Prescription and Other Medication Use in Pregnancy.

OBJECTIVE: To characterize prescription and other medication use in a geographically and ethnically diverse cohort of women in their first pregnancy. METHODS: In a prospective, longitudinal cohort study of nulliparous women followed through pregnancy from the first trimester, medication use was chronicled longitudinally throughout pregnancy. Structured questions and aids were used to capture all medications taken as well as reasons they were taken. Total counts of all medications taken including number in each category and class were captured. Additionally, reasons the medications were taken were recorded. Trends in medications taken across pregnancy and in the first trimester were determined. RESULTS: Of the 9,546 study participants, 9,272 (97.1%) women took at least one medication during pregnancy with 9,139 (95.7%) taking a medication in the first trimester. Polypharmacy, defined as taking at least five medications, occurred in 2,915 (30.5%) women. Excluding vitamins, supplements, and vaccines, 73.4% of women took a medication during pregnancy with 55.1% taking one in the first trimester. The categories of drugs taken in pregnancy and in the first trimester include the following: gastrointestinal or antiemetic agents (34.3%, 19.5%), antibiotics (25.5%, 12.6%), and analgesics (23.7%, 15.6%, which includes 3.6%; 1.4% taking an opioid pain medication). CONCLUSION: In this geographically and ethnically diverse cohort of nulliparous pregnant women, medication use was nearly universal and polypharmacy was common. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT01322529.

Use of injectable drugs with oral-formulation alternatives for outpatients in South Korea.

This study analyzed the use of injectable drugs with oral-formulation alternatives in the outpatient setting in South Korea. We conducted a retrospective cross-sectional data analysis using 2008 National Health Insurance claims data. All active ingredients were categorized into dual-formulation ingredients (DFIs) and single formulation ingredients (SFIs), and were identified by the type of healthcare service provider (HSP) and anatomical therapeutic chemical (ATC) group. 14.6 % (102/701) of total drugs were extracted as DFIs at about the same rate as that for drugs in the World Health Organization database (14.45 %), showing similar patterns by ATC group. The rate of injectable drug use varied more substantially for DFIs (range 0.94-4.54 %) than for SFIs (range 0.27-1.12 %) by the type of HSP. For DFIs, the highest proportion of injectable drug use was observed in group H (all hormonal preparations, 22.74 %) and group M (anti-inflammatory and anti-rheumatic preparations, 10.23 %) among ATC groups. The proportion of injectable drug use was higher in clinics and small hospitals than in tertiary hospitals and general hospitals where patients with more severe cases tend to visit. The results imply the potentially inappropriate or excessive use of injectable drugs and suggest the need to develop standard guidelines for injectable drug use and strategies to promote high-quality healthcare including education on rational prescribing.

Review of Italian primary care paediatricians identifies 38 commonly prescribed drugs for children.

AIM: Most Italian children are cared for by a family paediatrician until they are 14 years old, and their duties include prescribing drugs recommended by specialists so that they are free. This study aimed to draw up a list of the drugs most commonly prescribed by family paediatricians. METHODS: We surveyed 64 experienced family paediatricians to find out what drugs they prescribed over an 8-week period, including those recommended by a specialist, using cartons of drugs as the unit of measurement. A list of commonly prescribed drugs was then drawn up. RESULTS: A total of 381 active substances were prescribed. The most commonly prescribed drugs were amoxicillin (25.8% of the cartons), amoxicillin clavulanate (9.2%) and cetirizine (9.0%). The most commonly prescribed drug classes were antibiotics (43.8%), anti-asthmatics (12.9%) and antihistamines (11.8%). A list of 38 commonly prescribed drugs belonging to 16 therapeutic subgroups and covering 83.1% of cartons was identified. Of these, 33 were prescribed by 50% or more of the paediatricians and five were mainly prescribed following the recommendation of a specialist. CONCLUSION: Our review of the prescribing habits of family paediatricians showed that 38 commonly prescribed drugs were sufficient to treat most common diseases in children under 15 years of age.

Completeness, accuracy, and presentation of information on interactions between prescription drugs and alternative medicines: an internet review.

BACKGROUND: As the use of the Internet continues to increase across all age groups and education levels, with usage in the US around 78%, consumers are increasingly turning to the Internet for health related information. OBJECTIVE: To assess the completeness, accuracy, and consumer friendliness of information on the Internet pertaining to drug-Complementary and Alternative Medicine (CAM) interactions with cardiac drugs. METHODS: A review of online information was performed across three search engines and ten drug-CAM pairs. RESULTS: Overall, the quality of the drug-CAM interaction information available online to consumers is fairly poor. Only one site contained an interaction checker that provided interaction information for all ten pairs, but with an accuracy rate of 50%. Reading levels ranged from 10.5-23.5, with a mean of 16.7. A value greater than 22 indicates a graduate level reading skill. CONCLUSION: Web site developers should be cautious in presenting drug-CAM interaction information unless it is comprehensive and regularly maintained. Consumers should also know how to evaluate sites before trusting the content where the consequences are potentially severe.

Explaining primary healthcare pharmacy expenditure using classification of medications for chronic conditions.

