Practitioner Prescribing Research Articles

Prescribing within clinical toxicology

In 2020, the first clinical toxicology advanced nurse practitioner and independent prescriber post was introduced in the United Kingdom. This article discusses the remit of clinical toxicology and the integration of nurse prescribing into this service by following a patient journey from admission to discharge. The case study describes an acute paracetamol poisoning presentation following intentional self-harm. Paracetamol is widely available and safe in therapeutic dosages; however, it is the drug most commonly taken in intentional overdose and the toxic effect can result in hepatic failure and fatality. The nurse prescriber conducted a holistic consultation, assessed pharmacological management and instigated timely treatment. Current research on the benefits and disadvantages of paracetamol antidote regimes are discussed. Long-term physical and mental wellbeing following intentional overdose require interprofessional liaison with access to psychological support, arranged prior to patient discharge.

The Geographic Impact of Buprenorphine Expansion to Nurse Practitioner Prescribers in Oregon.

We examined the impact on geographic distribution of medications to treat opioid use disorder (MOUD) in Oregon after the Comprehensive Addiction and Recovery Act (CARA) was implemented in February 2017 to include nurse practitioner (NP) prescribers. We conducted interrupted time series analysis with linear regression on prescriptions dispensed for buprenorphine used for MOUD in the Oregon Prescription Drug Monitoring Database written by physician (MD/DO) and NP prescribers January 1, 2016, to December 31, 2018. We analyzed total prescriptions by prescriber type and pharmacy ZIP Code using STATA 16.1. From January 1, 2016, to December 31, 2018, 420,765 eligible prescriptions were written by waivered MD/DO and/or NP prescribers. Prior to CARA, buprenorphine use was increasing steadily at 140 prescriptions per month (95% CI: 78-201; P < .01). Following CARA, dispensing increased by 88 prescriptions per month (95% CI: 23-152; P = .01). The absolute number increased in rural areas immediately after CARA implementation (368 prescriptions; 95% CI: 124-613; P < .01). NP contribution to total buprenorphine prescribing increased significantly in both urban and rural areas (0.44% per month [95% CI: 0.30%-0.57%; P < .01] and 0.74% per month [95% CI: 0.62%-0.85%; P < .01]). The contribution of NPs had a particularly large impact for very rural (frontier) areas, where NPs provided 36% of all buprenorphine prescriptions by the end of 2018. Changes in federal law regarding MOUD had a positive impact on both supply and geographic distribution in Oregon, particularly in frontier areas comprising 10 of 36 counties (27%).

Challenges Faced by New Psychiatric-Mental Health Nurse Practitioner Prescribers.

One of the main challenges that psychiatric-mental health nurse practitioner (PMNHP) students experience is preparing to prescribe medications by demonstrating psychopharmacological competency. To examine the challenges as they relate to this issue, self-reflective journaling narratives were evaluated from two cohorts of Post-Master's PMHNP program graduates, across each of two semesters of pediatric and adult clinical experience. The most prominent challenges reported by students were in regard to medication treatment adherence, decision making, and monitoring symptom-related outcomes. The narratives also demonstrate that reflection, combined with faculty- and preceptor-supported clinical education, assists PMHNP students in developing psychopharmacological competency. All PMHNP students described in this article were nurse practitioners before they began the program. By seeking to augment their competencies and through continued self-reflective learning and practice, they will improve access to mental health care for the populations they serve. [Journal of Psychosocial Nursing and Mental Health Services, 58(10), 7-11.].

Multimorbidity and fit note receipt in working-age adults with long-term health conditions.

