Prescription Items Research Articles

Epidemiology and healthcare resource utilisation associated with Duchenne muscular dystrophy

BackgroundThis study aimed to describe the prevalence of Duchenne muscular dystrophy (DMD) and associated healthcare resource utilisation and costs from an England perspective.MethodsPatients with DMD were selected by recorded diagnoses from the Clinical Practice Research Datalink Aurum database and matched to non-DMD controls. The point prevalence of DMD (2020) was estimated. Primary care, inpatient, outpatient, and A&E department contacts and prescription items emanating from primary care were aggregated and their costs were compared between cases and controls. People with DMD were further classified by ambulatory phase and ventilation status and respective costs presented.ResultsThe point prevalence of DMD in 2020 was 3.23 per 100,0000 (95% confidence interval [CI] 2.82–3.63). There was a significant increase in contacts in all healthcare sectors compared to controls: primary care (incidence rate ratios (IRR) = 3.19 (95% CI 3.11–3.28)), inpatient admissions (IRR = 9.24 (95% CI 8.19–10.46)), outpatient appointments (IRR = 11.44 (95% CI 10.95–11.96)) and accident and emergency (IRR = 1.65 (1.52–1.81)). Overall, healthcare costs were almost ten-fold higher (adjusted cost ratio (ACR = 9.33 (95% CI 6.75–12.91)). Healthcare costs increased with the progression of DMD: £2816, on average, in the ambulatory phase; £5700 in the non-ambulatory without-ventilation, and £7634 in the non-ambulatory with ventilation phase.ConclusionDMD was associated with almost a ten-fold increase in healthcare costs. Worsening DMD status, as characterized by non-ambulation and requirement for ventilation, was associated with increased costs. However, the use of standard tariffs may underestimate the true financial burden of the condition. This assessment excluded social care and carer costs some of which will encompass medical needs and may contribute significantly to the cost burden of DMD.

Rising incidence, health resource utilization and costs of Polycystic Ovary Syndrome in the United Kingdom.

Trends in incidence of Polycystic Ovary Syndrome (PCOS) and effects on health resource utilization are unclear. To describe trends in prevalence and incidence of PCOS in the United Kingdom. To establish healthcare resource use and associated costs. Data were extracted from the Clinical Practice Research Datalink Aurum and Hospital Episode Statistics databases. Point prevalence and incidence were calculated (2004-2020). Patients with PCOS were matched to controls (1:1) by age, body mass index and primary care practice. Primary care contacts were assigned an average cost and prescription items assigned a net ingredient cost. Inpatient admissions and outpatient consultations were processed into Healthcare Resource Groups and costed to the National Tariff. PCOS incidence increased from 1.22 per 1000 person years in 2004 to 1.77 (2012) and 2.20 (2019). Point prevalence increased from 1.02% (2004) to 2.2% (2012) and 3.5% (2020), and was highest in Asians. Mean contacts per person year (ppy) for patients with PCOS versus controls were 0.48 vs 0.29 for inpatients (p<0.001), 3.81 vs 2.15 for outpatients (p<0.001) and 6.43 vs 4.68 (p<0.001) for primary care. Mean healthcare costs (ppy) were £837 vs £493 (p<0.001) for inpatients, £444 vs £253 (p<0.001) for outpatients, £157 vs £112 for primary care and £109 vs £83 (p<0.001) for primary care prescriptions. Total health care contacts ppy were 10.72 vs 7.11 (p<0.001) and total associated costs £1,546 vs £940 (p<0.001). The incidence of PCOS has risen significantly. Health resource utilization and costs of PCOS are significantly greater than controls.

Trends in prescription and cost of Sativex, a cannabinoid-based medicine, in treating patients with multiple sclerosis in England.

