Search

Aim: To determine the duration of initial treatment with high strength proton pump inhibitors prescribed for gastro-oesophageal reflux disease in the veteran population in Australia and variance by the medical professional who initiated treatment. Method: Retrospective cohort study in the Australian veteran population using Department of Veterans' Affairs pharmacy claims data. Veterans who had been dispensed at least one prescription for the high strength proton pump inhibitor indicative of gastro-oesophageal reflux disease between 1 July 2004 and 30 June 2007, were eligible for full health services, and who had not been dispensed any proton pump inhibitor in the previous 12 months were included in the study. The study end-point was time to discontinuation of initial high strength proton pump inhibitor (cessation or switch to maintenance strength) stratified by the type of initial prescriber. Results: Of the new users of high strength proton pump inhibitors ( n= 41 041), 32% discontinued within 8 weeks, and 62% discontinued within 12 months. The median treatment duration was: 195 days (95% CI, 186-205) for patients with hospital-initiated therapy ( n= 12 294), 124 days (95% CI, 121-127) for patients with treatment initiated by general practitioners ( n= 25 327) and 112 days (95% CI, 104-121) for patients with treatment initiated by specialist ( n= 3420). Conclusions: Only one-third of the Australian veteran patients who initiated high strength proton pump inhibitor treatment for gastro-oesophageal reflux disease discontinued (ceased or stepped down) within 8 weeks consistent with guideline recommendations. The majority continued treatment beyond recommended durations. This is not directly attributable to the initiating prescriber. [ABSTRACT FROM AUTHOR]

Objective: To describe the self-reported management of hypertension in general practice and how this compares to national guidelines for hypertension., Design: Analysis of self-reported cross-sectional clinical audit data., Setting: Australian general practice for the years 1999, 2001, 2003 and 2004., Study Population: A total of 5247 general practitioners who voluntarily participated in one of four hypertension clinical audits and provided data for 105,086 adult patients with a previous diagnosis of hypertension., Main Outcome Measures: Selection of blood pressure targets consistent with recommendation of hypertension guidelines, percentage of patients achieving target blood pressure and percentage of patients with selected co-morbidities treated with the preferred class of antihypertensive medications., Results: In 2001, target blood pressures of 140/90 mmHg and 130/85 mmHg were being used for 38% and 55% of patients, respectively. In 2004, target blood pressures were 140/90 mmHg (39%), 130/85 mmHg (49%) and 125/75 mmHg (0.5%). In 2003 and 2004, 58% and 70% of patients were reported to have achieved a target blood pressure that was consistent with guidelines according to patient age and co-morbidities. However, only 54-62% of hypertensive patients with heart failure were prescribed an ACE inhibitor and 52% of patients with a history of myocardial infarction were receiving a beta-blocker or ACE inhibitor., Conclusions: The self-reported data from general practitioners participating in clinical audits show that these general practitioners are using blood pressures targets consistent with guideline recommendations for most patients and that more patients are reaching their target blood pressure. However, drug selection based on co-morbidities could improve.

Background: The aim of this study was to identify the factors that influence prescribing of new drugs among general practitioners, endocrinologists and psychiatrists., Methods: Four focus groups were conducted with GPs, endocrinologists and psychiatrists on sources of awareness and influences on prescribing of new drugs., Results: Pharmaceutical companies were the most important source for becoming aware of new drugs. There were many influences on the decision to prescribe a new drug, the most important being efficacy, safety, cost and advantage over existing therapies. Endocrinologists placed greater emphasis on evidence from clinical trials and scientific conferences, and psychiatrists and GPs placed more weight on pharmaceutical representatives, colleagues and specialists., Discussion: New drug prescribing occurs in a complex environment with many influences. Effective interventions to promote rational, safe and effective prescribing of new drugs will need to be cognisant of these factors.

Medicines make an essential contribution to the health of the community, but rapidly rising drug budgets have caused governments to seek ways of ensuring this expenditure results in value for money. The National Prescribing Service was established against this background to implement a quality use of medicines service as part of the National Medicines Policy. A range of programmes that attempt to use evidence-based strategies to deliver evidence-based messages have been established. These use multifaceted interventions, such as newsletters, prescriber feedback, clinical audit and educational visiting, that are provided both centrally, through the national office, and locally, through Divisions of General Practice. The work is underpinned by an evaluation strategy that incorporates strong qualitative elements as well as an emphasis on time-series analyses for changes in drug utilization. Some 80% of Australian general practitioners have voluntarily participated in activities such as educational visiting and clinical audit within the National Prescribing Service programmes. New programmes for the community and consumers will be coordinated with the work that has become well established within general practice.