Research on sickness absence has typically focussed on single diagnoses, despite increasing recognition that long-term health conditions are highly multimorbid and clusters comprising coexisting mental and physical conditions are associated with poorer clinical and functional outcomes. The digitisation of sickness certification in the UK offers an opportunity to address sickness absence in a large primary care population. Lambeth Datanet is a primary care database which collects individual-level data on general practitioner consultations, prescriptions, Quality and Outcomes Framework diagnostic data, sickness certification (fit note receipt) and demographic information (including age, gender, self-identified ethnicity, and truncated postcode). We analysed 326 415 people's records covering a 40-month period from January 2014 to April 2017. We found significant variation in multimorbidity by demographic variables, most notably by self-defined ethnicity. Multimorbid health conditions were associated with increased fit note receipt. Comorbid depression had the largest impact on first fit note receipt, more than any other comorbid diagnoses. Highest rates of first fit note receipt after adjustment for demographics were for comorbid epilepsy and rheumatoid arthritis (HR 4.69; 95% CI 1.73-12.68), followed by epilepsy and depression (HR 4.19; 95% CI 3.60-4.87), chronic pain and depression (HR 4.14; 95% CI 3.69-4.65), cardiac condition and depression (HR 4.08; 95% CI 3.36-4.95). Our results show striking variation in multimorbid conditions by gender, deprivation and ethnicity, and highlight the importance of multimorbidity, in particular comorbid depression, as a leading cause of disability among working-age adults.

Opioid Prescribing by Primary Care Providers: a Cross-Sectional Analysis of Nurse Practitioner, Physician Assistant, and Physician Prescribing Patterns.

Prescription opioid overprescribing is a focal point for legislators, but little is known about opioid prescribing patterns of primary care nurse practitioners (NPs) and physician assistants (PAs). To identify prescription opioid overprescribers by comparing prescribing patterns of primary care physicians (MDs), nurse practitioners (NPs), and physician assistants (PAs). Retrospective, cross-sectional analysis of Medicare Part D enrollee prescription data. Twenty percent national sample of 2015 Medicare Part D enrollees. We identified potential opioid overprescribing as providers who met at least one of the following: (1) prescribed any opioid to > 50% of patients, (2) prescribed ≥ 100 morphine milligram equivalents (MME)/day to > 10% of patients, or (3) prescribed an opioid > 90days to > 20% of patients. Among 222,689 primary care providers, 3.8% of MDs, 8.0% of NPs, and 9.8% of PAs met at least one definition of overprescribing. 1.3% of MDs, 6.3% of NPs, and 8.8% of PAs prescribed an opioid to at least 50% of patients. NPs/PAs practicing in states with independent prescription authority were > 20 times more likely to overprescribe opioids than NPs/PAs in prescription-restricted states. Most NPs/PAs prescribed opioids in a pattern similar to MDs, but NPs/PAs had more outliers who prescribed high-frequency, high-dose opioids than did MDs. Efforts to reduce opioid overprescribing should include targeted provider education, risk stratification, and state legislation.

Improving Antimicrobial Use in Adult Outpatient Clinics: the New Frontier for Antimicrobial Stewardship Programs

Antimicrobial stewardship (AS) programs are expanding efforts across the entire healthcare continuum. Antimicrobials are commonly overused in outpatient care locations, which have not received the same intensity of AS intervention as inpatient settings. Guidance for AS programs is needed on how to implement interventions and monitor for improvement. Antimicrobials prescribed in the outpatient setting are inappropriate in 23–76% of cases. Factors associated with inappropriate prescribing include older adult patients, advanced practice practitioner prescribers, and urgent care clinics. Indications such as upper respiratory infections and asymptomatic bacteriuria are common conditions in which antibiotics should not be used yet they are major contributors to inappropriate antibiotic use. Promising interventions include peer comparison and clinical decision support, but gaps remain. There is little evidence for how to limit the use of fluoroquinolones and newly approved antibiotics. Improving antibiotic use is needed in the outpatient setting and poses unique challenges for AS programs. Defining problems unique to designated outpatient centers and implementing proposed interventions targeting these problems is an effective strategy. Collaboration with State Health Departments, health insurers, and healthcare systems will be essential.

Try-It-On: Preparing family nurse practitioners to use holistic integrative interventions to reduce opioid prescriptions in chronic pain management.

