Prescribing Preferences Research Articles

Withdrawing gluten-free food from prescriptions in England: a mixed-methods study to examine the impact of policy changes on quality of life.

BackgroundSome local areas in England stopped have gluten‐free prescriptions for coeliac disease. An explanatory mixed‐methods study has investigated the impact of these changes.MethodsA cross‐sectional survey with 1697 participants was followed by 24 qualitative interviews. The survey included questions on the use of prescriptions and healthcare services, as well as the Coeliac Disease Assessment Questionnaire (CDAQ) to assess quality of life. The survey data were analysed by descriptive statistics, analysis of variance and regression analysis, and the interviews were analysed by thematic analysis. Findings from the interviews guided the survey analysis.ResultsDietary burden was significantly different between prescribing and nonprescribing areas, with little impact on other aspects of quality of life. Survey participants in nonprescribing areas who felt more impacted by the prescription changes reported a lower quality of life. Satisfaction with and use of services was lower in nonprescribing areas. Interviews indicated that, after initial frustrations, most people adapted to the changed prescription policy. However, there was a clear preference for gluten‐free prescriptions to be available, in particular for staple foods.ConclusionsThe main quality of life impact was on Dietary burden. It is encouraging that most participants in the present study maintained a good quality of life. However, issues of worse experiences of care, lower follow‐up opportunities and inequity arose, and these should be taken into consideration in decisions on gluten‐free food prescriptions. The new guidelines for the National Health Service in England have retained prescriptions for bread and flour mixes, which is more limited than the range of staple foods preferred in the present study.

Factors influencing enrolment in Vietnamese National Health Insurance: Evidence from six provinces in 2018.

This study examines the reasons why Vietnamese do not avail or subscribe to Social Health Insurance (SHI). This study collected data from the Project of Development and Strengthening the Management of Provider Payment Methods and Basic Health Service Package Reimbursed by Health Insurance Fund in Vietnam implemented by Japan International Cooperation Agency. In-depth interviews of nonsubscribers and logistic regression analysis were conducted to identify factors that influence enrolment in Vietnam's SHI. The results showed that financial burden, sound health condition, preference for prescriptions from pharmacies, and complicated enrolment procedures were factors that influenced subscription to SHI. Regression analysis displayed that respondents with high education and those who were aware of their rights and benefits and copayment responsibilities were more likely to subscribe to SHI. A negative correlation between household affluence and enrolment implies that the affluent was likely to subscribe to private health insurance over SHI. In-depth interviews revealed the need to address demand and supply factors and institutional procedures to improve programme enrolment. Disseminating information about SHI could also boost enrolment.

PMH41 THE REAL WORLD USE OF ORAL ANTIPSYCHOTICS IN SPAIN-STILL A NEED FOR NEW TREATMENTS?

Patients with schizophrenia receive multiple treatments along the course of their chronic disease. Several guidelines recommend to consider an alternative treatment if current one does not provide the expected efficacy. The “ideal” treatment controls both positive and negative symptoms and preserves patient’s functionality. First and second generation antipsychotics have different dopaminergic, serotoninergic or adrenergic receptor activities and affinities. They are equally recommended but neither of them seem to cover “ideal” criteria fully, which added to potential side effects, may led to a non-adherence-related risk of relapse. The Spanish market of oral antipsychotics has not changed in the past years. The objective of this study was to analyze the real use of oral antipsychotics in Spain and to interpret data from the clinical point of view. Analysis of oral antipsychotics prescription patterns in Spain by means of a representative sample of patients with schizophrenia from a Spanish Longitudinal IQVIA Patient Data base of two consecutive years (2016 and 2017) from 935 psychiatric sites. The mean percentage of use for second-generation antipsychotics was 93.43% while first generation 6.57%. Among the demographical and epidemiological-calculated 207,313 patients under second-generation of oral antipsychotics, the actual pattern of use was olanzapine 33.65 %, quetiapine 16.70 %, aripiprazole 14.34%, paliperidone 13.68 %, risperidone 10.67 %, clozapine 4.84 %, amisulpride 3.10 %, ziprasidone 2.83 %. A high and widespread use of second-generation oral antipsychotics is observed in the population diagnosed with schizophrenia in Spain. Prescription preferences (>80%) was predominantly using “pines” (olanzapine/quetiapine), “dones” (paliperidone/risperidone) or aripiprazole (the only dopaminergic partial agonist). This wide use could be due to the apparent need of different antipsychotics with different mechanisms of action able to adapt to patient’s characteristics. In an unchanged market for more than 10 years, it is also probable that new antipsychotics are still needed.

