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PubMed2005

What are the obstacles to generic substitution? An assessment of the behaviour of prescribers, patients and pharmacies during the first year of generic substitution in Sweden.

PURPOSE: The aim of the present study was to investigate obstacles to generic substitution and savings achieved during the first year after Sweden introduced generic substitution in October 2002. METHODS: Normal prescriptions encompassed by generic substitution were included. Data on dispensed prescriptions in the Vastra Gotaland region was obtained from the National Corporation of Swedish Pharmacies. The outcome variables were investigated in three categories of drugs represented by two indicator drugs each. RESULTS: In total, 501,400 dispensed prescriptions of six indicator drugs were analysed. The prescriber opposed substitution in 1-8% of the dispensed prescriptions, varying between the indicator drugs. Patients declined substitution more frequently when the average saving per substitution was low. Substitution occurred most frequently in indicator drugs where the average saving per substitution was high. The total possible saving was 26 million Swedish krona (Swedish krona 1=U.S. $0.13) for the indicator drugs. The actual saving achieved by substitution was on average 60% of the total possible savings and was largely dependent on the extent to which the pharmacies kept the cheapest brand in stock. CONCLUSIONS: Generic substitution has been implemented in practice although it did not reach full dividend during the first year. The potential savings from extended use of generic substitution are substantial.

Choice Behavior↗
PubMed2005

Communicating safety information to physicians: an examination of dear doctor letters.

PURPOSE: Recent research suggests that letters to healthcare providers may not effectively communicate safety-related information. This study examined whether content, organization, and formatting of dear doctor letters (DDLs) influences physicians' responses to the letters. METHODS: Drugs with warning label changes during 2000 and 2001 were identified, and corresponding DDLs were obtained. Letters were coded for content, organization, and formatting. Ten physicians rated letters on presentation, criticalness of the information, and likelihood of changing practice as a result of the letter. Areas of deficiency were identified. The relationships between key characteristics of the letters and physicians' ratings were examined using correlations; reliability of physicians' ratings was estimated using generalizability theory. RESULTS: For 2000 and 2001, 124 drugs were identified as having had changes to the warning section of the label; DDLs were sent in 32 (25.8%) instances. Letters varied in terms of the placement of key information, use of formatting, and length. Physicians' ratings suggested 25% of the letters were deficient in clarity, 28% in readability, 36% in the ratio of relevant information to supporting information, 36% in key information easily discernable, and 28% in overall effectiveness of communication. Letters with formatting highlighting key information were preferred. Letter length and placement of key information were not correlated with physicians' ratings. CONCLUSIONS: Many DDLs do not communicate labeling changes clearly and effectively. If DDLs are used to communicate safety information to physicians, special formatting and explicit wording should be used to emphasize new information.

Correspondence as Topic↗
PubMed2006

Perception of potentially inappropriate medication in elderly patients by Slovak physicians.

PURPOSE: The aim of the present study was to determine the risk perception of potentially inappropriate drug treatment of elderly patients by Slovak physicians. In Slovakia, a list of such drugs is not available. METHODS: The study sample consisted of 600 patients aged > or =65 years hospitalized at the Department of Internal Medicine in a Slovak general hospital between 1 December 2003 and 31 March 2005. The use of potentially inappropriate drugs at the time of hospital admission and discharge was compared. Potentially inappropriate drug use was defined by Beers 2003 criteria. In addition, 206 physicians were asked to mark the drugs that they considered potentially inappropriate for elderly patients out of a list provided in a questionnaire analysis. RESULTS: Out of 600 patients 20.2% and 20% were treated with at least one potentially inappropriate drug at the time of hospital admission and discharge, respectively. Hospitalization had no significant influence on the number of potentially inappropriate medicines used. The most frequently prescribed potentially inappropriate drugs were digoxin >0.125 mg/day and ticlopidine. Out of 206 responding physicians only 4.9% considered ticlopidine as potentially inappropriate for elderly patient. On the other hand, more than 20% of respondents were aware of the potential inappropriateness of amitriptyline, diazepam and chlordiazepoxide. Mentioned drugs were observed in less than 2% of study population (n = 600). CONCLUSIONS: The results of the questionnaire analysis in physicians as well as the prevalence of potentially inappropriate medication demonstrate that Slovak clinicians are aware of the risk of certain treatments in elderly patients.

