SEARCH · PubMed Health

Results for “inappropriate prescribing”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources

PubMed1979

Relationship of inappropriate drug prescribing to increased length of hospital stay.

The relationship of inappropriate drug prescribing to increased length of hospital stay was studied. The medical records of 77 cases of pyelonephritis were reviewed retrospectively. Appropriateness of antimicrobial drug therapy was judged by three types of explicit screening criteria: drug-specific, patient-specific, and match of drug to infecting organism. Patients whose therapy passed all the criteria were hospitalized, on the average, two days less than those whose therapy failed one or more of the criteria. This was a significant difference (p less than 0.05). Age, seriousness of the pyelonephritis, or method of payment appeared to have no significant moderating effect on this result. However, the increased length of stay may not have been associated with only inappropriate prescribing, because the inappropriately prescribing physicians kept their patients hospitalized longer beyond the point of symptom remission than did the appropriately prescribing physicians. The study suggest that successful interventions for improving drug therapy could result in large cost savings.

Anti-Bacterial Agents↗

PubMed1979

Appropriateness of drugs prescribed by primary care physicians for depressed outpatients.

In a sample of middle class individuals seeking martial and sexual counseling, 30% had diagnosable psychiatric illness, including 14% who had depressions at the time of interview. Those with psychiatric syndromes were significantly more likely to have prescribed psychoactive than those without these syndromes. Those with depression were more likely to have received diazepam and similar drugs than antidepressants. The same was true for those with other syndromes but in many of these cases, diazepam or other antianxiety agents seemed more appropriate. Thus, affective disorder might well be the psychiatric syndrome for which these drugs are most often inappropriately prescribed. Inappropriate treatment is a matter of concern in an illness which is potentially fatal.

Adult↗

PubMed1979

Strategy for increasing the demand for clinical pharmacists.

A strategy for increasing the demand for clinical pharmaceutical services in hospitals is described. The strategy consists of three steps: (1) Show that the overall quality of drug prescribing affects patient outcomes not only in a negative way but also in a positive manner; i.e., appropriate prescribing speeds recovery and minimizes the need for more expensive types of care; (2) show that the pharmacist can detect poor quality prescribing; and (3) show that after detecting poor quality prescribing, the clinical pharmacist can effectively intervene in the prescribing process to reduce inappropriate prescribing and improve patient outcomes.

Drug Prescriptions↗

PubMed1979

Self-audit of prescribing habits and clinical care in general practice.

General practitioners' prescribing habits were studied using encounter forms during a period of three years. Analysis of the first year's forms revealed examples of inappropriate prescribing, so an audit was undertaken on the treatment of fungal skin infections and coughs and colds in children. Data collection was continued for a further year to measure any changes in prescribing. Analysis after audit showed that more appropriate prescribing had reduced the number of drugs prescribed as well as the number of repeat consultations needed before resolution of the problem. These findings suggest that the continuous use of encounter forms can accurately reveal the prescribing habits of general practitioners. Self-audit can then be performed on a continuing basis with little disruption of the general practitioner's normal routine.

Adolescent↗

PubMed1978

Savings achieved through cephalosporin surveillance.

The process by which a 427-bed, acute-care teaching hospital reduced the cost of cephalosporin therapy is described. During a nine-month surveillance period, cefazolin prescribing patterns were monitored. Of the 674 patients who received cefazolin, 640 (92%) received dosages greater than those recommended in the literature. Attempts were made to alter inappropriate prescribing through pharmacist-physician consultation and through contact with the medical service representative of the company which supplied cefazolin. Because these efforts failed, the pharmacy and therapeutics committee decided to delete cefazolin from the formulary. Cephalothin and cephapirin were found to be clinically similar; therefore, the committee recommended that the less expensive cephapirin be dispensed whenever a parenteral cephalosporin was ordered. Prior to the switch to cephapirin, cefazolin accounted for 49% of all parenteral cephalosporin use and 62% of the cephalosporin cost. Cephalothin and cefazolin were 30% and 88%, respectively, more expensive than cephapirin. In the first year after the switch, the hospital saved $33,196 (28.8% of the previous year's total expenditures for cephalosporins).

Cephalosporins↗

PubMed2026

Medication safety in older adults in India: an integrative PhD synthesis of direct evidence and contextual implementation evidence.

BACKGROUND: Unsafe medication practices among older adults are an important global health concern, particularly in low- and middle-income countries where multimorbidity, fragmented care, self-medication, and informal healthcare provision intersect. OBJECTIVE(S): To synthesize direct evidence on medication safety among older adults in India and contextual evidence on deprescribing and community-level provider interventions relevant to safer medication use. METHODS: This PhD synthesis integrates four studies: a record-based cross-sectional study on polypharmacy and cardiovascular autonomic function in Kolkata; a six-city community study of 600 Indian older adults; a systematic review and meta-analysis on deprescribing preventive medications in frail or end-of-life older adults; and a systematic review of informal healthcare provider interventions in low- and middle-income countries. Studies I-II provided direct Indian older-adult evidence, while Studies III-IV provided indirect contextual evidence for their optimization and implementation. RESULTS: Polypharmacy was associated with higher anticholinergic burden and numerically higher cardiac autonomic neuropathy although residual confounding limits causal interpretation. In the multicity study, one-third had polypharmacy, while potentially inappropriate medications, prescribing omissions, and self-medication were common. Risks were higher with multimorbidity, recent hospitalization, care transitions, or living alone. Deprescribing showed no statistically significant increase in mortality, hospitalization, or major cardiovascular events, but heterogeneity was high and certainty low to very low. Informal-provider interventions showed the potential to improve knowledge, referral, case management, and medication-related practices. CONCLUSIONS: Medication safety among older adults in India requires an integrated continuum approach, but direct evidence supports only some components and implementation strategies that need prospective evaluation.

Humans↗

PubMed1979

Evaluation of albumin use by medical audit.

The appropriateness of albumin prescribing and accuracy of records of albumin use were studied at a 476-bed hospital. Medical records of 15 adults who had undergone surgery within one week of albumin administration were compared with eight prescribing and charting criteria that were developed by pharmacists. Charts of patients who did not meet every criteria were reviewed by a committee to determine if exceptions to the criteria were justifiable. Albumin prescribing was empirical for approximately 60% of the patients. Albumin use as judged by laboratory values was inappropriate in three patients. Charting of the amount and rate of albumin administered was inaccurate, incomplete or difficult to interpret for eight (53%) of the patients. The dosage of albumin prescribed was inappropriate for two (13%) patients. Appropriate concomitant therapy (e.g., packed red blood cells) was not prescribed for two patients. For only three patients did the patient's charge correspond to the amount charted as being administered. On an annual basis, patient charges for albumin were projected to be $9,321 less than the hospital's cost for the product. The audit identified problems in albumin prescribing and charting that, when corrected, would result in cost savings and improved patient care.

Adolescent↗

PubMed1978

Surveillance of antibiotic prescribing in office practice.

Using fiscal and administrative data routinely collected by the Tennessee Medicaid program, we conducted epidemiologic analyses of physicians' prescribing of selected antibiotics in office practice. This research has defined several subgroups of physicians who regularly malprescribed chloramphenicol or tetracyclines (to children less than 8 years old). After special educational mailings to all physicians, prescribing of these antimicrobial drugs diminished. Similar analyses could enable the profession to design specific remedial educational interventions, target them at physicians needing contemporary information, and assess their impact by monitoring subsequent prescribing. Such a program might diminish inappropriate drug use, reduce adverse drug reactions, help contain medical care costs, and produce better educated physicians.

Ambulatory Care↗

PubMed1977

Medication procedures in a nursing home: abuse of PRN orders.

Nursing home patients often receive more drugs than needed. Drug incompatibilities frequently are found, and PRN orders are apt to be overused. Regulatory agencies require periodic physician review in the hope of eliminating these loose prescribing habits. A study was made of the drugs prescribed for 98 patients in a proprietary nursing home. The principal findings were that PRN orders can indeed be inappropriate and indiscriminately followed, and that the multiplicity of drugs often prescribed can lead to drug incompatibilities and to additional illness of the patient. Concern is expressed about the medication review process currently in vogue in nursing homes.

Aged↗

PubMed2026

Study of prescription-indication of antivirals for herpesviruses in a Colombian population: a cross-sectional study.