In the United States, more than 130 people die each day from an opioid overdose. Nonopioid chronic pain management options are necessary in primary care. This educational innovation describes a new curriculum to teach future family nurse practitioner (FNP) prescribers holistic integrative interventions to decrease overprescribing of opioids for chronic pain management. The Modeling and Role Modeling theory and Kirkpatrick Evaluation Model guided the development and implementation of the curriculum innovation using a Try-It-On teaching-learning strategy, which focuses on immersion experience. The focus was to teach students to communicate effectively with patients in an effort to increase patient awareness of the pathophysiology of pain, risks of opioid use, and holistic integrative pain management options. Students learned to manage chronic pain within a holistic focus through immersion within integrative modalities, such as yoga, meditation, mindfulness, and guided imagery. Pre and post participation evaluations documented students' increased comfort level managing patients with chronic pain. Students reported they were much more likely to prescribe holistic integrative modalities after completing the Try-It-On learning modules. Holistic integrative interventions are a viable treatment option and/or adjunct treatment for chronic pain management. In conclusion, using the Try-It-On, teaching-learning strategy provided FNP students with the tools needed to prescribe nonopioid holistic integrative interventions to manage chronic pain.

Toward a Contingent Model of Mirroring Between Product and Organization: A Knowledge Management Perspective

Much of the contemporary modularity literature subscribes to the idea that increased product modularity is associated with advantageous increase in organizational modularity. Known as the “mirroring hypothesis,” this proposed relationship states that the structure of a product development organization and the architecture of the product being developed would “mirror” each other. This correspondence suggests that product modularity can be a substitute for overt organizational coordination mechanisms, thereby increasing the efficiency of product development. However, empirical research to date provides inconsistent support for the hypothesis and the extant literature has yet to converge on a systematic explanation for the inconsistent findings. Moreover, important conceptual inconsistencies still remain in the extant literature, which impede cumulative knowledge development. As the first step toward reconciliation, this conceptual paper puts forth a contingent model of mirroring between product and organization, based on the systematic examination of the requisite architectural knowledge that enables product and organizational modularity. The resulting contingent model clearly articulates the knowledge prerequisite of mirroring and its underpinning causal mechanism. Based on the contingent model, a set of propositions are derived to explain and predict when the mirroring relationship will hold and when it will not. This paper thus contributes to the literature by helping to resolve persistent conceptual inconsistencies and reconcile conflicting empirical findings. In addition, explicating the knowledge prerequisite for mirroring places boundary conditions on product modularity as an effective substitute for overt exercise of managerial coordination, which helps us gain a deeper understanding of modularity as a design strategy and how complex innovations can be organized, and provides a basis for more nuanced prescriptions for practitioners to assess the relationships between their product and organization design.

The illusion of technique: sustained enterprise innovation as an aspirational problem

Purpose This paper is based on insights from philosophy of science, centered in Gilbert Ryle’s notion of “category mistakes”. A category mistake occurs in a science when scholars have been thinking of a phenomenon as of a certain sort, when it is really nothing of the kind. This paper aims to claim that regarding sustained enterprise innovation (SEI) as a strictly operational problem commits such a category mistake. Instead, SEI is an aspirational problem and thus requires scholars to examine it from that perspective as well. Design/methodology/approach This paper begins by explicating Ryle’s notion of a category mistake. It develops the suggestion that innovation scholars have made such a mistake by thinking of innovation as a strictly operational problem. In reality, it is as much an aspirational problem. The paper then builds on the metaphor made famous by Isaiah Berlin, distinguishing between hedgehogs and foxes. A hedgehog is a leader who copes with the non-predictive nature of innovation. The paper builds on the findings from positive psychology and virtue epistemology to highlight how humans can act rationally in the face of non-predictive outcomes. Four virtues of hedgehog leadership are proposed and defined. Findings The paper concludes that hedgehog leadership is necessary for sustained enterprise innovation. It also concludes that hedgehogs can act rationally in pursuit of non-predictive outcomes by practicing a set of governing virtues. Research limitations/implications Further research needs to be conducted to validate the proposed governing virtues, to illuminate the optimal hedgehog/fox balance within the enterprise, and to validate through longitudinal work the impact of hedgehogs on sustained enterprise innovation. Practical implications Based on the continuing interest in innovation expressed by enterprise leaders around the world, hedgehogs are in increasing demand. Fortunately, hedgehogs can be made (and self-made) via deliberate practice of the governing virtues. Aspiring and current hedgehogs can be confident that practicing these virtues and becoming increasingly adept at their application will promote and effect enterprise innovation. Originality/value Very little research has been conducted on the aspirational aspect of SEI. This is an insidious gap in the literature, as it affects scholars and practitioners alike. Scholars are trapped in the “normal science” paradigm that treats the innovation problem as if it can be solved through operational techniques. This paper contends that this ubiquitous category mistake has led scholars down a blind alley. Instead, it is important for scholars and practitioners alike to view SEI as an aspirational problem that requires vastly different research frameworks and practitioner prescriptions.

