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Appropriateness of ambulatory prescriptions in Taiwan: translating claims data into initiatives

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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.

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References

  1. Cowen DL, Helfand WH. Ancient antecedents. In: Pharmacy: an illustrated history. New York: Harry N. Abrams, Inc., 1988. pp 17–25. ISBN:0-8109-1498-0.

  2. Tone A, Watkins ES, editors. Medicating modern America: prescription drugs in history. New York: New York University Press; 2007. ISBN:978-0-8147-8301-6.

  3. US Centers for Disease Control and Prevention. FastStats: therapeutic drug use. 2010. Available at: http://www.cdc.gov/nchs/fastats/drugs.htm. Accessed 02 Aug 2010 (Last updated: 18 Jan 2010).

  4. Ho Y-F, Lai Y-H, Lin F-J, Gau M-H, Chen M-T, Chen C-H, et al. An innovative model for releasing outpatient prescriptions from a community hospital. Formosan J Med. 2003;7:326–36. (in Chinese).

    Google Scholar 

  5. Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system. Institute of medicine: committee on quality of health care in America. Washington, DC: National Academy Press; 2000. ISBN:0-3090-6837-1.

  6. Krähenbühl-Melcher A, Schlienger R, Lampert M, Haschke M, Drewe J, Krähenbühl S. Drug-related problems in hospitals: a review of the recent literature. Drug Saf. 2007;30:379–407.

    Article  PubMed  Google Scholar 

  7. Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, et al. Incidence of adverse drug events and potential adverse drug events: implications for prevention. J Am Med Assoc. 1995;274:29–34.

    Article  CAS  Google Scholar 

  8. Leape LL, Bates DW, Cullen DJ, Cooper J, Dermonaco HJ, Gallivan T, et al. Systems analysis of adverse drug events. J Am Med Assoc. 1995;274:35–43.

    Article  CAS  Google Scholar 

  9. Ghaleb MA, Barber N, Franklin BD, Wong IC. The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Arch Dis Child. 2010;95:113–8.

    Article  PubMed  Google Scholar 

  10. Facchinetti NJ, Campbell GM, Jones DP. Evaluating dispensing error detection rates in a hospital pharmacy. Med Care. 1999;37:39–43.

    Article  PubMed  CAS  Google Scholar 

  11. van Doormaal JE, van den Bemt PMLA, Mol PGM, Zaal RJ, Egberts ACG, Haaijer-Ruskamp FM, et al. Medication errors: the impact of prescribing and transcribing errors on preventable harm in hospitalised patients. Qual Saf Health Care. 2009;18:22–7.

    Google Scholar 

  12. Ho Y-F, Wu R-S, Wu F-L L, Yang H-Y, Suen M-P, Chen W-H, et al. Establishment of a web-based pharmacy reporting system for in-patient prescribing errors. Formosan J Med. 2005;9:439–47 (in Chinese).

    Google Scholar 

  13. Pearson A, Aromataris E. Patient safety in primary healthcare: a review of the literature. Australian Commission on Safety and Quality in Health Care/The Joanna Briggs Institute. 2009. Available at: http://www.health.gov.au/internet/safety/publishing.nsf/Content/com-pubs_PrimaryCare-con/$File/26889-Literature-Review.PDF. Accessed 04 Aug 2010.

  14. Kuo GM, Phillips RL, Graham D, Hickner JM. Medication errors reported by US family physicians and their office staff. