Indications For Prescription Research Articles

DRUG UTILIZATION STUDY AMONG GERIATRIC PATIENTS IN A TERTIARY CARE TEACHING HOSPITAL IN SOUTH INDIA

Objectives: The objective of our study is to evaluate the drug utilization pattern among geriatric patients in a tertiary care teaching hospital in South India and analyze the prescription pattern.
 Methods: Retrospective medical record analysis was performed for indoor cases of the geriatric patients (aged ≥65 years) admitted in medicine
 wards of Raichur Institute of Medical Sciences teaching hospital, Raichur, from June 2015 to May 2016. They were analyzed for demo graphics, disease pattern by system involved, disease diagnosed, comorbidity pattern, most commonly prescribed drugs, distribution of drugs according to their therapeutic class, evaluation of polypharmacy, route of administration, fixed-dose combinations, and the World Health Organization core prescribing indicators.
 Results: A total of 400 prescriptions of geriatrics patients admitted in inpatient medicine department were randomly selected and all the required data for the study were collected and evaluated. The majority of patients were found to be in the age group of 65–70 years (70.25%). It was noticed that females (51.75%) were more compared to males (48.25%). The drugs prescribed were analyzed. Ranitidine, ceftriaxone, theophylline, and salbutamol were prescribed to majority of the patients in this study group. The average number of drugs per prescription was 7.42; drugs prescribed by generic name were 33.62%. Among the drugs prescribed, 88.69% were from the National List of Essential Medicines. Total encounters having
 inject table preparations were 100% and total encounters having antibiotic prescribed were 91%. The prevalence of cardiovascular disorders (32.5%) was high followed by respiratory disorders (32.25%).
 Conclusion: This study provides insight into the patterns of drug use in our tertiary care hospital on geriatric patients as well as various diseases prevalent among geriatric patients. Widespread polypharmacy, high use of antibiotics and injections, and lack of generic prescribing are some concerns that need to be addressed to promote rational usage of drugs.

Medicinal cannabis and cannabis-based medication: an appeal to physicians, journalists, health insurances, and politicians for their responsible handling

Since the adoption of the law of March 6, 2017, any German physician can prescribe medical cannabis flowers and cannabis-based magistral and finished medicinal products. No specific indications for prescriptions are provided in the law. The statutory health insurance companies bear the costs once an application for cost coverage has been approved by the Medical Service of the Health Funds. The German associations of psychiatry (child, adolescents, and adults), neurology, palliative care, addictology, and pain medicine are watching these developments in the media, politics, and medical world with concern due to: the option to prescribe cannabis flowers despite the lack of sound evidence and against the recommendations of the German Medical Association; the lack of distinction between medical cannabis flowers and cannabis-based magistral and finished medical products; the indiscriminately positive reports on the efficacy of cannabis-based medicines for chronic pain and mental disorders; the attempts by the cannabis industry to influence physicians; the increase in potential indications by leaders of medical opinion paid by manufacturers of cannabis-based medicines. The medical associations make the following appeal to journalists: To report on the medical benefits and risks of cannabis-based medicines in a balanced manner. To physicians: to prescribe cannabis-based medicines with caution; to prefer magistral and finished medicinal products over cannabis flowers. To politicians: to consider data according to the standards of evidence-based medicine when making decisions and provide financial support for medical research into cannabis-based medicines.

Analysis of English general practice level data linking medication levels, service activity and demography to levels of glycaemic control being achieved in type 2 diabetes to improve clinical practice and patient outcomes

ObjectiveEvaluate relative clinical effectiveness of treatment options for type 2 diabetes mellitus (T2DM) using a statistical model of real-world evidence within UK general practitioner practices (GPP), to quantify the opportunities...