BACKGROUND: The Valencian Autonomous Community (Spain) has implemented a scheme of purchasing services with the participation of public and private providers. Five districts are managed using public-private partnership. The financing model is capitation and inter-center invoice. The pharmaceutical benefits are not included in the per capita assignment. OBJECTIVES: Modeling and explaining pharmacy expenditure using electronic prescriptions drug data. METHODS: A database of electronic prescription corresponding to 625,246 patients between November 2008 and October 2009 was used to run four linear models that explain the pharmaceutical expenditures. We take as dependent variable the neperian log of total pharmacy annual cost per patient in the primary health setting. The independent variables used combined demographics with revised classification in 18 chronic conditions obtained from the anatomical therapeutic chemical classification index (ATC). RESULTS: The retrospective model selected included: gender, pharmaceutical co-payment status and 8 dummy variables for the number of chronic conditions of each patient from 1 to 8 or more. The goodness-of-fit achieved is measured in R(2) of 57%. CONCLUSIONS: These models must be considered in the current capitation system for pharmaceutical budgeting in a primary care setting established at regional level, as is the case in the Valencian Autonomous Community. The use of diagnostics and information regarding hospital encounters appears to be a complementary option for refining models of capitation of pharmaceutical and total health expenditure.

Potentially inappropriate drug prescription in the elderly in France: a population-based study from the French National Insurance Healthcare system.

BACKGROUND: Inappropriate prescribing is a known risk factor for adverse drug event occurrence in the elderly. In various countries, several studies have used insurance healthcare databases to estimate the national prevalence of potentially inappropriate medications (PIM) in the elderly, as defined by explicit PIM lists. Recently, a representative sample of the French National Insurance Healthcare database, known as the "Echantillon Généraliste des Bénéficiaires" (EGB), was created, making it possible to assess the quality of drug prescription in France. Our objective was to evaluate the prevalence and the regional distribution of PIM prescription in the elderly aged 75 years and over in France, using the French PIM list and the EGB database. METHODS: The list of drugs reimbursed to patients aged 75 years and over from 1 March 2007 to 29 February 2008 was extracted from the EGB. Drugs were classified as inappropriate using the French PIM list. A PIM user was defined as a person receiving at least one PIM reimbursement during the study period. Interregion variability was estimated from logistic regression. RESULTS: In 53.6% (95% CI: 53.0-54.1) of the elderly aged 75 years and over, at least one PIM was given during the study period. The three main drug groups identified were cerebral vasodilators (19.4%), drugs with antimuscarinic properties (19.3%), and long half-life benzodiazepines (17.8%). There was an important disparity in PIM prescription among the French regions. In 14 out of 22 regions, the risk of PIM prescription was significantly elevated. This geographical variation differed for the different drug groups. CONCLUSION: PIM prescription in the elderly is a major and worrying problem in France. As in other countries, recent accessibility of the National Insurance Healthcare database makes it possible to create local indicators that the regional health agencies could use to manage public health policy in closer alignment to the needs of the patients within each French region.

Discrepancies between prescribed and defined daily doses: a matter of patients or drug classes?

PURPOSE: Defined daily doses (DDD) are used for the measurement of drug utilisation. The aim of the study was to analyse whether differences between DDD and prescribed daily doses (PDD) exist for relevant drug classes such as antihypertensive drugs and, if so, whether they primarily depend on drug classes or patient-related factors. METHODS: Using the data of a large German statutory health insurance scheme, we analysed continuous prescriptions for the following antihypertensive drug classes: thiazide diuretics, beta-blockers, dihydropyridine calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-II receptor blockers (ARBs). We summed the doses of all dispensed drugs per person during a defined time frame. We calculated the PDD (= total dose divided by the number of days) and expressed them as the PDD:DDD ratio (= amount of DDD per day and person). RESULTS: During the study period, 149,704 patients continuously received an antihypertensive medication. The average PDD:DDD ratio ranged from 0.84 (beta-blockers) to 1.88 (ARBs) and 2.17 (ACEIs). The average prescribed dosage of each drug class remained unchanged, even if the patients had previously received another antihypertensive drug with another PDD:DDD ratio. For example, if patients were switched from a beta-blocker to an ACEI, the PDD:DDD ratio increased, on average, from 0.79 to 2.17. Vice versa, the ratio decreased for patients with a drug change from an ACEI to a beta-blocker from 2.06 to 0.75. CONCLUSIONS: Even large differences between DDD and PDD seem to be a matter of drug classes and not primarily of patient characteristics.

Medication use among senior Canadians.

Based on data from the 1996/1997 (institutional component) and 1998/1999 (household component) National Population Health Survey, seniors were major consumers of prescription medications, over-the-counter (OTC) products, and natural and alternative medicines. Almost all (97%) seniors living in long-term health care institutions were current medication users (medication use in the two days before their interview), as were 76% of those living in private households. Over half (53%) of seniors in institutions and 13% of those in private households used multiple medications (currently taking five or more different medications). Both medication and multiple medication use were associated with morbidity. Medications for the nervous system, the alimentary tract and metabolism, and the cardiovascular system were reported most frequently. Among seniors in institutions, those with Alzheimer's disease were less likely to take multiple medication than were those without this condition.