Статті в журналах: "Prescribing appropriatene"

1

Aronson, J. K. "Rational prescribing, appropriate prescribing." British Journal of Clinical Pharmacology 57, no. 3 (March 2004): 229–30. http://dx.doi.org/10.1111/j.1365-2125.2004.02090.x.

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Onder, Graziano. "Appropriate prescribing." Journal of Gerontology and Geriatrics 69, no. 4 (December 2021): 286–88. http://dx.doi.org/10.36150/2499-6564-n462.

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Tully, Mary Patricia. "Appropriate prescribing." Reviews in Clinical Gerontology 3, no. 4 (November 1993): 359–66. http://dx.doi.org/10.1017/s0959259800003609.

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Tully, Mary P. "Appropriate prescribing." Reviews in Clinical Gerontology 6, no. 1 (February 1996): 49–56. http://dx.doi.org/10.1017/s0959259800004482.

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Drennan, Vari. "Appropriate antibiotic prescribing." Primary Health Care 25, no. 9 (October 30, 2015): 15. http://dx.doi.org/10.7748/phc.25.9.15.s19.

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Apisarnthanarak, Anucha, Kittiya Jantarathaneewat, Siriththin Chansirikarnjana, Nattapong Tidwong, and Linda Mundy. "2022. Antibiotic Prescribing Behavior Among Surgeon." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S679. http://dx.doi.org/10.1093/ofid/ofz360.1702.

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Abstract Background A comparative study was conducted to evaluate prescribed antibiotic (AB) use in surgical patients with the Transtheoretical Model of Behavior (TTM) and Theory of Planned Behavior (TPB). Methods A survey was conducted at Thammasat University Hospital from January 1 to 31, 2019. We evaluated the appropriateness of AB uses in the surgical department reported per the hospital’s Drug Use Evaluation (DUE) form. After review of the DUE, in-depth interviews were conducted to all prescribers to explore antibiotic prescribing behavior based on TTM vs. TPB, using a standardized data collection tool. Data collected included demographics, indications, appropriateness of AB uses, the individual prescriber’s behavior based on TTM and TPB. The five TTM stages of change were categorized precontemplation, contemplation, preparation, action, and maintenance. In TPB assessment, we evaluated attitude toward AB uses, subjective norm to AB uses behavior, and perceived behavior control of AB uses behavior. Results There were 92 AB uses from 64 prescribers; 70 (70/92; 76%) used antibiotics appropriately. The majority of AB uses (62/92; 67%) were for treatment of infections. The most common reasons for inappropriate AB uses included inappropriate AB choices for treatment and prophylaxis of SSIs (n = 11, 50%) and inappropriate duration (n = 8, 36%). Physicians categorized in higher stages of TTM (action and maintenance) were strongly correlated with appropriate AB uses, while there was no correlation between the total TPB score and appropriateness of AB uses. By multivariate analysis, the TTM action and maintenance (aOR = 7.95; P = 0.02) and self-reported prescribers who considered patients as first priority (aOR = 4.02; P = 0.04) were associated with appropriate AB uses, while neurosurgical procedures (aOR = 0.13; P = 0.003) and antibiotic prescriptions for surgical prophylaxis (aOR = 0.15; P = 0.04) were associated with inappropriate AB uses. Conclusion Antibiotic prescribers categorized by TTM stages strongly correlated with appropriate AB uses. Additional studies to assess appropriate AB prescribing behavior, based on TTM stages of change, offer an opportunity to optimize surgical care. Disclosures All authors: No reported disclosures.

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Hamill, Laura M., Julia Bonnett, Megan F. Baxter, Melina Kreutz, Kerina J. Denny, and Gerben Keijzers. "Antimicrobial Prescribing in the Emergency Department; Who Is Calling the Shots?" Antibiotics 10, no. 7 (July 10, 2021): 843. http://dx.doi.org/10.3390/antibiotics10070843.

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Objective: Inappropriate antimicrobial prescribing in the emergency department (ED) can lead to poor outcomes. It is unknown how often the prescribing clinician is guided by others, and whether prescriber factors affect appropriateness of prescribing. This study aims to describe decision making, confidence in, and appropriateness of antimicrobial prescribing in the ED. Methods: Descriptive study in two Australian EDs using both questionnaire and medical record review. Participants were clinicians who prescribed antimicrobials to patients in the ED. Outcomes of interest were level of decision-making (self or directed), confidence in indication for prescribing and appropriateness (5-point Likert scale, 5 most confident). Appropriateness assessment of the prescribing event was by blinded review using the National Antibiotic Prescribing Survey appropriateness assessment tool. All analyses were descriptive. Results: Data on 88 prescribers were included, with 61% making prescribing decisions themselves. The 39% directed by other clinicians were primarily guided by more senior ED and surgical subspecialty clinicians. Confidence that antibiotics were indicated (Likert score: 4.20, 4.35 and 4.35) and appropriate (Likert score: 4.07, 4.23 and 4.29) was similar for juniors, mid-level and senior prescribers, respectively. Eighty-five percent of prescriptions were assessed as appropriate, with no differences in appropriateness by seniority, decision-making or confidence. Conclusions: Over one-third of prescribing was guided by senior ED clinicians or based on specialty advice, primarily surgical specialties. Prescriber confidence was high regardless of seniority or decision-maker. Overall appropriateness of prescribing was good, but with room for improvement. Future qualitative research may provide further insight into the intricacies of prescribing decision-making.