Bacteriological profiles of acute suppurative otitis media in children in Brazzaville, Congo

Background: Acute suppurative otitis media (ASOM) is one of the main indications for antibiotic prescription in children. The close proximity of the middle ear to the brain and the increasing resistance of microbial organisms involved in otitis media make this pathology of great concern in children. The objective of this study is to determine the bacteriological profile of acute otitis media in Congo as a guide to the choice of antibiotics for empirical therapy. Methodology: A cross sectional study of children less than 17 years old with acute suppurative otitis media in the otorhinolaryngology service of the Brazzaville University Hospital, Congo, was conducted over a 14 month period. All subjects whose samples were sterile or contaminated (poly-microbial culture) and those who received antibiotic-corticosteroid therapy were excluded. The identification of bacteria to species level was done using conventional biochemical identification tests scheme. Antibiotic sensitivity was performed on isolates using the modified Bauer Kirby disk diffusion test on plain Mueller Hinton (MH) agar and MH agar with 5% horse blood. Results: Four bacteria families/species were identified; Staphylococcus aureus (32.7%), family Enterobacteriaceae (28.6%), Streptococcus pneumoniae (26.5%) and Pseudomonas aeruginosa (12.2%). Ps. aeruginosa was associated with greenish otorrhea while S. aureus , Enterobacteriaceae and S. pneumoniae were associated with yellowish otorrhea ( p = 0.001). Conclusion: The bacterial aetiology of acute suppurative otitis media varies from country to country. In Congo, this study reports four main bacteria families/species involved in acute otitis media with high resistance to β-lactam antibiotics but high sensitivity to macrolides and fluoroquinolones. Keywords: otitis; child; antibiogram; bacteria; Brazzaville

Implementation process for comprehensive medication review in the community pharmacy setting

ObjectivesTo (1) describe the implementation process for comprehensive medication reviews (CMRs) among community pharmacies (e.g., processes for prioritizing patients, staffing, and information collection) and (2) examine factors associated with community pharmacies’ CMR information collection process. MethodsA survey was administered to the pharmacist responsible for implementation of CMRs (i.e., the lead pharmacist) in the community pharmacy (n = 87). The survey included questions about pharmacy characteristics, satisfaction with the NC community pharmacy enhanced services network (NC-CPESN) program, and implementation of CMRs. Frequencies and means were calculated to describe the sample characteristics and pharmacies’ CMR implementation process. A multiple linear regression was conducted to examine which characteristics were associated with the CMR information collection process. ResultsThe majority of pharmacies in the sample were either independently owned single stores (46.5%) or multiple stores under the same independent ownership (41.6%). Most pharmacies used pharmacists (97.7%) or pharmacy technicians (65.5%) for patient outreach for CMRs. A small percentage of pharmacies used administrative staff to conduct patient outreach for CMRs (9.2%). Information for prescription medications (89.5%), indication (80%), and medication adherence (81.1%) was routinely collected. Information such as date of last dose for prescription medications (48.4%) and lifestyle factors, such as physical activity (21.1%), diet (29.5%), and alcohol (31.6%), was collected less routinely. Having a clinical pharmacist (P = 0.025) and pharmacist overlap hours (P = 0.009) significantly improved the CMR information collection process. ConclusionAlthough CMRs are important interventions for improving patient outcomes, more guidance is needed on how to effectively implement them. This would allow the process to be efficient and assure implementation with fidelity across all community pharmacies. In addition, staffing appears to influence the quality of CMR information collection. Future research is warranted on CMR implementation to develop efficient staffing models and standardize the process of information collection.

Mastectomy is no longer an indication for postoperative opioid prescription at discharge

BackgroundA 10-step protocol employing multimodal analgesia was implemented in patients undergoing mastectomy to decrease the quantity of opioids prescribed at discharge. MethodsPatients who received the Enhanced Recovery After Surgery (ERAS) protocol were compared to a control group. Inpatient and discharge prescription of opioids were compared using oral morphine equivalents (OMEs), along with postoperative pain scores. ResultsBetween 2017 and 2018, fifty-seven patients were eligible for inclusion: 20 patients received ERAS and 37 received usual care (UC). The ERAS group received a mean of 2.4 (0–13) inpatient OMEs and the UC group received 13.7 (0–80) (p = 0.002). The ERAS group received 2.0 (0–40) OMEs at discharge and the UC group received 59.8 (0–120) (p < 0.001). Postoperative pain scores were significantly lower in the patients who received the ERAS protocol. ConclusionsPatients who received the ERAS protocol required less postoperative opioids and reported lower pain scores when compared to a control group.

