Introducing a drug formulary to general practice--effects on practice prescribing costs.

A drug formulary comprising 249 preparations of 132 drugs and drug combinations was prepared by the partners in a three-doctor general practice serving more than 5000 patients. No attempt was made to change to generic prescribing nor were repeat prescription drugs altered. Introduction of the formulary in September 1981 was followed by an increase in the proportion of prescriptions containing drugs from the formulary from about 55% to more than 60% for both repeat and non-repeat prescriptions. The proportion of formulary drugs on non-repeat prescriptions reached a maximum of 78% within the first year with the additional influence of information feedback. Over the first year the level of formulary drugs used for both repeat and nonrepeat prescribing levelled off at about 62%. Even with these modest changes, when compared with the costs of general practice prescribing in Scotland as a whole, the introduction of the formulary resulted in savings of approximately 10% within the practice for the mean ingredient costs both per patient and per prescription.

Adrenocortical suppression in workers employed in manufacturing synthetic glucocorticosteroids: solutions to a problem.

Earlier studies showed gross adrenocortical suppression in three workers employed in manufacturing synthetic glucocorticoids. A further nine had either recognisable abnormalities of their responses to tetracosactrin or evidence of chronic skin contact with glucocorticoids. By 1978 the mean morning cortisol concentration of 20 workers employed in active steroid processes was 235 nmol/1 +/- 28.6 (8.5 microgram/ml +/- 1.04), which was significantly lower than the value of 428 nmol/l +/- 37.7 (15.5 microgram/ml +/- 1.40) obtained in a control group of 19 men (p less than 0.005). The mean morning cortisol of workers employed in processing steroids believed to be physiologically inactive, 306 nmol/l +/- 22.4 (11.1 microgram/ml +/- 0.81), was also significantly lower than this control group (0.01 greater than p greater than 0.005). Improvement of protection for workers together with operational and plant changes resulted in a significant rise in the mean morning cortisol values of workers until, in 1979, men employed in all steroid processes had concentrations that did not differ from those of a control group.