Number Of Prescribed Drugs Research Articles

The effect of changing reimbursement policies on quality of in-patient care, from fee-for-service to prospective payment

Using insurance claims for hemorrhoidectomies, we examined the effect of Taiwan's Bureau of National Health Insurance's case payment system, a fixed case payment rate method used to reimburse health care providers for in-patient care. This observational natural experimental study examined changes in medical care that occurred between two phases: the 9 months before case payment system was implemented on 1 October 1997 and the 9 months afterwards. The changes were analyzed by performing linear regressions with interaction between hospital type and the implementation of case payment system. This study was based on total claim data from National Health Insurance. A total of 23 638 hemorrhoidectomy insurance claims. Length of stay, number of medical services, and number of drug prescriptions. Medical services were stratified into those that were considered minimal requirements and those considered optional by the Bureau of National Health Insurance. Over the 18-month period, the number of patients increased by 23.7%. After the case payment system was implemented, length of stay decreased by 0.59 days (P < 0.0001), the number of minimally required services increased by 2.19 to 4.24 items (P < 0.0001), the number of optional service items decreased by 0.32 items (P < 0.0001), and drug prescription decreased slightly by 0.58 to 0.99 items (P < 0.0001) per hospitalization. The case payment system successfully shortened length of stay without significantly sacrificing the provision of services.

Benefit Cuts Force Many To Make Painful Choices

Benefit Cuts Force Many To Make Painful Choices

病棟薬剤師の介入による処方薬剤数，薬剤費および副作用発現頻度の減少

The major requirement for the hospital pharmacist is the practice of good pharmaceutical care. In this study, we examined the content of such pharmaceutical care and whether the average number of drugs, drug costs and the incidence of adverse drug events was reduced by the presence of the pharmacist in the neurology ward of Nagoya Daini Red Cross Hospital. We also considered ways of improving the function of clinical pharmacists in the future.The number of the clinical pharmacy practices for the month of September 2000 was 762 broken down into dispensing of drugs, consultation with patients and other clinical pharmacy practices, with 198, 338 and 226 practices each, respectively. The greatest proportion of other clinical pharmacy practices involved supplying drug information, with advice on prescription changes and amending prescriptions coming next. The number of the clinical pharmacy practices increased from 762 in 2000 to 893 in 2003, with practices covering a broad range of functions, all needing specialist pharmaceutical knowledge. Over this period, the average number of drugs in prescriptions, drug costs and incidence of adverse drug events decreased, which resulted from pharmacists ensuring that drugs were used properly by amending prescriptions.A major goal of clinical pharmacists is to ensure that drugs are used properly and this can be achieved through their active involvement in all aspects of pharmaceutical care as an active member of the health care team. Their role should not be limited to instructing patients on how to take drugs.

Psychopharmacotherapy and adverse drug effects in old age psychiatry

The number of drug prescriptions is continuously increasing with age. Physiologic age-associated pharmacodynamic and pharmacokinetic changes influence drug metabolism and tolerability. Therefore, we analysed the pattern of adverse drug effects, that has been reported to AGATE. Since 1992/1995 AGATE spontaneously monitors adverse drug effects (ADE) and treatment regimen, respectively, in psychiatric state hospitals in Germany. Our analysis comprised >8000 drug prescriptions with >200 ADE-reports (~2,7%) of patients older than 65 years, that have been treated with psychopharmaca. The qualitative composition of the ADE-reports revealed no age-associated differences. However, statistical analysis revealed, that delirium, red blood cell count, peripheral anticholinergic side effects, elevated liver enzymes and extra-pyramidal motor signs were significantly more frequently reported in elderly patients as compared to patients <65 years of age. We conclude, that despite the use of rather low doses in psychopharmacological treatment regimen in old age psychiatry, there is still a high risk for the occurrence of ADE.

Predictors of nursing facility admission: a 12-year epidemiological study in the United States.

