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Thiruchelvam K, Byles J, Hasan SS, Egan N, Kairuz T. Frailty and potentially inappropriate medications using the 2019 Beers Criteria: findings from the Australian Longitudinal Study on Women's Health (ALSWH). Aging Clin Exp Res 2021; 33:2499-2509. [PMID: 33449339 DOI: 10.1007/s40520-020-01772-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/03/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Frailty is an essential consideration with potentially inappropriate medications (PIMs), especially among older women. AIMS This study determined the use of potentially inappropriate medications according to frailty status using the Beers Criteria 2019, identified medications that should be flagged as potentially inappropriate and harmful depending on individual health factors, and determined the association between frailty and PIMs, adjusted for characteristics associated with PIMs. METHODS This prospective longitudinal study included 9355 participants aged 77-82 years at baseline (2003). Frailty was measured using the FRAIL (fatigue, resistance, ambulation, illness and loss of weight) scale. Generalised estimating equations using log-binomial regressions determined the association between frailty and risk of using PIMs. RESULTS Among participants who were frail and non-frail at baseline, the majority used ≥ 3 PIMs (74.2% and 58.5%, respectively). At 2017, the proportion using ≥ 3 PIMs remained constant in the frail group (72.0%) but increased in the non-frail group (66.0%). Commonly prescribed medications that may be potentially inappropriate in both groups included benzodiazepines, proton-pump inhibitors and non-steroidal anti-inflammatory drugs, and risperidone was an additional contributor in the non-frail group. When adjusted for other characteristics, frail women had a 2% higher risk of using PIMs (RR 1.02; 95% CI 1.01, 1.03). CONCLUSION Given that the majority of frail women were using medications that may have been potentially inappropriate, it is important to consider both frailty and PIMs as indicators of health outcomes, and to review the need for PIMs for women aged 77-96 years who are frail.
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Affiliation(s)
- Kaeshaelya Thiruchelvam
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
- International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia.
| | - Julie Byles
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Syed Shahzad Hasan
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - Nicholas Egan
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Therese Kairuz
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
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Norman RS, Jaramillo CA, Eapen BC, Amuan ME, Pugh MJ. Acquired Stuttering in Veterans of the Wars in Iraq and Afghanistan: The Role of Traumatic Brain Injury, Post-Traumatic Stress Disorder, and Medications. Mil Med 2019; 183:e526-e534. [PMID: 29912436 DOI: 10.1093/milmed/usy067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Indexed: 12/12/2022] Open
Abstract
Introduction Determine the association between acquired stuttering (AS), traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) in a cohort of 309,675 U.S. Iraq and Afghanistan veterans. The secondary aim was to determine the association between AS and medication patterns for veterans in the sample. Materials and Methods Retrospective study using data from the Veterans Health Administration National Repository for veterans deployed in support of combat operations in Iraq and Afghanistan and who received Veterans Health Administration care in 2010 and 2011. We identified stuttering using ICD-9 codes to establish the association between AS, TBI, and PTSD, controlling for demographic characteristics and other comorbidities. Multivariable logistic regression was used to determine the association between comorbid conditions and potentially problematic medications associated with stuttering. Results Two hundred thirty-five veterans (0.08%) were diagnosed with AS in the cohort. There was the greater likelihood of an AS diagnosis for veterans with concomitant TBI and PTSD when compared with veterans without these diagnoses. Over 66% of those with stuttering were prescribed at least one medication that affected speech fluency (antidepressants, anxiolytics, and antiepileptic drugs) compared with 35% of those without AS. Conclusion Veterans with a comorbid diagnosis of TBI and PTSD were more likely to be diagnosed with AS AOR: 9.77 (95% CI = 6.93-13.78, p < 0.05) and more likely to have been prescribed medications known to affect speech production OR: 3.68 (95% CI = 2.81-4.82, p < 0.05). Clinicians treating veterans with these complex comorbid conditions should consider the impact of medications on speech fluency.