Aged↗
PubMed2001

The development of a decisional balance measure of physician smoking cessation interventions.

BACKGROUND: Decreasing the prevalence of smoking is an important health care goal, and there is evidence that physicians' advice to quit is an important motivator for patients. However, fewer than half of smokers report that they have ever been advised to quit. This study was conducted to develop a decisional balance measure for physician delivery of smoking cessation interventions. METHODS: This study included a convenience sample of 155 primary care physicians. A decisional balance measure was developed using item generation and development, pilot testing, and principal components analyses. Validity was established by relating the decisional balance measure to a previously validated item of counseling behavior and to physician stage of readiness to deliver smoking cessation counseling. RESULTS: Based on principal components analyses and item analyses, the final measure consisted of 10 Pro and 10 Con items with coefficient alpha of 0.83 and 0.86. The Pros and Cons scales were significantly associated with self-reported counseling to patients who smoke and to stage of readiness to deliver smoking cessation counseling. CONCLUSIONS: A decisional balance measure of physician smoking cessation interventions can be used to assist investigators in developing effective interventions to enhance the delivery of smoking cessation interventions in primary care settings.

Adult↗
PubMed1996

Physicians' perspective on quality of life: an exploratory study of oncologists.

There is an implicit assumption that physicians incorporate quality of life (QOL) information in clinical decision-making. However, very limited data exists on how physicians view QOL information and how they actually use it. To explore this issue, an in-depth study was conducted using a semi-structured interview guide, with 60 oncologists in Canada and the USA. While the majority of respondents perceived QOL as important they reported a tendency to use it informally and not in all situations. Key findings include the belief expressed by 88% of respondents that the term QOL could be defined, although they differed in their definitions. Although 85% stated that QOL can be formally measured, only a third perceived that the current instruments provide valid and reliable data. Respondents noted a number of significant benefits and drawbacks of using QOL data in their clinical practice that had not been previously noted in the literature. For example, its use as an endpoint in clinical trials was generally perceived to enhance both physician and patient participation. A drawback noted was that including QOL might adversely affect the decision-making process. These findings have been used to develop a self-administered questionnaire (MD-QOL) which will test the generalizability of these findings.

Adult↗
PubMed1990

AIDS education practices among Massachusetts physicians.

Physicians have a major role to play in the prevention of AIDS transmission. Promotion of health behaviors needs to be expanded beyond the traditional AIDS high risk populations; however, little information is available on the AIDS education practices of physicians. A survey of Massachusetts physicians in four specialty groups, Family Medicine Practitioners, Internists, Obstetricians/Gynecologists and Pediatricians, was conducted to determine the extent of their AIDS education practices. Three hundred and ninety one physicians returned the questionnaire for an overall response rate of 66%. Sixty three percent (63%) of the physicians surveyed educate patients they believe to be at least at moderate risk for AIDS transmission or exposure. However, neither physicians screening for patients' AIDS risk status nor the content of the AIDS education was uniform. Also, very few physicians have received specific training in AIDS education. A number of practice, patient, and physician characteristics were found to be related to educational practices. This study suggests that a more comprehensive screening of patients' participation in AIDS risk behaviors be conducted as part of medical history taking, and that more comprehensive education be provided to those patients determined to be at least at moderate risk for AIDS transmission or exposure.

Acquired Immunodeficiency Syndrome↗
PubMed1990

European attitudes towards ethical problems in intensive care medicine: results of an ethical questionnaire.