To identify predictors of institutionalization in a community-based cohort of older adults. Prospective, longitudinal. After initial assessment at study entry, surviving participants were reassessed in a series of approximately biennial waves until October 2001; baseline for the current analysis was Wave 2 (1989-91). Largely rural, blue-collar community in the mid-Monongahela Valley of southwestern Pennsylvania. A population-based cohort of 1,147 adults, aged 66 and older (mean 74.1) at baseline, who were not already institutionalized and who had complete data on all variables of interest. Cox proportional hazards models were used to identify predictors of institutionalization from among selected variables measured at baseline, including age, sex, education, marital status, living arrangements, ability to perform instrumental activities of daily living (IADLs), depressive symptoms, number of prescription medications (as an index of overall morbidity), self-reported social support, hospitalization during the preceding year, and cognitive functioning. Dementia was defined according to the operational criteria of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, and by a Clinical Dementia Rating of 0.5 or greater, based on a standardized clinical assessment. The outcome variable was institutionalization, defined as entry into in a nursing home. Significant predictors of institutionalization were dementia (hazard ratio (HR)=5.09, 95% confidence interval (CI)=2.92-8.84), measured as a time-dependent variable; older age (HR=1.06, 95% CI=1.03-1.10); IADL disability (HR=1.31, 95% CI=1.15-1.50); worse/less social support (HR=1.27, 95% CI=1.10-1.46); and number of prescription medications (HR=1.21, 95% CI=1.11-1.32), measured at baseline. The interaction between number of prescription drugs and dementia was also significant, suggesting that prescription medication count had less effect on institutionalization in those with dementia than in those without. Dementia emerged as the most potent risk factor for institutionalization in this 12-year community-based epidemiological study. Medical burden conferred greater vulnerability to institutionalization in nondemented persons than in those with dementia.

The effect of active training in reducing severe drug interactions

Background: Purpose: Methods: Results Conclusion RUG INTERACTIONS , ACTIVE TRAINING : Drug interactions are common medical errors in Gorgan province and training can decrease their rate. Keywords. D : Overall prevalence of drug interactions was 8.93%, of which 6.55% were major, 65.58% moderate and 27.87% minor. Interactions were mostly seen among male doctors. The physicians with an average drug number of more than 4 had significantly more interactions in their prescriptions. The majority of physicians with major drug interactions did not know their clinical significance. After training, there was a significant reduction in major drug interactions, but none in moderate and minor interactions for which no education was provided. With an initial estimation of 8% severe drug interactions (95% confidence level, 7% accuracy), the sample size was calculated to include at least 5600 prescriptions. After classifying the observed interactions and identifying the physicians, a questionnaire was prepared and completed attending their offices. Training was provided using face-to-face conversation, audit feedback and educational notes. After training on the severe interactions, physicians’ prescriptions were reviewed again after three months and the number of interactions was compared with that observed at baseline, to evaluate the effect of training. Data were classified, computerized and analyzed with SPSS-10 using Chi-square and McNemar tests. The interactions’ clinical importance was also evaluated using relative test. To evaluate the effect of educational interventions including face-to-face, audit feedback and educational notes, among Gorgan physicians. Journal of Medical Education Fall 2004 6(1);107-112 Medication errors are among the most important medical errors. Considering the current trend of poly-pharmacy and a high average number of drugs in prescriptions, drug interactions are of great significance.

ORAL ADVERSE DRUG REACTIONS TO CARDIOVASCULAR DRUGS.