Recommended foscarnet dose is not associated with improved outcomes in cytomegalovirus salvage therapy

BackgroundCytomegalovirus (CMV) infection causes significant morbidity and mortality in transplant recipients. Ganciclovir and valganciclovir have proven efficacy but are limited by resistance and toxicity, whereas foscarnet typically retains activity when CMV has become resistant to other antivirals. Foscarnet dosing used in practice may be discordant with what is recommended in product labeling, as the result of an unconventional dosing nomogram or prescriber preference; however, it is unknown how discordant foscarnet dosing affects outcomes. ObjectiveOur purpose was to characterize the relationship between initial foscarnet dosing intensity (relative to product labeling) and key effectiveness and safety endpoints. Study designThis single-center, retrospective study included immunosuppressed adults with CMV viremia who received foscarnet between January 2012–July 2017. Subjects were divided into low dose (LD) and non-low dose (NLD) groups, according to foscarnet dose intensity. The primary endpoint was time-to-CMV eradication. Secondary endpoints included time-to-CMV clearance, acute kidney injury, hematologic toxicity, and mortality. ResultsOf 87 subjects, 38 met inclusion. Primary immunosuppression reasons were solid organ (63%) or hematopoietic cell transplant (29%). Seventeen and 21 subjects were in the LD and NLD groups, respectively. Median time-to-CMV eradication was 17 days (LD group) versus 13 days (NLD group), p = 0.823. Median time-to-CMV clearance was also non-significant (p = 0.505). There was no association between initial foscarnet dosing intensity and acute kidney injury, hematologic toxicity, or mortality (24% in both groups). ConclusionsThese findings suggest outcomes may be sensitive to other factors and underscore the need for further studies to improve understanding of foscarnet dosing in immunosuppressed patients.

A theoretical exploration of therapeutic monomania as a physician-based instrumental variable.

PurposeTo explore the utility of physician prescribing preference as an instrumental variable.MethodsExpert (non‐systematic) review of relevant literature on the appropriate selection of instrumental variables and theoretical exploration of individual physician and physician group prescriber preference.ResultsAn instrumental variable must satisfy three criteria: (1) It must predict the treatment received (strength of the instrument); (2) it cannot influence the outcome other that through the treatment received (exclusion restriction); and (3) it cannot be influenced by any factor that also influences the outcome (independence assumption). Arguments in favor of prescriber preference as an instrumental variable and suggestions for how to approach specific scenarios that may be encountered are offered.ConclusionsPrescriber preference, be it of individual physicians or groups of physicians, may, under the right conditions, be powerful instrumental variables. Empiric experimental data are required to determine the appropriateness of combining propensity matching and instrumental variable analysis.

A qualitative exploration of factors influencing medical staffs\u2019 decision-making around nutrition prescription after colorectal surgery