Cannabis-based medication has recently been made available in the NHS for reducing pain and spasticity in patients with multiple sclerosis (MS). The currently available preparation of Sativex (nabiximols) contains a combination of botanical cannabis extracts with cannabidiol (CBD) and tetrahydrocannabinol (THC) with almost equal amounts in addition to minor cannabinoids and terpenoids and is delivered via an oro-mucosal spray. The present study aims to examine the use and trends in prescribing cannabinoid-based Sativex to control pain in patients diagnosed with MS. Primary care prescribing data for cannabinoid-based Sativex (2013-2022) from the Prescription Cost Analysis were extracted and analysed. Linear regression analyses were performed to examine prescription trends and prescription costs (average change per year). There was a general increasing trend in the number of prescriptions each year, from 4.42 items dispensed per 100,000 people in 2013 to 5.15 in 2022. Overall, prescription items for cannabinoid-based Sativex increased by 0.34% per year (95% CI:-3.98, 4.67, p = 0.860) on average between 2013 and 2022. On average, a 2.43% (95% CI: -5.78, 0.92, p = 0.133) increase per year was observed for the costs of cannabinoid-based Sativex from 2013 to 2022. The results suggested that cannabinoid-based Sativex should be considered an option due to its effectiveness, acceptable tolerance, and safety profile in the prescribing of Sativex.

Carbon Reduction Impact from Synchronising PrescriptionS (CRISPS): A pilot study

Abstract Introduction Synchronising the dates of patients’ repeat prescriptions can reduce monthly community pharmacy visits or home deliveries, which may improve patients’ adherence to medicines.[1] It should also reduce carbon dioxide (CO2) emissions associated with avoidable travel, but previous research does not appear to have determined the potential size of this reduction. This pilot study therefore attempted to do so using routinely collected data. Aim To estimate potential carbon savings from synchronising repeat medicines for a sample of patients from one community pharmacy. Methods All patients who had prescriptions dispensed four times per month or more from a single medium-sized (approximately 2,500 items dispensed per month) urban community pharmacy in England were identified from the pharmacy’s home delivery application. The threshold of four deliveries per month was selected to increase the likelihood of this frequency being due to asynchronised prescriptions. Data were collected (August 2023) for deliveries in June 2023 as there were no public holidays or events to affect prescription ordering. Data included patients’ postcode, delivery dates, and using the Patient Medication Record, the pharmacist collecting the data determined acute or one-off prescription items, that neither the patients nor the repeat medicines were new, and where deliveries were made to supply medicines owing. The pharmacy was selected because it efficiently managed stock to minimise items owing. The distance that would have been travelled was calculated as if the medicines had been collected from the pharmacy as a dedicated journey to and from the patient’s home address instead of being delivered. The saving in miles and CO2 emitted for different vehicle types was modelled by assuming that for each patient, all deliveries that were not for acute items or medicines owing could have been reduced to a single delivery if prescriptions had been synchronised. UK Government conversion factors were used to calculate CO2 emissions.[2] Results Data were collected for 59 patients, of whom 7 patients had 8 deliveries, 4 had 7 deliveries, 6 had 6 deliveries, 16 had 5 deliveries and 26 had 4 deliveries. The total number of deliveries to these patients was 269 but would have been 80 deliveries if the repeat prescriptions had been synchronised (70% reduction). The distance travelled would have been reduced from 842 miles to 241 miles (71% reduction). This would have resulted in a 71% reduction in CO2 emissions, although the reduction in volume in kilograms of CO2 emitted would have varied (by an estimated 137 Kg CO2 or 51%) depending on whether e.g., a small diesel car was used or a large petrol car (reduction of 133kg versus 270 kg CO2). An average diesel car was estimated to have reduced CO2 emissions by 163 kg. Conclusion The findings demonstrate that potential carbon savings from medicines synchronisation can be modelled from routinely collected data, but with limited accuracy, especially as patients receiving home deliveries may not be representative of all pharmacy users. Challenges remain in how to measure actual carbon savings of prescription synchronisation and overcoming barriers to widespread implementation of clinically appropriate synchronisation.