A great many cardiovascular drugs (CVDs) have the potential to induce adverse reactions in the mouth. The prevalence of such reactions is not known, however, since many are asymptomatic and therefore are believed to go unreported. As more drugs are marketed and the population includes an increasing number of elderly, the number of drug prescriptions is also expected to increase. Accordingly, it can be predicted that the occurrence of adverse drug reactions (ADRs), including the oral ones (ODRs), will continue to increase. ODRs affect the oral mucous membrane, saliva production, and taste. The pathogenesis of these reactions, especially the mucosal ones, is largely unknown and appears to involve complex interactions among the drug in question, other medications, the patient's underlying disease, genetics, and life-style factors. Along this line, there is a growing interest in the association between pharmacogenetic polymorphism and ADRs. Research focusing on polymorphism of the cytochrome P450 system (CYPs) has become increasingly important and has highlighted the intra- and inter-individual responses to drug exposure. This system has recently been suggested to be an underlying candidate regarding the pathogenesis of ADRs in the oral mucous membrane. This review focuses on those CVDs reported to induce ODRs. In addition, it will provide data on specific drugs or drug classes, and outline and discuss recent research on possible mechanisms linking ADRs to drug metabolism patterns. Abbreviations used will be as follows: ACEI, ACE inhibitor; ADR, adverse drug reaction; ANA, antinuclear antigen; ARB, angiotensin II receptor blocker; BAB, beta-adrenergic blocker; CCB, calcium-channel blocker; CDR, cutaneous drug reaction; CVD, cardiovascular drug; CYP, cytochrome P450 enzyme; EM, erythema multiforme; FDE, fixed drug eruption; I, inhibitor of CYP isoform activity; HMG-CoA, hydroxymethyl-glutaryl coenzyme A; NAT, N-acetyltransferase; ODR, oral drug reaction; RDM, reactive drug metabolite; S, substrate for CYP isoform; SJS, Stevens-Johnson syndrome; SLE, systemic lupus erythematosus; and TEN, toxic epidermal necrolysis.

Potentially inappropriate medication use in community residential care facilities.

To describe the prevalence of potentially inappropriate medication use in community residential care (CRC) facilities at baseline, describe exposure to potentially inappropriate drugs during the 1-year follow-up, and examine characteristics associated with potentially inappropriate use. A cohort study was conducted using 282 individuals aged >/=65 years entering a CRC facility in a 3-county area in the Puget Sound region of Washington State between April 1998 and December 1998 on Medicaid funding. Use of potentially inappropriate medications as defined by explicit criteria (e.g., drugs that should generally be avoided in the elderly because potential risks outweigh any potential benefits). Sixty-two (22%) residents took a total of 75 potentially inappropriate medications at baseline. The most common agents used at baseline were oxybutynin (3.5%) and amitriptyline (3.5%). The incidence of new use of potentially inappropriate medications was 0.1/100 person-days during the follow-up period. Potentially inappropriate use was related to self-reported fair or poor health (adjusted OR 1.42; 95% CI 1.05 to 1.92) and number of prescription drugs (adjusted OR 1.12; 95% CI 1.05 to 1.19). In the Cox proportional hazard model, no characteristics predicted new potentially inappropriate medication use during the follow-up. Potentially inappropriate medication use is common among residents in CRC facilities. A comprehensive periodic review may be beneficial for reducing potentially inappropriate use, especially for patients taking multiple drugs.

Drug-drug interactions among elderly patients hospitalized for drug toxicity.