BackgroundEnhanced Recovery After Surgery (ERAS) guidelines recommend early oral feeding with nutritionally adequate diets after surgery. However, studies have demonstrated variations in practice and poor adherence to these recommendations among patients who have undergone colorectal surgery. Given doctors are responsible for prescribing patients’ diets after surgery, this study explored factors which influenced medical staffs’ decision-making regarding postoperative nutrition prescription to identify potential behaviour change interventions.MethodsThis qualitative study involved one-on-one, semi-structured interviews with medical staff involved in prescribing nutrition for patients following colorectal surgery across two tertiary teaching hospitals. Purposive sampling was used to recruit participants with varying years of clinical experience. The Theoretical Domains Framework (TDF) underpinned the development of a semi-structured interview guide. Interviews were audio recorded, with data transcribed verbatim before being thematically analysed. Emergent themes and sub-themes were discussed by all investigators to ensure consensus of interpretation.ResultsTwenty-one medical staff were interviewed, including nine consultants, three fellows, four surgical trainees and five junior medical doctors. Three overarching themes emerged from the data: (i) Prescription preferences are influenced by perceptions, experience and training; (ii) Modifying prescription practices to align with patient-related factors; and (iii) Peers influence prescription behaviours and attitudes towards nutrition.ConclusionsIndividual beliefs, patient-related factors and the social influence of peers (particularly seniors) appeared to strongly influence medical staffs’ decision-making regarding postoperative nutrition prescription. As such, a multi-faceted approach to behaviour change is required to target individual and organisational barriers to enacting evidence-based feeding recommendations.

Academic oncology clinicians' understanding of biosimilars and information needed before prescribing.

Background:With increasing numbers of oncology biosimilars in the approval pipeline, it is important to investigate oncology clinicians’ understanding of biosimilars and what information they need prior to adoption.Methods:Between January and May 2018, 77 oncology clinicians (52 physicians, 16 pharmacists, and 9 advanced practice providers) completed a survey covering three domains: clinician understanding, prescription preferences, and patient involvement. An in-depth interview was designed based on themes identified in the first 50 surveys: cost, safety and efficacy, patient preference, and disease stage. Participants were chosen to participate in the interview based on outlying responses to survey questions.Results:When asked to define a biosimilar, 74% (57/77) of respondents could not give a satisfactory definition, and 40.3% (31/77) considered a biosimilar the same as a generic drug. The most important factor in biosimilar prescription was safety and efficacy (4.51 out of 5) followed closely by cost differences (4.34 out of 5). A 40% increase (53.2–94.8%) in clinicians’ prescribing likelihood was seen after a biosimilar is designated as interchangeable. Participants in this study were split regarding the importance of shared decision-making with patients [50.7% (39/77) important or extremely important, 39.0% (30/77) somewhat or not at all important]. Clinicians were also split concerning the role that pharmacists should play in the decision to prescribe or substitute biosimilars.Conclusion:Understanding of biosimilars is low, and educational needs are high. The information that clinicians deem important to assess, such as safety, efficacy and cost, will need to be provided before they are comfortable prescribing biosimilars.

336 The Effect of Implementing Electronic Health Record Default Prescribing Preferences on Opioid Prescriptions Written in the Emergency Department

336 The Effect of Implementing Electronic Health Record Default Prescribing Preferences on Opioid Prescriptions Written in the Emergency Department

Real-world incidence of patient-reported dyspnoea with ticagrelor.

Dyspnoea, a common and multifactorial symptom in patients with acute coronary syndrome, has been associated with lower quality of life and hospital readmission. Prescriber preference for antiplatelet therapy, the standard of care in this patient group, is shifting to ticagrelor due to mortality benefits demonstrated in trials compared with clopidogrel. In these trials, dyspnoea was more commonly reported in patients prescribed ticagrelor but the aetiology is still debated. An observational cohort study was conducted to quantify the rates and severity of dyspnoea reported in patients with acute coronary syndrome and newly prescribed ticagrelor compared with those prescribed clopidogrel. Dyspnoea was more commonly reported in patients prescribed ticagrelor at each follow up post-discharge (p = 0.016). Rates were higher than previously reported in clinical trials. In some patients, dyspnoea necessitated drug therapy change and was associated with readmission to hospital (p = 0.046). As ticagrelor is widely prescribed as a first-line antiplatelet agent for a range of patients with acute coronary syndrome, the incidence of dyspnoea in a generalized patient cohort may result in higher rates of drug discontinuation. This in turn could lead to higher rates of rehospitalisation and potential treatment failure than that reported from the controlled setting of a clinical trial.

