Telephone Prescriptions Research Articles

'Red Flags' and 'Red Tape': Telehealth and pharmacy-level barriers to buprenorphine in the United States.

Structural vulnerabilities for people who use drugs (PWUD) were exacerbated by the COVID-19 pandemic. In this context, federal lawmakers in the United States (U.S.) invoked an exemption to the 2008 Ryan Haight Act requiring in-person evaluation to prescribe buprenorphine for treatment of opioid use disorder (OUD), which allowed for the initiation and maintenance of buprenorphine via telehealth. Despite the potential for telehealth to address some of the geographic disparities in OUD treatment access, recent research has suggested that significant barriers to buprenorphine also exist at the pharmacy level. The purpose of this study was to qualitatively assess how efforts to increase access to buprenorphine via telehealth are implemented by prescribers and pharmacists and experienced by patients. Participant observation and semi-structured interviews focused on telehealth for OUD treatment and buprenorphine prescribing and dispensing were conducted with patients (n=19), prescribers and clinic staff (n=24), and pharmacists (n=10) in Pennsylvania and California between May 2020 - May 2021. While participants stated that telehealth for OUD treatment was a welcome option, pharmacy-level barriers to buprenorphine persisted. Geographical distance from patient to provider or pharmacist continued to serve as "red flags" for pharmacists, leading to pharmacy-level "red tape:" gatekeeping measures including geographic restrictions, telephone prescription "confirmations," prescription cancellations and refusals. Patients' unmet expectations of buprenorphine access in some cases led to unanticipated risks including a return to injection drug use. Challenges to increasing buprenorphine access persist in the U.S. even in settings where telehealth is implemented, and telehealth may inadvertently produce new barriers for some patients. Despite national support for policies aimed at increasing access to treatment for substance use disorders rather than punishment, policy shifts from punishment to treatment have not permeated evenly across all geographic areas and populations. Perceived threats of Drug Enforcement Administration (DEA) enforcement, and self-defensive institutional practices in pharmacies, reinforce ideologies of drug law enforcement, leading to poor patient outcomes including lack of buprenorphine access.

Telephone Consultation and Prescription in Pediatrics: Contributing Factors and Impact on Clinical Outcomes.

Objectives: To evaluate phone-based consultation practices and drug prescription profiles in pediatrics and to highlight their possible uses, contributing factors, and effects on clinical outcomes.Background: The ownership and everyday use of cell phones are increasing worldwide. Telehealth is gaining the support of health professionals for the delivery of simple healthcare measures to more complex management decisions. Despite this, in our country, doctors have been advised by concerned authorities to avoid any phone-based medical activity as the safety of such practices is still not well-established, especially among vulnerable pediatric patients.Patients and Methods: This cross-sectional study was conducted on a national level over 5 months. Phone consultations and prescription behaviors data were collected through a self-administrated questionnaire. The target population consisted of pediatric-trained physicians with at least 1 year of experience. Factors influencing telephone prescriptions were assessed using bivariate analysis.Results: Of among 120 included physicians (75.0% male), 64.2% were general pediatricians, 77.5% practiced in private clinics, and 27.5% had more than 20 years of work experience. All participants gave medical advice over the phone; 61.7% considered that they should be reimbursed for these activities and 29.2% of them reviewed 50% of their patients for the same complaint. A total of 109 participants (90.8%) prescribed drugs using a direct phone call (80.7%), SMS (27.5%), or WhatsApp application (61.5%). Antipyretics (97.2%) and cough suppressants (48.1%) were the most frequently prescribed drugs. Pharmacists' corrective interventions were seen in 40.4% of prescriptions. Fever was the only symptom that was statistically associated with phone prescriptions. Prescribers seemed to be less experienced and were more likely to consider phone-based practices as reimbursable activities.Conclusions: Consultations and prescriptions through mobile phones are extremely frequent in pediatric practices, even when restricted by responsible authorities. Our results highlight the frequency of medical prescription errors and the need for corrective interventions by pharmacists. The current practice of telemedicine may not ensure the patient's safety but exists rather as a convenience. There is a need for proper oversight with a regulatory framework and input from all stakeholders, including pediatricians and pharmacists.