Drug-drug interactions are a preventable cause of morbidity and mortality, yet their consequences in the community are not well characterized. To determine whether elderly patients admitted to hospital with specific drug toxicities were likely to have been prescribed an interacting drug in the week prior to admission. Three population-based, nested case-control studies. Ontario, Canada, from January 1, 1994, to December 31, 2000. All Ontario residents aged 66 years or older treated with glyburide, digoxin, or an angiotensin-converting enzyme (ACE) inhibitor. Case patients were those admitted to hospital for drug-related toxicity. Prescription records of cases were compared with those of controls (matched on age, sex, use of the same medication, and presence or absence of renal disease) for receipt of interacting medications (co-trimoxazole with glyburide, clarithromycin with digoxin, and potassium-sparing diuretics with ACE inhibitors). Odds ratio for association between hospital admission for drug toxicity (hypoglycemia, digoxin toxicity, or hyperkalemia, respectively) and use of an interacting medication in the preceding week, adjusted for diagnoses, receipt of other medications, the number of prescription drugs, and the number of hospital admissions in the year preceding the index date. During the 7-year study period, 909 elderly patients receiving glyburide were admitted with a diagnosis of hypoglycemia. In the primary analysis, those patients admitted for hypoglycemia were more than 6 times as likely to have been treated with co-trimoxazole in the previous week (adjusted odds ratio, 6.6; 95% confidence interval, 4.5-9.7). Patients admitted with digoxin toxicity (n = 1051) were about 12 times more likely to have been treated with clarithromycin (adjusted odds ratio, 11.7; 95% confidence interval, 7.5-18.2) in the previous week, and patients treated with ACE inhibitors admitted with a diagnosis of hyperkalemia (n = 523) were about 20 times more likely to have been treated with a potassium-sparing diuretic (adjusted odds ratio, 20.3; 95% confidence interval, 13.4-30.7) in the previous week. No increased risk of drug toxicity was found for drugs with similar indications but no known interactions (amoxicillin, cefuroxime, and indapamide, respectively). Many hospital admissions of elderly patients for drug toxicity occur after administration of a drug known to cause drug-drug interactions. Many of these interactions could have been avoided.

The number of prescription drugs used by patients treated for schizophrenic or bipolar disorders

The number of prescription drugs used by patients treated for schizophrenic or bipolar disorders

A Review of the Comprehensiveness of Provincial Drug Coverage for Canadian Seniors

ABSTRACTProvincial government drug plans are the primary source of insurance for drugs taken by seniors in outpatient settings. The adequacy of this coverage has been called into question, given the increased clinical importance of pharma-ceuticals, shifts in the provision of health care from inpatient to outpatient settings, increased use of restrictive formularies, and reductions in provincial drug subsidies. To assess the adequacy of provincial coverage, we estimated what a typical single senior beneficiary of a provincial drug plan paid out-of-pocket in 1998 on prescription drugs covered by the public program, depending on his/her province of residence, level of drug consumption, and income. We compared provincial coverage for seniors with large drug costs. We also assessed provincial coverage of drugs that were introduced into the Canadian market between 1991 and 1998. The cost of drugs consumed by a senior in a given province and year was estimated by multiplying the average number of prescription drugs consumed by senior drug users by the average per-prescription costs. High drug consumption was defined as twice the average. We used the provincial drug cost sharing rules to estimate the senior's share of the total cost of drugs consumed. Mean out-of-pocket costs range from $42 to $1,302 per year, are lower for lower-income seniors, and increase with drug use, although the charge per drug decreases with the number used. There was up to a 12-fold variation among the provinces in the charges faced by seniors with similar incomes and drug use. All but one province limits costs to seniors with catastrophic drug costs, but there was 21-fold variation in the expenditure limits. The substantial variation in seniors' out-of-pocket drug costs raises questions about the distributive equity of drug subsidies in Canada. Recent evidence on the deleterious health effects of drug charges faced by seniors in Quebec and the fact that seniors in some other provinces face direct charges similar to those faced in Quebec raise the possibility of adverse consequences of drug charges in other provinces.

Le patologie gastrointestinali dall’epidemiologia all’intervento terapeutico nella pratica di medicina generale: analisi dei costi sanitari indotti

