Utilization of appetite suppressants in England: a putative indicator of poor prescribing practice

Prescription of anorectic and benzodiazepine drugs through notification B prescriptions in Natal, Rio Grande do Norte, Brazil

A study was conducted on 22,158 special B prescriptions (notificações B) containing amphetamine-type anorectic drugs or benzodiazepines, obtained from compounding pharmacies or drugstores located in the city of Natal, RN, Brazil. The data obtained were compared with those from other Brazilian cities. Results showed that compounding pharmacies dispensed 85.4% of the prescriptions, indicating that these pharmacies filled out nearly 10 times more of these prescriptions than did the drugstores. The majority (83.5%) of B prescriptions issued for the compounding pharmacies were for women, where the female/male patient ratio ranged from 7.1/1.0 for mazindol to 10.3/1.0 for amfepramone. Similar results were obtained for the benzodiazepines with ratios of 1.9/1.0 for clonazepam to 15.6/1.0 for oxazepam. Omissions and mistakes were present in the B prescriptions, including missing information about the patient (in 49.6% of the documents) or about the pharmacies or drugstores (50.4%). There were cases where the name and/or CRM of the physician was lacking. It was noted that one medical doctor made out 1855 B prescriptions within one year. The same patient's name appeared on 138 prescriptions, and the same RG (identification card number) was present in 125 others. Comparison of Natal's data with those of several other Brazilian cities disclosed a striking similarity throughout Brazil, from Pelotas - Rio Grande do Sul State to Belem-Para State, revealing a practically identical medical/pharmaceutical behavior. This pattern of prescription/dispensation of amphetamine-type substances mostly to women for weight loss is therefore for cosmetic reasons. Consequently, there is an urgent need for an ethical review of this behavior.

The application of prescribing indicators to a primary care prescription database in Ireland

OBJECTIVE

To develop appropriate prescribing indicators and apply these to Irish prescription data.

METHODS

A postal survey of 145 randomly selected general practitioners working within the Eastern Health Board region of the State-supported General Medical Services scheme in Ireland regarding the applicability of selected prescribing indicators was carried out. Such indicators were then applied to aggregate prescription data.

RESULTS

Prescribing indicators based on agents of questionable efficacy/poor quality prescribing and those based on good prescribing practice were thought to make suitable indicators. Low rates of prescribing were noted for indicators based on drugs of limited efficacy, e.g. cerebral and peripheral vasodilators (rate 3.1 per 1,000 prescriptions), whilst indicators based on drugs associated with good prescribing practice were associated with higher prescribing rates, e.g. the prescription of aspirin in patients receiving nitrate therapy(rate 7.13 per 1,000 patients). However, a low rate of generic prescribing (4.6%) was found amongst general practitioners in the study. The largest variability in prescribing was seen with the prescribing of peripheral and cerebral vasodilators (75th/25th centile=5.6) and the prescription of long-acting sulphonylureas (75th/25th centile=66.6).

CONCLUSIONS

Quality indicators based on aggregate prescribing provide valuable information on prescribing standards and should be developed with the close involvement of prescribers.

Use of anorectic amphetamine-like drugs by Brazilian women

The history of anorectic drug use was investigated in 2370 subjects in São Paulo and Brasília cities. Socio-demographic data and the number of previous treatments to lose weight were obtained. When the last treatment was drug-based, the substance(s) used, its duration, the occurrence of adverse reactions, and whether it was adequate were studied. There was a prevalence of female patients, 92.7%, in both cities and as many as 72.4% of them had already undergone from 1 to >10 previous treatments. Out of those patients, 75.37% had undergone pharmacological treatment, 79.2% of those with amphetamine-like anorectic drugs. Treatment was longer than 3 months in half of the cases, and 60% of the subjects had a Body Mass Index below 29.9. Over 50% of the subjects was given amphetamine-like drugs through compounded formulas containing four or more substances, which had been specifically tailored by the doctor for each patient. On the other hand, 86.3% of all the subjects reported adverse reactions to the amphetamine-like drugs, 37.4% of them sought medical advice, and 3.9% required hospitalization. In conclusion, the use of amphetamine-like drugs in Brazil is particularly prevalent among women and this use is strongly related to the culture of slimness as a symbol of beauty.

Drug interactions avoided-a useful indicator of good prescribing practice

AIMS

To develop an index of quality prescribing in general practice by investigating the incidence of potential drug interactions when medicines were coprescribed within the State supported General Medical Services (GMS) in Ireland.

METHODS

We determined an odds ratio (OR), as a measure of the relative risk of being exposed to a potential interaction, comparing the use of the H2-receptor antagonist, cimetidine, with that of the noninteracting agents ranitidine, famotidine and nizatidine in users and nonusers of warfarin, phenytoin and theophylline.

RESULTS AND CONCLUSIONS

In 86 510 prescriptions for the H2-receptor antagonists potentially interacting drugs were dispensed to 8188 (9%) patients in the Eastern Health Board Region of the GMS. We found that prescribers were significantly less likely to use cimetidine (OR = 0.20,95% CI 0. 17-0.21, P < 0.001) in those patients who were coprescribed warfarin, suggesting good prescribing practice within the GMS. Similarly there was preferential use of the noninteracting H2-receptor antagonists in patients receiving phenytoin or theophylline and the extent of this selective prescribing was in keeping with the rank order of severity of interaction with these drugs. This novel pharmacological index may be a sensitive marker of good prescribing practice.

Clearing 'the fog on the Tyne': can the quality of therapeutics be assessed?

1. The rise in prescribing costs in developed countries is a concern for all physicians, but a particular challenge for clinical pharmacologists. 2. There are wide variations in the amounts and types of drugs prescribed in developed countries. 3. In order to address cost appropriately it is also necessary to address quality. Various aspects of the quality of therapeutics may be considered, including audit of process, patterns of prescribing of specific drugs and reporting of adverse drug reactions. 4. A consensus process is described in which primary care physicians developed criteria of prescribing quality, using data readily available within the UK. Practitioners scores using these criteria did not correlate directly with prescribing costs, indicating that cost alone cannot be used as criterion of quality. 5. The measurement of quality in therapeutics remains an important challenge for the future.