David A. Knapp

Drug Prescribing for Ambulatory Patients 85 Years of Age and Older

Drug prescribing for ambulatory patients ≥85 years of age was studied using data from the 1980 National Ambulatory Medical Care Survey (NAMCS) on office visits to physicians. NAMCS is a survey by the US National Center for Health Statistics, which collected information on office visits and extrapolated the results to the US population. Of the 575.7 million office visits by all ages, 6.8 million (1 per cent) were by persons ≥85 years of age, and 64 per cent involved females. Ninety per cent of the total office visits of those ≥85 years were with a physician who had seen them before; 94 per cent were with MDs as compared with DOs; 56 per cent were with general practitioners or internists; and 95 per cent had some type of follow‐up planned. The most frequent duration of the office visit was 11–15 minutes (36 per cent). The most frequent diagnostic class was diseases of the circulatory system. The survey physicians were asked to list all drugs, new or already in use by the patient, that were ordered, administered, or prescribed during the visit. The authors converted the drug brand names to their nonproprietary or generic name component(s); each active ingredient of combination products was treated as a separate drug entity. All drug analyses used generic names. Thirty‐two per cent of visits did not involve the use of any drug, 21 per cent involved one drug; 12 per cent, two drugs; and 16 per cent, three drugs. Cardiovascular‐renal drugs were the most frequently mentioned. One‐third of the visits involved the use of one or more drugs that have psychologic effects, either intended or as side effects. Three per cent of the office visits involved the use of two or more drugs that had the potential for clinically important interactions.

Community pharmacists help HMO cut drug costs.

Twenty-seven independent community pharmacies that were preferred providers for a health maintenance organization (HMO) were enrolled in a study to determine the effect of increased intervention activities on the cost of a drug benefit in a managed care environment. Pharmacists from nine pharmacies were trained to initiate changes in medication prescriptions to contain costs, to enhance communication with patients and prescribers, and to intervene in drug-related problems. Their intervention activities during the nine-month study period were compared with activities of nine pharmacies assigned to a control group and nine pharmacies assigned to a comparison group. Patients who visited the intervention pharmacies had a 6.5% lower prescription mean ingredient cost; a 6.0% higher generic substitution rate; an 8.3% lower average patient drug cost per month; and no difference in the days supply, the average number of prescriptions per patient, or the aggregate hospital admission rate. The pharmacists in the intervention group spent more time with patients before preparing prescriptions (2.4-fold increase); initiated more requests for prescribers to change prescriptions (2.5-fold increase); intervened more often to reduce the cost of drug therapy (3.7-fold increase); and suggested medication changes more often for better quality of care (1.9-fold increase). In this study, community pharmacists altered their practice procedures and settings to foster communication with patients and prescribers. Also, the prospective drug regimen review changed prescribing patterns: physicians permitted increased use of generic medications, which reduced monthly prescription expenditures.

Medicine—Pharmacy: Review of One Year of Drug Prescribing for the Elderly in a Hospital Clinic

Abstract A chart review of one year of drug prescribing for 163 ambulatory patients ≥ 75 years trated at a university hospital primary care clinic was done. Cardiovascular-renal drugs were the most frequently prescribed, reflecting the high prvalence of circulatory system diseases. The average number of drugs per patient for the year was 4.8 with an average of one of the drugs having potential psychitric effects. About one-fifth of the patients prescribed potassium-depleting diuretics were neither monitored appropriately nor prescribed potassium supplements. Dosage regiment information often was not found in the medical record.

Rule-Based Drug Prescribing Review: An Operational System

This paper describes an operational computer-based system for conducting Drug Prescribing Review (DPR). The system was designed to: arrive at specific judgements about the potential problems of drug orders taking into account the characteristics of the patient and their medical conditions; be relatively independent of the structure of the data base; and be capable of expressing and evaluating any DPR criteria. This was accomplished by developing a hierarchical, rule-based system for expressing and evaluating DPR criteria. This system was then linked with a specific patient data base for implementation. Drug orders for 65 patients have been evaluated and the results agree with expert judgement. The rule-based DPR system appears to be a feasible method of evaluation of drug orders.

Disruption Coming to Pharmacy and Pharmacy Education

To the Editor: Romanelli and Tracy write persuasively about a coming disruption in pharmacy.1 Evidence that pharmacy graduation rates may lead to pharmacist supply overtaking job openings is found in US Bureau of Labor Statistics (BLS) data, which report pharmacy employment projections for 2012-2022.2 The bureau projects a positive employment change over this period of 41 400 positions, from a 2012 base of 286 400, an increase of 14.5%. Between 2012 and 2022, job openings, as a result of growth and replacement needs, are projected to be 109 800. Assuming that 14 000 to 15 000 new graduates will enter the workforce annually during the period, an oversupply of 40 000 or more is likely to accumulate by 2022.

Panel II. Application: The application of criteria to data*

Clinical Pharmacology and Therapeutics (1991) 50, 629–632; doi:10.1038/clpt.1991.197

Physicians as Pharmacists

One may tend to think of biomedical ethics issues from a noneconomic perspective, i.e., rights and responsibilities, life and death, situational “oughts.” Yet, as an interdisciplinary forum, biomedical ethics at times rubs shoulders with business ethics in its quest to explore patient care dilemmas and health-policy issues.

Drug use in Australia and the United States as Reflections of Legislation and Social Attitudes

The opinions expressed in this paper are those of the authors and not necessarily those of their respective governments. attitudes. Drug use is defined as use in a legitimate, medical context; nonmedical uses of drugs or drug abuse are not considered. Three major aspects are examined: government controls over the distribution of drug products, economics of obtaining drugs and related pharmacy services, and factors affecting individual decisionmaking in prescribing.