EVALUATION OF THE ATTITUDES AND EXPERIENCES OF THE FAMILY PHYSICIANS AND SPECIALISTS RELATING TO PROVIDED TREATMENTS IN TERMS OF RATIONAL USE OF MEDICINE

Introduction: Physicians’ perspectives are essential for rational use of medicine (RUM) activities. This study aimed at evaluation of physicians’ attitudes and experiences about therapeutical management process in terms of RUM in primary and secondary care. Methods: A survey was applied to 1062 family physicians (FP) and 562 specialist physicians (SP) in Turkey. The questionnaire consisted of items assessing physicians’ RUM approaches, stratified by their demographic and occupational characteristics. Results: A total of 55.4% of FPs and 32.1% of SPs declared that they prescribed to “>80% of their patientsâ€. The attitude of “no prescribing without physical examination†was more in females, in seniors, and in those with longer professional experiences in SP group (p<0.05), where no difference was found among FPs. More markedly in FPs, women provided more information than men about their patients’ diseases and pharmacological/non-pharmacological treatments. Most commonly demanded drugs by patients were “analgesics/antirheumaticsâ€, “cold-medicationsâ€, and “antibioticsâ€. Conclusion: Physicians’ statements showed that patients had an underestimated tendency to demand specific drug prescriptions and physicians met such demands more than expected. Moreover, female physicians are more likely to inform their patients about pharmacotherapy details in both groups. These findings may be considered as beneficial for RUM dissemination activities. Key words: physicians, rational drug use, primary health care, hospitals, prescribingÂ

Investigation of injectable drug utilization in primary care: A focus on different age groups in pediatric population

Objective: The suitability of the injectables may vary across different age groups especially for children; therefore, knowledge on their usage patterns is critical in terms of rational pharmacotherapy. This study aimed to investigate pediatric injectable drug utilization in primary care with a focus on different age groups. Method: By simple sampling method, 100 prescriptions that contained at least one injectable drug were randomly selected for each month of the year in 32 provinces of Turkey (n = 38 .400). Among these prescriptions, injectable drugs that were for children (< 18 years) were analyzed. Patterns of injectable drug utilization were compared according to the pediatric age group of infants, children, and adolescents. Results: We identified 5446 patients (14.2%) with a mean age of 7.4 +/- 5.2 years and a slight male tendency in distribution (53.8%). The most common indication for these patients was for the respiratory system (65.4%), of which 96.3% were respiratory tract infections. While less pronounced in adolescents than in infants and children, the most commonly prescribed injectable drugs were antibiotics in all age groups (61.5% vs. 78.6% and 79.9%, P < 0.0001), which was upheld across all seasons. More than 90% of all prescribed injectable antibiotics consisted of penicillins and cephalosporins; the latter being predominant in infants (67.4%) compared with penicillins in children (53.9%) and adolescents (59.0%). Analgesics and insulin were found to be prescribed more frequently to adolescents than they were to infants and children (P < 0.0001 and P < 0.0001, respectively). The mean cost of prescription and injectable drugs per encounter was significantly more likely to escalate with increasing age (P < 0.0001 and P < 0.0001, respectively). Conclusion: Considering the predominance of antibiotics as well as the substantially higher prescription of third-generation cephalosporins in primary care, which was especially more marked for younger children, our study indicates an inappropriate use of injectable drugs by primary care physicians for managing medical conditions in the pediatric population. (C) 2020 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved

The association of chiral characteristic with drug withdrawal due to safety: A comparative analysis

