This study serves as an exemplar to demonstrate the scalability of a research approach using survival analysis applied to general practice electronic health record data from multiple sites. Collection of these data, the subsequent analysis, and the preparation of practice-specific reports were performed using a bespoke distributed data collection and analysis software tool.

Statins are a very commonly prescribed medication, yet there is a paucity of evidence for their benefits in older patients. We examine the relationship between statin prescriptions for general practice patients over 75 and all-cause mortality.

We carried out a retrospective cohort study using survival analysis applied to data extracted from the electronic health records of five Australian general practices.

The data from 8025 patients were analysed. The median duration of follow-up was 6.48 years. Overall, 52 015 patient-years of data were examined, and the outcome of death from any cause was measured in 1657 patients (21%), with the remainder being censored. Adjusted all-cause mortality was similar for participants not prescribed statins versus those who were (HR 1.05, 95% CI 0.92–1.20, P = 0.46), except for patients with diabetes for whom all-cause mortality was increased (HR = 1.29, 95% CI: 1.00–1.68, P = 0.05). In contrast, adjusted all-cause mortality was significantly lower for patients deprescribed statins compared to those who were prescribed statins (HR 0.81, 95% CI 0.70–0.93, P < 0.001), including among females (HR = 0.75, 95% CI: 0.61–0.91, P < 0.001) and participants treated for secondary prevention (HR = 0.72, 95% CI: 0.60–0.86, P < 0.001). This study demonstrated the scalability of a research approach using survival analysis applied to general practice electronic health record data from multiple sites. We found no evidence of increased mortality due to statin-deprescribing decisions in primary care.

Measures to reduce the spread of the SARS-CoV-2 virus have an impact on the mental health of the general population. Drug prescription rates can be used as a surrogate marker to estimate help seeking and health parameters of a population. The aim of this study was to compare psychopharmacologic drug prescriptions in Austria from the start of the pandemic in 2020 over time and with the previous year and to investigate the impact of the COVID-19 lockdowns in 2020.

Data from the three largest public health insurances in Austria, covering over 98% of the general population, were analyzed. A total of 1,365,294 patients with a prescription of a psychopharmacologic drug in the months March to December in 2019 and 2020 were selected.

There was no significant change in prescribed defined daily doses (DDDs) during the lockdowns. However, there was a stockpiling effect before and at the beginning of lockdown 1. The number of new patients initiating psychopharmacologic treatment was significantly reduced during lockdown 1 but not during lockdown 2.

The first COVID-19 lockdown in 2020 functioned as a barrier for new psychiatric patients seeking help, whereas the patients with ongoing treatments did not have significant problems. These results have to be taken into account for future planning, but follow-up studies are needed, as our results could be indicative of a change in the effect of the protective measures on the utilization of the healthcare system over time.

The Antipsychotic Long-acTing injection in schizOphrenia (ALTO) study was a non-interventional study across several European countries examining prescription of long-acting injectable (LAI) antipsychotics to identify sociodemographic and clinical characteristics of patients receiving and physicians prescribing LAIs. ALTO was also the first large-scale study in Europe to report on the use of both first- or second-generation antipsychotic (FGA- or SGA-) LAIs.

Patients with schizophrenia receiving a FGA- or SGA-LAI were enrolled between June 2013 and July 2014 and categorized as incident or prevalent users. Assessments included measures of disease severity, functioning, insight, well-being, attitudes towards antipsychotics, and quality of life.

For the 572 patients, disease severity was generally mild-to-moderate and the majority were unemployed and/or socially withdrawn. 331/572 were prevalent LAI antipsychotic users; of whom 209 were prescribed FGA-LAI. Paliperidone was the most commonly prescribed SGA-LAI (56% of incident users, 21% of prevalent users). 337/572 (58.9%) were considered at risk of non-adherence. Prevalent LAI users had a tendency towards better insight levels (PANSS G12 item). Incident FGA-LAI users had more severe disease, poorer global functioning, lower quality of life, higher rates of non-adherence, and were more likely to have physician-reported lack of insight.

These results indicate a lower pattern of FGA-LAI usage, reserved by prescribers for seemingly more difficult-to-treat patients and those least likely to adhere to oral medication.

Our objective was to explore the processes and determinants leading physicians to integrate estimated glomerular filtration rate (eGFR) in their drug prescriptions

Access to patients’ eGFR would allow primary care pharmacists to optimise their role in the procedure of safe prescribing. Some rare physicians actively integrate eGFR in their prescriptions, in a sporadically and uncoordinated manner.