BACKGROUND: To describe the utilization patterns and therapeutic indications of antivirals used for herpesvirus infections in Colombian patients. RESEARCH DESIGN/METHODS: A cross-sectional study on the use of antivirals for treating outpatients with herpesviruses between November 2023 and January 2024 in a Colombian population database. The Micromedex® database was used to identify Food and Drug Administration (FDA)-approved indications, off-label uses, and potentially inappropriate indications. RESULTS: A total of 14,816 individuals were included (median age:53.0 years [IQR:35.0-65.0]; 60.5% women). Acyclovir was the most frequently prescribed antiviral (oral:77.3%; topical:43.4%). Overall, 56.1% received oral therapy only, 25.2% combined oral and topical therapy, and 18.7% topical therapy only. FDA-approved indications accounted for 29.1% of use (herpes zoster), off-label use for 26.9% (mainly prophylaxis in immunocompromised patients), and potentially inappropriate use for 25.3% (primarily topical treatment of herpes zoster). Acyclovir use (OR:5.93; 95%CI:4.60-7.64) and specialist care (OR:2.17; 95%CI:1.73-2.71) were associated with off-label use. CONCLUSIONS: Antiviral prescribing for herpesvirus infections in a group of patients in Colombia is largely driven by acyclovir, with a substantial proportion of off-label and potentially inappropriate use, particularly involving topical therapies for herpes zoster. These findings highlight significant gaps in adherence to evidence-based recommendations and underscore the need for targeted interventions to optimize prescribing practices.

Humans↗

PubMed1979

Appropriateness of vitamin and mineral prescription orders for residents of health related facilities.

A study was made of the medical charts of 433 elderly patients admitted to four Health Related Facilities in upper New York State, to determine whether the respective prescription orders for vitamins and minerals were appropriate to the given diagnoses and, if not, identify the variables correlated with inappropriateness. For 11.1 percent of the patients, vitamins or minerals were prescribed when there was no specific diagnostic indication, or they were not prescribed when the medical diagnosis indicated that they should have been. Women and medicaid patients were more likely than men and self-paying patients to be treated inappropriately with respect to vitamins and minerals, but the differences were not satistically significant.

Aged↗

PubMed1977

[Some thoughts on the adaptation of technical aids for children with cerebral palsy (author's transl)].

The technical aids used by children undergoing inpatient treatment at a centre for the cerebral palsied were critically assessed over a one-year period. Of the evaluated technical aids 50% were optimal for the child under consideration, the remainder was inappropriate for one or more reasons. The most frequent amongst the non-optimal were either not medically prescribed or adequately adapted and tested. The children in question are hence threatened with unnecessary deformations, an insufficient utilisation of their development potential and a lower degree of independence. Also, the financially responsible agencies have to cope with considerably larger expenditures.

Adolescent↗

PubMed2026

Deimplementation of inappropriate feeding practices in early care and education: a Hybrid Type 3 cluster-randomized trial.

BACKGROUND: The science of deimplementation-reducing harmful or ineffective practices-has focused almost exclusively on clinical prescribing, with no studies conducted in community or educational settings. Early care and education (ECE) settings offer a strategic venue for shaping eating behaviors, with children consuming up to 500 meals annually in these environments. However, ECE educators routinely use feeding practices that undermine self-regulation, including pressuring children to eat, rushing mealtimes, and offering food as reward. These practices contribute to food aversions, diminished self-regulation, and obesity risk. METHODS: We will conduct a Hybrid Type 3 cluster-randomized trial evaluating a co-designed deimplementation strategy package (WISE Words) across 88 ECE sites in Arkansas and Louisiana. Sites will be randomized 1:1 to WISE Words or usual practice, with usual practice sites receiving the intervention after two years (waitlist design). WISE Words includes six strategies: dynamic training using improvisation methods, peer learning collaboratives with goal setting, external facilitation, audit and feedback, environmental reminders, and tailored educational materials. The primary outcome is de-adoption of inappropriate feeding practices measured via direct mealtime observation (Table Talk). Secondary outcomes include adoption of evidence-based practices, acceptability, appropriateness, and sustainability at 12- and 24-months post-intervention. Child outcomes include Body Mass Index, skin carotenoid levels (Veggie Meter) willingness to try new foods (observed) and food neophobia (teacher and caregiver report). An explanatory sequential mixed methods design will test mechanisms of change derived from the Implementation Trust Building Theory of Change examining whether trust mediates strategy effects on outcomes. DISCUSSION: This trial extends deimplementation science into community settings by targeting culturally embedded behavioral practices rather than clinical prescribing behaviors. Results will inform approaches to shifting entrenched practices in ECE and similar settings while testing trust as a deimplementation mechanism. Sustainability assessments will address a notable gap, as few studies have examined whether deimplementation effects persist. TRIAL REGISTRATION: NCT07101321, July 20, 2025.