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Affiliation(s)
- Rocío S Norman
- Speech-Language Pathology Program, School of Health Professions, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX
| | - Carlos A Jaramillo
- South Texas Veterans Health Care System, Polytrauma Rehabilitation Center, 7400 Merton Miner Dr. San Antonio, TX
| | - Blessen C Eapen
- South Texas Veterans Health Care System, Polytrauma Rehabilitation Center, 7400 Merton Miner Dr. San Antonio, TX
| | - Megan E Amuan
- Bedford Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Rd. Bedford, MA
| | - Mary Jo Pugh
- South Texas Veterans Health Care System, Polytrauma Rehabilitation Center, 7400 Merton Miner Dr. San Antonio, TX.,Department of Epidemiology & Biostatistics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX
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Elliott RA. Problems with Medication Use in the Elderly: An Australian Perspective. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2006.tb00889.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Rohan A Elliott
- Austin Health, Heidelberg, and Department of Pharmacy Practice; Monash University; Parkville Victoria
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Joseph J, Ramesh M, Harugeri A, Parthasarathi G, Basavanagowdappa H. Frequency and Nature of Medication-Related Problems in Elderly Indian Inpatients. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2010.tb00560.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jinta Joseph
- Department of Pharmacy Practice, JSS College of Pharmacy, Department of Clinical Pharmacy; JSS University, and Professor and Head, JSS Medical College Hospital
| | - Madhan Ramesh
- Department of Pharmacy Practice, JSS College of Pharmacy, Department of Clinical Pharmacy; JSS University, and Professor and Head, JSS Medical College Hospital
| | - Anand Harugeri
- Department of Pharmacy Practice, JSS College of Pharmacy, Department of Clinical Pharmacy; JSS University, and Professor and Head, JSS Medical College Hospital
| | - Gurumurthy Parthasarathi
- Department of Pharmacy Practice, JSS College of Pharmacy, Department of Clinical Pharmacy; JSS University, and Professor and Head, JSS Medical College Hospital
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Scott IA, Anderson K, Freeman CR, Stowasser DA. First do no harm: a real need to deprescribe in older patients. Med J Aust 2014; 201:390-2. [PMID: 25296059 DOI: 10.5694/mja14.00146] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 06/12/2014] [Indexed: 11/17/2022]
Abstract
Inappropriate polypharmacy in older patients imposes a significant burden of decreased physical functioning, increased risk of falls, delirium and other geriatric syndromes, hospital admissions and death. The single most important predictor of inappropriate prescribing and risk of adverse drug events in older patients is the number of prescribed medications. Deprescribing is the process of tapering or stopping drugs, with the goal of minimising polypharmacy and improving outcomes. Barriers to deprescribing include underappreciation of the scale of polypharmacy-related harm by both patients and prescribers; multiple incentives to overprescribe; a narrow focus on lists of potentially inappropriate medications; reluctance of prescribers and patients to discontinue medication for fear of unfavourable sequelae; and uncertainty about effectiveness of strategies to reduce polypharmacy. Ways of countering such barriers comprise reframing the issue to one of highest quality patient-centred care; openly discussing benefit-harm trade-offs with patients and assessing their willingness to consider deprescribing; targeting patients according to highest risk of adverse drug events; targeting drugs more likely to be non-beneficial; accessing field-tested discontinuation regimens for specific drugs; fostering shared education and training in deprescribing among all members of the health care team; and undertaking deprescribing over an extended time frame under the supervision of a single generalist clinician.
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Affiliation(s)
- Ian A Scott
- Princess Alexandra Hospital, Brisbane, QLD, Australia.
| | - Kristen Anderson
- Centre of Research Excellence in Quality and Safety in Integrated Primary/Secondary Care, University of Queensland, Brisbane, QLD, Australia
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Pearson SA, Schaffer A. The use and impact of cancer medicines in routine clinical care: methods and observations in a cohort of elderly Australians. BMJ Open 2014; 4:e004099. [PMID: 24793244 PMCID: PMC4025442 DOI: 10.1136/bmjopen-2013-004099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION After medicines have been subsidised in Australia we know little about their use in routine clinical practice, impact on resource utilisation, effectiveness or safety. Routinely collected administrative health data are available to address these issues in large population-based pharmacoepidemiological studies. By bringing together cross-jurisdictional data collections that link drug exposure to real-world outcomes, this research programme aims to evaluate the use and impact of cancer medicines in a subset of elderly Australians in the real-world clinical setting. METHODS AND ANALYSIS This ongoing research programme involves a series of retrospective cohort studies of Australian Government Department of Veterans' Affairs (DVA) clients. The study population includes 104 635 veterans who reside in New South Wales, Australia, and were aged 65 years and over as of 1 July 2004. We will investigate trends in cancer medicines use according to cancer type and other sociodemographic characteristics as well as predictors of the initiation of cancer medicines and other treatment modalities, survival and adverse outcomes among patients with cancer. The programme is underpinned by the linkage of eight health administrative databases under the custodianship of the DVA and the New South Wales Ministry of Health, including cancer notifications, medicines dispensing data, hospitalisation data and health services data. The cancer notifications database is available from 1994 with all other databases available from 2005 onwards. ETHICS AND DISSEMINATION Ethics approval has been granted by the DVA and New South Wales Population and Health Service Research Ethics Committees. RESULTS Results will be reported in peer-reviewed publications, conference presentations and policy forums. The programme has high translational potential, providing invaluable evidence about cancer medicines in an elderly population who are under-represented in clinical trials.
