Ambulatory prescriptions with short-acting nifedipine as a PRN (pro re nata) order in Taiwan, 1997–2011 (0.2% sampling).

<p>Ambulatory prescriptions with short-acting nifedipine as a PRN (pro re nata) order in Taiwan, 1997–2011 (0.2% sampling).</p

Characteristics of ambulatory visits in Taiwan, 1997–2011 (0.2% sampling).

a<p>CCBs: calcium channel blockers.</p>b<p>PRN: pro re nata.</p

Characteristics of ambulatory prescribed drug items with oral extended-release or enteric-coated formulations that should not be split over the study period.

a<p>Top 10 drugs which most frequently triggered warnings during the intervention period.</p>b<p>Drugs were classified by the American Hospital Formulary Service (AHFS) Pharmacologic-Therapeutic Classification System.</p><p>Characteristics of ambulatory prescribed drug items with oral extended-release or enteric-coated formulations that should not be split over the study period.</p

Association between Physician Specialty and Risk of Prescribing Inappropriate Pill Splitting

<div><p>Background</p><p>Prescription errors that occur due to the process of pill splitting are a common medication problem; however, available prescription information involving inappropriate pill splitting and its associated factors is lacking.</p><p>Methods</p><p>We retrospectively evaluated a cohort of ambulatory prescriptions involving extended-release or enteric-coated formulations in a Taiwan medical center during a 5-month period in 2010. For this study, those pill splitting prescriptions involving special oral formulations were defined as inappropriate prescriptions. Information obtained included patient demographics, prescriber specialty and prescription details, which were assessed to identify factors associated with inappropriate pill splitting.</p><p>Results</p><p>There were 1,252 inappropriate prescriptions identified in this cohort study, representing a prescription frequency for inappropriate pill splitting of 1.0% among 124,300 prescriptions with special oral formulations. Among 35 drugs with special oral formulations in our study, 20 different drugs (57.1%, 20/35) had ever been prescribed to split. Anti-diabetic agents, cardiovascular agents and central nervous system agents were the most common drug classes involved in inappropriate splitting. The rate of inappropriate pill splitting was higher in older (over 65 years of age) patients (1.1%, 832/75,387). Eighty-seven percent (1089/1252) of inappropriate prescriptions were prescribed by internists. The rate of inappropriate pill splitting was highest from endocrinologists (3.4%, 429/12,477), nephrologists (1.3%, 81/6,028) and cardiologists (1.3%, 297/23,531). Multivariate logistic regression analysis revealed that the strongest factor associated with individual specific drug of inappropriate splitting was particular physician specialties.</p><p>Conclusion</p><p>This study provides important insights into the inappropriate prescription of special oral formulation related to pill splitting, and helps to aggregate information that can assist medical professionals in creating processes for reducing inappropriate pill splitting in the future.</p></div

Physicians' responses of the top 10 frequent inappropriate drug prescriptions when receiving hard-stop warnings.^a

a<p>At the points of the first (June, 2010), second (July, 2010), twelfth (May, 2011) and fifteenth (August, 2011) months after intervention.</p>b<p>For example, 0.5 tab twice daily changed to 1 tab once daily; 0.5 tab once daily changed to 1 tab once daily; or 1.5 tab once daily changed to 1 tab once daily.</p>c<p>Products with different formulations or with the same formulation but lower strength.</p>d<p>Products with the same therapeutic effects.</p>e<p>No available products in the study hospital.</p><p>Physicians' responses of the top 10 frequent inappropriate drug prescriptions when receiving hard-stop warnings.^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0114359#nt105" target="_blank">a</a>}</p

The number and proportion of prescriptions with inappropriate splitting, by physician specialty.

<p>Prescriptions for adult (age >18 yrs).</p><p>Metabolism, Metabolism & endocrinology; Gen Med, General medicine; n, number of prescriptions with inappropriate splitting.</p><p>%, n/N, proportion of prescriptions with inappropriate splitting by specific drug and physician specialty (N: number of prescriptions with special oral formulation by the specific drug and physician specialty in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0070113#pone.0070113.s001" target="_blank">Table S1</a>.).</p

Characteristics of ambulatory prescriptions with special oral formulation.

<p>n, number of prescriptions with inappropriate splitting; N, number of prescriptions with special oral formulation.</p><p>%, n/N, proportion of prescriptions with inappropriate splitting; –, no prescriptions with special oral formulation.</p

Comparison of warning prescriptions with inappropriate pill splitting in the baseline period and in the third intervention period, stratified by patient age, prescriber specialty and the specific drug.

<p>n, number of prescriptions with warnings; N, number of prescriptions with special oral formulations; %, n/N, proportion of prescriptions with warnings.</p><p>* Inappropriate prescriptions of pill splitting were retrieved retrospectively by applying the same algorithm of the real warning system adopted in intervention period.</p><p>Comparison of warning prescriptions with inappropriate pill splitting in the baseline period and in the third intervention period, stratified by patient age, prescriber specialty and the specific drug.</p

Odds ratios (OR) and 95% confidence interval (95% CI) for association of prescribing inappropriate splitting drugs and physician specialty.

<p>Multiple logistic regression, Hosmer and Lemeshow goodness-of-fit test: all p>0.05.</p>a<p>Adjusted by age and sex.</p>b<p>Female, adjusted by age, sex, sex and physician specialty interactions.</p>c<p>Age 18–64 yrs, adjusted by age, sex, age and physician specialty interactions.</p>d<p>The physician specialty which has the lowest proportion of prescriptions with inappropriate splitting.</p>e<p>Data was excluded due to small sample size (n/N = 4/5).</p>*<p>p<0.05.</p

Drugs with special oral formulations, selected from TVGH formulary^a.

<p>Cap, capsule; CR, controlled-release; DR, delayed release; EC, enteric-coated; ER, extended-release; HBS, Hydrodynamically Balanced System; MR, modified release; NSAID, non-steroids anti-inflammatory and antirheumatic products; OROS, Osmotic-controlled Release Oral delivery System; PR, prolonged release; SR, sustained release; tab, tablet; TVGH, Taipei Veterans General Hospital; XL, <i>extended</i>-<i>release;</i> XR, <i>extended</i>-<i>release</i></p>a<p>Taipei Veterans General Hospital Formulary 2011 Edition</p>b<p>Drugs were classified by the American Hospital Formulary Service (AHFS) Pharmacologic-Therapeutic Classification System</p>c<p>Pharmacologic and formulation considerations</p