Humans↗

PubMed1978

Clinical considerations in the management of the menopause: the endometrium.

Exogenous oestrogens prescribed for the relief of menopausal symptoms are being given in pharmacological doses and the term 'hormone replacement therapy' is inappropriate. The frequent development of endometrial hyperplasia during unopposed cyclical oestrogen therapy is therefore to be expected, but no single pattern of vaginal bleeding accurately reflected the histology of the endometrium. As such doses of oestrogens are required for effective relief of symptoms, progestogens must be given to protect against endometrial hyperstimulation. Patient acceptability of sequential oestrogen/progestogen therapy is high (90%) and with such therapy breakthrough bleeding may subsequently be shown to be a reliable indicator of underlying endometrial pathology.

Endometrial Hyperplasia↗

PubMed1978

Use review of nutritionally complete liquid diets.

A study was conducted to determine the manner in which semisynthetic fiber-free liquid diets and complete oral liquid diets were being used in a large teaching hospital, and to determine the influence of the establishment of a dietary formulary and guidelines on prescribing. A use review of the dietary formulations was conducted both prior and subsequent to the publication of the formulary and guidelines. Ninety-five patients were monitored on 22 adult medical, surgical, psychiatric and gynecological divisions. The inappropriate or questionable orders for all types of dietary formulations decreased from 65% to 52% after the publication of the formulary and guidelines. There was a significant decrease (p less than 0.005) in orders for semisynthetic fiber-free diets, from 34 to 4, after publication of the formulary and guidelines. The guidelines and formulary appeared to have caused the decreased use of the diet formulations and to have aided in eliminating less than optimal prescribing of the products.

Diet↗

PubMed1977

Antibiotic use at Duke University Medical Center.

A study of antibiotic use at Duke University Medical Center in June 1973 showed that 34.2% of all patients received antibiotics (43.6% surgical, 21.4% medical patients). Cephalothins were most frequently ordered for surgical patients, ampicillin sodium and penicillin G or penicillin V with potassium for other patients. A retrospective analysis of 50 randomly selected patients, according to the Kunin's categories of use, showed 64% of total antibiotic therapy as not indicated or inappropriately administered in terms of drug or dosage. These results are similar to previous reports of antibiotic surveillance and further establish the need for continuing education of prescribing physicians.

Anti-Bacterial Agents↗

PubMed1979

Antibiotic control in a municipal hospital.

The choice of an antibiotic for a patient is often a difficult decision. The clinician must contend with a bewildering variety of bacteria and use a number of expensive and toxic antimicrobial agents judiciously. To deal with the problems of excessive and inappropriate use, the medical staff of Coney Island Hospital established compulsory, prospective antibiotic control. Two years after initiation of this program, we analyzed changes in sensitivity patterns of hospital flora, physicians' prescribing habits and antibiotic use. A trend toward increasing resistance on the part of some Gram-negative isolates to certain beta-lactam antibiotics was noted. Antibiotic costs decreased an average of 38%, while prescribing skills improved.

Anti-Bacterial Agents↗

PubMed1978

Macro-monitoring: a step toward rational psychopharmacotherapy.

A 15-item checklist was used to monitor the drug therapy of 516 patients in five clinical settings. The primary purpose of this study was to determine the extent of irrational drug use in these several settings. After gathering baseline data, two similar clinical units were selected for a six-month follow-up to determine the impact of drug consultation by an expert clinical psychopharmacologist. In the unit where drug consultation was provided, there was a significnat reduction in extended antiparkinsonian agent use (p less than 0.001), multiple daily dosage (p less than 0.001), inappropriate anxiolytic use (p less than 0.01), polypharmacy (p less than 0.001) and too rapid change in medication (p less than 0.01). The unit that did not have drug consultation continued to have a high percentage of patients receiving drugs in an inappropriate manner. Although the consultant had a significant impact on drug use, it was recognized that such consultation is not feasible for most psychiatric facilities. The checklist itself is a systematic tool that can be used to identify prescribing practices of questionable appropriateness. If used properly by the pharmacist, the checklist can serve as a supportive system to assist the physician in providing better patient care.

Drug Information Services↗