The Phelophepa Health Care Train: a pharmacoepidemiological overview of the Western Cape in 2009

Background: The Phelophepa Health Care Train is the only primary healthcare train in the world. Phelophepa is an innovative initiative that attempts to make a positive difference to primary healthcare in rural South Africa. The primary aim of this study was to determine the epidemiological and prescribing statistics for Phelophepa during the period that the train was stationed in the Western Cape in 2009.Methods: Phelophepa visited seven stations during the eight weeks that it was stationed in the Western Cape (between 6 April and 5 June 2009). Data were collected by workers and students on the train.Results: A total of 4 026 prescriptions were dispensed by the pharmacy on Phelophepa during the eight weeks. The average number of items per prescription was 3.51. The average cost per prescription was R65,48 (average cost of R18,64 per item). Patients only paid R5,00 per prescription. There was an increase in the number of pulmonary diseases/infections as well as ophthalmic conditions (especially dry eyes). Common problems experienced during the outreach to schools were ear infections and chest infections. Common conditions identified in Caledon, for example, were musculoskeletal problems, genitourinary conditions, fungal infections and eye disorders. Medication is prescribed mainly by nurses and includes those listed in the Primary Healthcare Essential Drug List.Conclusions: The statistics compiled by Phelophepa are a useful source of pharmacoepidemiological data about rural South Africa. It is recommended that more studies be conducted to detect especially epidemiological differences between regions visited, as well as changes over time.Keywords: Phelophepa; primary healthcare; epidemiology; Western Cape; prescription

Prescribing of meprobamate-containing combination analgesics in South Africa

Background: Meprobamate is a constituent of various combination analgesics in South Africa. Due to the lack of recent literature on the prescribing patterns of combination analgesics containing meprobamate and in the light of its possible higher re-scheduling, this study was conducted. The primary aim was to establish the extent of meprobamate-containing combination analgesic prescribing using a prescription claims database.Methods: A retrospective, cross-sectional drug utilisation study was conducted on prescription data of a medical insurance scheme administrator in South Africa for 2011.Results: A total of 31,854 patients received 97,491 analgesics during 2011. Within ATC category N02B, 62.10% of prescriptions were for analgesic combinations, of which 20,326 prescriptions were for meprobamate-containing analgesics. A total of 10,404 patients (53.00% males) were prescribed meprobamate-containing analgesics. Overall, 20.85% of all analgesics prescribed were therefore meprobamate-containing analgesics. Patients who received meprobamate-containing analgesics were slightly older (39.52 years) compared with patients who received analgesics in general (33.61 years). Twenty-two trade names of meprobamatecontaining analgesics were prescribed. Seventeen of these products contained exactly the same strengths of active ingredients, namely 320 mg paracetamol, 8 mg codeine phosphate, 32 mg caffeine and 150 mg meprobamate. The originator product constituted 3.72% of prescribing frequency (average cost: R30.42) compared with 70.63% for the most popular generic (average cost: R11.65).Conclusions: Prescribers should be conscious of the benefits and risks of the active ingredient combinations. Further studies including patient and prescriber perceptions of different combinations are recommended.Keywords: combination analgesics, drug utilisation, meprobamate, polycomponent analgesics, prescribing pattern

Prescribing of methylphenidate to children and adolescents in South Africa: A pharmacoepidemiological investigation

Background: Pharmacoepidemiological studies on ADHD are limited in South Africa. The primary aim was to analyse the prescribing of methylphenidate to patients aged 18 years and younger in the private health care sector. Methods: Data for a one-month period in 2004 were obtained from a large medical aid administrator. Data were retrospectively analysed. The total database contained medicine records for 355 998 patients. Results: A total of 66 450 medicine items were prescribed to 34 733 patients aged 18 years and younger. A total of 1 028 patients received prescriptions for methylphenidate. Nearly 3% of children and adolescents therefore received prescriptions for methylphenidate. The average age of these patients was 10.87 (SD = 2.79) years. Most of these prescriptions (63.14%) were for children between seven and twelve years of age. Most prescriptions were for long-acting methylphenidate in 20 mg, 30 mg and 40 mg capsules (48.87%). The average prescribed daily dose (PDD) for methylphenidate was 19.27 (SD = 11.87) mg. The most popular average PDD was 20 mg (42.63% of all methylphenidate prescriptions). The highest average percentage of methylphenidate prescriptions was in the Western Cape (2.58%), and the lowest in the Northern Cape (0.63%). Conclusions: Numerous claims are being made that methylphenidate is overused or even abused, especially in children of school-going age. Mostprescriptions were issued in metropolitan areas in this study, but overuse could not be established. This study was a preliminary study that can lead to more comprehensive studies in future

Prescribing Patterns of Methylphenidate and Atomoxetine for Patients with Attention-Deficit/Hyperactivity Disorder

Purpose: To determine the prescribing pattern of methylphenidate and atomoxetine to patients with Attention-Deficit/Hyperactivity Disorder (ADHD) in South Africa.Methods: A retrospective, cross-sectional pharmacoepidemiological study was conducted based on the data from a medical aid administrator in South Africa for 2011. All records for ADHD patients who received one or more prescriptions for methylphenidate and/or atomoxetine (ATC Code N06BA) were extracted for analysis.Results: A total of 455 patients (mean age: 16.5 ± 11.56 yr) received 1653 prescriptions for methylphenidate and/or atomoxetine at a total cost of South African Rand 554,915.84 (US dollar 1.0 = Rand 6.76). A majority of these patients (70.34 %) were males and 21.10 % were older than 18 yr (25.76 % of females and 19.81 % of males). About a third of the prescriptions (30.44 %) were dispensed to children younger than 12 years while 25.88 % were dispensed to adolescents (12 to 18 years). Most prescriptions (92.01 %) were for methylphenidate while atomoxetine accounted for 7.99 % of the prescription. A majority of the prescriptions for methylphenidate (47.86 %) were for children younger than 12 yr, and most prescriptions for atomoxetine (52.27 %) were for adolescents.Conclusion: Methylphenidate is the mainstay in the treatment of ADHD in South Africa, with atomoxetine prescribed more often to older patients. Drug use is rational and dosages are within the recommended dosage ranges. As expected, older patients are receiving treatment for ADHD.Keywords: Methylphenidate, Atomoxetine, Attention-Deficit/Hyperactivity disorder, Pharmacoepidemiolog