Factors Affecting Waiting Time for Outpatient Prescription Services in BPJS Patients at the Pharmacy Installation of the M Natsir Solok Regional General Hospital Year 2022

Modern hospital services are currently associated with one of the hospital quality indicators, namely waiting time, this waiting time is closely related to the level of patient satisfaction. The purpose of this study was to see what factors influence waiting time at the outpatient pharmacy installation at RSUD M Natsir Solok. Methods The research was conducted using a cross-sectional study design approach. The factors that influence the waiting time examined in this study are the type of prescription, the number of prescription items, the completeness of the amount of drug administration, the price of the BPJS prescriber, facilities, infrastructure and manpower. The results showed that there were more types of prescription types of officinalis (87.5%) than magistralis prescriptions (12.5%), the number of prescription items was more that did not comply with WHO standards (&gt; 2 items) namely (77.2%), the completeness of the number of drug administration was obtained more many medicines were given in full (86.6%), BPJS prescription prices were obtained according to standards (90.4%), facilities, infrastructure, and staff were found to be incompatible with PMK and technical instructions. The conclusion in this study is that the most related factor is the type of recipe. Efforts that can be made by the hospital are to make improvements in efforts to increase waiting time to standard by maximizing power and increasing the power of the hospital. Keywords: factors that affect waiting time: BJPS prescription

A cohort study comparing pharmacist activities during participation in general medical ward rounds: telehealth versus in-person during the COVID-19 pandemic.

The COVID-19 pandemic created systemic challenges in patient care delivery. To evaluate the impact on pharmacist activities during pharmacist participation in ward rounds via telehealth, compared to physical attendance. A single-centre, retrospective cohort study conducted from 18th Aug through 26th Oct 2020. Patients admitted to COVID and non-COVID general medical teams were included. Pharmacists attended ward rounds via telehealth for COVID teams; physical attendance continued for non-COVID teams. Telehealth involved pharmacists interacting with clinicians and patients virtually via videoconferencing whilst stationed remotely on the ward. Routine clinical pharmacy activities during telehealth ward rounds were compared to those during face-to-face ward rounds using comparative statistics. Among the 1230 patients included (762 COVID, 468 non-COVID), pharmacist participation in telehealth ward rounds demonstrated significantly more documented activities compared with face-to-face rounds (mean 6.7 vs 4.9 per patient per day, p < 0.001). The telehealth cohort exhibited a higher number of orders placed via pharmacy-partnered medication charting (3.0 vs 2.4 per patient per day, p < 0.001), medication orders verified (2.3 vs 1.1, p < 0.001), and documented pharmacy notes (0.6 vs 0.2, p < 0.001). No significant difference was observed in medication requests processed (0.4 vs 0.4, p = 738), whilst non-COVID patients had more discharge prescription items generated (0.3 vs 0.7, p < 0.001). Pharmacist involvement in medical ward rounds via telehealth enabled the ongoing provision of advanced clinical pharmacy services to inpatients in isolation rooms during the COVID-19 pandemic. This approach resulted in a greater number of pharmacy activities during telehealth ward rounds compared to standard in-person attendance.

A multi-site repeated prevalence study of medicine shortages in community pharmacies.

Medicine shortages are a global problem. Prior studies have focused on hospitals, and staff views, with less information on community practice. This study aimed to estimate the prevalence of medicine shortages in community pharmacies and potential impact on patients. Four community pharmacies (two urban, two rural) in Ireland recorded details of prescription request shortages per items dispensed. Data were gathered one study day per month from February to April 2023. A prevalence across sites was estimated and trends examined using a Poisson regression. There were 76 medicine requests defined as shortages out of 3734 prescription item requests, giving a mean shortage prevalence of 2% (95% CI 1.6-2.5%). There was a non-significant, 17%, increase in shortage rate across the study period (p = 0.256). Higher rates were observed in the two urban pharmacies. In total, 61/76 (80%) of shortages were associated with a delay in patient treatment. Shortages are prevalent in community pharmacy and cause delays in patient treatment and increase in workload of pharmacy staff. Regulatory initiatives to address the issue at a manufacturer level have been proposed, although workforce planning, resourcing and professional role expansion are also required to protect pharmacy staff and patient outcomes.