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Campbell, M., D. N. Bateman, S. J. Roberts, and J. M. Smith. "Appropriate prescribing in asthma." BMJ 310, no. 6986 (April 22, 1995): 1069. http://dx.doi.org/10.1136/bmj.310.6986.1069b.

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Naish, J., C. Griffiths, P. Sturdy, and P. Toon. "Appropriate prescribing in asthma." BMJ 310, no. 6992 (June 3, 1995): 1472. http://dx.doi.org/10.1136/bmj.310.6992.1472a.

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Lexchin, Joel. "Improving the Appropriateness of Physician Prescribing." International Journal of Health Services 28, no. 2 (April 1998): 253–67. http://dx.doi.org/10.2190/abwy-yfpa-me5r-7bqp.

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Appropriate prescribing means that prescribers should try to maximize effectiveness, minimize risks and costs, and respect patients' choices. Evidence from studies on prescribing to individuals and from administrative databases reveals a significant level of inappropriate prescribing by Canadian physicians. Two important reasons for inappropriate prescribing seem to be physicians' level of knowledge and physicians' practice settings. A large number of methods have been tried to improve prescribing behavior, but most are unsuccessful. Academic detailing, and audit and feedback, have both been shown to work but may be difficult to implement in Canada, where most physicians practice in solo fee-for-service settings. Alternative forms of physician payment such as capitation or salary are probably necessary to make prescribing more appropriate.

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Penge, Justin, and Peter Crome. "Appropriate prescribing in older people." Reviews in Clinical Gerontology 24, no. 1 (December 2, 2013): 58–77. http://dx.doi.org/10.1017/s0959259813000221.

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SummaryPrescribing for older people is often complex and challenging. With age, people almost invariably develop diseases leading to the prescription of drugs and the risk of multiple prescribing increases, especially if there is strict adherence to single disease guidelines. There remains a paucity of evidence from clinical trials as to the efficacy of many drugs in patients aged over 80 years due to the gross under-representation of older people in clinical trials. Older people are also at increased risk of adverse drug events, which are an important cause of morbidity and mortality. A significant percentage of these are both predictable and potentially avoidable.In this updated review the concept of appropriate prescribing in older people is explored, including the importance of individualized care and shared decision-making. The available tools to enhance prescribing practice are examined, including those aimed at reducing inappropriate prescriptions and under prescribing. The limitations of existing tools are discussed and areas with particular promise and scope for advancement are highlighted, including the development of integrated IT systems and software engines to aid clinicians in appropriate prescribing.

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Thomson, S., and P. Crome. "Appropriate prescribing in older people." Reviews in Clinical Gerontology 12, no. 3 (August 2002): 213–20. http://dx.doi.org/10.1017/s0959259802012340.

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It is clearly established that older people suffer a high rate of disease related to medication. Probably the major reason for this is that older patients are prescribed more drugs than younger people and the rate of prescribing appears to be increasing all the time. In the UK, data are currently collected on all prescriptions dispensed and this shows that older patients (aged over 65 years) receive 35-40% of all drugs prescribed. Between 1977 and 1988, prescription items increased by 17% overall, but by 52% in people over 65 years. compared to only 1% in adults under 65. Prescription rates are rising for a number of reasons, including new advances in therapeutics, a rapidly enlarging older population, moves to treat older patients more effectively (i.e. a less agist policy), rising patient expectations and defensive medical practice.

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Mukhopadhyay, Indranil, Frank Lally, and Peter Crome. "Appropriate prescribing in older people." Reviews in Clinical Gerontology 17, no. 2 (May 2007): 139–51. http://dx.doi.org/10.1017/s0959259808002396.

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As people age they almost invariably develop diseases which lead to the prescription of drugs – both to prevent disease progression and for symptomatic relief. Unfortunately, drug treatment in later life is also problematic. There is a dearth of evidence on the efficacy of drugs in people over the age of 80, and members of this age group are at highest risk of adverse drug reactions (ADR).

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Remiao, M. Y. T., J. Blythe, R. Anand, and P. Brennan. "Preoperative investigation prescribing practice in OMFS: are we prescribing appropriately?" British Journal of Oral and Maxillofacial Surgery 49 (June 2011): S92. http://dx.doi.org/10.1016/j.bjoms.2011.03.193.

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Issa El-Hussain, Fatima, Abdullah Balkhair, Ibrahim Al-Zakwani, and Mohammed Al Za’abi. "Appropriateness of antifungal prescribing in Oman." Pharmacy Practice 20, no. 1 (March 26, 2022): 2613. http://dx.doi.org/10.18549/pharmpract.2022.1.2613.

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Wheeler, Evan D., Gerry McDonald, and Peter Daley. "Appropriateness of antibiotic use in community hospitals in rural Newfoundland and Labrador." Official Journal of the Association of Medical Microbiology and Infectious Disease Canada 6, no. 2 (July 2021): 114–18. http://dx.doi.org/10.3138/jammi-2020-0041.

