Robert J. Michocki

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.

Heparin Requirements in Pulmonary Embolism and Venous Thrombosis: A Prospective Study

Abstract: To investigate the relationship between the clinical diagnosis of thromboembolic disease and heparin requirements for anticoagulation, we prospectively studied 31 patients suspected to have either deep vein thrombosis or pulmonary embolism. Six had the diagnosis of pulmonary embolism confirmed by a combination of ventilation and perfusion scans with pulmonary angiography, eight had venograms showing deep vein thrombosis, seven had diseases which mimicked pulmonary embolism, and ten had normal venograms. These four diagnostic groups were not significantly different with respect to heparin requirements during the first 24 hours of therapy (x̄ ± S.D. = 426 ± 105, 507 ± 105, 434 ± 79, and 457 ± 46 units/kg per 24 hours, respectively). Patients with pulmonary embolism and deep vein thrombosis did not differ significantly with respect to heparin requirements (UNITS/kg per 24 hours) on the second (386 ± 108 vs. 439 ± 127), third (415 ± 136 vs. 464 ± 130), and fourth (374 ± 104 vs. 418 ± 127) days of therapy. Our data suggest that the clinical diagnosis does not affect the dose of heparin necessary to anticoagulate patients with pulmonary embolism and deep vein thrombosis.

Drug Prescribing for Very Elderly Ambulatory Patients: 1985

To the Editor:Our article, “Drug Prescribing for Ambulatory Patients 85 Years of Age and Older,”’ was based on 1980 national data. We have completed identical analyses using 1981 data. The following is the abstract from the previously published article with 1981 data inserted; for comparison, the 1980 data are presented in brackets: Drug prescribing for ambulatory patients 285 years of age was studied using data from the 1981 [ 19801 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 585.2 [575.7] million office visits by all ages, 8.6 [6.8] million (1 [l] per cent) were by persons 285 years of age, and 67 [64] per cent involved females. Ninety-one [go] per cent of the total office visits of those 285 years old were with a physician who had seen them before; 96 [94] per cent were with MDs as compared with DOs; 60 [56] per cent were with general practitioners or internists; and 96 [95] per cent had some type of followup planned. The most frequent duration of the office visit was 11-15 minutes (34 [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-three [32] per cent of visits did not involve the use of any drug; 18 [21] per cent involved one drug; 13 [12] per cent, two drugs; and 12 [16] per cent, three drugs. Cardiovascularrenal drugs were the most hequently mentioned. Thirty-six per cent [a third] of the visits involved the use of one or more drugs that have psychologic effects, either intended or as side effects. Five [three] per cent of the office visits involved the use of two or more drugs that had the potential for clinically important interactions. As can be seen, 1981 data were similar to 1980 data. DEE A. KNAPP, PHD