Number of dispensed HRT prescription items increased by a fifth in 2023/2024

Number of dispensed HRT prescription items increased by a fifth in 2023/2024

The impact of the COVID-19 pandemic on cardiovascular disease prevention and corresponding geographical inequalities in England: interrupted time series analysis

BackgroundThere has been disruption to the detection and management of those with hypertension and atrial fibrillation (AF) during the COVID-19 pandemic. This is likely to vary geographically and could have implications for future mortality and morbidity. We aimed to estimate the change in diagnosed prevalence, treatment and prescription indicators for AF and hypertension and assess corresponding geographical inequalities.MethodsUsing the Quality and Outcomes Framework (2016/17 to 2021/22) and the English Prescribing Datasets (2018 to 2022), we described age standardised prevalence, treatment and prescription item rates for hypertension and AF by geography and over time. Using an interrupted time-series (ITS) analysis, we estimated the impact of the pandemic (from April 2020) on missed diagnoses and on the percentage change in medicines prescribed for these conditions. Finally, we described changes in treatment indicators against Public Health England 2029 cardiovascular risk targets.ResultsWe observed 143,822 fewer (-143,822, 95%CI:-226,144, -61,500, p = 0.001) diagnoses of hypertension, 60,330 fewer (-60,330, 95%CI: -83,216, -37,444, p = 0.001) diagnoses of AF and 1.79% fewer (-1.79%, 95%CI: -2.37%, -1.22%), p < 0.0001) prescriptions for these conditions over the COVID-19 impact period. There was substantial variation across geography in England in terms of the indirect impact of the COVID-19 pandemic on the diagnosis, prescription, and treatment rates of hypertension and AF. 20% of Sub Integrated Care Boards account for approximately 62% of all missed diagnoses of hypertension. The percentage of individuals who had their hypertension controlled fell from 75.8% in 2019/20 to 64.1% in 2021/22 and the percentage of individuals with AF who were risk assessed fell from 97.2% to 90.7%.ConclusionsHypertension and AF detection and management were disrupted during the COVID-19 pandemic. The disruption varied considerably across diseases and geography. This highlights the utility of administrative and geographically granular datasets to inform targeted efforts to mitigate the indirect impacts of the pandemic through applied secondary prevention measures.

An analysis of direct and indirect costs in Hidradenitis Suppurativa.

Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition with recurrent nodules and abscesses that culminate in purulent discharge and scarring. It has significant physical, psychological and financial impact. This study plans to analyse patient costs associated with HS. Direct costs include prescription items. Indirect or out-of-pocket costs include dressings, analgesia, and healthcare-related travel costs. This study will also assess disease impact on quality-of-life (QOL). Patients with HS diagnosis attending dermatology OPD at our public tertiary centre were invited to participate. Ethical approval was secured, and informed consent was obtained. Participants completed an anonymous survey which was analysed to identify costs associated with HS as well as demographics and QOL impact. A total of 25 patients completed the survey; median age was 29% and 80% were female. Median time from HS onset to diagnosis was 2years, with 24% waiting >10years to be diagnosed. In the past 3months, 20% spent >€200 in both categories; prescription and non-prescription items. In the non-prescription category, 36% of patients reported expenditure >€100 in the past 3months. Dressings were the most common out-of-pocket expense (in 15/25 patients), followed by analgesia and protective clothing. Attendance at medical appointments cost 24% of patients €50-€200. Four participants reported difficulty accessing HS treatments due to associated costs. Mean number of absence days from work/education as result of HS was 8.7 in the past 3months. Two patients reported being on disability allowance, and two on unemployment benefit as result of their skin disorder. In the QOL question; 96% reported disease impact on QOL, and 11 participants reported that it affected their life 'very much'. HS is a chronic inflammatory skin condition with significant financial burden alongside the well-analysed biopsychosocial disease impact. Financial burden can be divided into direct prescription costs and indirect costs such as non-prescription items, protective clothing and travel costs which we have explored in this study. Further research is needed in this area to identify and optimise both the financial and QOL implications of HS in acute flares and chronic disease management.