Aims Chirality of drugs might be associated with safety issues through pharmacokinetic or pharmacodynamic variations, interactions, or direct toxicological responses. We aimed to compare chiral status of the available drugs to that of drugs withdrawn due to adverse drug reactions (ADRs). Methods We searched the literature regarding withdrawn drugs due to safety-related issues (n = 391) to compare them with all available small-molecule drugs (n = 1633). We examined their chiral status and assigned as achiral compound, chiral mixture or pure enantiomer. We compared the mean survival (i.e., nonwithdrawal) time and withdrawal rates of drugs by their chirality, with further stratification by the launch year, ATC-1 (Anatomical Therapeutic Chemical) level and ADR. Results We identified higher withdrawal rate in achiral drugs (hazard ratio 2.1, 95% CI: 1.6-2.7) and chiral mixtures (hazard ratio 2.6, 95% CI: 1.9-3.5) compared to that in pure enantiomers. Pure enantiomers had the longest mean survival time (62.4 +/- 0.8 years), followed by achiral drugs (55.4 +/- 0.9 years, P < .01) and chiral mixtures (52.4 +/- 1.4 years, P < .01). Pure enantiomers had higher survival rates than chiral mixtures if launched before 1941 (P = .02), in 1961-1980 (P < .001) or 1981-2000 (P < .001). Pure enantiomers had lower withdrawal rate (18.2%) vs. chiral mixtures (35.1%, P = .02) in nervous system drugs. Pure enantiomers had lower withdrawal rate than chiral mixtures in hepatotoxic (P < .01) and cardiovascular ADRs (P < .01). Conclusion Our study showed lower likelihood of withdrawal for pure enantiomers compared to that in chiral mixtures and achiral drugs, which was more remarkable for those launched in certain time periods and several ADRs, including hepatotoxicity and cardiovascular toxicity

Evaluation of specialist and family physicians’ attitudes regarding rational drug selection

OBJECTIVE: Physicians' personal (P) drugs, which were ranked by priority, may show variations even for the same indication. We aimed to evaluate physicians' knowledge and attitudes regarding P-drug list preparation with respect to the rational use of medicine context. METHODS: A total of 1062 family physicians (FPs) and 562 specialist physicians (SPs) were interviewed and questioned about their knowledge and attitude regarding P-drug list preparation. RESULTS: Compared with SPs (64.9%), significantly more number of FPs (72.8%) prepared a P-drug list. Women were more likely to prepare the P-drug list in both groups; gender comparison showed that significantly more number of female FPs (75.9%) exhibited this attitude than female SPs (67.8%) (p=0.002). Among SPs, the trend for P-drug list preparation attitude decreased with increasing age (p=0.006), and significantly less number of senior physicians showed this attitude compared with junior physicians (p=0.007). The most common source of information referred to by FPs (78.9%) and SPs (74.3%) during P-drug list preparation was "pharmaceutical company activities." More than 80% of responders (80.9% of FPs and 83.6% of SPs) specified that a difference "exists" or "partially exists" between original and generic drugs. Approximately one in 10 physicians in both groups stated that they "rarely/never" consider their patients' "liver/kidney disease" during prescribing. CONCLUSION: More prominently in male and senior physicians, the attitude of P-drug list preparation remained lower than expected. Moreover, it is remarkable that pharmaceutical company promotions are the most common source of information for drug selection. These findings disclose the need for the rational use of medicine dissemination interventions for all physicians focusing on more effective use of P-drug list

Investigation of prescribing trends and prescriptions for common diagnoses in primary care: Nationwide data of Turkey

Purpose: This study aimed to examine the details of prescriptions issued in primary care and the changes over the years in Turkey. Materials and Methods: We analyzed all electronic prescriptions registered to Prescription Information System by primary care physicians in Turkey between 2013 and 2016. The mean number of drugs per prescription (nDPP) was determined by patients' sex and age groups. The percentages of the prescriptions containing the top twenty most frequently encountered drugs were determined for each year of the study. In the four-year period, the percentage of prescriptions with the ten most common diagnoses among prescriptions with single diagnosis and nDPP were examined. Results: A total of 1.457.034.275 drugs were prescribed in 518.335.821 prescriptions and nDPP was 2.81 for the four-year period. The most commonly used drugs in all prescriptions were other cold preparations (19.2-19.7%) and amoxicillin+beta-lactamase inhibitor (9.9-10.5%). The diagnosis of hypertension (6.9%, nDPP: 2.00) and acute upper respiratory tract infection, unspecified (URTI), (6.5%, nDPP: 2.61) were in the top ranks in single-diagnosis prescriptions during four-year period. Conclusion: Primary care prescriptions appear to be mostly generated for women and elderly populations, with a tendency for URTI and hypertension indications. Overprescriptions of cold preparations, NSAIDs, PPIs, analgesics, and broad-spectrum antibiotics imply existence of important problems in the primary care regarding rational prescribing behavior

The Contribution of Community Pharmacists to the Rational Management of Drug Use in Pregnancy: Practical Recommendations