PDG104 DECREASING NUMBER OF PRESCRIPTIONS AFTER THEY BECAME MANDATORY AND THEIR VALIDITY PERIOD WAS EXTENDED TO TWO YEARS: CASE FINLAND SINCE 2017

In Finland, implementation and adoption of the national Kanta services has been carried out step-by-step since May 2010. Electronic prescription (eP) is mandatory and prescription validity period was extended to two years since January 2017. The administrative nationwide 'big bang' changes brought up the first opportunity to find out prescription volume in Finland. Written and telephone prescriptions were recorded into the national Prescription Centre (PC) in community pharmacies, and ePs via electronic health record systems or Kelain web prescription service. Data from PC were extracted from 1 January 2017 till 30 April 2019. Cumulatively 5.57 million (M) persons had 162.26M ePs in PC by 31 December 2018. Number of persons who received ePs was 4.34M in 2017 and 4.38M in 2018. Of the 31.91M ePs recorded into PC in 2017, only 1.26% were recorded at community pharmacies, whereas 28.29M and 1.23% in 2018. Number of ePs in 2018 was 11% lower than in 2017. Basing on numbers of recorded ePs from January to May 2019, it is estimated that there would be 28.86M ePs in 2019. Cumulatively 322.30M dispensations from ePs at community pharmacies were recorded by 31 December 2018. Numbers for dispensations were 61.39M and 64.42M in 2017 and 2018. Number of dispensations in 2018 was 5% higher than in 2017. Altogether, 2.30M eP renewal requests were sent to healthcare via My Kanta Pages patient portal in 2017 and 2.07M in 2018 (service was launched in mid-November 2015). Some 2,111 dispensations in Estonia were based on the Finnish ePs (January–May 2019). All (100%) prescriptions are recorded into a national PC database since January 2017. Number of ePs recorded into PC decreased whereas number of dispensations increased from 2017 to 2018 in Finland. We estimate that the decreasing recorded eP trend would continue in 2019.

Suomen lääkemääräysten seurannan ensimmäiset yksitoista kuukautta vuonna 2017

Lääkemääräys on laadittava sähköisesti 1.1.2017 alkaen. Laissa määriteltyjen poikkeustapausten perusteella laaditussa kirjallisessa ja puhelinlääkemääräyksessä on perusteltava, miksi sitä ei ole annettu sähköisesti. Valtakunnallisen toiminnallisen muutoksen myötä on mahdollista selvittää ensimmäisen kerran lääkemääräysten kokonaismäärä Suomessa. Tutkimusaineistona ovat reseptikeskukseen tallennetut potilastietojärjestelmissä ja Kelaimessa laaditut sähköiset lääkemääräykset sekä apteekeissa tallennetut (sähköistetyt) kirjalliset, puhelin- ja erityislupavalmisteiden lääkemääräykset tutkimusjaksolla 1.1.–30.11.2017. Reseptikeskukseen tallennettiin tutkimusjaksolla 29,477 (100 %) milj. sähköistä lääkemääräystä, joista 96,6 % oli laadittu potilastietojärjestelmissä ja 1,0 % Kelaimella. Apteekeissa sähköistettiin 0,375 (1,3 %) milj. lääkemääräystä, joista 0,246 (0,8 %) milj. oli kirjallisia ja 0,122 (0,4 %) milj. puhelinlääkemääräyksiä. Apteekeissa sähköistetyistä lääkemääräyksistä yli puolet oli kirjallisia lääkemääräyksiä, jotka oli laadittu teknisen häiriön perusteella. Tutkimuksessa selvitettiin ensimmäisen kerran Suomessa lääkemääräysten kokonaismäärää vuoden 2017 yhdentoista kuukauden tietojen perusteella. Valtakunnallisessa seurannassa ilmeni päivittäin teknisiä häiriöitä, joiden perusteella laadittiin kirjallisia ja puhelinlääkemääräyksiä.