Medical marijuana use for pediatric oncology patients: single institution experience

Medical marijuana (MM) is widespread in many medical fields, including oncology, with limited use in pediatric oncology where research is scarce and often shows conflicting results. This research focuses on alleviating side effects of anticancer treatment as an integral part of supportive and palliative care of children with cancer. We report our experience with MM treatment in 50 children, adolescents, and young adults with different types of cancer during 2010–2017. The main indications for prescriptions were nausea and vomiting, decreased mood, disturbed sleep, and pain. The medication was supplied to 30 patients via oil drops (60%) and 11 via smoking (22%), followed by vaporization, capsules, or combinations of various routes. Positive effects were reported by verbal children and parents in 80% of cases. MM was generally well tolerated with few patients reporting toxicity, with the most common adverse reactions being burning in the throat and anxiety attacks in subjects who chose to smoke the product. We conclude that MM may serve as a potentially useful complementary therapy to conventional supportive treatment of children suffering from cancer at the end of life. Further research is needed on the safety and efficacy and the consequences of prolonged use in pediatric populations.

Trends in gabapentinoid prescribing in patients with osteoarthritis: a United Kingdom national cohort study in primary care

To investigate trends in gabapentinoid prescribing in patients with osteoarthritis (OA). Patients aged 40 years and over with a new OA diagnosis recorded between 1995 and 2015 were identified in the Clinical Practice Research Datalink (CPRD) and followed to first prescription of gabapentin or pregabalin, or other censoring event. We estimated the crude and age-standardised annual incidence rates of gabapentinoid prescribing, stratified by patient age, sex, geographical region, and time since OA diagnosis, and the proportion of prescriptions attributable to OA, or to other conditions representing licensed and unlicensed indications for a gabapentinoid prescription. Of 383,680 newly diagnosed OA cases, 35,031 were prescribed at least one gabapentinoid. Irrespective of indication, the annual age-standardised incidence rate of first gabapentinoid prescriptions rose from 1.6 [95% confidence interval (CI): 1.3, 2.0] per 1000 person-years in 2000, to 27.6 (26.7, 28.4) in 2015, a trend seen across all ages and not explained by length of follow-up. Rates were higher among women, younger patients, and in Northern Ireland, Scotland and the North of England. Approximately 9% of first prescriptions could be attributed to OA, a further 13% to comorbid licensed or unlicensed indications. Gabapentinoid prescribing in patients with OA increased dramatically between 1995 and 2015. In most cases, diagnostic codes for licensed or unlicensed indications were absent. Gabapentinoid prescribing may be attributable to OA in a significant proportion but evidence for their effectiveness in OA is lacking. Further research to investigate clinical decision making around prescribing these expensive and potentially harmful medicines is recommended.

Effectiveness of an intervention to improve antibiotic-prescribing behaviour in primary care: a controlled, interrupted time-series study.

High rates of antibiotic misprescribing in primary care, with alarming clinical and economic consequences, highlight the urgent need for interventions to improve antibiotic prescribing in this setting. To assess the effectiveness on antibiotic prescribing quality indicators of a multifaceted intervention targeting health professionals' and patients' behaviour regarding antibiotic use. We conducted a pragmatic cluster-randomized controlled trial in the catchment area covered by Portugal's Central Regional Health Administration. The intervention consisted of a multidisciplinary, multifaceted programme involving physicians, pharmacists and patients, and comprising outreach visits for physicians and pharmacists, and educational materials for health professionals and patients. The following were assessed: relative ratios of prescription of penicillins sensitive to β-lactamase, penicillin combinations including β-lactamase inhibitors, third- and fourth-generation cephalosporins and fluoroquinolones; and the ratio of broad- to narrow-spectrum antibiotics. An interrupted time-series analysis for multiple-group comparisons was performed. The study protocol was registered on Clinical.trials.gov (NCT02173509). The participation rate in the educational intervention was 64% (197/309 GPs) in a total of 25 counties. Statistically significant improvements were obtained, not only in the relative prescription of penicillins sensitive to β-lactamase (overall relative change of +896%) and penicillin combinations including β-lactamase inhibitors (-161%), but also in the ratio of broad- to narrow-spectrum antibiotics (-200%). Statistically significant results were also obtained for third- and fourth-generation cephalosporins, though only in the immediate term. This study showed that quality indicators of antibiotic prescribing can be improved by tackling influences on behaviour including knowledge and attitudes surrounding physicians' clinical practice. Accordingly, these determinants must be considered when implementing interventions aimed at improving antibiotic prescribing.