A questionnaire was sent to the 590 members of the European Society of Intensive Care Medicine to define both the current practices and the opinions of these specialists on various ethical issues. The answers from 242 (41%) European members were collected and analysed. The first part of the questionnaire was designed to define the criteria for admission to Intensive Care throughout Europe. Admissions to the ICU were generally or commonly limited by the number of available beds according to 57% of the respondents and sometimes or almost never according to 41% (100/242). Bed availability in the ICU was especially limited in Spain, Portugal, Italy and the United Kingdom. Despite limited bed availability, two thirds of the respondents did admit patients who were thought to have little or no hope of survival other than for a few weeks. When asked about what ought to be done in these circumstances, the number of respondents who supported the admission of such terminal patients to ICU was halved. These data illustrate the heterogeneity of admission practices in Europe and stress the need for all ICUs to define a policy for admission. The second part was designed to assess the information given to patients in the ICU. Only 24 (10%) of the respondents stated that they always delivered complete information to their patients and only 31 (13%) thought they should do so. When an iatrogenic incident occurred, only 39 (16%) claimed to relate exactly what had happened, to the patient or their relatives but 121 (50%) thought they should. Informed consent was usually required for surgery or gastroscopy and the administration of a new medication.

Adult↗
PubMedDate not supplied

Choosing between apples and apples: physicians' choices of prescription drugs that have similar side effects and efficacies.

OBJECTIVE: To examine physician choices of commonly used medications having similar side effects and efficacies, and to evaluate factors that may affect these choices. DESIGN/SETTING: Cross-sectional survey conducted in winter 1989-1990. PARTICIPANTS: 263 physicians at a university teaching hospital (response rate = 71%). MEASUREMENTS AND MAIN RESULTS: Physicians rated patient compliance, cost to patient, and patient preference as the three most influential factors in their selection of a particular agent from a class of similar drugs. Housestaff were less likely than faculty to consider cost to patient as a "very important" factor (33% vs. 60%; p less than 0.05), and only 11% of all physicians felt that cost to third-party payer was very important. Physicians reported that their choices of particular nonsteroidal anti-inflammatory drugs (NSAIDs), histamine-2 (H2) blockers, and inhaled beta-agonists were mainly determined by which drugs enhanced compliance or were used by others (the "traditional choice"); cost to patient was a less important influence in these instances. All physician subgroups were inaccurate in predicting the approximate prices of their first- and second-choice agents. For example, only 28% of those selecting naproxen as their preferred NSAID were within $10 of the range of the prices of a one-month supply, and 14% were within $10 for cimetidine. CONCLUSION: Although this group of physicians reported considering drug costs to be important when choosing between similar drugs, they acknowledged that cost was relatively unimportant in several specific instances studied and their knowledge of the absolute and relative prices of drugs they commonly prescribed was deficient.

Adrenergic beta-Agonists↗
PubMed2004

Comparison of rational pharmacotherapy decision-making competence of general practitioners with intern doctors.

OBJECTIVE: The aim of this study was to compare rational pharmacotherapy decision-making competency of interns (final-year medical students) who had received rational pharmacotherapy education (RPE), with their classmates at another medical school and general practitioners (GPs) who had not been exposed to RPE. DESIGN: A written, objective, structured clinical examination (OSCE), consisting of open and structured questions, was given to all participants. The participants were expected to make a treatment plan and prescribe for simple, uncomplicated beta-hemolytic streptococcal tonsillitis and mild-to-moderate essential hypertension patients, explain their proposed treatment plans and reasons affecting their drug choice. After the OSCE, a questionnaire to assess knowledge of the rational use of drugs was given to the participants. RESULTS: Fifty RPE(+) interns, 54 RPE(-) interns and 53 GPs participated in the study. Mean scores of RPE(+) interns were higher than those of GPs, which were in turn found to be higher than those of RPE(-) interns for all cases. The RPE(+) interns scored the highest regarding all components of rational pharmacotherapy process for all cases of both indications. However, participants in all groups had higher scores for the structured questions compared with the corresponding open ones for both diseases. Prescription analysis also revealed better results for RPE(+) interns regarding the number of drugs/prescription and treatment costs. CONCLUSION: The present study demonstrated that the final-year medical students (interns) markedly benefited from undergraduate RPE at the medical school in developing rational prescribing skills compared with their classmates from a medical school with traditional pharmacology education. Interestingly, they got higher scores than not only RPE(-) interns, but also than the GPs participating in this study, indicating the urgent need for continuous medical education programs in this field throughout the country for practicing GPs.