Protocol for a Randomised controlled trial to Evaluate the effectiveness and cost benefit of prescribing high dose FLuoride toothpaste in preventing and treating dEntal Caries in high-risk older adulTs (reflect trial)

BackgroundDental caries in the expanding elderly, predominantly-dentate population is an emerging public health concern. Elderly individuals with heavily restored dentitions represent a clinical challenge and significant financial burden for healthcare systems, especially when their physical and cognitive abilities are in decline. Prescription of higher concentration fluoride toothpaste to prevent caries in older populations is expanding in the UK, significantly increasing costs for the National Health Services (NHS) but the effectiveness and cost benefit of this intervention are uncertain. The Reflect trial will evaluate the effectiveness and cost benefit of General Dental Practitioner (GDP) prescribing of 5000 ppm fluoride toothpaste and usual care compared to usual care alone in individuals 50 years and over with high-risk of caries.Methods/designA pragmatic, open-label, randomised controlled trial involving adults aged 50 years and above attending NHS dental practices identified by their dentist as having high risk of dental caries. Participants will be randomised to prescription of 5000 ppm fluoride toothpaste (frequency, amount and duration decided by GDP) and usual care only. 1200 participants will be recruited from approximately 60 dental practices in England, Scotland and Northern Ireland and followed up for 3 years. The primary outcome will be the proportion of participants receiving any dental treatment due to caries. Secondary outcomes will include coronal and root caries increments measured by independent, blinded examiners, patient reported quality of life measures, and economic outcomes; NHS and patient perspective costs, willingness to pay, net benefit (analysed over the trial follow-up period and modelled lifetime horizon). A parallel qualitative study will investigate GDPs’ practises of and beliefs about prescribing the toothpaste and patients’ beliefs and experiences of the toothpaste and perceived impacts on their oral health-related behaviours.DiscussionThe Reflect trial will provide valuable information to patients, policy makers and clinicians on the costs and benefits of an expensive, but evidence-deficient caries prevention intervention delivered to older adults in general dental practice.Trial registrationISRCTN: 2017-002402-13 registered 02/06/2017, first participant recruited 03/05/2018.Ethics Reference No: 17/NE/0329/233335.Funding Body: Health Technology Assessment funding stream of National Institute for Health Research.Funder number: HTA project 16/23/01.Trial Sponsor: Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL.The Trial was prospectively registered.

Reforming Women's Health Care: A Call to Action for Lifestyle Medicine Practitioners to Save Lives of Mothers and Infants.