To define the occurrence and costs of medical therapy of GI diseases in a general practice setting and to evaluate the role of general practitioners (GPs) and patients in the prescription of gastrointestinal (GI) drugs. An observational study conducted from July 1999 to June 2000 in the Treviso area (North-East Italy). Prescription data were obtained from a questionnaire filled out by randomly recruited GPs. Data were compared with official records of drug utilization and diagnostic/therapeutic procedures provided by the Local Health Authority database, in order to obtain costs and occurrence of all prescriptions. 24 GPs (out of 80 contacted) were asked to fill out a form for each patient with a GI pathology. Inclusion criteria for patients were: age ≥ 18 years; prescription of a drug with ATC code A02AD*, A02BA*, A02BC*, A02BB01, A02BX* or A02FA*. The total number of patients monitored was 27 948 (7.7% of the local population). In the analysed period, the number of patients receiving a GI drug prescription was 1 235 (712 females and 523 males). The number of drug prescriptions was 7 682. The GPs were determinant for all kinds of drug prescription, though specialists and patients also had a role in inducing it. Gastritis and gastroesophageal reflux disease (GERD) were the most frequent GI pathologies, affecting females more often than males. The cost of drug therapy was highest for GERD (€ 252), followed by ulcer (€ 162), gastritis (€ 139), prevention of drug-induced gastric damage (€ 118), while the overall treatment costs were highest for ulcer. When costs of diagnostic and therapeutic treatments of most GI diseases were also considered, PPIs show an economic advantage over H2-receptor antagonists. Only for the prevention of gastric lesions by drugs, the use of prostaglandins was economically more convenient. The data provide evidence of a peculiar therapeutic attitude in treating GI diseases in the general practice setting. Pharmacoeconomic data point out to a different treatment pattern from the one found in the hospital setting.

Frequency of daily over-the-counter drug use and potential clinically significant over-the-counter-prescription drug interactions in the Finnish adult population.

To explore the frequency of continuous use of over-the-counter (OTC) drugs among the Finnish adult population and the potential for harmful interactions between OTC drugs and prescribed (Rx) drugs. Data were extracted from a 1995-1996 population-based interview survey on health care (n = 10,477, response rate 86%). The drug interaction classification system from the Swedish Drug Compendium FASS 1997 was used to identify OTC drugs likely to have clinically significant interactions with prescription drugs. Logistic regression was used to study factors related to continuous use and risks for interactions. Seventeen percent of the population had used OTC drugs and 15% had used OTC vitamins during the 2 days prior to the interview. Daily use of OTC drugs and of vitamins was reported by 7% and 9%, respectively. Continuous use of OTC drugs was related to older age, female gender, higher education, poor health status, long-term morbidity, psychosomatic symptoms (fatigue) and use of prescription drugs, but not to poor lifestyle. Four percent of the OTC drug users had taken drug combinations with potential for clinically significant interactions. Interactions were most common for ketoprofen (15% of ketoprofen users), ibuprofen (10%), and acetylsalicylic acid (ASA) (6%). The number of prescription drugs, long-term illness and lower education best explained the risk for interactions. Continuous use and potentially harmful Rx/ OTC drug interactions occur among OTC drug users. Further studies should be done to investigate whether potential combinations will actually lead to clinical problems. The possible interactions of non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics with prescription drugs should especially be taken into account in drug information.

Assessment of a patient-based pharmaceutical care scale.

The Purdue Pharmacist Directive Guidance scale (PPDG), which is designed to measure patients' perceptions of the level of directive guidance received from pharmacists, was studied. Hypertension patients were interviewed by telephone between July 15 and August 15, 1998, with a survey including the PPDG, the Medication Adherence Scale (MAS), and the Friends and Family Support scale (FFS). The Behavioral Pharmaceutical Care Scale (BPCS) was mailed between May 15 and July 15, 1998, to pharmacies from which the patients obtained most of their prescriptions. The MAS measures patients' medication adherence, and the FFS measures their perceptions of the social support they receive from family and friends. Analysis of variance was used to assess whether there was significant variation in scale scores across pharmacies. Pearson correlation analysis was used to assess simple correlation among scales, and regression analysis was used to examine the association between scale scores while controlling for demographic variables, family support, and number of prescription drugs taken. Interviews with 163 patients were analyzed, and 64 pharmacists representing 32 pharmacies responded. The PPDG did not detect any difference across pharmacies in patients' perceptions of the level of directive guidance received. There was no significant correlation between PPDG scores and pharmacists' perceptions of the level of pharmaceutical care provided as measured with the BPCS or between PPDG scores and MAS scores. The findings reconfirmed the PPDG's reliability and factor structure and provided some evidence of convergent validity. The PPDG was reliable. Evidence of validity was not conclusive, although the high threshold for validity may have been responsible for this.