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Background: Surveillance of the appropriateness of antimicrobial prescribing can identify targets for quality improvement in antimicrobial stewardship. Our objective was to measure antibiotic prescription prevalence, indication, and appropriateness at three rural community hospitals in a 1-day point prevalence study. Methods: Inpatient antibiotic prescriptions given at three community hospitals on April 24, 2019 were provided by the hospital pharmacies. These prescriptions were analyzed using the Australian National Antimicrobial Prescribing Survey (NAPS) tool. Prescriptions were assessed by an infectious diseases physician and analyzed per prescription. Results: Eighty prescriptions given to 58 inpatients were included. Antibiotic treatment prevalence was 58/120 beds (48.3%), and overall appropriateness was 37/80 prescriptions (46.3%). The most prescribed antibiotics were ceftriaxone (17 [21.3%]; 47.1% appropriate), piperacillin–tazobactam (10 [12.5%]; 10.0% appropriate), and moxifloxacin (9 [11.3%]; 0% appropriate). The most common indications were respiratory tract infections (36 [45.0%]; 36.1% appropriate), skin and soft tissue infections (14 [17.5%]; 78.6% appropriate), and urinary tract infections (9 [11.3%]; 11.1% appropriate). Of the 80 prescriptions, 50 (62.5%) documented an indication, and 71 (88.8%) documented a stop or review date. Conclusions: We observed a high treatment prevalence and low appropriateness. Overall appropriateness was lower than in urban hospitals.

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Wattles, Bethany A., Kahir S. Jawad, Yana Feygin, Maiying Kong, Navjyot Vidwan, Michelle D. Stevenson, and Michael J. Smith. "1333. A Cross-Sectional Analysis of Inappropriate Outpatient Antibiotic Use in Children Insured by Kentucky Medicaid." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S678. http://dx.doi.org/10.1093/ofid/ofaa439.1515.

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Abstract Background Kentucky (KY) consistently has one of the highest rates of outpatient pediatric antibiotic prescribing in the nation. Previous analyses identified significant variation in volume of antibiotic prescribing by geographic location, patient demographics, and provider type, but less is known about the appropriateness of this prescribing. We describe appropriateness of outpatient antibiotic prescribing in children insured by KY Medicaid. Methods We utilized KY Medicaid pharmacy and medical claims from 2017 for children < 20 years. Patient demographic variables were abstracted from Medicaid enrollment data. Antibiotic prescriptions were identified by NDC and matched to medical claims within 3 days prior to fill date to identify corresponding diagnoses via ICD-10 codes. A previously published appropriateness classification scheme (Chua, BMJ 2019) was applied to categorize antibiotic prescriptions as “appropriate”, “potentially appropriate”, “inappropriate” or “not associated with indication”. Results Of the 779,751 antibiotic prescriptions included, 19.5% were appropriate, 45.3% were potentially appropriate, 20.8% were inappropriate, and 14.4% were not associated with an indication (Table 1). Inappropriate prescriptions were more common among children 0-2 years (24.4%) and those living in non-metro areas (22.2%). Antibiotics prescribed by general practitioners were also more likely to be inappropriate (22.2%). The most common diagnoses for each category are summarized in Table 2. Amoxicillin was the most commonly prescribed antibiotic in all categories. Azithromycin was more frequently prescribed for inappropriate indications or those not associated with a diagnosis code. Cefdinir was more common for appropriate and potentially appropriate indications. Table 1: Antibiotic Prescription Characteristics, 2017 Table 2: Top Diagnoses for Antibiotic Prescriptions by Category Conclusion Inappropriate antibiotic prescribing is more common among young children living in non-metro areas seen by general practitioners. Outpatient antibiotic stewardship interventions should target these patient demographics and provider types. This classification scheme to describe inappropriate prescribing is feasible for use in pediatric Medicaid patients and could serve as a valuable metric for provider feedback reports on antibiotic use. Disclosures Bethany A. Wattles, PharmD, Kentucky Medicaid (Grant/Research Support)Merck (Grant/Research Support) Michael J. Smith, MD, MSC.E, Kentucky Medicaid (Grant/Research Support)Merck (Grant/Research Support)

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Wattles, Bethany A., James A. Stahl, Kahir S. Jawad, Yana Feygin, Maiying Kong, Navjyot Vidwan, Michelle D. Stevenson, and Michael J. Smith. "1123. Appropriateness of Antibiotic Prescribing Through the COVID-19 Pandemic and Associated Telehealth Visits." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S653. http://dx.doi.org/10.1093/ofid/ofab466.1316.

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Abstract Background The COVID-19 pandemic and resulting mitigation strategies have impacted rates of outpatient infections and delivery of care to pediatric patients. Virtual healthcare was rapidly implemented but much is unknown about the quality of care provided in telehealth visits. We sought to describe changes in visits throughout the pandemic and evaluate the appropriateness of antibiotic prescribing. Methods We utilized EHR data from a large health care system that provides primary care via pediatric, family medicine, and urgent care clinics. We included outpatient visits from 1/1/19 - 4/30/21 for children < 20 years. The COVID-19 era was defined as after March 2020. Visits were labeled as virtual according to coded encounter or visit type variables. The appropriateness of antibiotic prescriptions was assigned using a previously published ICD-10 classification scheme that defines each prescription as appropriate, potentially appropriate, or inappropriate (Chua, et al. BMJ, 2019). Results There were 805,130 outpatient visits during the study period. The mean rate of antibiotic prescriptions in the pre-pandemic period was 23% (range 17-26% per month) and 11% (range 9-15%) in the COVID-19 era. Mean rates of inappropriate prescribing were 17% (range 14-20% per month) and 20% (range 19-22%), respectively (Figure 1). Coded virtual visits during the COVID-19 era were uncommon (1-2%) with the exception of April and May 2020 (11% and 5%, respectively). During the COVID-19 era, approximately 9% of telehealth visits resulted in antibiotics, compared to 11% of in-person visits (Table 1). Virtual visits had lower rates of inappropriate and appropriate prescribing, but higher rates of potentially appropriate prescribing (Table 1). Visits and associated antibiotic prescribing in the pre-pandemic and COVID-19 era Appropriateness of antibiotic prescribing in the COVID-19 era, by visit type Conclusion Rates and volume of antibiotic prescribing in outpatient pediatric visits have declined in the COVID-19 era, while rates of inappropriate prescribing have increased slightly. Our study suggests use of telehealth for pediatric visits was minimal and led to higher prescribing rates for “potentially appropriate” indications. This could be explained by a lack of clinical certainty in conditions such as otitis media and pharyngitis in virtual visits. Disclosures Bethany A. Wattles, PharmD, MHA, Merck (Grant/Research Support, Research Grant or Support) Yana Feygin, Master of Science, Merck (Grant/Research Support, Research Grant or Support) Michelle D. Stevenson, MD, MS, Merck (Grant/Research Support) Michael J. Smith, MD, M.S.C.E, Merck (Grant/Research Support)Pfizer (Grant/Research Support)