Effect of a voice recognition system on pediatric outpatient medication errors at a tertiary healthcare facility in Kenya.

Medication-related errors account for one out of every 131 outpatient deaths, and one out of 854 inpatient deaths. The risk is threefold greater in the pediatric population. In sub-Saharan Africa, research on medication-related errors has been obscured by other health priorities and poor recognition of harm attributable to such errors.Our primary objective was to assess the effect of introduction of a voice recognition system (VRS) on the prevalence of medication errors. The secondary objective was to describe characteristics of observed medication errors and determine acceptability of VRS by clinical service providers. This was a before-after intervention study carried out in a Pediatric Accident and Emergency Department of a private not-for-profit tertiary referral hospital in Kenya. A total of 1196 handwritten prescription records were examined in the pre-VRS phase and 501 in the VRS phase. In the pre-VRS phase, 74.3% of the prescriptions (889 of 1196) had identifiable errors compared with 65.7% in the VRS phase (329 of 501).More than half (58%) of participating clinical service providers expressed preference for VRS prescriptions compared with handwritten prescriptions. VRS reduces medication prescription errors with the greatest effect noted in reduction of incorrect medication dosages. More studies are needed to explore whether more training, user experience and software enhancement would minimize medication errors further. VRS technology is acceptable to physicians and pharmacists at a tertiary care hospital in Kenya.

Part 2. Current prescribing trends of dental non-antibacterial medicines in Australia from 2013 to 2016.

There is limited literature regarding dental prescribing preferences for medicines other than antibiotics. This study aimed to describe the prescribing trends of dispensed prescription medicines by dentists in Australia from 2013 and 2016 and assess adherence to current guidelines. Data were accessed from the Department of Health of all dental prescriptions dispensed under the Pharmaceutical Benefits Scheme (PBS) from 2013 to 2016 and prescribing patterns were analysed. The prescribing rates were standardized to the dose and population. There was an overall increase in the standardized use of opioid analgesics by almost 30% over the time frame, with the combination paracetamol 500 mg plus codeine 30 mg tablet accounting for the majority of dispensed opioid prescriptions (96.2% in 2016). Dispensed benzodiazepine prescriptions increased by 14.6%. The increase in the consumption of opioids is concerning, suggesting that continuing education is required for dentists to better understand their limited role in managing dental pain and potential for abuse. The substantial increase in the dispensed use of benzodiazepines also requires further investigation and there were some drugs prescribed inappropriately and not in accordance with guidelines. Consideration could also be given to reviewing the drugs listed on the PBS for dental prescribing.

Update on the Pharmacological Treatment of Tics with Dopamine-Modulating Agents.

More than 40 years of research and clinical practice have proven the effectiveness of dopamine receptor antagonists in the pharmacological treatment of tics. A blockade of the striatal dopamine-D2 receptors is mainly responsible for their tic-reducing effect. A broad spectrum of dopamine-modulating agents, such as typical and atypical antipsychotics, but also dopamine receptor agonists are used with an immanent discord between experts about which of them should be considered as first choice. The present Review outlines the state of the art on pharmacological treatment of tics with dopamine-modulating agents by giving an systematic overview of studies on their effectiveness and a critical discussion of their specific adverse effects. It is considered as an update of a previous review of our research group published in 2013. The Review closes with a description of the current resulting treatment recommendations including the results of a first published revised survey on European expert's prescription preferences. Based on the enormously growing evidence on its effectiveness and safety, aripiprazole currently seems to be the most promising agent in the pharmacological treatment of tics. Furthermore, benzamides (especially tiapride), which are commonly used in Europe, have proven their excellent effectiveness-tolerability profile over decades in clinical practice and are therefore also highly recommended for the treatment of tics. Nevertheless, pharmacological treatment of tics remains an indiviual choice depending on each patient's own specific needs.