Cost of medication therapy in ambulatory HIV-infected patients.

To examine the use and cost associated with prescribed medications as well as the use of over-the-counter medications and nontraditional therapies among ambulatory HIV-infected patients at Ryan White Title IIIb grantee centers. Study participants (n = 223) were enrolled from eight centers across the US and Puerto Rico. Data were collected by a nurse, pharmacist, or physician through review of medical records and medication profiles. Information on the use of over-the-counter drugs and alternative therapies was obtained from the patients. Two hundred eleven (94.6%) patients received a mean +/- SD of 5.3 +/- 3.8 prescription medications during a consecutive 90-day period. The cost of medication was $1237.62 +/- $1751.49 per patient. Patients with a diagnosis of AIDS received a greater number of prescription drugs: an average of 6.6 compared with 3.4 among HIV-positive patients and 3.5 among asymptomatic patients. Antiretroviral agents were used by 143 (68.7%) patients. Zidovudine and stavudine had the highest cost ($611.81 +/- $254.10 and $596.96 +/- $352.80, respectively). Eighty-one (40.9%) patients reported the use of at least one over-the-counter product (range 0-11) and 11.8% reported use of alternative therapies. This study shows the cost of drug treatment for HIV-infected patients has remained stable since the early 1990s. However, it is anticipated this will change due to the introduction of new anti-HIV agents, greater use of combination therapies, greater use of prophylactic therapies, and increased survival times.

Development of a scale to measure directive guidance by pharmacists.

To develop and test a questionnaire that can be used to measure directive guidance behaviors by pharmacists. QUESTIONNAIRE DESIGN: The Purdue Pharmacist Directive Guidance (PPDG) scale was developed based on the directive guidance dimension of socially supportive behaviors, as described by Barrera and Ainlay. The final scale consists of 10 items. Individuals on the Walker Test Crew database who were 18 years of age or older and self-reported taking medications for asthma, hypertension, and/or diabetes in the past 3 months were eligible for inclusion. All data were collected through telephone interviews. A total of 464 contacts were made, resulting in 300 responses. Principal components analysis was performed to determine the construct subscales of the PPDG. Internal consistency of the PPDG and its subscales was assessed using Cronbach's alpha and corrected item-total correlations. Pearson product-moment correlations of the PPDG with measures of family and friend support (FFS) and self-reported medication adherence were used to determine convergent validity. Spearman rank-order correlations of the PPDG with the total number of prescription medications as well as those for asthma, hypertension, and diabetes taken in the past 3 months were obtained. ANOVA and Student's t-tests were used to determine differences in PPDG across demographic characteristics. Principal components analysis yielded two subscales for the PPDG. These were named Instruction and Feedback and Goal Setting, based on their content. The PPDG scale had good internal consistency (Cronbach's alpha = 0.86), and correlated positively and significantly with FFS (r = 0.27), giving some evidence of convergent validity. The PPDG scale and its subscales also had logically intuitive positive and significant correlations with the total number of prescription drugs taken in the past 3 months. The PPDG is short and easy to administer, and showed validity and reliability. The PPDG scale should be useful in developing a better understanding of the process by which pharmacists influence healthcare outcomes, assessing variations in pharmaceutical care, and as a tool in identifying means of overcoming barriers to higher levels of pharmaceutical care.

La Prescripción Farmacéutica en Cataluña tras, el Decreto de Financiación Selectiva de Medicamentos

To assess the consequences of the Selective Financial Decree for prescription drugs in Catalonia. Observational longitudinal study of the registry of prescribed pharmaceutical specialties that were charged to the Catalan Service of Health, from august 1991 to July 1994. 243.8 million of prescriptions were analyzed. Between the 12 months prior to the Decree and the 12 months following, the number of drug prescriptions was reduced by 10%. As a whole, the drugs included in the decree were loosing sales before the Decree; 38% of then were not been prescribed at all during the period studied. The main groups affected by the Decree were, vitamins associations, stimulants an associations with cough suppressants, mainly with a low therapeutic value. There has only been and important and clear substitution effect in antianemic and cough suppressants associations. In general, substitutions between pharmaceutical groups were few and positive.