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Jones, Jacklyn. "Tackling undernutrition through appropriate supplement prescribing." British Journal of Community Nursing 8, no. 8 (August 2003): 343–52. http://dx.doi.org/10.12968/bjcn.2003.8.8.11564.

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Stockmann, Chris. "Appropriate prescribing for acute childhood infections." Paediatrics and International Child Health 35, no. 1 (July 28, 2014): 1–2. http://dx.doi.org/10.1179/2046905514y.0000000138.

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&NA;. "Antibacterial prescribing habits in Germany appropriate." Inpharma Weekly &NA;, no. 849 (August 1992): 14. http://dx.doi.org/10.2165/00128413-199208490-00030.

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Doyle, Harry. "Need for information about appropriate prescribing." Psychiatric Bulletin 18, no. 12 (December 1994): 778–79. http://dx.doi.org/10.1192/pb.18.12.778-c.

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Choi, Patricia W., Jessica A. Benzer, Joel Coon, Nnaemeka E. Egwuatu, and Lisa E. Dumkow. "Impact of pharmacist-led selective audit and feedback on outpatient antibiotic prescribing for UTIs and SSTIs." American Journal of Health-System Pharmacy 78, Supplement_2 (March 26, 2021): S62—S69. http://dx.doi.org/10.1093/ajhp/zxab110.

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Abstract Purpose An estimated 30% of all outpatient antibiotic prescriptions in the United States are unnecessary. The Joint Commission, in 2016, implemented core elements of performance requiring antimicrobial stewardship programs (ASPs) to expand to outpatient practice settings. A study was conducted to determine whether pharmacist-led audit and feedback would improve antibiotic prescribing for urinary tract infections (UTIs) and skin and soft tissue infection (SSTIs) at 2 primary care practices. Methods A retrospective, quasi-experimental study was conducted to evaluate antibiotic prescribing for patients treated for a UTI or SSTI at 2 primary care offices (a family medicine office and an internal medicine office). The primary objective was to compare the rate of appropriate antibiotic prescribing to patients treated before implementation of a pharmacist-led audit-and-feedback process for reviewing antibiotics prescribed for UTIs and SSTIs (the pre-ASP group) and patients treated after process implementation (the post-ASP group). Total regimen appropriateness was defined by appropriate antibiotic selection, dose, duration, and therapy indication in accordance with institutional outpatient empiric therapy guidelines. Secondary objectives included comparing rates of infection-related revisits and Clostridioides difficile infection between groups. Results A total of 400 patients were included in the study (pre-ASP group, n = 200; post-ASP group, n = 200). The rate of total antibiotic prescribing appropriateness improved significantly, from 27.5% to 50.5% (P < 0.0001), after implementation of the audit-and-feedback process. There were also significant improvements in the post-ASP group vs the pre-ASP period in the individual components of regimen appropriateness: appropriate drug (70% vs 53%, P < 0.001), appropriate duration (83.5% vs 57.5%, P < 0.001), and appropriate therapy indication (98% vs 94%, P = 0.041). There were no significant between-group differences in other outcomes such as rates of adverse events, treatment failure, C. difficile infection, and infection-related revisits or hospitalizations within 30 days. Conclusion A pharmacist-led audit-and-feedback outpatient stewardship strategy was demonstrated to achieve significant improvement in outpatient antibiotic prescribing for UTI and SSTI.

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Hood, Graeme, Kieran Hand, Emma Cramp, Philip Howard, Susan Hopkins, and Diane Ashiru-Oredope. "Measuring Appropriate Antibiotic Prescribing in Acute Hospitals: Development of a National Audit Tool Through a Delphi Consensus." Antibiotics 8, no. 2 (April 29, 2019): 49. http://dx.doi.org/10.3390/antibiotics8020049.