Drug prescriptions in Danish out-of-hours primary care: a 1-yearpopulation-based study

Objective: General practitioners are the first point of contact in Danish out-of-hours (OOH) primary care. The large number of contacts implies that prescribing behaviour may have considerable impact on health-care expenditures and quality of care. The aim of this study was to examine the prevailing practices for medication prescription in Danish OOH with a particular focus on patient characteristics and contact type.Design and setting: A one-year population-based retrospective observational study was performed of all contacts to OOH primary care in the Central Denmark Region using registry data.Main outcome measures: Prescriptions were categorised according to Anatomical Therapeutic Chemical Classification (ATC) codes and stratified for patient age, gender and contact type (telephone consultation, clinic consultation or home visit). Prescription rates were calculated as number of prescriptions per 100 contacts.Results: Of 644,777 contacts, 154,668 (24.0%) involved medication prescriptions; 21.9% of telephone consultations, 32.9% of clinic consultations and 14.3% of home visits. Around 53% of all drug prescriptions were made in telephone consultations. Anti-infective medications for systemic use accounted for 45.5% of all prescriptions and were the most frequently prescribed drug group for all contact types, although accounting for less than 1/3 of telephone prescriptions. Other frequently prescribed drugs were ophthalmological anti-infectives (10.5%), NSAIDs (6.4%), opioids (3.9%), adrenergic inhalants (3.0%) and antihistamines (2.3%).Conclusion: About 25% of all OOH contacts involved one or more medication prescriptions. The highest prescription rate was found for clinic consultations, but more than half of all prescriptions were made by telephone.KEY POINTSAs the out-of-hours (OOH) primary care services cover more than 75% of all hours during a normal week, insight into the extent and type of OOH drug prescription is important.General practitioners (GPs) are responsible for more than 80% of all drug prescriptions in Denmark.Of all contacts 24.0% involved medication prescriptions; 21.9% of telephone consultations, 32.9% of clinic consultations and 14.3% of home visits.Of all prescriptions, 53% were made in telephone consultations.Anti-infective medications for systemic use accounted for 45.5% of all prescriptions, thereby being the most frequently prescribed drug group for all three contact types.

Effectiveness and cost-effectiveness of telephone consultations for fever or gastroenteritis using a formalised procedure in general practice: study protocol of a cluster randomised controlled trial.

BackgroundTelephone consultations in general practice are on the increase. However, data on their efficiency in terms of out-of-hours general practitioner (GP) workload, visits to hospital emergency departments (ED), cost, patient safety and satisfaction are relatively scant. The aim of this trial is to assess the effectiveness of telephone consultations provided by French emergency call centres in patients presenting with isolated fever or symptoms of gastroenteritis, mainly encountered diseases.Methods/designThis is a prospective, open-label, multicentre, pragmatic, cluster randomised clinical trial of an estimated 2880 patients making an out-of-hours call to one of six French emergency call centres for assistance with either fever or symptoms of gastroenteritis without seriousness criteria. Each call is handled by a call centre physician. Out-of-hours is 8 p.m. to 7.59 a.m. on weekdays, 1 p.m. to 7.59 a.m. on Saturdays and round-the-clock on Sundays and school holidays. Patients will be enrolled over 1 year.In the intervention arm, a telephone consultation based on a protocol, the formal Telephone Medical Advice (fTMA), is offered to each patient calling. This protocol aims to overcome a physical consultation during out-of-hours periods. It offers reassurance and explanations, advice on therapeutic management which may include, in addition to hygiene and diet measures, a telephone prescription of antipyretic, analgesic, rehydration medication or others, and recommendations on surveillance of the patient and any action to be taken. The patient is invited to call again if the condition worsens or new symptoms develop and to make an appointment with their family GP during office hours. In the control arm, the call centre physician handles calls as usual. This physician can carry out a telephone consultation with or without a telephone prescription, dispatch an on-duty GP, the fire brigade or an ambulance to the patient, or refer the patient to an on-duty physician or to the ED. Each patient will receive a follow-up call on day 15.The primary endpoint is the frequency of out-of-hours, face-to-face GP consultations or visits to the ED during the 15 days following the index call. The secondary endpoints measured on day 15 are the number of stays in intensive care, the number of hospital admissions, the number of interventions by the fire brigade, emergency medical and ambulance services, the number and length of prescribed sick-leave episodes, all-cause mortality, morbidity, clinical outcome, patient compliance, patient satisfaction, the number of renewed calls to the call centre, the number of patients receiving multiple face-to-face GP consultations and costs incurred.DiscussionThis trial will assess the effectiveness and the cost-effectiveness of a formalised response to calls for assistance with fever or symptoms of gastroenteritis without seriousness criteria.Trial registrationClinicalTrials.gov Identifier: NCT02286245, registered on 9 September 2014.

