Prescribing pattern of antihypertensive drugs in two European cohorts: a population-based database study (original) (raw)
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Journal of Evaluation in Clinical Practice, 2002
Background: Antihypertensive drugs play a crucial role in reducing cardiovascular morbidity and mortality. Variability in prescribing patterns constitutes a major challenge for current healthcare systems. This study aimed to compare patterns of use of antihypertensives in general practice in two southern European populations. Methods: Observational study. Data on antihypertensive drugs consumption in primary care setting (2016) were obtained from pharmacy refill records in Campania (Italy) and Aragon (Spain). Prescribing rates and the number of defined daily doses [DDD]/1,000 inhabitants/day (DID) were calculated, and the Drug Utilization 90% (DU90%) approach used to reveal differences in prescribing patterns in both regions. Results: Antihypertensive prescribing rates in Campania and Aragon were 250.8 (95%CI: 250.2-251.3) and 201.7 (95%CI: 200.9-202.5) users/1,000 inhabitants/year. Overall consumption was of 310.1 and 256.8 DID, respectively. Spanish users, especially women and the elderly, consumed a greater volume of diuretics. Conversely, other therapeutic subgroups were more consumed in Campania. However, the most prescribed subgroups accounted for comparable proportions of the total consumption in each region. Conclusions: Both prescribing rates and intensity of antihypertensive use were higher in Campania. Pharmacy refill records in cross-national comparisons allow to know the factors influencing variability in prescribing habits with a view to improving prescribing quality.
Expert Review of Pharmacoeconomics & Outcomes Research
The aim of this article was to evaluate the influence of different demand-side measures to enhance the prescribing of generics in ambulatory care based on cross-national comparisons. An observational retrospective study was conducted using administrative databases from across Europe, documenting changes in reimbursed utilization and expenditure of different proton pump inhibitors (PPIs) and statins between 2001 and 2007, alongside different reforms to enhance prescribing efficiency. Utilization was converted to defined daily doses (DDDs) and expenditures were converted to euros. Demand-side measures were collated under the '4 Es'--education, engineering, economics and enforcement--to enable comparisons on the nature and intensity of reforms between countries. There were considerable differences in the utilization of generics and patent-protected PPIs and statins among Western European countries. Decreased utilization of omeprazole and simvastatin, alongside increased utiliza...
Prescribing Patterns of Antihypertensive Medications in US Ambulatory Care Settings
Pharmacy
Over 70 million Americans are diagnosed with hypertension. Adherence to current AHA/ACC 2017 hypertension guidelines and appropriate antihypertensive therapy is important for optimal treatment outcomes. This study investigates prescribing patterns for ambulatory care patients with hypertension and adherence to these guidelines. Data from the 2015 National Ambulatory Medical Care Survey (NAMCS) were used in the study. Patients with primary diagnoses of essential hypertension were extracted from the data using ICD-9 code “401”. A total of 595 patients were identified. Correlation among demographic variables, source of payment and prescriber specialty were examined. Chi-square and descriptive analysis were performed. 51.4% of the prescriptions were non-first-line medications. Primary care physicians and cardiologists adhered to the guidelines more, when compared to the other specialties. There was a significant difference between various geographic regions, as it relates to guidelines ...
1992
Two years of prescriptions for all the drugs included in the Italian National Formulary by 3,866 general practitioners, in a region of Northern Italy of almost 4 million inhabitants, were analysed to determine the pattern of drug use. The data (official code and proprietary name of the drug, number of packages prescribed, price of the drug, dispensing pharmacy, and date of dispensing) were collected monthly by retail pharmacies and were recorded and organized in database files. Quantitative and qualitative profiles of prescription patterns were studied for all the major therapeutic areas. Overall drug prescriptions averaged 600 DDD/1,000 inhabitants/day. Comparison of 1988 and 1989 data showed only a slight increase in total drug prescriptions, but greater changes were detected in certain drug groups, expecially those recently marketed. Overprescription of well-documented drugs, such as H2-antagonists, ACE-inhibitors, calcium antagonists and the HMG-CoA-reductase inhibitors, in comparison to other countries was shown. There was frequent prescribing of drugs devoid of documentation of their clinical efficacy, which were mainly given for clinical conditions lacking a specific treatment, or as placebos for minor disorders. The data demonstrate the need for educational intervention to improve the quality of drug prescribing habits in primary health care in Italy.
Physicians' and pharmacies' overview of patients' medication. An analysis of fidelity coefficients
European Journal of Clinical Pharmacology
Background It is essential that pharmacies and prescribers have an overview of each patient's medication in order to prevent drug interactions, unintentional co-prescribing, unnecessary polypharmacy and underprescribing. We have assessed this overview by measuring the 'fidelity coefficient', a measure of the extent to which a drug user has a preference for one prescriber or one pharmacy. Methods and setting Data for all prescriptions issued for the population in Southern Denmark (population 1.2 million) in 2009 was extracted from the Odense University Pharmacoepidemiological Database (OPED). Analysis of the extracted data was then limited to persons with at least ten prescriptions within the year, resulting in 8,246,064 prescriptions issued to 283,388 individuals. For each individual, we identified the most used prescriber and calculated the proportion of all prescriptions accounted for by that prescriber (FC presc ). The individual user's most frequented pharmacy was also identified and the FC pharm calculated in a similar fashion. Results The average FC Presc and average FC Pharm were 0.883 (standard deviation 0.158) and 0.927 (0.139), respectively. The estimated difference was 0.0446 (95% confidence interval 0.0439-0.0453). Among the factors associated with a high FC presc and high FC pharm were older age, male gender and a high volume of prescriptions. The major drug classes that were most often prescribed by a non-main prescriber were beta-lactams, antidepressants and opioids. Similarly, the major drug classes associated with use of non-main pharmacy were beta-lactams, antidepressants and inhaled beta-agonists. Conclusion Based on this analysis, both prescribers and pharmacies generally have an equal potential for maintaining an excellent overview of their patients' medication, but the pharmacies account for a slightly higher proportion of patients.