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This study developed a patient-level audit tool to assess the appropriateness of antibiotic prescribing in acute National Health Service (NHS) hospitals in the UK. A modified Delphi process was used to evaluate variables identified from published literature that could be used to support an assessment of appropriateness of antibiotic use. At a national workshop, 22 infection experts reached a consensus to define appropriate prescribing and agree upon an initial draft audit tool. Following this, a national multidisciplinary panel of 19 infection experts, of whom only one was part of the workshop, was convened to evaluate and validate variables using questionnaires to confirm the relevance of each variable in assessing appropriate prescribing. The initial evidence synthesis of published literature identified 25 variables that could be used to support an assessment of appropriateness of antibiotic use. All the panel members reviewed the variables for the first round of the Delphi; the panel accepted 23 out of 25 variables. Following review by the project team, one of the two rejected variables was rephrased, and the second neutral variable was re-scored. The panel accepted both these variables in round two with a 68% response rate. Accepted variables were used to develop an audit tool to determine the extent of appropriateness of antibiotic prescribing at the individual patient level in acute NHS hospitals through infection expert consensus based on the results of a Delphi process.

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Douglas, Abby, Lisa Hall, Rodney James, Leon Worth, Monica Slavin, and Karin Thursky. "1010. Exploring Antimicrobial Prescriptions in a National Audit of Hematology/Oncology Inpatients Compared with the General Inpatient Population: Targeted Analysis Highlights Key Areas for Targeted Intervention." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S355. http://dx.doi.org/10.1093/ofid/ofz360.874.

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Abstract Background Little is known about the antimicrobial prescribing practices in hematology and oncology (haemonc) populations. We aimed to explore antimicrobial prescribing practices in haemonc patients compared with other acute inpatients, in order to target areas for intervention. Methods In Australia, facilities nationwide participate in an annual point-prevalence survey of antimicrobial prescribing in hospitalized patients (Hospital National Antimicrobial Prescribing Survey (Hospital NAPS)). The results for adult inpatients from 2015–2018 were analyzed. Assessments of appropriateness were undertaken by local antimicrobial stewardship teams according to a structured algorithm, and defined as: 1 (optimal); 2 (adequate); 3 (suboptimal); 4 (inadequate); 5 (not assessable). A score of 1 or 2 is considered to be”appropriate’ and 3 or 4 ‘inappropriate’; those not assessable were excluded. Antimicrobial class, indication and appropriateness were compared between haemonc and other acute inpatient populations. Using logistic regression analysis, factors associated with appropriate prescribing of antibacterials were explored. Results The survey comprised 95809 antibiotic prescriptions for 63668 adult inpatients (4097 haemonc, 59571 other inpatients) in 423 acute facilities. The top treatment and prophylactic indications for all classes of antimicrobials were highly disparate between haemonc and other inpatients (table). Of note in the haemonc group, vancomycin use was high, and amphotericin B was used frequently for antifungal treatment. In multivariate analysis, haemonc patients were strongly associated with antibacterial appropriateness compared with other inpatients (adjusted OR 1.72, 95% CI 1.59–1.87, P < 0.001); factors associated with inappropriate prescription included antibiotic allergies and prophylactic indications. Conclusion Haemonc patients were more likely to receive appropriate antimicrobials compared with other inpatients. However, we have identified key areas for targeted interventions (prophylaxis use, antimicrobial allergy labels, vancomycin and amphotericin B treatment). Separate analysis of haemonc populations is necessary to identify key areas of concern specific to this patient group. Disclosures All authors: No reported disclosures.

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Matera, Robert M., Christine M. Duffy, James Robbins, Camille Higel-Mcgovern, Ashley Chartier, and Don S. Dizon. "Appropriateness of opioid prescribing in cancer patients." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e24129-e24129. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e24129.

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e24129 Background: The American Cancer Society estimates 48% people with cancer and 34% of cancer survivors report issues with chronic pain and 43 and 10% report taking an opioid, respectively. We sought to further examine the indications for pain medications in people with cancer and whether they were related to cancer, treatment, or neither. Methods: Retrospective chart review was conducted on 122 cancer patients treated at a single American academic cancer center. Authors created criteria to categorize whether patients’ pain was attributable to their malignancy or treatment regimen. Two trained coders reviewed each case with a third to resolve coding differences. Pain due to disease was further subdivided into pre-determined categories (tumor site, fracture, surgery, neuropathy, disease progression). The relationship between demographic, disease and pain type were examined in relation to inappropriate opioid prescribing using Chi-square analysis and Fischer’s exact test. Results: 55% of patients were male, 39% had metastatic disease, and 33% NED. 95% had received chemotherapy 69% radiation and 43% surgery. Factors associated with inappropriate opioid prescribing included increased age and female sex. Appropriateness of opioid prescribing was not associated with a specific cancer type or pain indication subset. Conclusions: As survivorship among cancer patients increases this may result in a cohort of patients in which opioid pain medication may not be indicated and in whom the risks may outweigh the benefits.

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Loosbrock, Danielle L., Molly E. Tomlin, Rebecca L. Robinson, Robert L. Obenchain, and Thomas W. Croghan. "Appropriateness of Prescribing Practices for Serotonergic Antidepressants." Psychiatric Services 53, no. 2 (February 2002): 179–84. http://dx.doi.org/10.1176/appi.ps.53.2.179.

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Buetow, Stephen A., Bonnie Sibbald, Judith A. Cantrill, and Shirley Halliwell. "Appropriateness in health care: Application to prescribing." Social Science & Medicine 45, no. 2 (July 1997): 261–71. http://dx.doi.org/10.1016/s0277-9536(96)00342-5.

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Rijswijk, E. van, S. M. Zandstra, E. H. van de Lisdonk, F. G. Zitman, and C. van Weel. "Appropriateness of benzodiazepine prescribing in general practice." Int. Journal of Clinical Pharmacology and Therapeutics 43, no. 08 (August 1, 2005): 411–12. http://dx.doi.org/10.5414/cpp43411.