The Veterans Choice Act and Dual Health System Use.

T he Veterans Access, Choice and Accountability Act (Choice Act), formally enacted on August 7, 2014, arose largely in response to outrage about delays in veteran access to health care and falsification of wait time records by Veterans Administration (VA) employees. The law includes a number of provisions to improve care for veterans, including increasing health care staffing and residency training positions, streamlining employee disciplinary procedures, improving treatment of military sexual trauma, and establishing a Presidential Commission on Care to evaluate access to VA health care. The most well-known, and perhaps controversial, provision is the Choice Program, which established a mechanism for eligible veterans to receive care outside the VA for 3 years. Veterans unable to schedule an appointment within 30 days of their preferred date or who live more than 40 miles from a VA facility are now eligible to receive care from non-VA providers. However, many of these veterans will also continue to use VA facilities and services, and this ‘dual use’ of health care systems may lead to care fragmentation and its ensuing adverse consequences. This commentary describes the problems of dual use and care fragmentation, the complexity of the Choice Program, and some ideas for ensuring its safe and effective implementation. The challenges surrounding the implementation of the Choice Program have been monumental. In the 90 days between passage of the law and the start of the program on November 5, 2014, the VA developed a system for identifying and reaching out to eligible veterans, tracking Choice Program visits, and paying for services through the program. As of April 2015, the VA had coordinated more than 45,000 Choice Program medical appointments and dispensed more than 3,200 Choice prescriptions. However, this implementation has received tremendous public criticism because of the relatively low uptake of services compared to the perceived need for immediate care. In response, in May of 2015, the U.S. Senate unanimously voted to amend the Choice Act, expanding access to veterans living within 40 miles of a VA facility if it does not offer them the needed medical care. The measure, however, has not passed the U.S. House of Representatives. The Choice Program is not the first time that an expansion of non-VA care for veterans has increased the complexity or fragmentation of care. In 2006, the rollout of Medicare Part D prescription drug coverage gave millions of VA patients the opportunity to obtain prescription drugs through the private health care system. Despite almost 10 years having elapsed since Part D’s implementation, however, and the concerns related to dual use, there are limited data on its impact on care fragmentation among veterans. In 2014, the Affordable Care Act (ACA) again expanded access for veterans to non-VA care through both the private insurance marketplace and Medicaid. Similar concerns have been raised about increased care fragmentation with dual use as a consequence of the ACA, although the full impact will not be known for some time. Even before these insurance expansions, veterans with Medicare coverage were known to receive care through both Medicare and VA. Prior work has documented convincing evidence that dual use of Medicare and VA services comes with inherent risks of care fragmentation and duplication of services, including, for example, higher rates of hospitalization for ambulatory care-sensitive conditions, higher cost and worse outcomes in cancer, and higher rates of rehospitalization. 4 Despite the best efforts, care received outside the VA cannot be seamlessly integrated into the sophisticated electronic medical record (EMR) and decision support systems that unify the VA. Physicians outside the VA do not have access to the VA’s EMR and ordering systems, leading to risks of duplication of services, errors, and inefficient care. These risks of care fragmentation with dual use extend to the Choice Program, especially given its complexity. As an example, consider how prescription drugs are dispensed through Choice. Under the Program, non-VA providers must prescribe within the same formulary rules that guide VA providers. Choice providers do not have access to the electronic ordering with decision support that helps VA providers prescribe within formulary guidelines. In 2003, when VA temporarily implemented the Transitional Pharmacy Benefit for patients waiting more than 30 days for their initial primary care appointment, roughly 40% of prescriptions received from non-VA providers were non-formulary, substantially increasing the workload and costs for VA pharmacy. Each Choice prescription must be faxed, mailed, or delivered in person to a VA facility to be processed; verbal and telephone prescriptions Published online August 20, 2015

Benzodiazepine reduction in general practice. Are the elderly neglected?

