Effects of using free sample medications on the prescribing practices of family physicians.

INTRODUCTION: We determined whether family physicians (FPs) who distribute free sample medications are more likely to prescribe those medications than physicians who do not. METHODS: We reviewed administrative health plan prescription data of three similar clinics with 23 FPs within a comprehensive health care delivery system. Only clinic X physicians dispensed free sample medications. To determine which prescribed medications to study, the sample medications log from clinic X was categorized. The 25 sample medications most frequently dispensed by category were selected as study medications. Outcome measures included the number, proportion, cost, and formulary status of study medications prescribed and the average 30-day prescription costs. RESULTS: Physicians at clinic X prescribed the largest proportion of prescriptions for study medications, the smallest proportion of preferred name brands among study medications, and had the highest costs for prescriptions of non-listed formulary study medications (P < .0001). The average 30-day prescription costs differed significantly by clinic (P < .0001), with clinic X being the highest. There was a significant association between the number of samples dispensed and the number of prescriptions written for study medications by physicians at clinic X (P = .006). CONCLUSIONS: Our data support the conclusion that FPs who distribute free samples are more likely to prescribe those medications than their counterparts who do not.

Cigar smoking: an ignored public health threat.

Cigar smoking is rapidly increasing. Studies have exposed the move to cigar smoking by smokers who do not necessarily believe cigar smoking is risky behavior. However, cigar smoking poses significant risk that leads to well-documented morbidity and mortality. Currently, there is a dearth of primary prevention efforts related to cigar smoking. Furthermore, the literature is lacking in program, practice, and theory development as well as in the planning, execution, and evaluation of programs targeting cigar smoking cessation. A clear need exists to promote early prevention of cigar smoking, and to incorporate cigar smoking cessation into other tobacco cessation projects.

Physician response to written feedback on a medication discrepancy found with their elderly ambulatory patients.

OBJECTIVES: To assess physicians' responses to written feedback on medication discrepancies found with their elderly ambulatory patients. DESIGN: Cross-sectional survey. SETTING: Four clinics of a large university-affiliated, multispecialty group practice associated with a 186,000-member health maintenance organization. PARTICIPANTS: Patients aged 65 and older (n=202) and their family physicians (n=32). MEASUREMENTS: Medication discrepancies and physicians' responses to written feedback on letters and adhesive labels containing a list of patients' actual medications. RESULTS: A medication discrepancy was identified with 171 of 202 patients (84.7%). They resulted from patients not taking charted medications (52.9%), patients taking medications that were not charted (34.3%), or difference in dosage and/or schedule (12.8%). The medications involved were mostly complementary/alternative (28.3%), respiratory/allergy (15.1%), and analgesics (14.1%). The majority of physicians reported that the letters (93.8%) and accompanying labels (90.6%) were helpful to them. Half of the physicians reported filing the letters in patients' charts, whereas the other half discarded them. The majority (93.8%) also perceived the labels as an additional benefit to their practice and placed them in patients' charts to be used to correct patients' medications. Receptivity to the feedback was unrelated to physician age group, sex, years in practice, or clinic of practice. CONCLUSION: Although medication discrepancies are common in elderly ambulatory patients, their family physicians appreciate assistance in correcting these discrepancies, although potential problems, such as cultural or organizational resistance to the open disclosure of medication discrepancies in medical records due to associated legal ramifications, may need to be resolved.

Teaching medical students complementary and alternative medicine using evidence-based principles.

OBJECTIVES: Introducing new ideas such as complementary and alternative medicine (CAM) and evidence-based medicine (EBM) to medical students early in their education may help to nurture their interest. This study evaluated the effectiveness of teaching CAM using EBM principles and assessed changes in student perceived knowledge, attitudes, and skills following a new curriculum on CAM. DESIGN: A before-and-after evaluation using a one-page, anonymous questionnaire. SETTING AND SUBJECTS: All third year students of a state, public medical school in Texas. INTERVENTION: A new curriculum comprising interactive sessions on CAM, EBM, and basic principles of epidemiology and biostatistics. OUTCOME MEASURES: Changes in student-perceived knowledge, attitudes, and skills. RESULTS: Of 67 students, complete data were obtained for 54 (81%). The majority reported that the new instruction in CAM (98%), EBM (96%), biostatistics (91%), and epidemiology (87%) would be of some benefit in their future work. Significant changes were reported in the areas of appraising a clinical trial (p < 0.0001), critiquing the medical literature (p < 0.01), and the appropriateness of integrating EBM and CAM in the medical school curriculum (p < 0.05). There were modest increases in the mean responses on their skill level in reading/understanding the medical literature (3.40-3.52), comfort level in reading the medical literature (3.53-3.67), and preparedness in designing a research study (2.12-2.39) based on a five-point Likert scale, although not statistically significant. CONCLUSIONS: Medical students could be effectively taught CAM using EBM principles. In addition, a short, interactive curriculum on an important topic has a positive impact on medical students' desires to acquire new knowledge. This should be a good motivational message to family medicine educators regarding the contribution to new knowledge such as CAM.