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Cooper, R., J. Pinkney, and R. M. Ayling. "Appropriateness of prescribing thyroxine in primary care." Annals of Clinical Biochemistry: An international journal of biochemistry and laboratory medicine 52, no. 4 (January 9, 2015): 497–501. http://dx.doi.org/10.1177/0004563214568686.

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Healy, David, and David Nutt. "Prescriptions, licences and evidence." Psychiatric Bulletin 22, no. 11 (November 1998): 680–84. http://dx.doi.org/10.1192/pb.22.11.680.

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Aims and methodThere is considerable confusion at present among clinicians as regards the appropriateness of prescribing off-licence. Because of the nature of the registration process it is likely that a considerable proportion of prescribing will always be off-licence. This paper seeks to clarify when it is appropriate to prescribe off-licence. We convened a workshop on behalf of the British Association for Psychopharmacology involving clinicians and regulators from a variety of countries to explore this issue both generally and for specific childhood and learning disability clinical situations. Recent statements from the defence unions and consumer groups were also scrutinised.ResultsAcross senior clinicians and regulators from a number of European countries and North America there is a consensus that prescribing off-licence is a necessary part of the art of medicine.Clinical implicationsCurrent advice to clinicians on the issue of off-licence prescribing can sometimes overemphasise the hazards and neglect the benefits that may stem from appropriate off-licence prescribing. Good prescribing involves specifying treatment goals and monitoring outcomes and it is more important to share this with the patient than it is to communicate the licensed status of the drug being prescribed.

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Ulfa, Cut Fatia, Woro Supadmi, Dyah Aryani Perwitasari, and Endang Yuniarti. "Correlation Between Appropriateness Prescribing Antibiotics and Clinical Improvement on Hospitalized Patients with Community Acquired Pneumonia Based on The Gyssens Method." JURNAL ILMU KEFARMASIAN INDONESIA 19, no. 1 (April 21, 2021): 30. http://dx.doi.org/10.35814/jifi.v19i1.940.

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Community-acquired pneumonia is an acute inﬂammation of the pulmonary parenchyma caused by bacterial infection. . The main therapy for community-acquired pneumonia is the use of antibiotics. Inappropriate antibiotics can lead to bacterial resistance. The study aims to determine Appropriateness of antibiotics prescribing using the method Gyssens with clinical improvement. This study is a retrospective analytic cohort descriptive. Data was collected retrospectively based on medical records of inpatients at one of the hospital in Yogyakarta for the January-December 2019 period based. The accuracy of empiric antibiotic prescription using the Gyssens method. The clinical improvements observed were leukocyte count, temperature, respiratory rate. This study was analyzed using the chi square method. The results showed 41 patients met the inclusion and exclusion criteria, male gender (51.2%), age> 60 years 68.3%, the average length of stay was ﬁve days. Ceftriaksone is a commonly used antibiotic. Evaluation prescribing appropriateness based on the Gyssens method of 52 antibiotic regimens. appropriate antibiotic prescribing (13.5%) and inappropriate (86.5%). The correlation between appropriateness of antibiotics prescribing with clinical improvement leukocytes count, respiratory rate and temperature did not signiﬁcant (p> 0.05). There was no correlation between the accurasy of antibiotics prescribing based on the Gyssens method with clinical improvement.

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&NA;. "Appropriate prescribing the answer to antibacterial resistance?" Inpharma Weekly &NA;, no. 1124 (February 1998): 5. http://dx.doi.org/10.2165/00128413-199811240-00008.

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Arcavi, Lidia, Doaa Okasha, Suzi Trepp, Moshe Nehemya, Imad Kassis, Salim Haddad, and Norberto Krivoy. "Appropriate Antibiotic Prescribing Pattern in Hospitalized Children." Current Drug Safety 5, no. 3 (July 1, 2010): 194–202. http://dx.doi.org/10.2174/157488610791698343.

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Kazandjian, V. A. "Does appropriate prescribing result in safer care?" Quality and Safety in Health Care 13, no. 1 (February 1, 2004): 9–10. http://dx.doi.org/10.1136/qshc.2003.008698.

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36

Fisher, Rebecca. "Towards appropriate nutritional prescribing: challenges and solutions." Journal of Prescribing Practice 1, no. 11 (November 2, 2019): 556–64. http://dx.doi.org/10.12968/jprp.2019.1.11.556.

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The appropriate prescribing of nutritional supplements is coming under increasing scrutiny due to rising costs, workforce challenges, and a product pricing model that does not meet the needs of the healthcare economy. Data show that, whilst the number of items being prescribed is marginally decreasing, the cost of these items is increasing, and the assumption that all patients discharged on nutritional borderline substances from hospital have been assessed by a dietitian cannot be made. Standards of communication are highly variable but, with increasing knowledge about best practice and digitalisation, improvements are being made. There is a disparity between adequate knowledge of nutrition, prescribing, and best use of resources to effectively manage patient-centred care and costs. A number of strategies are being trialled to improve education and the utilisation of the right workforce. The need for a clear public health message on the importance of maintaining weight in older age is essential to ensure nutritional borderline substances are appropriately used.

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Lavan, Amanda Hanora, John O’Grady, and Paul Francis Gallagher. "Appropriate prescribing in the elderly: Current perspectives." World Journal of Pharmacology 4, no. 2 (2015): 193. http://dx.doi.org/10.5497/wjp.v4.i2.193.