In two Danish general practices a few simple rules applicable to all age groups were introduced in order to reduce consumption of benzodiazepines (BZ) and cyclopyrrolones (CP). These rules, termed the "Thyborøn-Model", included the termination of telephone prescriptions, the issuance of prescriptions only following personal consultation and the restriction of prescriptions to a maximum of a single month's consumption. The purpose of the present demographic analysis is to investigate whether the intervention was successful for the elderly, who are considered to be a special target group. The findings presented here reveal that the number of BZ and CP users increased with increasing age. Furthermore, the results indicate that the intervention was effective in reducing the consumption of BZ and CP for middle-aged and elderly patients, and that there is a significantly better effect of this model for middle-aged than for elderly patients. These findings constitute the first demographic evaluation of the effects of the "Thyborøn-Model" with focus on the special target group of elderly patients, and indicate that it is advisable to introduce these simple rules for all age groups, especially since they also are effective on elderly patients.

Intervention Against the Excessive Use of Anxiolytica and Hypnotica in Two General Practices

This publication describes the successful reduction in the use of benzodiazepines as anxiolytics by 87%, as well as the reduction in the use of benzodiazepines and cyclopyrrolones as hypnotics by 92%, for two general practitioners over a period of three years. The measures implemented were few and simple:  Cessation of telephone prescriptions.  Issue of prescriptions only following consultation.  Prescriptions limited to a single months requirements. At each monthly consultation, the patient as well as the practitioner was required to re-evaluate the need and extent of the subsequent prescriptions. During the first three months, only four to five additional consultancies per week per 1000 patients were required. Subse- quently, this number was stabilized at approximately one additional consultancy per week. The routine implementation of the aforementioned simple procedure is to be recommended for the ordination of BD and CP drugs, as the effect is both significant and persistent.

Pharmacy technicians obtaining medication histories within the emergency department

While studies have demonstrated the positive effect pharmacists have had on the medication reconciliation process, the costs can be prohibitive.1–3 Given their familiarity with medications, pharmacy technicians offer a reasonable solution. There have been published reports describing the use of pharmacy technicians to obtain medication histories.4–6 The use of technicians in a Minnesota surgical clinic’s medication reconciliation program and the legal aspects of this program were recently reviewed.7 In North Carolina, the state board of pharmacy defines a pharmacy technician as “a person who may, under the supervision of a pharmacist, perform technical functions to assist the pharmacist in preparing and dispensing prescription medications.”8 Certified technicians are allowed by North Carolina law to receive new telephone prescription orders and transfer prescription information to or from other pharmacies. Unaddressed in the state rules is the practice of technicians clarifying medication orders with prescribers or other health care professionals, a practice which routinely occurs in community pharmacy settings. We feel that technicians who work within a health system and have undergone proper training should be qualified to obtain a medication history from a patient as a technical function of their job.

