporary change in physician prescribing patterns of oral analgesics. For a sustained effect, alternative strategies are needed.