Exploring medication safety through a social determinants of health and health literacy lens

Abstract Background The study addressed an evidence gap in Northern Ireland (NI) on social determinants of health &amp; medication safety. Almost 50% more prescription items are prescribed in the most deprived areas and they suffer a heavier burden of illness &amp; higher mortality rates. Low health literacy is associated with medication adherence &amp; more negative beliefs about medication. The research aimed to discover the social circumstances behind unsafe medication practices and avoidable medication-related harm to inform the implementation of the Transforming Medication Safety in NI plan. Methods This exploratory study used a community-based participatory research (CBPR) approach that engaged community members to share their unique perspectives &amp; local knowledge. A community survey &amp; interviews with key stakeholders informed the sample &amp; topic guides for focus groups with people in the community (63 participants) &amp; health &amp; social care staff (25 participants). Data underwent thematic analysis &amp; findings were discussed &amp; interpreted at a Knowledge Exchange Workshop. Results Many social factors influence medication safety, such as busy lives, prioritising others, social support, work, physical &amp; psychological capabilities, mental health, addiction, income, transport, access to healthcare &amp; social stigma. Health literacy was a key theme; people have varying abilities accessing, understanding, appraising, remembering, &amp; using information about their medication. Health &amp; social care staff can assume people to know &amp; understand how to take their medication correctly. Health literacy was influenced by many sources including friends’ &amp; family's experiences, individual research, health &amp; social care staff, social media, &amp; stories in the media. Conclusions The research gathered people's lived experiences on medication use at home. It is evident that the social determinants of health, health literacy and social practices and norms need to be considered in medication safety.

SAT357 Rising Incidence, Health Resource Utilization and Costs of Polycystic Ovary Syndrome in the United Kingdom

Abstract Disclosure: T. Berni: None. C. Morgan: None. A. Rees: None. Background: Polycystic Ovary Syndrome (PCOS) is a common disorder but trends in incidence and impact on health resource utilization are not known. Objectives: 1. To describe secular trends in prevalence and incidence of PCOS in the UK. 2. To establish healthcare resource use and associated primary and secondary care costs. Methods: Data were extracted from the Clinical Practice Research Datalink Aurum database and linked Hospital Episode Statistics (HES) database (2004-2021). Patients (≥18 yrs) of acceptable research quality and eligible for linkage to HES were included. A diagnosis of PCOS was established from medcode or ICD-10 codes. Point prevalence was assessed at the midpoint of each year from 2004-2020. Incident cases (2004-2021) were defined as a first diagnosis (index date) at least 90 days after practice registration. Costs from index date were compared for incident cases (n=132,925) and controls matched (1:1) by age, BMI category and primary care practice. Primary care contacts were assigned an average cost as listed in the Unit Costs of Health and Social Care 2019. Prescription items were assigned a net ingredient cost from the Prescription Cost Analysis for England 2019. Inpatient admissions and outpatient consultations were processed into Healthcare Resource Groups and costed to the National Tariff. Results: The incidence of diagnosed PCOS increased from 1.22 per 1000 person years in 2004 to 1.77 in 2012 and 2.20 in 2019. Point prevalence increased from 0.9% in 2004 to 2.1% in 2012 and 3.4% in 2020. Mean contacts per person year (ppy) for patients with PCOS versus controls were 0.43 vs 0.25 for inpatients (p&amp;lt;0.001), 3.29 vs 1.83 for outpatients (p&amp;lt;0.001) and 6.46 vs 4.71 (p&amp;lt;0.001) for primary care. Mean healthcare costs (ppy) were £748 vs £438 (p&amp;lt;0.001) for inpatients, £383 vs £216 (p&amp;lt;0.001) for outpatients, £156 vs £111 for primary care and £114 vs £87 (p&amp;lt;0.001) for primary care prescriptions. Total health care contacts ppy were 10.81 vs 6.21 (p&amp;lt;0.001) and total associated costs were £1400 vs £852 (p&amp;lt;0.001). Conclusion: The prevalence and incidence of diagnosed PCOS has risen significantly in the United Kingdom over the last two decades. This may be partly due to increased ascertainment and recording on computerised systems. Health resource utilization and costs were almost doubled in women with PCOS compared to controls. Presentation Date: Saturday, June 17, 2023

Rescheduling gabapentinoids had negligible effects on prescribing behaviour by general practitioners in England.