An Approach to Reduce Benzodiazepine and Cyclopyrrolone Use in General Practice

The global use of benzodiazepines and cyclopyrrolones is generally high. The hypnotic and anxiolytic effects of these agents typically diminish after a period of weeks or months of continuous use. Patients may thus be caught in a trap where the usefulness of these substances is reduced and doses are consequentially escalated, and where a subsequent phased reduction in dose can be difficult. Although considerable resources have been expended on reducing the use of these agents, no unambiguous and effective method has been identified.In Denmark, it is estimated that there are approximately 100 000 benzodiazepine-dependent patients, constituting approximately 2% of the general population. The prescription of dependency-producing drugs (including benzodiazepine/cyclopyrrolone agents) in Denmark is regulated according to Danish directive CIR nr 12, introduced on 13 January 2003, which aimed for restrictions in the prescribing of benzodiazepine and cyclopyrrolone drugs while setting revised guidelines for the re-evaluation of these agents. However, by 2004, the use of these drugs had decreased by only 1.7%, far from the official objective of a 50% reduction. This article describes an effective strategy implemented in general practice in Denmark to reduce the use of benzodiazepine and cyclopyrrolone agents, while at the same time challenging practitioners' ingrained habits and prejudices in this field. An intervention involving new regulations for the prescription of benzodiazepines and cyclopyrrolones was introduced to ten Danish medical practices, comprising 13 medical practitioners and a patient base of approximately 18 500 patients. The new intervention was essentially in accordance with the official Danish regulations, such that a prescription for benzodiazepines and cyclopyrrolones could only be issued for 1 month at a time, and only following consultation. Telephone prescriptions were eliminated. Use was monitored using the Danish registration system, Ordiprax, which monitors sales of prescription medicine. All users of benzodiazepines and cyclopyrrolones within the ten practices, with the exception of seriously psychiatrically and physically ill patients, were included. Fifteen months after the inception of the intervention, the use of cyclopyrrolones was reduced by 50.3%. Use of benzodiazepine-hypnotics was reduced by 46.5% and use of benzodiazepine-anxiolytics was reduced by 41.7%. The reorganisation of prescription patterns proved to be significantly easier than practitioners had expected. During the first 3 months, only 4.3 additional consultations per week per 1000 patients were required. Subsequently, this number fell to 2.1 additional consultations. The usual collaborative partners, such as psychiatrists, homecare services, hospitals and substance abuse units, were essentially not deployed. No serious side effects developed in patients in whom drug use was reduced. The intervention was effective in reducing the use of benzodiazepine and cyclopyrrolone agents in general practices in a large municipality in Denmark. It is recommended that this intervention be introduced into the primary care sector, as it requires minimal effort on the part of the medical practitioner. The intervention is as simple as it is effective, and its implementation does not require any major level of supplementary training.

Incomplete Event Documentation in Medical Records of Lung Transplant Recipients

The medical record is frequently used in clinical studies as a source of information on illness events experienced by patients; however, it may be incomplete. To estimate the extent of incompletely documented acute bronchopulmonary events in a transplant clinic medical record at a single university medical center, using home monitoring data. Trends in daily home monitoring data were compared to contemporaneous medical record documentation at 150 different times in 30 lung transplant recipients over 45 subject-years. Proportion of acute bronchopulmonary illness events documented in clinic medical record. By using home monitoring data in a new way, we found that 40% of events actually suffered by lung recipients could not be ascertained to have occurred from the clinic medical record alone. All missed encounters occurred away from the transplant clinic, and involved hospitalizations and telephone prescriptions. Using the clinic medical record alone to identify acute bronchopulmonary events in lung transplant recipients may result in missing 40% of events. This has important ramifications for studies relying on the medical record for acute event ascertainment in lung transplantation and possibly other chronic diseases.

The North Carolina DIAL EC project: increasing access to emergency contraceptive pills by telephone

Objectives To evaluate a telephone prescription service designed to increase access to emergency contraceptive pills (ECPs) in North Carolina. Methods Women who wanted ECPs called a toll-free number and were screened over the telephone. Prescriptions were faxed to pharmacies chosen by callers. Results In 29 months, the service issued 9745 prescriptions to 7774 callers. Forty percent of callers were teens. Only 16% of callers received more than one prescription. Most callers heard about the service through referrals from Planned Parenthood staff and word-of-mouth. Conclusions This service was successful in providing prompt access to ECPs to women throughout the state. Frequent use of the service by individual women was uncommon. Callers preferred to obtain ECPs from local pharmacies rather than from Planned Parenthood health centers, despite generally higher prices at pharmacies.

Managing demand: transfer of management of self limiting conditions from general practice to community pharmacies

The management of patients who visit general practitioners for acute, self limiting, health problems is a widespread concern for the workload of general practitioners.1 Although nurses and pharmacists receive government...

Access to emergency contraception

Objective: To evaluate access to emergency contraception among women seeking help from clinicians who registered to be listed on the Emergency Contraception Hotline (1-888-NOT-2-LATE, ie, 1-888-668-2528) and the Emergency Contraception Website (not-2-late.com). Methods: Two college-educated investigators posing as women who had a condom break the previous night called 200 providers to seek help. Results: Only 76% of attempts resulted in an appointment or telephone prescription from a hotline provider within 72 hours, 14% were failures, and 11% resulted in referrals to other providers not listed on the hotline or website. Conclusion: Even under ideal conditions, access to emergency contraception is currently constrained. Although emergency contraception could reduce significantly the incidence of unintended pregnancy and the consequent need for abortion, its potential will not be realized unless women have better access to clinicians who can prescribe emergency contraceptive pills.