Circuit pharmaceutique, transplantation de microbiote fécal : Des pratiques hétérogènes

To describe current pharmaceutical practice in French hospitals regarding fecal microbiota transplantation in terms of prescription, preparation and compounding, as well as local legislation. A national survey was conducted at 28 French university hospital centers followed by the sending of a GoogleForm® questionnaire from June to August 2018 in the 16 respondent centers either performing or subcontracting fecal microbiota transplant. All hospitals performing or subcontracting fecal transplant (n=16,%57) report prescription indication of recurrent Clostridium difficile infection treatment, and 6 of them also as part of a clinical trial protocol. In hospitals performing fecal transplant themselves (n=11), the number of pre-donation consultations with donors varies from one (n=6) to two (n=5). Fecal sample is collected at the donor's home in 45% of cases. Route of administration for transplant is either naso-gastric administration (n=4), rectal (n=4) or both (n=5). Fecal samples for transplant are compounded either in the hospital pharmacy (n=73%) or in the laboratory (27%). Thawing methods include refrigeration between 2-8°C (50%), room temperature (25%) and water bath (25%). Billing system and reporting to health authorities are highly heterogeneous from one hospital to another. This survey shows significant pharmaceutical practice heterogeneity within French hospitals regarding fecal microbiota transplantation despite the existence of national and European recommendations.

Inappropriate opioid prescribing practices: A narrative review.

Results of a literature review to identify indicators of inappropriate opioid prescribing are presented. While prescription opioids can be effective for the treatment of acute pain, inappropriate prescribing practices can increase the risk of opioid-related harms, including overdose and mortality. To date, little research has been conducted to determine how best to define inappropriate opioid prescribing. Five electronic databases were searched to identify studies (published from database inception to January 2017) that defined inappropriate opioid prescribing practices. Search terms varied slightly across databases but included opioid, analgesics, inappropriate prescribing, practice patterns, and prescription drug misuse. Gray literature and references of published literature reviews were manually searched to identify additional relevant articles. From among the 4,665 identified articles, 41 studies were selected for data extraction and analysis. Fourteen studies identified high-daily-dose opioid prescriptions, 14 studies identified coadministration of benzodiazepines and opioids, 10 studies identified inappropriate opioid prescribing in geriatric populations, 8 studies identified other patient-specific factors, 4 studies identified opioid prescribing for the wrong indication, and 4 studies identified factors such as initiation of long-acting opioids in opioid-naive patients as indicators of inappropriate opioid prescribing. A literature review identified various indicators of inappropriate opioid prescribing, including the prescribing of high daily doses of opioids, concurrent benzodiazepine administration, and geriatric-related indicators. Given the significant contribution of inappropriate opioid prescribing to opioid-related harms, identification of these criteria is important to inform and improve opioid prescribing practices among healthcare providers.

Drug Utilization Study in Epilepsy in A Tertiary Care Hospital

Treatment of epilepsy is quite challenging as it requires the antiepileptic drugs to be taken for a long duration, sometimes throughout the lifetime of the patient. But such chronic drug intake results in adverse effects, drug interactions and added economic and emotional distress to the patients. It is therefore of utmost importance to analyze the pattern of prescription of antiepileptic drugs, the concurrent medications in epilepsy. The present study was conducted to collect, assess and understand the above data and also to analyze the rationality and correctness of prescription using the WHO prescription indicators. A total of 100 case records of patients diagnosed with epilepsy was analyzed and the data was recorded. We have total 34 children and 66 adult patients in our study. Generalized tonic-clonic seizures was the common type of seizure. Phenytoin was the most commonly prescribed antiepileptic drug. 1/3rd of the patients needed more than one drug for adequate seizure control and the most common add on drug was levetiracetam. Also, the average number of drugs prescribed to the patients was 6 which included drugs given for concomitant illnesses as well. A total of 561 medicines were prescribed which included the drugs prescribed for concomitant illnesses as well. Average number of medicines per prescription was 6. Prescription by generic name was seen in 42% of the cases. An injection was prescribed in 66% of the prescriptions. An antibiotic was encountered in 38% of the prescriptions. Most of the epileptic patients are subjected to polypharmacy which puts them at a higher risk of side effects, drug interactions and financial burden. Physicians should minimize the use of drugs and look into the rationality of each prescription.