An investigation into the prescribing of analgesics

CITATION: Truter, I. & Kotze, T. J. v. W. 1996. An investigation into the prescribing of analgesics. South African Medical Journal, 86(11):1394-1397.The original publication is available at http://www.samj.org.zaTo investigate the prescribing of analgesic agents in a defined South African patient population. Design: Retrospective drug utilisation study. Setting: Prescribing behaviour of a sample of 50 dispensing doctors in Port Elizabeth. Data were obtained from a medical aid which used a formulary system. Percentage of central nervous system drugs that analgesics comprised; proportion of patients using combination analgesics; cost of analgesics. On average, 83.3% of all central nervous system drugs dispensed were analgesic agents. These agents represented 70.9% of the total cost of central nervous system drugs. A high percentage (82.2%) of the analgesic agents dispensed were combination or polycomponent analgesics. The combination analgesic tablet, consisting of paracetamol, meprobamate, caffeine and codeine phosphate, was the most frequently prescribed central nervous system drug. This product accounted on average for 40.4% of all analgesics dispensed. Nearly half (46.0%) of all the analgesics dispensed by the sample of doctors were available without a prescription. The high prescribing rate of combination analgesic prescription was a cause for concern, given the dependence-producing potential of some of the ingredients, e.g. meprobamate. The prescribing and use of analgesics should be carefully monitored by further drug utilisation studies in light of the serious adverse effects, such as analgesic nephropathy, associated with the long-term use of these agents.Publisher’s versio

Systemic isotretinoin in the management of acne – a patient questionnaire survey

Background: The primary aim was to investigate the appropriateness (as outlined in the South African Acne Treatment Guideline1) for the prescription of systemic isotretinoin in the management and counselling of acne in the Nelson Mandela Bay Metropole. Methods: A questionnaire was distributed to patients receiving systemic isotretinoin by 30 community pharmacies. The response rate was 29.2% (57 respondents). Results: The acne medication history revealed that commercial brands of beauty products were used by 57.9% of respondents, topical benzoyl peroxide by 22.8%, and systemic cotrimoxazole by 19.3%. Only nine females used an oral contraceptive as acne treatment prior to isotretinoin. The average daily dose of isotretinoin was 44.2 (SD=16.9) mg. Half of the respondents received a suboptimal cumulative dosage of isotretinoin. The average prescribed duration of isotretinoin therapy was 6.2 months. Adequate counselling was received by only 57.9% of patients. A third of the patients who were able to fall pregnant received recommendations for contraception. Pregnancy tests were conducted in only two females. Just over 40% of patients reported a complete clearance of acne lesions. Conclusions: Many prescribers did not follow the recommendations for isotretinoin prescription. The counselling of patients regarding isotretinoin therapy was substandard, especially with respect to pregnancy prevention

Developing countries subcommittee of the clinical pharmacology division : The medicines utilization research in Africa (MURIA) group and IUOHAR co-organized a workshop in botswana for the promotion of rational use of medicines

The improper use of medicines is a major cause of poor therapeutic effect as well as adverse drug reactions, and has considerable financial consequences (1-4). In the present era of global economic recession, there is a need for the judicious use of resources to benefit all citizens in developing countries. Therefore, the promotion of the Rational Use of Medicines (RUM) should be a healthcare priority in African countries. Still, there is limited information available on how appropriately medicines are prescribed and used in Africa (5)

Prevalence of drug-drug interactions of antiretroviral agents in the private health care sector in South Africa

Objectives. Human immunodefiency virus (HIV) infection can be effectively treated with highly active antiretroviral therapy (HAART), requiring concomitant administration of three to four different agents, often with a high potential for drug-drug interactions (DDIs). This study aimed to determine the prevalence of possible DDIs between antiretrovirals (ARVs) themselves and other drugs. Design. Retrospective drug-utilisation study using data from from a national medicine claims database for the period 1 January to 31 December 2004. Setting. A section of the private healthcare sector in South Africa. Subjects. All ARV prescriptions (N=43482) claimed during 2004. The possible DDIs found were classified according to a clinical significant rating as described by Tatro7 (2005) in his book, “Drug Interactions – Facts and comparisons.” Results. A total of 5305882 medicine items were prescribed, of these, 1.92% (N=101 938) accounted for ARVs. Of the total number of 2595254 prescriptions, 1.68% (N=43 482), were ARVs. A total number of 18035 DDIs (81 different types) were identified, of these, 83.89%, (n=15130) were DDIs between ARVs and other drugs, while 16.11% (n=2905) were DDIs between ARVs themselves. Possible DDIs with a clinical significance level of 1 (major, n=17) and 2 (moderate, n=1436) represented 8.06% (n=1 453) of the total number of identified interactions. Conclusions. Since concomitant use of ARVs and other drugs used to treat HIV complications is increasing, there is a great need of understanding and anticipating these DDIs, overcoming them by dose adjustments and patient education by pharmacists, so that they are not life threatening to HIV/AIDS patients