Maternal and infant mortality are fundamental indicators of a society's health and wellness. These measures depict a health crisis in the United States. Compared with other rich countries, women in the United States more frequently die from pregnancy or childbirth, and infants are less likely to survive to their first birthday. Most of these deaths are preventable; disproportionately affect diverse, low-income groups; and are perpetuated by social and health care inequities and subpar preventive care. Lifestyle medicine (LM) is uniquely positioned to ameliorate this growing crisis. The article presents key prescriptions for LM practitioners to build health and health equity for women. These prescriptions, summarized by the acronym PURER, include action in the areas of (1) practice, (2) understanding/empathy, (3) reform, (4) empowerment, and (5) relationship health. The PURER approach focuses on partnering with diverse female patients to promote resilience, promoting social connection and engagement, facilitating optimal family planning and advocating for culturally responsive, equitable health care systems. Through PURER, LM practitioners can help women and partners resiliently overcome the harmful challenges of discrimination and stress characterizing present-day American life. Over time, the equitable and collective practice of LM can help ameliorate the health care barriers undermining the health of women, families, and society.

Exploring the Knowledge, Attitude and Practices towards Use of Unprescribed Drugs among Adults of a Selected City of Somaliland

Background: The emergence and spread of resistance related to the irrational use of antibiotics is a major global public health problem. The aim of this study was to assess Knowledge, Attitude and Practices towards use of unprescribed drugs among adults in a selected city of Somaliland. Methods: This study used cross-sectional survey and data was collected through semi-structured questionnaire. A purposive sampling of 400 individuals was obtained; Slovene’s Formula was used to calculate the sample size & Data was analysed by using SSPS v.20 and Ms Excel. Results: It is found that 64.3% of the respondents used any form of medicine without a medical practitioner's prescription. It is found that there is a significant association between respondent's level of knowledge and practice of unprescribed drug use. Conclusion: The conclusion is that it is important to formulate policies and strategies for drug distribution and sales aimed for controlling the public use of unprescribed drugs.

Behavioral disorders after TBI: Evaluation of pharmacological intervention 2 years after French guidelines of July 2013

Behavioral disorders (BD) after Traumatic Brain Injury (TBI) are common and have a major impact on the patient, his family and caregivers, leading to longer length of stay in hospitalization, and difficulties of social rehabilitation. The usual psychoactive drugs are not efficient, leading to side effects harmful for neurological recovery. French guidelines about management of these BD have been elaborated by the French Society of Physical and Rehabilitation Medicine and the French High Authority for Health in July 2013. We focused on pharmacological interventions of disruptive behavior by excess (aggressiveness, agitation, irritability). Propranolol is recommended in first-line treatment, mood regulating antiepileptics in second. The purpose of this work was to evaluate the impact of the guidelines on the practitioner's prescriptions for BD in intensive care, neurosurgery and physical and rehabilitation medicine (PRM) units. We compared the period 2011–2012 versus 2014–2015. This was a retrospective, descriptive, multicentric study. All adult patients with TBI hospitalized at primary stage in PRM, in the PRM center of Nantes and Angers University Hospitals were included. Among 208 patients analyzed, 84 (40,4%) had BD by excess. Propranolol was more prescribed after the guidelines: 34% vs 13.5% ( P = 0.03). It was prescribed at the average dose of 45 mg, guidelines recommend 40 to 80 mg. Over 21 prescriptions of Propranolol, 10 were stopped, 3 for cardiovascular side effects. Patients with BD had more psychoactive drugs prescribed (2.7 vs. 0.93, P < 0.05) and there was no difference between before and after the guidelines (2.95 vs. 2.51, P = 0.33). PRM specialists prescribed more psychoactive drugs than the others. Intensive care specialists never prescribed mood regulating antiepileptics. There is a need to inform all the doctors who take care of these patients about the guidelines. Propranolol is more prescribed but at the limit of the efficient dose, and psychoactive drugs are still long-term prescribed.

Intramuscular versus oral corticosteroids to reduce relapses following discharge from the emergency department for acute asthma.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To examine the effectiveness and safety of intramuscular (IM) versus oral corticosteroids in the treatment of acute asthma after discharge from a hospital emergency department (ED) or equivalent acute care setting.

Establishing priorities on the range of conditions managed by UK community practitioner nurse prescribers: A modified Delphi consensus study.