Asthmatic children from lower-income families are less likely to own an individualised asthma action plan.

This study aimed to explore the relationship between indicators of socio-economic status (SES) and prescription of a paediatric individualised asthma action plan (IAAP), as well as compliance with that plan. Between May and September 2017, parents/carers of children aged 2-16 years who presented with acute respiratory symptoms and a prior diagnosis of asthma to the emergency department at one regional and one metropolitan hospital in NSW, Australia, were invited to participate in a questionnaire-based study. A total of 175 eligible participants were identified, of which 113 completed the questionnaire. Eighty-seven children had been prescribed an IAAP (77%). Forty-nine parents/carers reported non-compliance with that plan (56.3%). Children from low- to middle-income families were significantly less likely to have a plan (P = 0.001). Being an only child was associated with greater IAAP compliance (P = 0.007) and better asthma control (P = 0.035). No significant relationship between other indicators of SES and rates of plan ownership or compliance was demonstrated. Although relatively high in our study sample, IAAP ownership rates remain well below published guidelines. Given the income-based disparity in plan ownership, physicians must routinely prescribe plans to all asthmatics. Strategies to ensure IAAP ownership and promote their use, especially in the public health sector, would be valuable. Repeating a similar study with a larger sample size will allow more robust conclusions to be drawn regarding the impact of parental SES on compliance.

Nationwide survey of indications for oral antimicrobial prescription for pediatric patients from 2013 to 2016 in Japan

BackgroundAntimicrobial resistance is a major public health concern. In 2016, the Japanese government launched a national action plan aimed at achieving a 33% and 50% reduction in the number of total and oral antimicrobial prescriptions (cephalosporins, macrolides, and quinolones) from the 2013 figures by 2020, respectively. The purpose of this study was to investigate the indications for recent antimicrobial prescriptions and to identify the primary targets for intervention to achieve the aims of the government's action plan. MethodsUsing the national health claims database, we retrospectively analyzed oral antibiotic prescriptions for Japanese children aged ≦ 15 years from 2013 to 2016. The trends were analyzed based on days of therapy (DOT) per infectious disease-related visit for each antibiotic. For patients whose chief diagnosis was an infectious disease, the number of antimicrobial prescriptions per diagnosis, their proportion, and the details of the type of antimicrobial were investigated. ResultsIn total, 297,197,328 infectious disease-related visits were identified during 2013–2016. Total antimicrobial prescriptions showed a 3.7% reduction from 1.519 DOT/visitor in 2013 to 1.463 DOT/visitor in 2016 (Ptrend < 0.001). Antimicrobials were prescribed for 31.7% and 36.9% of children with upper and lower respiratory tract infection, accounting for 54.6% and 26.2% of all antimicrobial prescriptions, respectively. Third generation cephalosporins and macrolides comprised the majority of these prescriptions. ConclusionsAntimicrobials were commonly prescribed for children with respiratory infections. Therefore, promoting appropriate antimicrobial use in this population is required to achieve the 2020 goals set by the action plan.

