Category Archives: Drug use

Drug use evaluation: DISCUSSION(5)

More recently, Davis and Taylor-Vaisey proposed that to be successfully implemented, any guideline must include strategies to facilitate its adoption. The nature of the guideline, the nature and beliefs of the physicians to whom it is directed, and environmental factors should all be considered to translate effectively clinical guidelines into practice. There appears to be two important steps: the effective dissemination of the information and the effective implementation strategies that reinforce changes in the practice setting. Although several interventions appear to be effective, strategies such as concurrent reminders or academic detailing have yielded the most consistently positive results.

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Drug use evaluation: DISCUSSION(4)

Drug use evaluation: DISCUSSION(4)

Efforts should be made to reduce antibiotic prescribing for this condition. Stewart and colleagues recently reported a reduction in antibiotic prescribing (—9.4%) in an Ontario community after an educational strategy was developed. The two main messages from this intervention program were not to use antibiotic for viral respiratory infections and to use drugs recommended in the Anti-infective Guidelines for Community-acquired Infections. Physicians, pharmacists and the public were targeted by this program. These authors also reported that physicians were 29% less likely to prescribe second line antibiotics after the intervention program. buy ortho tri-cyclen

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Drug use evaluation: DISCUSSION(3)

In addition, although this DUE was not designed to assess the appropriateness of using first line versus second line therapy, it was noted that a relatively high proportion of prescriptions were for second line agents, ie, 24% using the Ontario guidelines and 6% using the Sanford’s Guide. The lower percentage of deviation noted when using the Sanford Guide may be explained by the fact that resistance rates are generally higher in the United States, therefore leading to broad spectrum antibiotics being more frequently recommended. Nonetheless, this trend toward using broader spectrum and more expensive antimicrobial drugs, which generally constitute second line agents in guidelines, was reported by McCaig and Hughes . These authors were warning clinicians about the potential impact of such a trend because it may increase health care costs and lead to the development of antimicrobial resistance. This trend was also recently observed in Canada where the use of scheduled, second line antibiotics on the Manitoba provincial formulary increased between 1995 and 1998 . There is a paucity of published literature on outpatient DUE. One such study, evaluating the use of oral ciprofloxacin in community practice reported a noncompliance rate of 43.8% . Our results compare favourably.

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Drug use evaluation: DISCUSSION(2)

Drug use evaluation: DISCUSSION(2)

The results of this evaluation indicate that compliance of military prescribers with treatment guidelines for infectious conditions commonly encountered in the community is quite acceptable with a compliance rate of 86%. However, because our definition of compliance also included partial compliance, which involves using a dose or duration of treatment different from the guideline recommendations, full compliance would be expected to be somewhat lower. We did not make that determination, however, because based on the reasons identified for partial compliance, it was difficult to conclude that these prescriptions would necessarily result in treatment failure. ventolin inhaler

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Drug use evaluation: DISCUSSION(1)

It has been reported that appropriateness of antibacterial use in the community, as opposed to the hospital setting, has not been well studied . Also, DUE in the outpatient environment is not as well established as in the inpatient setting . From that perspective, data from this DUE would be expected to provide useful information in a field for which such data are missing. It should however be noted that the results apply to the military setting, which only partially reflects the general population because both pediatric and geriatric patients are de facto excluded from the sample. Accordingly, data reported in this DUE may be difficult to compare. ventolin inhalers

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Drug use evaluation: RESULTS(3)

Drug use evaluation: RESULTS(3)

Table 7 presents the five indications that were most commonly involved in partial compliance: bronchitis, CAP, pharyngitis, urinary tract infections (UTIs) and sinusitis. Again, we used the criteria of 5% to make that determination. Based on the percentage of deviant prescriptions, UTIs (71%) and pharyngitis (59%) were particularly involved in partial compliance. In the case of pharyngitis, two-thirds of the problems originated from the dose prescribed. It should be specified that the majority of these cases may be explained by the fact that a dose of 300 mg three times daily of oral penicillin is recommended in the Ontario guidelines and that a dose of 300 mg orally, four times daily was prescribed.

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Drug use evaluation: RESULTS(2)

The rates of compliance with the guidelines were similar between physician assistants and general practitioners, 86.2% and 85.3%, respectively. All the prescriptions written by specialists complied with the guidelines. It should be noted, however, that there were only five such prescriptions (Table 4). buy levaquin online

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Drug use evaluation: RESULTS(1)

Drug use evaluation: RESULTS(1)

A total of 704 data collection forms were received. Of these, 246 had to be rejected. Reasons for rejection included no information on diagnosis (59.8%), information on diagnosis unclear (29.3%), no recommendation available in both references for the indication being treated (8.9%), and other data missing such as name of the drug, dose, etc (2%). (Table 1). A total of 458 data collection forms qualified for data analysis. From these, 477 prescriptions were analyzed. Quite a wide range of conditions were treated (ie, dermatological, sexually transmitted, urogenital, enteric and respiratory infections) (Table 2). buy ampicillin

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Drug use evaluation: METHODS(3)

Noncompliance was defined as not meeting the treatment recommendations from either of the two guidelines. Compliance was defined as meeting in total or in part the recommendations from at least one of the guidelines. This relatively broad definition was used to account for the possibility of the prescriber using a different reference than the ones selected for the DUE. It was also recognized that there may be a number of factors preventing full compliance. For example, the use of a second line drug may be motivated by the patient having an adverse drug reaction to one of the first line agents. For this reason, the degree of recommanda-tion was not directly considered in the definition of compliance.

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Drug use evaluation: METHODS(2)

Drug use evaluation: METHODS(2)

The assessment of prescription appropriateness was performed by comparing the antibiotic selected by the military prescriber with the treatment recommendations for that indication from two sets of published guidelines. The two guidelines used were the Anti-infective Guidelines for Community-acquired Infections published by the Ontario Anti-infective Review Panel in 1997 and the treatment recommendations from the latest edition of Sanford’s Guide to Antimicrobial Therapy (Sanford’s Guide). Military prescribers had access to these guidelines, although they were not specifically trained to use them.

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