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  • 1
    ISSN: 1432-1041
    Keywords: drug utilisation ; prescribing habits ; hypnotics ; sedatives ; minor tranquillisers ; defined daily doses ; therapeutic audit
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The utilisation of hypnotics, sedatives, and minor tranquillisers (HSmT) was studied by means of drug-delivery and hospital occupancy statistics for 1975–1977 in a Swedish university hospital. A total of 0.53 so-called defined daily doses (DDD)/bed-day were delivered in 1975, implying that every second patient might have regularly been prescribed HSmT. The benzodiazepines were predominant with 71% of the deliveries. Five major drugs accounted for 88%. The drug pattern and the range of DDD/bed-day (0.09–1.18) differed considerably between the departments. Drugs not recommended by the hospital's Pharmacy and Therapeutics Committee accounted only for 3% of deliveries. In a drug surveillance study performed in two medical wards, HSmT were prescribed for 43% of 274 patients. Drug delivery and prescription data were in broad agreement. Drug information activities in the hospital had a clearly discernable influence on the delivered DDD/bed-day. This measure is an inexpensive indicator of drug utilisation in a hospital and a suitable basis for therapeutic audit.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1041
    Keywords: drug problems ; patient compliance ; adverse drug reactions ; interview ; pharmacokinetics ; inadequate therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The association between hospital admission and drug-related problems was evaluated in 285 consecutive admissions to two medical wards in a Swedish university hospital. Standardised definitions and criteria for causality were used. A drug-related problem was judged to have been the main reason for admission of 36 patients, and a strongly contributory reason for 9. These 45 patients comprised 16% of all patients, and 19% of those receiving medication prior to admission. For 19 patients the problem was considered to be failure to achieve the desired therapeutic effect. 11 of these 19 took less medication than prescribed, and an inadequate dose had been presented for the other 8 patients. In 26 patients there was an excessive or otherwise adverse effect. In 10 it was an intentional or accidental poisoning, and 16 had an adverse drug reaction. Non-compliance with the prescribed regimen caused almost half of the drug-related admissions: 11 took too little and 10 took too much of the prescribed drugs. The majority of the other problems could probably have been prevented by better application of pharmacokinetic principles to the prescribing.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1041
    Keywords: chlorpropamide ; diabetes ; drug utilisation ; patient compliance ; diet ; plasma concentration ; maturity onset diabetes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary Serum chlorpropamide concentrations (s-CPA) were determined and related to clinical findings in 83 outpatients with maturity onset diabetes. The daily doses of CPA (mg/kg) varied six-fold, but s-CPA ranged 18-fold between the patients. There was a significant correlation between dose and s-CPA (r=0.61), which rose to 0.75 in the 30 patients who had prescribed no other drugs. Patients given other drugs concomitantly were over-represented amongst subjects with extreme values of apparent plasma clearance of CPA. There was no correlation either between serum creatinine or age and s-CPA. Of the 83 patients 40 (48%) had acceptable blood and urinary glucose values according to our criteria; but as 17 were overweight, only 23 patients (28%) had acceptable clinical control. Of the remaining 60 patients, too low a dose was being given to only 12, and dietary failure was the most probable explanation in the others. Thirteen patients (16%) probably did not need CPA. It is likely that this is a partial explanation for the high utilisation of oral antidiabetic drugs in Sweden. There was no general correlation between dose or s-CPA and blood glucose values, but analysis of s-CPA may still be of value in explaining unexpected changes in clinical control.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-1041
    Keywords: compliance ; prescribing habits ; drug utilisation ; age effect ; multiple therapies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The drug history of 285 consecutive patients admitted to two medical wards of a Swedish university hospital was investigated. In 30 cases (11%) no information about current drug therapy could be obtained from the patients themselves, and in further 21 (7%) additional drugs from other sources were discovered. Current drug therapy of 234 patients (82%) was identified, of whom 217 had medicines supplied by prescription and 52 used drugs bought over the counter. The medication was “chronic” for 85% of the prescribed drugs, and 18% were prescribed to be taken as required. Significantly more women than men were taking medicines, but, amongst the users, there was no significant difference in the number of drugs taken by men or women. The average number of drugs prescribed for the 217 patients was 3.7, more being prescribed for the older patients. Cardiovascular and psychotropic medicines were the agents most commonly prescribed. Digoxin was prescribed for 65 patients. The mean daily dose was 0.20 mg, and it was reduced for older patients and for those with elevated serum creatinine. Twelve patients (19%) had no measurable digoxin in their plasma; the median concentration was 1.15 nmol/l. Ten of 32 patients (31%) had a significant change in their plasma digoxin concentration after supervised drug intake in hospital, indicating previous irregular intake of digoxin. Compliance with the prescribed drug regimen was evaluated from interviews of 151 patients. Of them, 59 (39%) were classified as having been non-compliant for half their drugs during the last two days prior to admission. Non-compliance was reported significantly more often by patients who were aged 65 years or more, and who had more than three drugs prescribed for regular intake. The number of drugs prescribed did not seem to influence compliance in patients under 65 years of age. Significantly more doses were reported to be missed for drugs meant to be taken thrice daily (31%), than for those with once (18%) or twice (20%) daily dosage schedule. The difference between once and twice daily schedules was not significant.
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