Drug repurposing in alternative medicine: herbal digestive Sochehwan exerts multifaceted effects against metabolic syndrome

New drug development is a challenging process that requires high-risk, huge costs and long lead times. Therefore, drug repurposing is considered a strategic and economic way towards successful drug development. Sochehwan (SCH) is a herbal formula well known as a digestive aid in traditional oriental medicine, is referred to in classic medical texts, and is available as an over-the-counter drug for indications of digestive ailments. Interestingly, another medical text written in earlier age describes different indication of SCH yet to be examined. We conducted a series of investigations using maturated adipocytes, free fatty acid (FFA) induced hepatic steatosis model in vitro and high-fat diet (HFD) mice model in vivo. Exposure to SCH regulated expression of adipogenic genes and proteins, significantly inhibiting formation of lipid droplets in 3T3-L1 cells. Similarly, SCH treatment modulated proteins related with energy metabolism decreasing lipid accumulation in FFA induced HepG2 cells. Furthermore, HFD-fed c57BL/6 J mice supplemented with SCH exhibited significant changes in serum glucose and lipid profiles. Histologic analysis of mice liver and adipose tissue showed that SCH administration attenuated hepatic steatosis and hypertrophy of adipose tissue. In overall, the results show that SCH can potentially be used to treat metabolic syndrome (MetS) by enhancing glucose metabolism and inhibiting lipogenesis through activating AMP-activated protein kinase (AMPK) and its downstream signaling. Furthermore, it seems to be a feasible drug repurposing strategy for drugs originating from alternative medicine to revise the value for buried indications of some herbal prescription in old traditional Chinese Medicine (TCM) classics.

Socioeconomic deprivation and benzodiazepine/Z-drug prescribing: a cross-sectional study of practice-level data in England

BackgroundBenzodiazepines and Z-drugs (such as zopiclone) are widely prescribed in primary care in England. Prescribed for various indications, such as anxiolysis and insomnia, it has been previously reported that an association may exist with deprivation.AimTo determine whether there was an association between benzodiazepine/Z-drug prescribing (overall, and by individual drug) and practice-level socioeconomic deprivation in England.MethodMonthly primary care prescribing data for 2017, as well as practice age and sex profile, were downloaded from NHS Digital. Prescribing was aggregated by year. Drug doses were converted to their milligram-equivalent of diazepam to allow comparison. Practice-level Index of Multiple Deprivation (IMD 2015) scores were obtained from Public Health England. Multiple linear regression was used to examine the association between IMD and prescribing (for all benzodiazepines/Z-drugs, and individually), after adjusting for practice sex (% male) and older age (% &gt;65 years) distribution. Practice-level prescribing was defined as milligrams of diazepam-equivalent per 1000 registered patients in 2017.ResultsOn univariate analysis, overall benzodiazepine prescribing was positively associated with practice-level IMD score, with more prescribing in more deprived practices (P&lt;0.001). After adjusting for practice age and sex profile, IMD score remained an independent predictor of prescribing levels (P&lt;0.001). These associations were consistent for all benzodiazepines/Z-drugs when analysed separately.ConclusionHigher practice-level socioeconomic deprivation, as described by IMD score, was associated with increased benzodiazepine/Z-drug prescribing. This may, in part, be a reflection of an underlying association of the indications for prescribing and socioeconomic deprivation. Further work is required to more accurately define the underlying reasons for these associations.

Learning and recommending treatments using electronic medical records

Treatment directly affects patient health status. In recent years, the fast development electronic medical records (EMRs) has provided valuable resources for solving healthcare issues, especially learning and recommending treatments. However, most of the related studies are limited in exploiting various patient information, handling varying-length treatment records, capturing different kinds of treatment patterns and interpreting the recommendation mechanism. This research proposes three methods, one for learning and two for recommending treatments, to overcome the above drawbacks. All methods adopt a mixed-variate restrict Boltzmann machine to represent different kinds of patient records. The treatment learning method captures significant changes in prescription indication to split varying-length records flexibly and organizes sequences of prescription drugs into regimen trees to reveal many more different kinds of treatment patterns. The two treatment recommendation methods illustrate different ideas that can improve the treatment recommendation mechanism by combining the treatments derived from patient groups and neighbor patients. Our experimental evaluation was conducted on three acute disease cohorts extracted from the MIMIC III database. The obtained results show that the proposed methods are able to provide different kinds of treatment patterns and yield competitive efficacy with better interpretability as compared to relevant studies.