Qualitative study using semi-directed interviews conducted among 12 French physicians who integrated eGFR in their drug prescriptions, (February 2016–April 2017). These voluntary participants were recruited through different means: Twitter®, forums, direct contact and snowball sampling. Data analysis was based on the grounded theory approach, underpinned by a comprehensive perspective of interactionist orientation.

Residency and training, professional experience – including experiences of adverse drug reactions – and the membership in various communities of professionals were key drivers for the integration of eGFR in prescriptions. The theoretical aim was above all safe prescribing in order to reduce adverse drug reactions, with the control by a dispensing pharmacist and/or other healthcare professionals. Nevertheless, none of the physicians had received any feedback from any healthcare professionals. Despite their disappointment, the physicians remained convinced of the interest of integrating eGFR in their prescriptions and would continue to do so. Characteristics associated with integration of eGFR in drug prescriptions belong partly to Roger’s theory of innovations. If a widespread diffusion of this habit takes place, it will be necessary to evaluate its adoption by both physicians and pharmacists.

To increase the proportion of patients with no psychotropic drug discrepancies at the community mental health team (CMHT)–general practice interface. Three CMHTs participated. Over a 14 month period, quality improvement methodologies were used: individual patient-level feedback to patient's prescribers, run charts and meetings with CMHTs.

One CMHT improved medicines reconciliation accuracy and demonstrated significant reductions in prescribing discrepancies. One in three (119/356) patients had ≥1 discrepancy involving 20% (166/847) of all prescribed psychotropics. Discrepancies were graded as: ‘fatal’ (0%), ‘serious’ (17%) and ‘negligible/minor harm’ (83%) but were associated with extra avoidable prescribing costs. For medicines routinely supplied by secondary care, 68% were not recorded in general practice electronic prescribing systems.

Improvements in medicines reconciliation accuracy were achieved for one CMHT. This may have been partly owing to a multidisciplinary team approach to sharing and addressing prescribing discrepancies. Improving prescribing accuracy may help to reduce avoidable drug-related harms to patients.

To evaluate the antibiotic prescribing of prescriber-trained nurse practitioners in a primary care setting.

As of 1st May 2006, legislation was introduced extending the prescriptive powers of appropriately trained nurses and nurse practitioners to nearly equal that of fully registered doctors. Following this increase, we believe that it is important to ensure that these new powers are being used judiciously. In this paper, we focus on a particular aspect of prescribing: that of antibiotics in a primary care setting. We examine how the prescriber-trained nurse practitioners’ prescribing of antibiotics compares with the practice guidelines on prescribing.

An audit of all consultations for six months following 1st May 2006 by the three nurse practitioners trained to prescribe was conducted. Where an antibiotic was prescribed, the anonymous clinical detail was compared with the appropriate practice guideline. The antibiotic-prescribing habits of doctors were identified from a literature search using Medline, by using UK-wide data provided by the Prescriptions Pricing Authority and from the practice Primary Medical Services review.

The nurse practitioners were found to prescribe antibiotics in a total of 1296 out of 3211 consultations at an average monthly rate of 41 per 100 consultations. The most common antibiotics prescribed in descending order of frequency were as follows: amoxicillin; flucloxacillin; erythromycin; pencillin V; cefalexin and trimethoprim. Of the antibiotics prescribed during this period, 1065 were found to adhere to practice guidelines and 200 did not. A further 31 were deferred prescriptions. Off-guideline prescribing was accompanied by clear clinical indication as to the reason for the prescription identified in the medical record. Overall prescribing rates in this study of 80 per 100 consultations (including items other than antibiotics) are comparable with those published in the literature.

A small number of prescriptions ordered by the patient from their general practice remain uncollected and hence undispensed. No research has been published on this phenomenon and on how this is managed. We aimed to evaluate this in one primary care trust.

To find out what prescription items are not collected, and why.

A descriptive cross-sectional analysis of prescription data. Semi-structured interviews with 21 primary health care team members, and 10 patients who had apparently not collected their prescription. Fifty-seven patients from the lead author’s practice were telephoned and gave their comments.

Twenty general practices in the Gateshead Primary Care Trust.

Nineteen practices provided suitable data for analysis from one month’s uncollected prescriptions plus total items issued during the same period of time. All suitable patients who had uncollected prescriptions from 10 practices were invited to participate in a telephone interview. Similar patients from the lead author’s practice were telephoned and invited to comment.