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Cantillon, Peter. "Inappropriate prescribing: are there ‘appropriate’ educational solutions?" Education for Primary Care 24, no. 4 (January 2013): 294–96. http://dx.doi.org/10.1080/14739879.2013.11494188.

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Ljungberg, Christina, Åsa Kettis Lindblad, and Mary Tully. "Secondary care doctors' perception of appropriate prescribing." Journal of Evaluation in Clinical Practice 15, no. 1 (February 2009): 110–15. http://dx.doi.org/10.1111/j.1365-2753.2008.00963.x.

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Sikkens, Jonne J., Sophie L. Gerritse, Edgar J. G. Peters, Mark H. H. Kramer, and Michiel A. van Agtmael. "The ‘morning dip’ in antimicrobial appropriateness: circumstances determining appropriateness of antimicrobial prescribing." Journal of Antimicrobial Chemotherapy 73, no. 6 (March 5, 2018): 1714–20. http://dx.doi.org/10.1093/jac/dky070.

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Saatchi, Ariana, Jennifer N. Reid, Marcus Povitz, Salimah Z. Shariff, Michael Silverman, Andrew M. Morris, Romina C. Reyes, David M. Patrick, and Fawziah Marra. "Appropriateness of Outpatient Antibiotic Use in Seniors across Two Canadian Provinces." Antibiotics 10, no. 12 (December 3, 2021): 1484. http://dx.doi.org/10.3390/antibiotics10121484.

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Antimicrobials are among the most prescribed medications in Canada, with over 90% of antibiotics prescribed in outpatient settings. Seniors prescribed antimicrobials are particularly vulnerable to adverse drug events and antimicrobial resistance. The extent of inappropriate antibiotic prescribing in outpatient Canadian medical practice, and the potential long-term trends in this practice, are unknown. This study is the first in Canada to examine prescribing quality across two large-scale provincial healthcare systems to compare both quantity and quality of outpatient antibiotic use in seniors. Population-based analyses using administrative health databases were conducted in British Columbia (BC) and Ontario (ON), and all outpatient, oral antimicrobials dispensed to seniors (≥65 years) from 1 January 2000 to 31 December 2018 were identified. Antimicrobials were linked to an indication using a 3-tiered hierarchy. Tier 1 indications, which always require antibiotics, were given priority, followed by Tier 2 indications that sometimes require antibiotics, then Tier 3, which never require antibiotics. Prescription rates were calculated per 1000 population, and trends were examined overall, by drug class, and by patient demographics. Prescribing remained steady in both provinces, with 11,166,401 prescriptions dispensed overall in BC, and 27,656,014 overall in ON. BC prescribed at slightly elevated rates (range: 790 to 930 per 1000 residents), in comparison to ON (range: 745 to 785 per 1000 residents), throughout the study period. For both provinces, a Tier 3 diagnosis was the most common reason for antibiotic use, accounting for 50% of all indication-associated antibiotic prescribing. Although Tier 3 indications remained the most prescribed-for diagnoses throughout the study period, a declining trend over time is encouraging, with much room for improvement remaining. Elevated prescribing to seniors continues across Canadian outpatient settings, and prescribing quality is of high concern, with 50% of all antimicrobials prescribed inappropriately for common infections that do not require antimicrobials.

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Gonçalves, João R., Betsy L. Sleath, Manuel J. Lopes, and Afonso M. Cavaco. "Prescribing-Assessment Tools for Long-Term Care Pharmacy Practice: Reaching Consensus through a Modified RAND/UCLA Appropriateness Method." Pharmacy 9, no. 4 (December 3, 2021): 194. http://dx.doi.org/10.3390/pharmacy9040194.

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Medicines are the most used health technology in Long-Term Care. The prevalence of potentially inappropriate medicines amongst Long-Term Care patients is high. Pharmacists, assisted by prescribing-assessment tools, can play an important role in optimizing medication use at this level of care. Through a modified RAND/UCLA Appropriateness Method, 13 long-term care and hospital pharmacists assessed as ‘appropriate’, ‘uncertain’, or ‘inappropriate’ a collection of commonly used prescribing-assessment tools as to its suitability in assisting pharmacy practice in institutional long-term care settings. A qualitative analysis of written or transcribed comments of participants was pursued to identify relevant characteristics of prescribing-assessment tools and potential hinders in their use. From 24 different tools, pharmacists classified 9 as ‘appropriate’ for pharmacy practice targeted to long-term care patients, while 3 were classified as ‘inappropriate’. The tools feature most appreciated by study participants was the indication of alternatives to potentially inappropriate medication. Lack of time and/or pharmacists and limited access to clinical information seems to be the most relevant hinders for prescribing-assessment tools used in daily practice.

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Ray, Michael J., Caitlin M. McCracken, Kendall J. Tucker, Diana Yu, Margaret Underwood, Erin Wu, Kylee Kastelic, Dawn Nolt, and Jessina C. McGregor. "225. Evaluating Appropriateness of Antibiotic Prescribing in Pediatric Inpatients." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S113—S114. http://dx.doi.org/10.1093/ofid/ofaa439.269.