Factors Influencing Judgments to Consult Prescription Monitoring Programs: A Factorial Survey Experiment

BackgroundPrescription monitoring programs (PMPs) can provide health care professionals with valuable information. However, few studies have explored providers’ decision making for accessing PMPs. AimsThis study aimed to identify provider characteristics and situational factors most influencing perceived importance of consulting the PMP for patients in a simulated context. DesignThe study used a cross-sectional factorial survey. SettingsThe survey was administered electronically. Participants/SubjectsCommunity pharmacists, advanced practice registered nurses (APRNs), and physicians in Iowa. MethodsParticipants were recruited by mail which included a link to the online survey. The survey consisted of demographic questions, eight randomly generated vignettes, and one ranked item. The vignettes described a hypothetical prescription using eight experimental variables whose levels were randomly varied. Respondents evaluated each vignette for importance to access the PMP. Analyses used linear mixed-effects models in R (Version 3.5.0). ResultsA total of 138 responses were available for multilevel analysis. Women, physicians, and APRNs rated it more important to consult the PMP for a given prescription compared with men and pharmacists. Accessing a PMP was perceived as more important with cash payments, quantity dispensed, suspicion for misuse, hydromorphone and oxycodone prescriptions, and headache. Advancing age, postoperative pain, and anxiety or sleep indications were associated with less importance. ConclusionsAge, indication for prescribing, misuse, and payment mode each independently had greater importance to providers in accessing the PMP. This was the first study to isolate the influence of different controlled substances on how important it was to consult the PMP.

ANALYSIS OF PRESCRIPTION INDICATORS FOR OUTPATIENTS WITH HEALTH INSURANCE IN OUTPATIENTS DEPARTMENT AT CAN THO UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL IN THE PERIOD 2017-2018

Objective: The main objective of this study was to evaluate the drug prescription parameters and to find out the elements had an influence on the prescribing practice of doctors’.&#x0D; Methods: A descriptive cross-sectional study was conducted to collect 300 outpatient drug prescriptions and 30 questionnaires of physicians during the period of 2017-2018. The data were analyzed according to WHO’s the guideline.&#x0D; Results: Average number of drug per prescription: 3.73, percentage of drugs prescribed by generic or international name (INN): 100%, percentage of prescriptions with an antibiotic prescribed: 24%, of β-lactam antibiotics group, including cephalosporin (31.17%) and aminopenicillin (27.27%), accounted for the highest percentage of using in antibiotic groups with a total of 58.44%, of corticosteroid: 12%, of vitamin: 27.3%, of drugs prescribed including in the Essential Medicines List issued by the Ministry of Health: 35.3%. Average drug cost per prescription: 88,867 VNĐ. Percentage of drug costs for antibiotics (%): 7.48%, of corticosteroids (%): 1.85% and of vitamins (%): 5.25%.&#x0D; Conclusion: The results of this research have identified some prescription indicators and elements affect the prescription indicators such as drug information, patient, drug, which may lead to intervention studies for evaluating changes in these issues in the outpatient clinic.

Real-Life Data on Mirabegron in Neurogenic Bladder Dysfunction

Aims: To determine factors for treatment persistence in a real-life cohort of adult neurogenic lower urinary tract dysfunction. Methods: We reviewed records of patients with neurogenic lower urinary tract dysfunction and mirabegron prescriptions. Exclusion criteria were indwelling urethral or suprapubic catheters and implanted neurostimulators. We extracted demographic data, indication for prescription, concomitant use of other agents with possible anticholinergic effect, beta blockers, duration of treatment and reason of discontinuation. Results: We included 110 subjects in this study. Neurologic diagnoses included multiple sclerosis, Parkinson’s disease, and other diagnoses (dementia, paraplegia, and tetraplegia). Previous usage of antimuscarinics was found in 78 patients (71%). Mirabegron was combined with antimuscarinics in 15 patients (14%). Drugs with any anticholinergic activity were taken by 94 subjects (86%). Mirabegron was taken for a median of 497 days and 60 patients discontinued the medication within the study period. Main reasons of discontinuation were lack of effect (44/110), side effects (10/110), and non-reimbursement (6/110). There were no differences in mirabegron discontinuation by neurological disease, beta blocker usage, or anticholinergic burden. Conclusions: Mirabegron is continued in more than half of patients with neurogenic lower urinary tract dysfunction for more than 6 months. Further research is needed to identify eventual predictive factors.