Gebelik, akılcı ilaç kullanımı ilkelerinin hassasiyetle uygulanması gereken klinik durumlarınbaşında gelmektedir. Doğru işleyen bir sağlık sisteminde eczacı, ilaçla ilgili bilgiye ulaşma konusundabaşvurulacak birincil kaynaklardan biridir. Eczacıların bu misyonu, gebeler gibi özel populasyonlardadaha kritik önemdedir. Çok sayıda anne adayının gebeliğisırasında farkında olmadan/bilinçsiz ilaç kullanabildiği tahmin edilmektedir. Üstelik gebeliklerin yarıya yakınının planlı olmadığı dikkate alındığında; gelişigüzel ilaç kullanımından sakınılması, olası ilaca bağlı teratojenitelerden kaçınılması gibikonularda eczacının kilit rolünün daha da arttığı düşünülebilmektedir. Planlı olsun ya da olmasın gebelik sırasında ilaç maruziyetinden tamamen uzak kalınması çoğu zaman mümkün olamamaktadır.Diyabet, astım, hipertansiyon gibi kronik hastalığı olanlar, gebelikleri sırasında çoğunlukla ilaç tedavisine devam etmek zorundadır. Ayrıca; üriner enfeksiyon, bulantı/kusma, ağrı gibi annenin bazı akuthastalıkları ya da semptomları da ilaç tedavisi gerektirebilmektedir. Erken dönemde folik asit ve diğerbazı vitamin/minerallerin kontrollü biçimde alınması önerilmektedir. Özel koşullarda indüksiyon/düşük tehdidinden korunmak amaçlı birtakım ilaçlar da gebelik öncesi ve sırasında kullanılabilmektedir. Gebelikte risk-yarar değerlendirmesi yapılmaksızın doğrudan farmakoterapiden kaçınılması dakendi başına çok daha önemli sağlık sorunlarına yol açabilmektedir. Dolayısıyla gebelik, anne adaylarının ilaç kullanımından tümüyle arındırılabileceği bir dönem olmadığından, bu kritik sürecin akılcıyönetiminde eczacı ve diğer sağlık çalışanlarına önemli sorumluluklar düşmektedir. Bu çalışmada, gebelikte oluşan farmakokinetik/farmakodinamik değişiklikler, bunların ilaç kullanımına yansımaları veilaca bağlırisklerin gebelik yaşıyla olan ilişkisi üzerinde durulmuştur. Gebelikte sıkça kullanılabilen ilaçlara ve farkında olmadan kullanılan/kontrendike olduğu bilinen ilaçların risklerine yer verilmiştir.Böylece eczacıya yönelik temel bilgiler vermesi amaçlanan bu çalışmayla gebelikte gereksinim duyulan durumlarda ilacın daha akılcı kullanımının yaygınlaştırılmasına katkı sağlanması beklenmektedir.Pregnancy is one of the main clinical situations where principles of rational use of_x000D_ drugs need to be practiced precisely. In a properly functioning healthcare system, pharmacist constitutes a primary source to reach information on drugs. This mission becomes more critical in special populations like pregnant women. Many pregnant women are estimated to use drugs_x000D_ unintentionally/unconsciously. Moreover, as half of the pregnancies are not planned, the key role_x000D_ of the pharmacist is increased considering avoidance of arbitrary drug use or possible drug-related_x000D_ teratogenicity. Whether planned or not, it may not be possible to thoroughly avoid drug exposure_x000D_ during pregnancy. People with chronic conditions such as diabetes, asthma, hypertension often_x000D_ have to continue medical treatment despite pregnancy. In addition, certain acute diseases or symptoms of the mother, such as urinary infection, nausea/vomiting, pain may require pharmacological_x000D_ therapy. In early periods, folic acid and some other vitamins/minerals are recommended to be administered under supervision. In special conditions, drugs for induction/threatened abortion may_x000D_ also be used before and during pregnancy. Avoiding pharmacotherapy without a risk-benefit assessment in pregnancy can lead to more dramatic health problems. This review focuses on the pharmacokinetic/pharmacodynamic changes in pregnancy, their implications on drug use, and the_x000D_ relationship between drug-related risks and gestational age. Drugs that are commonly used in pregnancy and risks of drugs known to be contraindicated or unintentionally used are also discussed._x000D_ Therefore, aiming to introduce basic background knowledge to pharmacists, this paper is expected_x000D_ to contribute to dissemination of rational use of drug in pregnancy

Investigation of Patients' Attitudes Regarding Drug Use Before Application to Dental Clinics