Association of Household Opioid Availability and Prescription Opioid Initiation Among Household Members

Increases in prescription opioid use in the United States have been attributed to changing prescribing guidelines and attitudes toward pain relief; however, the spread of opioid use within households through drug diversion may also be a contributing factor. To investigate whether individuals living in a household with a prescription opioid user are more likely to initiate prescription opioids themselves, compared with individuals in households with a prescription nonsteroidal anti-inflammatory drug (NSAID) user. This was a retrospective cohort study using administrative health care claims data from 2000 to 2014 of commercial insurance beneficiaries sharing a health plan with continuous prescription drug coverage, without opioid or NSAID use in the prior year. Enrollees were followed from the date of the first prescription filled by a household member for an eligible opioid or NSAID until initiation of prescription opioids, disenrollment, or administrative censoring after 1 year or the end of follow-up on December 31, 2014. Risk of opioid initiation was derived from inverse probability-weighted (IPW) Kaplan-Meier estimators that adjusted for potential confounders, prognostic factors, and predictors of censoring. Outpatient pharmacy dispensing of a prescription opioid or prescription NSAID. Incident outpatient pharmacy fill for a prescription opioid by a household member. From 2000 to 2014, 12 695 280 individuals were exposed to prescription opioids and 6 359 639 to prescription NSAIDS through an index prescription to a household member. The IPW estimated risk of opioid initiation in the subsequent year was 11.83% (95% CI, 11.81%-11.85%) among individuals exposed to prescription opioids in the household, compared with 11.11% (95% CI, 11.09%-11.14%) among individuals exposed to prescription NSAIDs, resulting in a risk difference of 0.71% (95% CI, 0.68%-0.74%). An unmeasured confounder that is modestly associated with the exposure (eg, prevalence difference = 0.9%) and the outcome (eg, risk difference = 0.9) after adjustment for all measured variables could explain our observed estimate of the overall risk difference (0.71%). Living in a household with a prescription opioid user may increase risk of prescription opioid use, which may reflect both increased access to these products as well as shared risk factors, such as prescriber preference and prescription drug monitoring.

A single institution experience with palbociclib toxicity requiring dose modifications

PurposeSince the widespread implementation of adding palbociclib to endocrine therapy in clinical practice, myelosuppression is becoming increasingly recognized as a toxicity that may lead to dose modification. We aimed to characterize toxicities observed with palbociclib resulting in dose modifications and prescriber preferences in modifying palbociclib dosage in response to treatment-related toxicities outside the context of a clinical trial.MethodsWe conducted a single institution, retrospective study of treatment-related adverse events (AEs) resulting in modifications in dose and schedule and the methods by which dose modifications occurred in patients with advanced hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer receiving palbociclib and endocrine therapy.ResultsFrom 2/2015 to 10/2016, 100 patients were identified for inclusion in this study. Treatment with palbociclib and endocrine therapy resulted in dose modifications in 38.0% of patients due to AEs with 18.4% requiring subsequent dose changes. Most palbociclib dose modifications occurred during the first 2 cycles. Grade 3–4 neutropenia accounted for 54.8% events of palbociclib dose modification. Most providers (65.8%) dose reduced palbociclib from 125 mg to 100 mg as their preferred method of dose modification, while others dose reduced from 125 mg to 75 mg (10.5%) and altered the schedule to 125 mg every other day (7.9%). A comparable rate of palbociclib dose modifications and subsequent dose changes were identified in an age ≥ 65 subgroup. In this group, dose adjustments were most commonly from grade 3–4 neutropenia, occurred mainly during cycle 1, and were most frequently addressed by dose reduction from 125 to 100 mg.ConclusionsNeutropenia remains the predominant cause for palbociclib dose modification and most modifications occur within the first two cycles. Older age (≥ 65) does not affect palbociclib tolerance. Our findings provide context outside of a clinical trial that inform ongoing studies evaluating the safety and feasibility of palbociclib-based therapies.