On average 0.5% items were uncollected. Drugs for a specific diagnosis (eg, cardiovascular drugs) were significantly less likely to be uncollected than drugs prescribed either symptomatically or for a presumptive diagnosis (0.48% versus 0.67% uncollected, respectively, P < 0.001). Many uncollected prescriptions were due to administrative causes: few resulted from patient error or forgetfulness. The majority of patients reported obtaining their medication. No adverse events arising from uncollected prescriptions were reported.

Uncollected prescriptions are a small proportion (0.5%) of the total issued and were more likely to be for non-essential items; therefore the policy of destroying uncollected prescriptions after an appropriate period without any further action is probably safe.

It is important to identify what kinds of drugs are required by disaster-affected populations so that appropriate donations are allocated. On 26 December 2003, an earthquake with an amplitude of 6.3 on the Richter scale struck southeastern Iran, decimating the city of Bam. In this study, the most frequently utilized and prescribed drugs for Bam outpatients during the first six months after the Bam Earthquake were investigated.

In this descriptive, cross-sectional study, the data were collected randomly from 3,000 prescriptions of Bam outpatients who were examined by general practitioners from Emergency Medical Assistance Teams in 12 healthcare centers during the first six months after the Bam Earthquake. The data were analyzed for: (1) patient sex; (2) number of drugs/prescriptions; (3) drug category; (4) drug name (generic or brand); (5) route of administration; (6) percent of visits where the most frequent drug categories were prescribed; and (7) the 25 most frequently prescribed drugs, using World Health Organization (WHO) indicators of drug use in health facilities.

Male patients represented 47.4% and females 52.6% of the total number of outpatients. The mean number of drugs/prescriptions was 3.5 per outpatient. Oral administration was the most frequent method of administration (81.7%), followed by injections (10.9%). Respiratory drugs were the most frequently used drugs (14.2%), followed by analgesics/non-steroidal anti-inflammatory drugs (non-steroidal anti-inflammatory drugs) (11.3%), antibacterials (11.2%), gastroinestinal (GI) drugs (9.6%), and central nervous system drugs (7%). Penicillins (6.8%), cold preparations (8%), and systemic anti-acids (ranitidine and omeprazole) were among the 25 most frequently used drugs by outpatients and inhabitants of Bam during the first six months after the Bam Earthquake.

Respiratory, analgesic, antibacterial, gastrointestinal, and psychiatric medications were among the most commonly prescribed pharmaceuticals after the catastrophic Bam Earthquake.The results of this study may help to predict the needs of patients during future disasters and prevent unnecessary donations of medicine.

The medical impacts of disasters have focused on the injuries, illnesses, and deaths related to the disaster. Little has been written about the impact of disasters on persons who use prescription medications or those medications that require refrigeration, or those who require health aids. The objective of this study was an evaluation of the level of utilization of prescription medications and medications that require refrigeration as well as the use of health aids by the population affected by the disaster.

Following the Northridge earthquake of 1994, a survey of Los Angeles County households was conducted to assess the impact of the earthquake. A total of 1247 households completed the 48 minute telephone interview. As part of the interview, 10 questions assessed the utilization of medications and medical aids by household members and the effects that the earthquake had on those medications and devices. Chi-square, analysis of variance (ANOVA), and logistic regression analysis were applied.

Of the 1,212 completed interviews, 21% of the households had a family member taking a prescription medication or a medication requiring refrigeration. Associated factors included gender, race, age, household income, level of education, presence of children, and the intensity of the earthquake (by the Modified Mercalli Index). Only 3% of those that reported medication usage noted problems associated with the use of these medications.

Thirty-nine percent of the respondents indicated that someone in the household used a health aid (e.g., eyeglasses, hearing aid, etc.). Usage was related to gender, race, age, household income, level of education, presence of children, and the intensity of the shaking associated with the earthquake. Of these, 6.5% reported difficulty with these aids, usually related to loss or breakage.

Although the proportions of the population requiring prescription or refrigerated medications and/or for those using health aids in Los Angeles seemingly are small, this translates to 630,000 households in which someone requires medications and 1.2 million households with a requirement for health aids. Thus, there are a huge number of persons at risk for serious medical problems related to these medications and devices that could produce profound medical problems during a disaster. However, during and following a moderate earthquake, it does not seem that the consequences will be great.