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Abstract Background Antibiotic appropriateness is the gold standard for informing antimicrobial stewardship efforts to optimize prescribing. The objectives of this study were to evaluate appropriateness of antibiotics for resistant gram-positive infections in pediatric inpatients and identify factors associated with inappropriate prescribing. Methods We included pediatric inpatients between July 2017 and July 2018 where an antibiotic typically used for resistant Gram-positive infections (per NHSN) was administered. We developed an algorithm based on laboratory data and diagnosis codes to categorize each antibiotic day of therapy as appropriate, inappropriate, or indeterminate. If indeterminate, we reviewed charts to assess appropriateness. We calculated total, appropriate, and inappropriate days of therapy (DOT) overall and per patient-day. We evaluated clinical characteristics and indications as potential predictors of inappropriate DOT using Chi-squared or Kruskal-Wallis tests. Results Among 591 included encounters, we assessed 708 total antibiotic courses. The algorithm allowed for classification of 422 encounters (71%) and the remaining 171 encounters (29%) were classified using manual record review. The most frequent antibiotics were vancomycin (68%) and clindamycin (29%). Patients received a median of 3 days of gram-positive agent therapy per visit, or 5 per every 10 patient-days. Most common indications for gram-positive therapy were surgical prophylaxis (28% of encounters) and empiric therapy (10%) (Figure 1). Of the 1,754 total days of therapy assessed, 94.8% were ruled appropriate. Thirty-one (4.4%) courses were classified as at least partially inappropriate among 27 unique encounters (4.6%). There was a median of 2 inappropriate days among those with any inappropriate therapy. The reason for inappropriate rulings for empiric or prophylaxis indications was most often “longer than necessary duration,” which was the case for 16 of 21 (76%) occurrences. Figure 1. Appropriate and Inappropriate Days of Therapy (DOT) by Indication and Antibiotic Conclusion Inappropriate antibiotic use for Gram-positive infections was low in our patient population for the agents studied. We identified limiting the duration for patients receiving prophylactic or empiric therapy as a potential stewardship intervention target. Disclosures All Authors: No reported disclosures

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Blades, Stephen, Martin Eccles, Elaine McColl, and Mark Campbell. "Understanding the Appropriateness of Prescribing in Primary Care." European Journal of General Practice 4, no. 2 (January 1998): 60–64. http://dx.doi.org/10.3109/13814789809160795.

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Mintzes, Barbara, and Agnes Vitry. "‘Drugs to avoid’: can we improve prescribing appropriateness?" Drug and Therapeutics Bulletin 59, no. 11 (October 28, 2021): 162. http://dx.doi.org/10.1136/dtb.2021.000029.

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46

Guell, Rous. "Long-term oxygen therapy: Are we prescribing appropriately?" International Journal of Chronic Obstructive Pulmonary Disease Volume 3 (June 2008): 231–37. http://dx.doi.org/10.2147/copd.s1230.

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Grégoire, Jean-Pierre, Jocelyne Moisan, Isabelle Chabot, and Michel Gaudet. "Appropriateness of Omeprazole Prescribing in Quebec’s Senior Population." Canadian Journal of Gastroenterology 14, no. 8 (2000): 676–80. http://dx.doi.org/10.1155/2000/702980.

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BACKGROUND: Prescribing omeprazole for the treatment of digestive disorders accounts for an important part of the costs in Quebec’s drug benefit plan. In July 1993, the Quebec drug program listed omeprazole, with restriction, in its formulary. On January 1, 1994, this restriction was lifted; since then, omeprazole has been listed in the regular provincial formulary.OBJECTIVE: To describe the appropriateness of initial omeprazole prescribing in the ambulatory senior population of Quebec in the 27 months after being listed without restriction.SUBJECTS AND METHODS: A retrospective population-based cohort study was performed using prescription and medical services claims databases of the Quebec drug program. Data were extracted for elderly patients who received their first omeprazole prescription between July 1, 1994 and March 31, 1996. RESULTS: Among the 47,140 first-time users of omeprazole identified, 7516 (15.9%) had had an endoscopy in the previous six months, 2308 (4.9%) were given an antimicrobial agent and omeprazole simultaneously, and 22,730 (48.2%) received omeprazole after prior use of an H2receptor antagonist (H2RA) or a prokinetic drug. A total of 26,525 (56.3%) first-time users were prescribed omeprazole based on at least one of the three criteria listed above. Among these users, 729 (2.8%) received an H2RA concurrently with omeprazole. Altogether, 25,796 (54.7%) first-time users received omeprazole appropriately.CONCLUSIONS: Although reimbursement for omeprazole prescriptions has not been restricted in Quebec since January 1, 1994, it was prescribed appropriately for elderly patients in the majority of cases studied.

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McCarthy, Lisa M., Jessica D. Visentin, and Paula A. Rochon. "Assessing the Scope and Appropriateness of Prescribing Cascades." Journal of the American Geriatrics Society 67, no. 5 (February 12, 2019): 1023–26. http://dx.doi.org/10.1111/jgs.15800.

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MD, Kenneth Schmader, Joseph T. Hanlon, Morris Weinberger, Pamela B. Landsman, Gregory P. Samsa, Ingrid Lewis, Kay Uttech, Harvey J. Cohen, and John R. Feussner. "Appropriateness of Medication Prescribing in Ambulatory Elderly Patients." Journal of the American Geriatrics Society 42, no. 12 (December 1994): 1241–47. http://dx.doi.org/10.1111/j.1532-5415.1994.tb06504.x.

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Toscani, Franco. "Prescribing in palliative care A quest for appropriateness." Palliative Medicine 27, no. 4 (March 28, 2013): 293–94. http://dx.doi.org/10.1177/0269216313479843.

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