To provide national consensus on the range of conditions community practitioner nurse prescribers manage and for which it is considered important that they can prescribe. Around 35,000 community practitioner nurse prescribers in the United Kingdom are able to prescribe from a limited formulary. Although prescribing is a key role for these nurses, there has been a decline in the numbers of community practitioner nurse prescribers who prescribe. It is evident that changing patterns of client and service delivery, changes the role of community nurses and the conditions they manage, however, little is known about the conditions community practitioner nurse prescribers manage. A modified Delphi approach comprising three on-line surveys delivered to a national Expert Panelof 89 qualified community practitioner prescribers. Data collection took place between January-March 2017. Panelists reached a consensus, with consistent high levels of agreement reached, on nineteen conditions for which it is believed community practitioner nurse prescribers should be able to prescribe. Conditions identified by school nurses (N=12) and health visitors (N=7) were mainly acutely focused, whereas those identified by district nurses (N=9) and community staff nurses (N=6) included both long-term and acute conditions. Given the high degree of consensus, this list of conditions should influence any decisions about the items community and public health nurses should be able to prescribe. The findings should also influence the education and training of these nurses.

Comparing Nurse Practitioner and Physician Prescribing of Psychotropic Medications for Medicaid-Insured Youths.

Objective: To describe psychotropic medication prescribing practices of nurse practitioners (NP) and physicians for Medicaid-insured youths in 2012-2014 in a mid-Atlantic state where NP independent prescribing is authorized. Method: From annual computerized administrative claims data in a mid-Atlantic state, we analyzed 1,034,798 dispensed psychotropic medications prescribed by NPs and physicians for 61,526 continuously enrolled Medicaid-insured youths aged 2-17 years. Demographic and clinical characteristics of psychotropic medication users were compared for youths who received psychotropic medication dispensings by NP-only, physician-only, or by both providers using descriptive statistics and generalized estimating equations. We then characterized psychotropic medication prescribing practices by providers within each specialty. Results: From 2012 to 2014, the number of psychotropic medication dispensings increased from 346,922 to 349,080. There was a 50.9% increase in the proportion of psychotropic medications prescribed by psychiatric NPs (from 5.9% to 8.8%) and a 28.6% proportional increase by non-psychiatric NPs (from 4.9% to 6.3%). By contrast, the proportion of psychotropic medications prescribed by psychiatrists and by non-psychiatric physicians declined (56.9%-53.0% and 32.3%-31.8%, respectively). Youths diagnosed with depression or anxiety were more commonly treated by NP-only than by physician-only (AOR = 1.33, 95% CI = 1.24-1.43), whereas youths with two or more psychiatric comorbidities were significantly more commonly treated by both NP and physician providers (AOR = 1.44, 95% CI = 1.39-1.50). Psychiatric specialists prescribed the bulk of antidepressants (82.0%) and lithium (92.3%), with much lower prescribing by non-psychiatric specialists (18.0% and 7.7%, respectively). Antipsychotic orders originated from psychiatric specialists 7.4 times more than from their non-psychiatric specialty counterparts, whether physician or NP. Conclusions: NPs, relative to physicians, have taken an increasing role in prescribing psychotropic medications for Medicaid-insured youths. The quality of NP prescribing practices deserves further attention.

Evaluating a nurse-led community model of service for perinatal mental health

BackgroundPerinatal mental illness is prevalent in Australia. Accessible and affordable specialist perinatal mental health services are important in ensuring optimal maternal and infant outcomes, but remain scarce in some areas. AimThis paper describes the development and evaluation of a community model for perinatal mental health based on the practice principles of: nurse-led; partnership approach; individualised evidenced based treatments and accessible, flexible service delivery. MethodsData collected prospectively as part of routine care for two years was analysed. Data included Edinburgh Depression Scale, Parent Coping Scale and Health of the Nation Outcome scale scores, rates of attendance, diagnostic codes, nurse practitioner prescribing and the appointment locations. FindingsThere was a significant reduction in depressive and anxiety symptoms and for women parenting infants, an increase in their perception of coping with parenting. There were comparatively high rates of attendance once women attended once. Diagnostic codes indicated the service saw the target group with the majority of diagnoses consisting of adjustment disorders, depression and anxiety. The nurse practitioner role enhanced continuity of care for women requiring antidepressant treatment. DiscussionThe perinatal nurse-led community model of service has been shown to provide effective specialist perinatal mental health assessment and brief intervention and treatment services. ConclusionThe model offers the potential for replication in other areas where service gaps for perinatal women and families persist and resources remain scarce.