A Study on the Characteristics of Prescription Transmittal Processes and the Effect of a Patient Prescription Reminder System on Patient Compliance

This study investigates the effect of telephoning patients on the number of prescriptions claimed after having been phoned to the pharmacy by a health care provider. The study also compares the number of unclaimed prescriptions belonging to patients who have their prescriptions telephoned to the dispensing pharmacy versus those patients who present the prescription in person. The setting for this study was a chain pharmacy serving a middle-to-upper-income area in western Omaha, Nebraska. The average prescription volume is 250 prescriptions per day, with approximately 70% of patients using a third-party provider for payment of their prescriptions. Pharmacists provide several clinical services to patients (lipid, hypertension, and diabetes monitoring). In the first phase of the study, the number of unclaimed prescriptions was measured by how the prescription was presented-by telephone or in person. In the second phase, investigators telephoned patients who had not claimed their telephone prescriptions and reminded them about their prescriptions. In Phase I, 99.7% of the

Telephone Medical Care Administered by Internal Medicine Residents: Concerns of Program Directors and Implications for Residency Training

AbstractThe objective of this study was to determine the need for telephone medicine curricula and to help define important content for internal medicine residencies using scales that measure program director attitudes toward telephone medicine. Data were collected by surveying all 416 program directors of accredited internal medicine residencies in the United States. We applied factor analysis to develop reliable attitudinal scales and employed regression models to identify predictors of these attitudes. Response rate was 60%. Formal training for telephone medicine was available in only 6% of programs. The factor analysis showed three attitudinal concepts; all described marked program director discomfort with aspects of resident telephone prescription. Predictors of improved program director comfort included more frequent documentation of resident telephone calls, chart availability, and clear definition of resident roles pertaining to telephone interactions with patients (P < 0.02 for all predictor variables). These results identify a need for telephone curricula and suggest components that might alleviate program director discomfort with resident telephone practices. KEY INDEXING TERMS: Telephone medicine; Resident education; Internal medicine

Telephone medical care administered by internal medicine residents: concerns of program directors and implications for residency training.

The objective of this study was to determine the need for telephone medicine curricula and to help define important content for internal medicine residencies using scales that measure program director attitudes toward telephone medicine. Data were collected by surveying all 416 program directors of accredited internal medicine residencies in the United States. We applied factor analysis to develop reliable attitudinal scales and employed regression models to identify predictors of these attitudes. Response rate was 60%. Formal training for telephone medicine was available in only 6% of programs. The factor analysis showed three attitudinal concepts; all described marked program director discomfort with aspects of resident telephone prescription. Predictors of improved program director comfort included more frequent documentation of resident telephone calls, chart availability, and clear definition of resident roles pertaining to telephone interactions with patients (P < 0.02 for all predictor variables). These results identify a need for telephone curricula and suggest components that might alleviate program director discomfort with resident telephone practices.

An evaluation of the information given on veterinary prescriptions in Norway. Compliance with the legal regulations

Compliance with Norwegian legal regulations for veterinary prescriptions was investigated and evaluated. The study was designed as a cross-sectional prescription survey, and the prescriptions were recorded in Dbase III. Of the 6505 written and telephone prescriptions collected only about one in five fulfilled the legal requirements, namely, giving information about the animal species the drug was intended for, indication for the prescribed drug and directions for use. On average 86% contained information about the animal species, while 26% and 80%, respectively, contained formation about the indication for the prescribed drug and directions for use. The number of prescriptions on which indication and directions for use were given, was significantly higher for written prescriptions than for telephone prescriptions, and for prescriptions of human preparations compared with prescriptions of veterinary preparations. For pets, the number of prescriptions containing directions for use was significantly higher than for production animals. The proportion of prescriptions for pets giving a statement of the indication was not significantly different from prescriptions for production animals.