Appropriateness of ambulatory prescriptions in Taiwan: Translating claims data into initiatives
Journal
International Journal of Clinical Pharmacy
Journal Volume
34
Journal Issue
1
Pages
72-80
Date Issued
2012
Author(s)
Abstract
Background Appropriate prescribing is fundamental to successful pharmacotherapy. The status of current ambulatory medication practices in medicine and pharmacy would be better understood through an analysis of community pharmacy prescription claims. Objective The aims of the study were to investigate patterns of the types of prescriptions claimed by community pharmacies, undetected prescription errors by community pharmacists, and associated factors of prescription errors. Setting A population-based claims database of prescriptions dispensed by community pharmacies in Taiwan. Methods Ambulatory prescriptions were randomly sampled and reassessed for prescribing appropriateness by medical center pharmacists using explicit criteria. Demographics of patients, physicians, care facilities, and prescription/ dispensing details were assessed and used to identify associated factors for prescription errors using descriptive analyses as well as logistic regression. Main outcome measures Erroneous prescriptions prescribed by physicians, and dispensed and claimed through community pharmacies. Results The study included analyses of 3065 prescriptions dispensed in community pharmacies resulting from 1003 patient visits, mostly to physician or dental clinics (99.5%). Prescribing characteristics, patterns, and examples of prescription errors are described. Prescription errors were identified in 18.3% (n = 560) of prescriptions and 34.9% (n = 350) of patient visits. Potential prescribing errors included errors of omission (25.5%), errors of commission (53.4%), and others (21.1%). The top three errors were incorrect dosage (27.5%), missing indication (23.6%), and insufficient or unavailable drug information (18.9%). Drugs most frequently associated with prescription errors included antihistamines, hormones, and gastrointestinal agents. Prescription were also higher in the central and eastern regions of Taiwan. Pediatricians accounted for a disproportionate number of prescription errors. Conclusion Prescription errors are prevalent in ambulatory care in Taiwan, and differential practice standards exist between community and hospital services. This disparity needs to be reconciled by pertinent initiatives to enhance community-hospital and pharmacist-general practitioner communication and interprofessional educational efforts to improve medication use and safety. ? 2011 CARS.
Subjects
Community pharmacy; Dispensing; Medication reconciliation; National Health Insurance; Prescription appropriateness; Taiwan
SDGs
Other Subjects
agents interacting with transmitter, hormone or drug receptors; amoxicillin; analgesic agent; antihistaminic agent; antipyretic agent; antitussive agent; benproperine; central stimulant agent; codeine; dextromethorphan; diclofenac; erythromycin; expectorant agent; gastrointestinal agent; hormone; ketoconazole; loperamide; loratadine; mefenamic acid; mequitazine; mucolytic agent; nalidixic acid; nystatin; ofloxacin; paracetamol; prednisolone; pseudoephedrine; zolpidem; adolescent; adult; aged; ambulatory care; article; billing and claims; child; colitis; community care; controlled study; demography; drug information; drug overdose; enteritis; ethnicity; female; gastroenteritis; geography; health care facility; health care personnel; health service; human; major clinical study; male; medical practice; medication error; pharmacist; pharmacy; population research; preschool child; prescription; priority journal; professional standard; reimbursement; school child; skin infection; Taiwan; treatment indication; urinary tract disease; vagina candidiasis; ambulatory care; clinical practice; factual database; infant; medication error; middle aged; organization and management; pharmacist; pharmacy; standard; statistical model; statistics; Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Care; Child; Child, Preschool; Community Pharmacy Services; Databases, Factual; Female; Humans; Infant; Logistic Models; Male; Medication Errors; Middle Aged; Pharmacists; Physician's Practice Patterns; Taiwan; Young Adult
Type
journal article