Oral Contraceptive Preference and Prescription Patterns Among Primary Care Residents in an Academic Medical Center [1F

INTRODUCTION: Oral contraceptive pills (OCPs) are the most widely-used form of reversible contraception in the United States. There are a variety of formulations available with little evidence in the literature on which to recommend over another. This study analyzes OCP prescription patterns among primary care residents within the University of California Los Angeles (UCLA) Health System. METHODS: An IRB-approved cross-sectional survey was administered electronically to residents in three primary care specialties (family medicine, internal medicine, obstetrics and gynecology). The survey contained questions analyzing frequency of OCP prescription, as well as attitudes and practices regarding prescription of OCP formulations. Data analysis was performed using univariate statistics. RESULTS: Survey response rate is 34% with 52 completed surveys. 52% of respondents reported prescribing up to 5 OCPs per week. A majority of residents (85%) demonstrated understanding of the pharmacological and clinical equivalences between generic and branded OCPs. However only 35% of residents felt comfortable helping patients choose an appropriate OCP or counseling patients on choices between generic versus branded pills. More than half of the respondents (62%) did not feel comfortable managing breakthrough bleeding with the use of OCPs. When asked to choose a “preferred” formulation, residents tended to choose a monophasic (72%), combined hormonal (92%), generic (72%) oral contraceptive pill. CONCLUSION: There is extensive redundancy of OCP formulations on the market. Improving knowledge of OCP prescription preferences is essential to clarifying common practices among physicians. Curriculum for primary care residents should elucidate the differences between formulations of OCPs, types of progestins, and relative side effects.

Decision-making interventions to stop the global atrial fibrillation-related stroke tsunami.

Atrial fibrillation affects 33.5 million people worldwide and its prevalence is expected to double by 2050 because of the aging population. Atrial fibrillation confers a 5-fold higher risk of ischemic stroke compared to sinus rhythm. We present our view of the role of shared medical decision-making to combat global underutilization of oral anticoagulation for stroke prevention in atrial fibrillation patients. Oral anticoagulation underuse is widespread as it is present within atrial fibrillation patients of all risk strata and in countries across all income levels. Reasons for oral anticoagulation underuse include but are probably not limited to poor risk stratification, over-interpretation of contraindications, and discordance between physician prescription preferences and actual administration. By comparing a catastrophic event to the consequences of atrial fibrillation related strokes, it may help physicians and patients understand the negative outcomes associated with oral anticoagulation under-utilization and the magnitude to which oral anticoagulations neutralize atrial fibrillation burden.

Use and cost comparison of clobazam to other antiepileptic drugs for treatment of Lennox-Gastaut syndrome

ABSTRACTBackground: Lennox-Gastaut syndrome (LGS) is a severe form of childhood-onset epilepsy associated with serious injuries due to frequent and severe seizures. Of the antiepileptic drugs (AEDs) approved for LGS, clobazam is a more recent market entrant, having been approved in October 2011. Recent AED budget impact and cost-effectiveness analyses for LGS suggest that adding clobazam to a health plan formulary may result in decreased medical costs; however, research on clinical and economic outcomes and treatment patterns with these AED treatments in LGS is limited.Objectives: To compare the baseline characteristics and treatment patterns of new initiators of clobazam and other AEDs among LGS patients and compare healthcare utilization and costs before and after clobazam initiation among LGS patients.Methods: A retrospective study of probable LGS patients was conducted using the MarketScan® Commercial, Medicare Supplemental, and Medicaid databases (10/1/2010-3/31/2014).Results: In the Commercial/Medicare Supplemental population, clobazam users were younger, had fewer comorbidities, and more prior AED use than non-clobazam users. In the 12 months pre-treatment initiation, clobazam users had significantly more seizure-related inpatient stays and outpatient visits and higher total seizure-related (P < 0.001) and all-cause (P < 0.001) costs than non-clobazam users. Among clobazam users, when compared to the 12 months pre-clobazam initiation, seizure-related medical utilization and costs were lower in the 12 months post-clobazam initiation (P = 0.004). Total all-cause (P < 0.001) and seizure-related (P = 0.029) costs increased post-clobazam initiation mainly due to the increase in outpatient pharmacy costs. Similar results were observed in the Medicaid population.Conclusions: Baseline results suggest a prescribing preference for clobazam in severe LGS patients. Clobazam users had a reduction in seizure-related medical utilization and costs after clobazam initiation. The improvement in medical costs mostly offset the higher prescription costs following clobazam initiation.