To determine whether the rescheduling of gabapentinoids in England as Schedule 3 Controlled Substances in April 2019, changed prescribing behaviour for gabapentinoids by general practitioners. Data on the monthly number of prescription items and the monthly average dose per prescription item were analysed for the period April 2017 to April 2021 under three models: (i) a simple linear regression, (ii) a linear spline with a knot at April 2019, and (iii) a parallel slopes model with time before and after the rescheduling as a covariate. Best fit models were selected based on them having the lowest corrected Akaike's information criterion. Auto-regressive integrated moving average (ARIMA) models were also generated. For gabapentin, the best fit model for the number of prescription items was the simple linear model, and for the dose per prescription item it was the parallel slopes model. For pregabalin, the best fit model was the linear spline for the number of prescription items and the dose per prescription item. For all models, the interval estimates for the slopes were consistent with no change or no meaningful change in prescribing behaviour after April 2019. Forecasts from ARIMA models for gabapentin and pregabalin were consistent with no change in the number of prescription items per month. However, forecasts for the dose per prescription item for gabapentin or pregabalin did not fully capture the post-April 2019 trajectories. The reclassification of gabapentinoids did not materially change the prescribing behaviour of these drugs by general practitioners in England.

An Overview of the Use of Antihypertensive Drugs at the Outpatient Pharmacy of Tarakan "X" Hospital in 2022

Hypertension is a global health problem often encountered, and the appropriate use of antihypertensive drugs is very important for optimal blood pressure control. Therefore, it is necessary to research the description of the use of antihypertensive drugs in various health facilities. The purpose of this study was to describe the prescription of antihypertensive drugs in patients at "X" hospital in the outpatient department. The research data obtained were digital data from prescription services from January-December 2022. This study used retrospective data by accessing computer service data at the "X" hospital outpatient pharmacy to track the history of past hypertensive patients’ treatment. The sampling technique used is total sampling. The results showed that the most prescribed antihypertensive drugs were amlodipine, with 13,203 prescription items. Bisoprolol with 10,704 prescription items, and candesartan with 9,885 prescription items. The frequency of prescribing the antihypertensive drug class the most was calcium channel blockers, as much as 13,784 (23.41%), while for the drug class which was the least prescribed, namely alpha-2 agonists, there were 68 drugs (0.12%). Based on the study results, it can be concluded that the most widely prescribed antihypertensive drugs at the outpatient pharmacy at "X" hospital are amlodipine, bisoprolol, and candesartan.

Drugs Prescribing Trends in Three Polyclinics in Benghazi-Libya 2020

Background: There is an efforts made to improve drug prescribing practices in developing countries. The aim of present work was to comparing prescribing indicators, patient care, and missing information on prescriptions and identifying and assessing drug use patterns in three polyclinics in Benghazi city, Libya. Methods: In this descriptive cross section study a random sample of 1522 prescriptions were selected from three polyclinics include Ras-Ebida, Khalid Ibn-Elwalid and Al-Kish, over 4 months (July-October 2020). The data was collected through predesigned questionnaire. The prescriptions were analyzed for the following indicators: prescribing indicators, patient-care indicators and drug-use indicators. Results: A total of 1522 prescriptions (average = 507.3/clinic) were collected from the three polyclinics including 2329 prescribed (average = 1.4/prescription) items. Percentage of drugs prescribed with generic name was 0.0%, the percentage of prescriptions with antibiotics was 46.3%. The average of prescriptions of injections was 0.84. The average consultation time is 3.4 min and the average dispensing time was found to be 24 seconds. Major classes of drugs prescribed included analgesics, antibiotics, drugs used in medicine &amp; derma clinics, ophthalmic drugs, minerals &amp; vitamins, anti-inflammatory drugs, antihistaminic and antifungal drugs. The most prescribed analgesic was paracetamol (94.4%) and antibiotic was Augmentin (50.3%). In regarding prescribed drug in medicine clinics was found lisinopril (32.0%) and ophthalmic drug was cusicrom (36.8%). In addition, the majorities of prescribed vitamin were vitamin C (81.0%), for GIT drug was omeprazole (59.3%), and for dermatology was Fucidin (56.3%). While most prescribed anti-inflammatory was aspirin (52.4%), antihistaminic was loratidine (97.0%), for antifungal drug was flagyl (58.0%). Conclusion: Despite the efforts being made to improve prescribing habits and to rationalize the use of drugs, the obtained results confirm the deficiencies as reported earlier and suggest that methods of intervention should be initiated to improve prescribing trends in these polyclinics.