Obtaining feedback from clients

In a previous article (Breese, 1988), I reported on a study of objective measures (number of drug prescriptions and surgery attendances) obtained from 32 clients who had been seen for counselling in an agency located in a GPs’ surgery. In the summer of 1988 six colleagues and I who see clients in that surgery and in a Health Centre in a nearby town decided to carry out a subjective study by contacting clients themselves who had been counselled. The 51 clients whom we wrote to, enclosing a questionnaire and s.a.e., could be described as fairly representative of those we had seen; “fairly” because we only contacted those whose current addresses we knew and we eliminated any whom we knew should not be contacted by post because a spouse or other household member had not been aware they had been for counselling. All 51 were clients whose counselling had ended in either 1987 or 1988. This article reports briefly on some of the findings.

Influence of patients’ of age, sex, and race on prescription drug use among Georgia Medicaid recipients

Interactions among patients' age, sex, and race that influence prescription drug use in a state Medicaid population are described. A database containing information about all 574,762 Medicaid prescriptions dispensed in Georgia during December 1985 was sorted and summarized so that each record represented one Medicaid recipient. The following data were included for each recipient: the total number of Medicaid prescriptions received by that patient during that month, the total payments made by the state for those prescriptions, and the patient's age, sex, and race. Analyses were conducted on a 10% random sample representing 17,128 patients. The age variable was broken down as follows: Child, 0-5 years; Youth, 6-23 years; Adult, 24-64 years; and Old, 65 years of age or older. Race was recorded as white or nonwhite, and sex as male or female. The average white patient received significantly more prescriptions than did the average nonwhite patient. The largest percentage (41.6%) of the patients in the sample were classified as Old, and this group received the greatest mean number of prescriptions. The differences between mean numbers of prescriptions for white and nonwhite patients increased as the age of the patients increased. Gender influenced drug use only through its interaction with age and race. Patients in the white female Old category had the greatest mean number of prescriptions per patient, and patients in the nonwhite male Youth category had the fewest. The peak period of prescription drug use occurred between the ages of 70 and 80 years, and thereafter use decreased. In this Medicaid population a patient's age and race significantly influenced the number of prescription drugs that he or she used.

Opportunity-based suicide rates.

Clarke (1984) discussed the possibility of basing crime rates on the number of opportunities for crimes being committed rather than per capita of the population. Crime rates can be expressed relative to the target of crime (for example, the number of burglaries per houselapartment), to the means of commission (for example, auto thefts per car), to routine activities on the part of the criminal (for example, how many houses does the burglar break into per houses encountered), or to situations in which crimes take place (for example, the rate of shoplifting per number of stores entered, both for the average shopper and for the shoplifter). Clarke's idea suggests the possibility that suicide rates might be expressed in similar ways. For example, in 1967, the year before emission controls were introduced for cars, there were 72.9 million cars in the USA, 198.7 million people, and 2049 suicides using car exhaust. This gives a rate of 1.03 suicides per 100,000 people per year or 2.81 suicides per 100,000 cars per year. Using estimates of firearms in America (Moscicki & Boyd, 1983-1985) we can estimate the suicide rate using firearms in the USA in 1979 as 6.87 per 100,000 people per year or as 9.38 per 100,000 guns per year. And using estimates of the number of drug prescriptions for psychotherapeutics issued (Anon, 1985) we can estimate the number of suicides by psychotherapeutics in 1983 as 1.20 per 100,000 people per year or as 2.17 per 100,000 prescriptions per year. Suicide rates based upon opportunities may be psychologically more meaningful in the light of modern theories of suicide that stress the importance of opportunities for committing suicide as a major factor in determining the suicide rate (Clarke & Lester, 1987).