Patients' approaches are crucial at rational use of medicine (RUM). Irrational pharmacotherapy is common problem both in Turkey and worldwide. There is limited research about RUM in dentistry. In this research, it was aimed to evaluate the patients' attitudes regarding their drug utilization for dental problems. Surveys were conducted with 139 patients who applied to dental clinics (DCs) at a dentistry faculty (DF) or an oral-dental health center (ODHC). Answers were compared to DF and ODHC groups. Some respondents (29.3%) stated that they used medication before application to DCs, 77.5% of them used analgesic and 15.0% of them used antibiotic. Nearly half of the participants (47.3%) stated they did not consult anyone and 25.0% of them declared that they contacted with their dentist before using medicines that contain in their home for dental reasons. In case of periodontal problems with accompanying systemic disease which includes fatigue and fever; % 14.2 of the participants declared the use of antibiotics even without oral examination, % 11.7 of respondents would start antibiotics but stop taking them when they feel better. Drug use before application to DCs is higher in ODHC group. While those who received non-drug treatment for dental problems in the last year is higher in DF group (p< 0,05). Although there are some differences among the applicants of clinics, it is certain that patients have some attitudes associate with irrational pharmacotherapy. Self-medication of some drugs especially antibiotics is a remarkable drawback. These should be taken into consideration while planning RUM activities in dentistry

Prescription audit adjunct to rational pharmacotherapy education improves prescribing skills of medical students

Objective: To assess the impact of a rational pharmacotherapy (RP) teaching program during clinical pharmacology clerkship by analyzing the results of prescription audits (PAs) of the medical students. Collectively, we intended to observe the possible improvement of the students in their prescribing, problem solving and self-directed learning skills. Design: At the beginning and end of the clerkship, the students were presented with cases of uncomplicated osteoarthritis to assess their prescribing skills; format and rationality were scored. Setting: A medical school in Turkey that teaches RP to the fourth-year students in clinical pharmacology clerkship. Participants: There were 94 students of the 2002-2003 academic year in three groups and a single group of students belonging to the previous academic year tested. Of those students from the previous academic year, 26 were also analyzed a year later to demonstrate the long-term impact of the training. Main outcome measures: Prescribing skills of medical students and their opinions about PA. Results: Direct assessment via PA demonstrated that the scores for post-clerkship prescriptions were far better than those for pre-clerkship prescriptions in terms of format and rationality. Long-term assessment showed that the scores declined within a year following clerkship, but they were still higher than those of their pre-clerkship scripts. Analysis of the questionnaires revealed that the students were satisfied with PA. The majority of the students stated they had learned the general principles of RP and gained better prescribing skills, and they intended to apply most of the principles learned to their future professional lives. The script format scores of a retrospectively created PA-exempted group were significantly lower than those of the students to whom an established PA education was given. Conclusion: PA sessions were shown to be an easy and a useful method of both evaluating and reinforcing prescribing skills gained though problem-based RP education

Investigation of Warnings Regarding Driving and Machine Use in Summary of Product Characteristics and Patient Information Leaflets of Drugs Frequently Used in Psychiatry

Objective: This study aimed to investigate details of warnings about effects on ability to drive and use machines in the summary of product characteristics (SmPC) and patient information leaflet (PIL) of the drugs that are frequently used in psychiatry and have expected and undesirable effects in central nervous system. Methods: Current SmPCs/PILs of the ten most commonly prescribed drugs in Turkey were examined in detail. The information under the subheadings of effects on ability to drive and use machines in SmPC and driving and using machines in PILs was assessed in at least two different time periods via standard evaluation criteria. Results: SmPCs/PILs of 409 generic drugs were examined. While 80.2% of these generics had same warnings as their reference drugs, major differences were found in 8.3% of SmPCs and 8.1% of PILs, compared to that of originals. The active ingredients with major differences in SmPCs included venlafaxine (47.8%), risperidone (34.0%), sertraline (22.2%), and paroxetine (5.6%) whereas those having major differences in their PILs were paroxetine (72.2%), mirtazapine (52.0%), sertraline (22.2%) and venlafaxine (13.0%). Except paroxetine, all examined active ingredients were found to have consistent SmPCs and PILs in their warnings about driving and machine use. Conclusion: Although SmPCs/PILs of examined drugs overall seem compatible regarding the warnings of driving and machine use, it is noteworthy that warnings in SmPCs/PILs of considerable amount of reference drugs differed from their generics. The study findings indicate the need for a more rigorous approach to the standardization of the content within the SmPCs/PILs