Psychotropic drug use was evaluated in 2022 ambulatory elderly subjects in 1978-80 and again in 1984-86. Use of hypnotic drugs declined from 8.5 percent (n = 3234) in 1978-80 to 6.3 percent (n = 2681) in 1984-86 (p less than 0.01). Use of the long-acting hypnotic flurazepam decreased (p less than 0.01) and use of two short-acting drugs, triazolam and temazepam, increased. Prescribing of long half-life benzodiazepines, such as diazepam (p less than 0.01) and chlordiazepoxide, clorazepate, halazepam, and prazepam as a group (p less than 0.01) decreased as well as the use of nearly all products containing barbiturates (p less than 0.01).

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Metoclopramide: an analysis of inappropriate long-term use in the elderly.

OBJECTIVE: To present a case of possible metoclopramide-induced tardive dyskinesia and document the frequent use of metoclopramide for inappropriate lengths of treatment in elderly, ambulatory subjects. DESIGN: Descriptive study that identified long-term users of metoclopramide among a population of 4515 elderly subjects. SETTING: Participants in an ambulatory health-screening program in Florida (Florida Geriatric Research Program). PARTICIPANTS: Individuals (2898 women and 1617 men) over the age of 65 years who volunteered for annual health screening. INTERVENTIONS: All medication histories for participants were reviewed to identify subjects who reported metoclopramide use on at least one visit to the program. RESULTS: Thirty-four participants (0.75 percent) reported the use of metoclopramide during at least one visit. Eleven subjects (32.4 percent) reported that they had used this drug for longer than one year. Nine of the 34 subjects (26.5 percent) also reported the use of metoclopramide at their next annual visit. CONCLUSIONS: Results from this study suggest that metoclopramide is frequently prescribed inappropriately to treat gastrointestinal disorders. Long-term use of this drug exposes patients to an unnecessary risk of adverse drug reactions.

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Provider satisfaction: an analysis based on expectation.

Provider organizations will need to be in closer touch with their medical staffs in order to successfully anticipate and react to the many changes that lie ahead in the financing and delivery of health care services. This will mean understanding both physicians feelings and expectations. If you were asked today how satisfied your physicians are with your HMO, what would be your reply? How would you know? This staff-model HMO conducted a formal survey of its physicians to determine their expectations of the organization and their level of satisfaction with their work and environment. Such a tool is recommended for others interested in maintaining good relations with their physicians.

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[Non-surgical treatment of intracranial meningiomas].

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