Prescribing Behavior of General Practitioners for Generic Drugs
International Journal of Environmental Research and Public Health, 2020
The factors influencing General Practitioners’ (GPs) prescribing behavior are diverse in terms of health care policies and regulations, GPs’ education and experience, demographic trends and disease profiles. Thus, it can be useful to analyze the specific local patterns, as they affect the quality of healthcare and the stability of the healthcare market. The aim of the present longitudinal retrospective study is to investigate the prescription of generic drugs in a database of about 4.6 million prescriptions from a sample of 38 GPs practicing in Salerno, Italy, within a timeframe of 15 years, from 2001 to 2015. The GPs in our study show a general tendency to increase prescriptions of generic drugs during the studied time span, to fulfill regulatory obligations and with some differences in prescription behavior according to age, gender and experience. The generics prescription depends also on the different diagnoses, with some diagnostic areas showing a greater generic drug prescripti...
Journal of Evaluation in Clinical Practice, 2012
Rationale, aims and objectives This study was to examine changes in doctor pharmaceutical utilization behaviour in response to Taiwan's newly implemented National Health Insurance individual hospital global budget (GB) programme and the changes in health care costs and prescription trends for hypertensive (HT) patients. Method We analysed hospital outpatient prescription utilization with a pre-post individual hospital GB group and comparison group (the hospitals who did not join the programme) to evaluate the impact of GB strategies on hypertensive expenditure. Descriptive analyses were performed based on the average daily medication expenditure for each prescription, and average number of items per prescription. Results This study reviewed 16 770 057 outpatient records and prescription records of 213 568 hypertensive patients. The average total medication expense (+17.6%), HT medication expense (+8.8%), daily medication expense (+16.3%), and daily HT medication expense (+6.3%) significantly increased after the action. After the individual hospital GB action, hospital doctors participating in action switched their patients' prescription drugs to other less expensive drugs such as rennin-angiotensin-aldosterone system inhibitors (-1.1%). The increase in volume of medications prescribed for control group were significantly larger for both alfa-and beta-adrenergic blocking agents (1.5%), and calcium channel blocking agents (3.9%). Conclusion The individual hospital GB programme slowed down the trend of prescription drug cost increasing rate and reduced the prescription drug volume in hospitals.
Study of Prescribing Patterns of Antihypertensive Drugs
Prescribing practices are a reflection of health professional's abilities to discriminate among the various choices of drugs and determine the ones that will most benefit their patients The main objectives of the study include understanding the prescribing behaviour of physicians, evaluate average cost per prescription, educate the patients regarding their medication and health status and to promote rational use of drugs for achieving better patient outcomes The study was conducted in three outpatient clinics which include Aparna Clinic, Chaitanya Clinics, Warangal from March 2011 to May 2011 with patients of either sex attended that clinic. The prescription written by the physicians were collected and the original prescription was used for data collection. A total of 677 prescriptions were collected from three outpatient clinics. Out of 677 patients 56.6 % were males and 43.4 % were females with age ranging from 31 years to 80 years. Among 677 patients, fever/Cold/Cough was found to be more common due to climatic conditions and seasonal variations. On an average 2.46 (Mean± SD of 2.46±0.9) drugs were prescribed per prescription. The patients were also educated regarding the medication use and hypertensive and diabetic patients were educated regarding their life style modifications by providing information in the form of Patient Information leaflets. There is an ample scope of improving the prescribing pattern by keeping the number of medicines as low as possible, prescribing medicines by official names, using medicines appropriately after selecting and consciously keeping the cost of therapy low. Hence, the clinical pharmacist must be considered to be an integral part of the multidisciplinary healthcare team. They should be involved in collection and presentation of prescribing data as part of clinical audit. All attempts to enhance quality of prescribing should be encouraged as also education of patients / caretakers remains crucial.
Comprehensive Comparison of Drug Prescribing in the United States and United Kingdom
Pharmacotherapy the Journal of Human Pharmacology and Drug Therapy, 2011
Study Objective. To compare the frequency of outpatient drug prescribing in the United States and United Kingdom according to individual drugs and therapeutic categories during 2004-2006. Design. Retrospective prescription record review. Data Sources. United Kingdom General Practice Research Database, and the MarketScan Commercial Claims and Encounters Database for U.S. data. Subjects. In the U.K. database, we identified 1.6 million people younger than 65 years who were prescribed at least one prescription drug in at least one of the calendar years during the study period (2004-2006). For comparison, for each U.K. person identified, we randomly identified one person of the same sex and year of birth in the U.S. database who was also prescribed at least one drug in the same calendar year. Measurements and Main Results. We compared the frequency of prescribing of individual drugs, as well as selected therapeutic categories. Substantially higher proportions of people in the United States were prescribed antibiotics, statins, and postmenopausal hormones, but asthma drugs were prescribed more frequently in the United Kingdom. In those younger than 20 years, antidepressants and antipsychotics were prescribed more than twice as frequently in the United States, and males in the United States were far more likely to be prescribed drugs for attention-deficithyperactivity disorder than were their counterparts in the United Kingdom. Conclusion. This study provides documented quantification of differing patterns of drug use in the United States and United Kingdom during 2004-2006. The higher proportionate prescribing for most indications in the United States and the greater use of drugs under patent suggest that monetary costs are likely to be considerably higher in the United States than in the United Kingdom.