Turkish Final Year Medical Students' Exposure to and Attitudes Concerning Drug Company Interactions: A Perspective from a Minimally Regulated Environment for Medical Students.

Interactions between drug companies and medical students may affect evidence-based medical practice and patient safety. The aim of this study was to assess drug company–medical student interactions in a medical faculty where limited specific national or institutional regulations apply between drug companies and medical students. The objectives of the study were to determine the exposure and attitudes of final year medical students in terms of drug company–medical student and physician interactions, to identify factors affecting those attitudes and to provide data for policymakers working on the regulation of interactions between drug companies and medical students. This anonymous questionnaire-based study of 154 medical final year medical students at the Karadeniz Technical University Medical Faculty, Trabzon, Turkey, in April and May 2015 attracted a response rate of 92.2% (n/N, 154/164). Exposure to interaction with a pharmaceutical representative was reported by 90.3% (139/154) of students, and 68.8% (106/154) reported experiencing such interaction alongside a resident. In addition, 83.7% (128/153) of students reported an interaction during internship. Furthermore, 69.9% (107/153) of students agreed that interactions influence physicians’ prescription preferences, while 33.1% (51/154) thought that a medical student should never accept a gift from a drug company and 24.7% (38/154) agreed with the proposition that “drug companies should not hold activities in medical faculties”. Students with rational prescription training expressed greater agreement with the statement “I am skeptical concerning the information provided by drug companies during interactions” than those who had not received such training, and this finding was supported by logistic regression [O.R.(C.I), p -3.7(1.2–11.5), p = 0.022]. Acceptance of advertisement brochures was found to significantly reduce the level of agreement with the proposition that “A physician should not accept any gift from a drug company.” (0.3[0.1–0.9], p = 0.030). In summary, exposure to drug companies was widespread among our final year medical students who, like students in both Western and non-Western societies, hold permissive attitudes concerning accepting gifts, and drug advertising brochures may relax those permissive attitudes still further. Rational prescription training was useful in generating rational attitudes. Policies concerning drug company–medical student relationships should be developed in Turkey as well as internationally.

Prescription preferences in antipsychotics and attitude towards the pharmaceutical industry in Belgium

ObjectivesThe number of antipsychotic prescriptions are increasing rapidly worldwide, a trend which is mainly driven by the steep rise in second-generation antipsychotic (SGA) prescriptions. However, the success of SGA, compared...

Medication Palatability Affects Physician Prescribing Preferences for Common Pediatric Conditions.

The objective of this study was to determine if physicians would alter their prescribing preferences after sampling liquid formulations of medications for common pediatric diagnoses. This was a prospective interventional before/after study conducted at an academic medical center in the United States. The participants of interest included emergency, family medicine, and pediatric physicians. Participants initially completed a brief survey for their primary oral liquid medication of choice for the treatment of selected disease states. These included otitis media, sinusitis, cellulitis, asthma, colitis, and pneumonia. Participants were asked to choose one of the medication options for each disease and then were given all medications to sample for a taste test. The prescribing preference survey was then repeated. The primary outcome was change in prescribing. McNemar's test was used to evaluate change in proportion of medications chosen before and after taste testing. There were 101 physicians who participated in the study. There were three conditions for which participants changed their prescribing preferences significantly. These were otitis media (change from amoxicillin to cefdinir, difference = 13.2%, 95% confidence interval [CI] = 5.5% to 21.0%), asthma exacerbation (change from dexamethasone or prednisone to prednisolone, 28%, 95% CI = 15.9% to 40.1%), and pneumonia (change from azithromycin to amoxicillin, 16.0%, 95% CI = 6.4% to 25.6%). There was no significant change with respect to the other scenarios. Physicians showed preferences for certain pediatric medications based on taste and showed significant changes in prescribing preferences for some common pediatric diagnoses after tasting different medications for these conditions.