Decision Making↗
PubMed2006

A small economic inducement to stimulate increased reporting of adverse drug reactions--a way of dealing with an old problem?

PURPOSE: To assess the effect of a small economic inducement on the rate of spontaneous reporting of adverse drug reactions (ADRs) and the attitudes of general practitioners and physicians towards reporting of ADRs. METHOD: One intervention and one control county were selected for the study. Written information about the main purpose of spontaneous reporting of ADRs was personally addressed to all physicians in the two counties. The information was identical, except for the addition that during a period of 6 months two lottery tickets would be given to the receivers in the intervention area with the standard personal feedback to the reporter of the ADR. After the 6-month study period, the actual number of reported ADRs and the seriousness of the reported ADRs were assessed. To investigate the attitude towards this stimulation of reporting, a questionnaire was addressed to all physicians within the intervention area (IA). RESULTS: From the IA a total number of 57 ADR reports were received containing 62 suspected ADRs, 40% of which were assessed as serious reactions. From the control area (CA), 49 reports containing 50 suspected ADRs were received, 32% of which were assessed as serious reactions. The increase of ADR reports from the IA compared to the same time period the previous year was 59% as compared to an unchanged reporting from the CA. Of those responding to the questionnaire, 80% did not believe that a small economic bonus would be a useful tool to improve the reporting rate. CONCLUSION: A small economic inducement is associated with an increase in the reporting of suspected ADRs.

Adverse Drug Reaction Reporting Systems↗
PubMed2005

Physician, organisational and patient characteristics explaining the use of angiotensin converting enzyme inhibitors in heart failure treatment: a multilevel study.

OBJECTIVE: Heart failure treatment in general practice is not concordant with guideline recommendations. Insight into the key determinants at different levels is needed in order to improve care. The aim was to assess the influence of physician, organisational and patient characteristics on the treatment of chronic heart failure with angiotensin converting enzyme (ACE) inhibitors in primary care. METHODS: Physician and organisational data were collected by means of a questionnaire. Patient and treatment data were extracted from electronic medical records. Multilevel analysis was used to assess the effect of physician, organisational and patient factors on the treatment with ACE inhibitors in terms of prescription rate and dosage. RESULTS: Data from 735 randomly selected heart failure patients were extracted from the medical records of 95 general practitioners (GPs). Patients who visited a cardiologist or an outpatient heart failure clinic were more likely to receive an ACE inhibitor. In addition, relatively young patients, male patients and patients already using a diuretic were more likely to receive an ACE inhibitor. Furthermore, male patients and patients with concomitant hypertension were more likely to receive a higher dose of ACE inhibitor. GP characteristics did not determine whether CHF patients received ACE inhibitor treatment. CONCLUSION: The differences in ACE inhibitor prescribing seem to be linked more to patient than physician characteristics. Interventions to improve the quality of care should therefore focus on the treatment of specific patient groups. Specialised care, particularly through outpatient clinics, could lead to improvement in the use of ACE inhibitors.

Age Factors↗
PubMed1997

How Estonian and Finnish primary care doctors rate their need for common drugs.