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Affiliation(s)
- Sallie-Anne Pearson
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrea Schaffer
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Basger BJ, Chen TF, Moles RJ. Inappropriate medication use and prescribing indicators in elderly Australians: development of a prescribing indicators tool. Drugs Aging 2009; 25:777-93. [PMID: 18729548 DOI: 10.2165/00002512-200825090-00004] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Evidence-practice gaps, adverse medication-related incidents and unplanned medical admissions to hospital are common in elderly Australians. Many prescribing indicator tools designed to address some of these problems have been reported in the literature, the most common of which is the Beers list of inappropriate medications in the elderly. However, many of these tools are not appropriate for the Australian healthcare environment without modification and validation, and there appears to be a need for a tool based on Australian data. OBJECTIVE To develop a list of prescribing indicators for elderly (aged >65 years) Australians based on the most frequent medications prescribed to Australians, and the most frequent medical conditions for which elderly Australians consult medical practitioners. METHOD The most common reasons for elderly Australians to seek or receive healthcare were cross-referenced with the 50 highest-volume Pharmaceutical Benefits Scheme medications prescribed to Australians in 2006 to develop prescribing indicators in the elderly using Australian medication and medical condition information resources. RESULTS Forty-eight prescribing indicators were identified, consisting mainly of optimum as well as inappropriate medication choices for a large number of common medical conditions in the elderly. CONCLUSION A prescribing indicators tool was developed. This tool is envisaged as forming an important part of the medication review process, which is aimed at addressing the common problem of adverse medication-related events in elderly Australians.
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Affiliation(s)
- Benjamin J Basger
- Pharmacy Practice Department, The University of Sydney, Sydney, New South Wales, Australia.
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Pearson SA, Ringland C, Kelman C, Mant A, Lowinger J, Stark H, Nichol G, Day R, Henry D. Patterns of analgesic and anti-inflammatory medicine use by Australian veterans. Intern Med J 2007; 37:798-805. [DOI: 10.1111/j.1445-5994.2007.01516.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Woodward MC, Streeton CL, Guttmann A, Killer GT, Peck RW. Polypharmacy management among Australian veterans: improving prescribing through the Australian Department of Veterans' Affairs' prescriber feedback programme. Intern Med J 2007; 38:95-100. [PMID: 18005132 DOI: 10.1111/j.1445-5994.2007.01453.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Older patients are potentially at risk from the effects of polypharmacy (PP) and/or drug-drug interactions. AIMS To examine the effects of a targeted patient-specific prescriber feedback programme on patients prescribed more than 19 individual medications over the 3-month study period. METHODS The Commonwealth Department of Veterans' Affairs commissioned a review of Repatriation Pharmaceutical Benefit Scheme claims data to identify patients potentially at risk of drug injury through either PP (> or =20 unique medications during 3 months) or clinically significant drug interactions (DI). Dispensing information for the patient at risk, relevant clinical guidelines and a personalized covering letter were mailed to the main prescribing general practitioner of the identified veteran patient. The claims data were then re-analysed after the programme. RESULTS There was a significant reduction in the mean number of unique medications prescribed over a 3-month period 1 year after the prescriber feedback (mean change = -2.22; 95% confidence interval -3.54 to -0.90; P = 0.0013) for patients identified with ongoing PP. There was also a significant reduction in the number of DI pairs (mean change = -0.73; 95% confidence interval -0.77 to -0.69; P < 0.0001) for the patients identified with an ongoing DI. The number of patients dispensed one or more DI pairs decreased from 836 to 318 after the feedback. CONCLUSION A targeted prescriber feedback programme can influence general practitioner prescribing at an individual patient level and, therefore, contribute to the quality use of medicines.
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Affiliation(s)
- M C Woodward
- Aged and Residential Care, Heidelberg Repatriation Hospital, Melbourne, Victoria, Australia.