Impact of removing prescription co-payments on the use of costly health services: a pragmatic randomised controlled trial

ObjectivesTo determine whether exempting people (with high health needs and living in areas of high deprivation) from a $5 prescription charge reduces hospital use.DesignTwo-group parallel prospective randomised controlled trial.SettingPeople living in the community in various regions of New Zealand.ParticipantsOne thousand sixty one people who lived in areas of high socioeconomic deprivation, and either took medicines for diabetes, took antipsychotic medicines, or had chronic obstructive pulmonary disease (COPD). Of the 1053 who completed the study, just under half (49%) were Māori. InterventionsParticipants were individually randomized (1–1 ratio) to either be exempted from the standard $5 charge per prescription item for one year (2020-2021) (n = 591) or usual care (n = 469). Those in the intervention group did not pay the standard NZ$5 charge, and pharmacies billed the study for these. Participants continued to pay any other costs for prescription medicines. Those in the control group continued to pay all prescription charges for the year although they may have received one-off assistance from other agencies.Main outcome measuresThe primary outcome was length of stay (hospital bed-days). Secondary outcomes presented in this paper included: all-cause hospitalisations, hospitalisations for diabetes/mental health problems/COPD, deaths, and emergency department visits.ResultsThe trial was under-powered because the recruitment target was not met. There was no statistically significant reduction in the primary outcome, hospital bed-days (IRR = 0.68, CI: 0.54 to 1.05). Participants in the intervention group were significantly less likely to be hospitalised during the study year than those in the control group (OR = 0.70, CI: 0.54 to 0.90). There were statistically significant reductions in the number of hospital admissions for mental health problems (IRR = 0.39, CI: 0.17 to 0.92), the number of admissions for COPD (IRR = 0.37, CI: 0.16 to 0.85), and length of stay for COPD (IRR 0.20, CI: 0.07 to 0.60). Apart from all-cause mortality and diabetes length of stay, all measures were better for the intervention group than the control group.ConclusionsEliminating a small co-payment appears to have had a substantial effect on patients’ risk of being hospitalised. Given the small amount of revenue gathered from the charges, and the comparative large costs of hospitalisations, the results suggest that these charges are likely to increase the overall cost of healthcare, as well as exacerbate ethnic inequalities.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618001486213 registered on 04/09/2018.

Nearly 1 billion e-prescriptions issued over past year

Prescribers in England have issued nearly 1 billion e-prescriptions over the past year, NHS England has said. In a statement published on 8 February 2023, NHS England said that 996 million prescription items were issued electronically in 2021/2022, accounting for 95% of all prescriptions. The number of e-prescriptions issued has almost doubled since 2016/2017, when […]

The influence of non-medical prescribers on antimicrobial stewardship: a national evaluation of the impact of the COVID-19 pandemic on the prescribing of antibiotics by non-medical prescribers in England in 2020 (part 2)

Background Part one of this study identified that prescribing behaviours during 2020 differed significantly from 2016-2021. Part 2, presented here, covers a more detailed analysis of the impact of the early part of the COVID-19 pandemic is presented here. Aims To describe patterns in community prescribed and dispensed antibiotic volumes attributable to non-medical prescribers during 2020 compared to the previous 4 years and identify any changes of behaviour during this period and their impact on antimicrobial stewardship. Methods An analysis of retrospective non-medical prescribers' prescribing data was performed to determine the numbers of independent non-medical prescribers and the patterns of prescribed community dispensed antibiotic volumes between 2016-2021. The 2020 data were then compared to the data from previous years. Findings The total amount of dispensed non-medical prescribers antibiotic prescription items per 100000 population dropped by 12% in 2020 compared to 2019, driven predominantly by reductions in nurse prescribing. However, high-risk antibiotic prescribing rose from 5.3% of antibiotics prescribed in 2019 to 6.4% in 2020. Seasonal patterns of antibiotic prescribing differed in 2020, with significant reductions in prescribing of antibiotics normally associated with treating LRTI from the first lockdown in March 2020. Conclusions The COVID-19 pandemic forced rapid changes in practice, including increased remote working, which created a challenging prescribing environment that adversely affected the high-risk antibiotic prescribing behaviour of non-medical prescribers more than it affected their medical colleagues. There were unusually low levels of prescribing for respiratory tract infections over the last quarter of 2020 which, although likely multifactorial, may indicate over-prescribing for self-limiting viral infections in previous years. More research is needed to establish ongoing prescribing trends and patient outcomes, and how antimicrobial stewardship programmes and training can be better targeted to support prescribers to address quality and safety issues arising from changing modes of practice.