Antibiotic usage pattern among under-five wheezers: A Bhubaneswar based study

Introduction: Acute under-five wheezers are the most suitable group for targeting focus aimed at reducing unnecessary use of antibiotics. Viral bronchiolitis is an important cause of wheezing in under-five children. Rationality behind antibiotic usage has rarely been reported from Odisha. Aim: The aim of the present study is to look into the decision of private practitioners of Bhubaneswar, Odisha, for an antibiotic prescription to under-five wheezers. Materials and Methods: Hundred prescriptions of private practitioners for under-five patients suffering from acute wheeze were analyzed between January and June 2016. The prescriptions were grouped as with antibiotics (Group A) and without antibiotics (Group B). The groups were compared for the presence of clinical, hematological, and radiological signs and results were statistically analyzed. Result: The number of prescriptions with antibiotic inclusion is higher (67%). Antibiotics are mostly prescribed to younger patients. Antibiotic administration was significantly higher with the symptoms of fever, tachypnea, crepitation’s and leukocytosis, and X-ray findings. (p&lt;0.05) The average recovery period was almost the same in both the groups. The prescription patterns in the present study show rational usage.

Patterns of Prescription of Private Practitioners in Bangladesh

A prescription - a written instruction of doctors to pharmacist to supply drugs in particular form to a patient and the directions to the patients regarding the use of medicines.This study was undertaken to observe the prescribing patterns of the practitioners in Bangladesh, 500 prescriptions were collected randomly from Dhaka city and analyzed using WHO/INRUD indicators. There were average 4.40drugs per prescription.Drugs were prescribed in generic name only in 0.30%. About 48% drugs were prescribed from the essential drug list, only prescriptions were complete. In respect to patient medication information, antibiotics were prescribed in 72% of the prescriptions; injections were prescribed in about 10% of the prescriptions.J Dhaka Medical College, Vol. 26, No.1, April, 2017, Page 48-51

Seasonal patterns of oral antihistamine and intranasal corticosteroid purchases from Australian community pharmacies: a retrospective observational study.

PurposeTo explore patterns in the purchase of prescription and over-the-counter (OTC) oral antihistamines (OAHs) and intranasal corticosteroids (INCSs) by patients, from pharmacies in different geographical regions of Australia.Patients and methodsRetrospective observational study using a database containing anonymous pharmacy transaction data from 20.0% of the pharmacies in Australia that link doctor prescriptions and OTC information. Pharmacy purchases of at least one prescription or OTC rhinitis treatment during 2013 and 2014 were assessed.ResultsIn total, 4,247,193 prescription and OTC rhinitis treatments were purchased from 909 pharmacies over 12 months. Of treatments purchased, 75.9% were OAHs and 16.6% were INCSs. OTC purchases of both treatments exceeded purchases through prescription. OTC OAHs purchasing patterns were seasonal and almost identical in the Australian Capital Territory, Victoria, Western Australia, South Australia, and New South Wales, and similar seasonal patterns for OTC INCSs were noted in most regions except for South Australia and Tasmania. Prescription purchasing patterns of both OAHs and INCSs remained unchanged throughout the year in most regions.ConclusionThis large-scale retrospective observational study identified seasonal purchasing patterns of OTC and prescription OAHs and INCSs in a real-world setting. It highlighted that seasonality only affects OTC purchasing patterns of OAHs and INCSs across Australia and that practitioner prescribing remains unchanged, suggesting that it is only for persistent disease.