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Roughead EE, Anderson B, Gilbert AL. Potentially inappropriate prescribing among Australian veterans and war widows/widowers. Intern Med J 2007; 37:402-5. [PMID: 17535384 DOI: 10.1111/j.1445-5994.2007.01316.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examined the extent of potentially inappropriate medicine, as defined by explicit criteria, dispensed to Australian veterans using the Repatriation Pharmaceutical Benefits Scheme Pharmacy Claims database. Twenty-one per cent of the 192,363 veterans aged 70 years, with an eligible gold card, were dispensed at least one potentially inappropriate medicine in the first 6 months of 2005. Long-acting benzodiazepines, amitriptyline, amiodarone, oxybutynin and doxepin were the medicines most commonly implicated. Strategies to support quality prescribing of medicines to the elderly must include a focus on these medicines.
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Affiliation(s)
- E E Roughead
- Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
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Roughead EE, McDermott B, Gilbert AL. Antidepressants: prevalence of duplicate therapy and avoidable drug interactions in Australian veterans. Aust N Z J Psychiatry 2007; 41:366-70. [PMID: 17464724 DOI: 10.1080/00048670701213294] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study assessed the prevalence of duplicate antidepressant prescribing and avoidable potential antidepressant drug interactions in the Australian war veteran population. METHOD The Department of Veterans' Affairs Pharmacy Claims database was interrogated, using specific criteria, to identify antidepressant duplication. In addition, potential drug interactions where safer alternative therapies were available were assessed. These included anticholinergic agents with tricyclic antidepressants and tramadol with antidepressants. Episodic tramadol dispensings with antidepressants were also assessed. RESULTS A total of 46,859 veterans had antidepressants regularly dispensed to them in the period 1 April-31 July 2005. Overall, 4037 potential interactions were identified in 3818 veterans (8.1%) to whom were dispensed antidepressants regularly. Antidepressant and tramadol co-prescribing was the most common potential interaction identified among 3.6% of veterans. Two or more interactions were identified in 212 veterans (0.5%). Analysis of episodic tramadol dispensings with antidepressants suggested a much higher prevalence of 7.7%. CONCLUSION The increasing use of antidepressants and the high level of potentially avoidable interactions detected in the present study, highlight the necessity of ongoing vigilance concerning the use of potentially inappropriate drug combinations, particularly in the elderly.
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Affiliation(s)
- Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
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Sorensen L, King MA, Peck R, Roberts MS. In-Home Medication Reviews for War Veterans: Early Experience in Australia. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2004. [DOI: 10.1002/jppr2004342100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Alderman CP, Gilbert AL, Condon JT. Characteristics of tranquilizer use among Australian Vietnam War veterans. Ann Pharmacother 2000; 34:1243-8. [PMID: 11098335 DOI: 10.1345/aph.19418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine characteristics of tranquilizer use in a cohort of Australian Vietnam War veterans. DESIGN Prospective analysis of medication use and assessment of social and clinical variables, including tranquilizer dependence. PATIENTS Fifty-one Australian Vietnam War veterans were recruited from the department of psychiatry of an Australian teaching hospital. All subjects were men, with a mean +/- SD age of 52.2 +/- 3.3 years. MAIN OUTCOME MEASURES A structured interview was used to obtain details of medical and psychiatric history, medication use, substance use, forensic history, and health service utilization data. Anxiety was assessed using the Hamilton Anxiety Rating Scale (Ham-A). A validated tranquilizer dependence rating scale was administered for each patient. RESULTS Commonly used tranquilizers included diazepam (n = 19 patients) and zopiclone (26). Most patients (44) reported the use of one or more drugs for the purpose of nighttime sedation, while exclusive daytime use of tranquilizers for anxiolytic effect was uncommon. The median time spent in the hospital during the preceding year was 21.0 +/- 56.8 days. Symptoms of anxiety were prevalent, with a mean Ham-A score of 35.5 +/- 7.8. Screening criteria suggestive of tranquilizer dependence were met in 34 subjects. Health service utilization was correlated with tranquilizer intake and overall medication use. Tranquilizer dependence was independently associated with cigarette smoking (p = 0.039; odds ratio = 5.13, 95% CI 1.08 to 24.33). CONCLUSIONS This study provides insight into the nature of tranquilizer use in an Australian population of Vietnam War veterans. The extensive use of these drugs suggests that further research and possibly intervention in this area is needed.
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Affiliation(s)
- C P Alderman
- Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia.
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Pillans PI, Roberts MS. Overprescribing: have we made any progress? AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1999; 29:485-6. [PMID: 10868524 DOI: 10.1111/j.1445-5994.1999.tb00747.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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