Prescription patterns of herbal medicines at a Brazilian Living Pharmacy: The Farmácia da Natureza experience, 2013–2019

IntroductionHerbal medicines are an important part of healthcare worldwide. In Brazil, the national authorities issued the concept of “living pharmacies”, that produce and offer herbal medicines in the Brazilian unified public health system. Farmácia da Natureza (Nature’s Pharmacy) is a living pharmacy and a single, not-for-profit institution that integrates traditional and scientific knowledge on medicinal plants, along with the preservation of Brazilian biodiversity, with benefits to the health of the population that uses herbal drugs. A six-year experience of medical prescription of herbal medicines at Farmácia da Natureza is reported MethodsA retrospective, descriptive analysis of data on medical prescriptions of herbal medicines was conducted (September 2013 to December 2019) retrieved from a computerized database. ResultsA total of 47,418 prescription items for 4739 patients were analyzed. The most frequent pharmaceutical forms were tinctures (39.6%); capsules containing powdered plant material (20.7%); creams, ointments, or gels (12.3%); and aqueous extracts (11.7%). The five most frequently prescribed single-constituent herbal medicines were: Curcuma longa L. (Zingiberaceae); Valeriana officinalis L. (Caprifoliaceae); Aloysia polystachya (Griseb.) Moldenke (Verbenaceae); Eclipta prostrata (L.) L. (Asteraceae); and Baccharis trimera (Less.) DC. (Asteraceae). Nearly half of the plants were naturally occurring in Brazil, while more than 80% of the products were not present in Brazilian official documents. ConclusionAt Farmácia da Natureza, herbal medicines are usually prescribed as tinctures and capsules containing powdered plant material, but other pharmaceutical forms are also prescribed. Half of the plants are of Brazilian origin and almost all preparations are galenic formulations.

316 Improving Electronic Prescribing of Mechanical VTE Prophylaxis in General Surgery Patients

Abstract Aim Mechanical VTE prophylaxis forms part of NICE guidance in general surgical patients. Locally, thromboembolic deterrent (TED) stockings are used but not available as a prescription item on the electronic system. They are often prescribed verbally or via noted plans but do not appear on the medication administration record. Importantly, multiple incidents of patient harm through pressure damage have been seen due to poorly checked TEDs. Our aim was to audit and improve safe mechanical VTE prophylaxis prescribing. Method At each cycle, we retrospectively collected data from two weeks of admissions. Data relating to VTE assessment completion, VTE score, TEDs in use, TEDs prescription and LMWH prescription was collected. Our initial intervention consisted of departmental education regarding a work around enabling TEDs to be prescribed as a freehand extra-formulary item. This was reaudited at 12 months. Results All patients in both cycles had VTE assessments completed. TED stocking use increased significantly from 5.1% to 26.4% and prescription of TEDs, when used, increased from 0% to 61.1%. However, documentation regarding daily checks was non-existent. Conclusions Our QIP showed a significant improvement in TEDs use and prescription. However, the intervention is difficult and time consuming. Subsequently from this project, a TEDs stocking item is in the final approval phase for integration into the online prescribing system and will come with associated safety checks built into the nursing medication administration system. Once this is live, we will complete a third cycle to assess uptake and again at 6 months to assess for lasting change.