OBJECTIVE: To compare ratings of the necessity of drugs in the daily practice of experienced primary care doctors in Estonia and Finland to find out the differences and similarities in the therapeutic traditions of the two different societies. METHODS: A questionnaire was sent to all Estonian district doctors born in the 1940s and to all Finnish specialized general practitioners born in the 1940s, who then evaluated the necessity of the listed drugs on a visual analogue scale. The ratings, from 0 to 100, were entered into a computer, using a graphic tablet and a pressure sensitive pointer. RESULTS: The six most highly-evaluated drugs among the Estonian respondents were digoxin, glyceryl trinitrate, aspirin, calcium-channel blockers, beta-adrenoceptor blockers and frusemide; and among the Finnish general practitioners (GPs) were penicillin, insulin, glyceryl trinitrate, beta-adrenoceptor blockers, frusemide and angiotensin-converting enzyme (ACE) inhibitors. The ratings of 15 out of 33 drugs/drug groups were very similar both in Estonia and Finland. The biggest differences between the opinions of the Estonian and Finnish doctors appeared in the ratings regarding the necessity of antacids, cimetidine, insulin, sulphonylureas, reserpine. ACE inhibitors, oral contraceptives, penicillin, metronidazole, trimethoprim, indomethacin, phenobarbital and theophylline. CONCLUSION: The revealed differences are suggested to be related to the different health care systems (different task profiles of doctors, different pharmaceutical services), different education of doctors, different availability of drugs in the past and different prices, all of which influence therapeutic traditions.

Estonia↗
PubMed2006

Different attitudes of oncology clinicians toward truth telling of different stages of cancer.

OBJECTIVES: To investigate different attitudes of oncology clinicians toward whether and how to disclose diagnosis to patients with different stages of cancer. MATERIALS AND METHODS: A questionnaire investigating physician's demographic information and attitude toward truth telling was delivered to 256 Chinese oncology clinicians. RESULTS: Two hundred thirty-two (90.6%) physicians completed the questionnaire. Of these oncology clinicians, 87.5% reported that a patient with early-stage cancer should be informed of the diagnosis, while only 40.5% believed that a patient with terminal illness should know the truth (P<0.001). Physicians who preferred to tell the truth reported that patients with early or terminal stage of cancer should be informed by the doctor-in-charge (81.3 vs 77.7%, respectively; P>0.05), immediately after the diagnosis (83.7 vs 87.2%, respectively), and in a quiet and undisturbed room (63.5 vs 68.1%, respectively; P>0.05). In stepwise multiple logistic regression analyses, no demographic information showed association with truth telling of early-stage cancer. Women doctors [odds ratio (OR), 2.25; 95% CI, 1.31 to 3.89; P=0.004] were more likely than men to want the patient to be informed of the terminal illness. Physicians with cancer relatives (OR, 0.55; 95% CI, 0.31 to 0.97; P=0.04) were less likely than physicians without cancer relatives to want the patient to be informed of the terminal illness. CONCLUSION: Oncology clinicians differed in their attitudes toward truth telling of different stages of cancer. Physicians reported that the doctor-in-charge should be the ones to disclose the condition of the patient, immediately after the diagnosis, and in a quiet and undisturbed room.

Adult↗
PubMed2005

Physician contributions to disparities in HIV/AIDS care: the role of provider perceptions regarding adherence.

Racial/ethnic minorities in the United States are disproportionately affected by HIV/AIDS. In addition to having higher rates of HIV/AIDS, minorities with HIV/AIDS have higher mortality rates than others in the United States. Disparities in the care received by minorities living with HIV/AIDS contribute to these higher mortality rates. This article provides a review of HIV/AIDS health care disparities and explores providers' contributions to these disparities. An important source of provider contribution to disparities appears to be differential prescribing based on perceptions and assumptions that minority patients may have lower adherence to highly active antiretroviral therapy. Literature regarding this topic is reviewed and strategies for reducing disparities are suggested.

Antiretroviral Therapy, Highly Active↗