Assessment of the appropriateness of extemporaneous preparations prescribed in Swedish primary care

Abstract

Abstract Extemporaneous preparations are drugs that are compounded for individual patients or made in larger batches for stock-keeping. This study aimed to assess the prescribing of extemporaneous preparations in Swedish primary care, both therapeutically and pharmaceutically. An analysis of the extent to which alternative commercial drugs were available at the time of the prescription was also conducted. Information was taken from the Swedish diagnosis and therapy survey for the time period October, 1986, to September, 1988, inclusive. This survey collects from a random sample of physicians the details of all prescriptions they write during one week, as well as the corresponding diagnoses. The present study analysed the 1,043 extemporaneous prescriptions written during that period. The majority (62 per cent) were considered to be therapeutically appropriate in that they formed recommended treatment for the diagnosis in question according to the medical literature. Another 15 per cent were neither recommended nor questioned in the consulted sources; 20 per cent were designated as controversial because they were recommended in some sources and questioned in others. About 3.5 per cent were considered to be therapeutically inappropriate, ie, the literature suggested that their use should be abandoned. One per cent were pharmaceutically inappropriate. Many preparations probably could have been replaced by commercial alternatives, about half differing from available commercial alternatives only by strength and/or vehicle. Whether substitutions could have been made in practice would depend on the clinical picture in the individual patient case.