Drug therapy for ambulatory pediatric patients in 1979.

Little data are available on the use of drugs in children on an outpatient basis. Therefore, the present study investigated national patterns in the prescribing of drugs for children by office-based physicians during 1979, in order to describe the most commonly encountered pediatric drug therapies. The data are presented as descriptive norms of drug therapy by office-based physicians in two pediatric subgroups, 0 to 2 years old and 3 to 9 years old. Anti-infective drugs and cough and cold preparations accounted for approximately 50% of drugs used. Tetracycline and its congeners continue to be used in pediatric patients. Despite apparent advantages of amoxicillin, ampicillin is still widely used.

Noncontraceptive estrogens and progestins: use patterns over time.

The use of noncontraceptive estrogens and progestins, particularly in menopausal women, has been a subject of considerable controversy during the past decade. Reported is a review of overall trends in the use of these drugs from 1966 to 1983 and a more indepth qualitative and quantitative description of their use during 1983. The use of these estrogens and progestins appears to be increasing again. The estrogens are apparently being used at lower doses than in the past, and there is a trend toward using estrogens and progestins concomitantly. Exclusive of oral contraceptives, enough oral estrogen was purchased during 1983 to treat an average of 2.3 million people each day, while oral progestin purchases could have supplied 129,000 people daily.

Utilization of nonsteroidal antiinflammatory drugs.

Information derived from pharmaceutical marketing databases on the use of 12 nonsteroidal antiinflammatory drugs in 1983 is presented. Estimates of population exposure, regularity of treatment, average daily dose, age and sex distributions of users, concomitant use of other drugs, associated diagnoses, and trends in use are provided. Utilization patterns were similar for 8 of the nonsteroidal antiinflammatory drugs, with differing patterns seen for mefenamic acid, oxyphenbutazone, phenylbutazone, and zomepirac.

Need for uniform data elements in hospital drug use review.

The need of a nationwide system of drug use review (DUR) in hospitals is discussed. Many drugs important in terms of both potential adverse effects and cost (e.g., aminoglycosides and heparin) are used primarily in hospitals, a setting for which nationwide data on key elements of use and prescribing are not available. A main problem is one of logistics, stemming primarily from a lack of uniformity in how drug information is recorded. Since data collection and organization are pivotal prerequisites for drug use review, there is a need for standardization in data collection if data from various institutions are to be compared. Uniform data elements are proposed that would allow for national tabulations and estimates, which could provide the normative data critical to both drug use review and drug epidemiology.

Drug use and expenditures in 1982.

This article provides national estimates of drug use and drug expenditures in 1982. Total outpatient drug exposure increased 5% from 1981 to 1982 and 28% from 1971 to 1982. Hydrochlorothiazide was the most frequently dispensed drug chemical and was contained in more than 5% of all 1982 prescriptions. Sixteen major therapeutic classes accounted for about 80% of drugstore and hospital expenditures for ethical pharmaceuticals. Hospitals spent around +3.0 billion and a third of this total was for anti-infectives administered for systemic effects. The prescription drug component of the consumer price index increased 11.7% in 1982, and consumers spent about +14.5 billion on prescriptions from retail pharmacies alone.

Drug use in the United States in 1981.

This study provides national estimates of outpatient prescription drug use based on pharmaceutical marketing data. An analysis of total outpatient exposure from 1971 through 1981, generated from data on population and prescription size as well as total prescriptions, indicated that overall drug use is increasing. Overall use was also analyzed by patient age and sex, geographic region, and physician specialty. Data are presented for the most frequently used drug categories and therapeutic classes. Ranking drug chemicals across different products and therapeutic indications, which is a more precise measure of population exposure, indicated that nearly one of every ten prescriptions in 1981 contained either hydrochlorothiazide or codeine.

Low cost, manual drug use review of Medicaid recipients to screen prescriber and pharmacist performance.

A manual drug use review (DUR) methodology to screen outpatient prescribing which would meet the needs of large third-party programs that cannot afford elaborate computerized DUR was developed and pilot tested. A Medicaid drugs data base was used for the pilot test. A probability sample of 100 recipients over a three-month period was selected for the DUR. The drugs for each recipient, listed by their generic composition and amount, were recorded. Then a priori, explicit, screening criteria were developed for these generics. These criteria delineated drugs of choice, daily dose and refill patterns and, as appropriate, therapy length, drug holidays, and disease-drug and drug-drug interactions. Only 11% of recipients had prescribing patterns which passed all the screens. The most frequent screening failure was due to the prescribing of a drug which was not a drug of choice. In nearly all of the cases which failed the other screens, an alert pharmacist with patient records should have noticed these problems. An analysis showed that the initial start-up cost for the manual DUR was estimated at $1053 (not including personnel fringe benefits); for subsequent quarterly review, the cost was estimated to be about $530. The project showed that manual DUR can effectively and efficiently screen prescribing in a large third-party program.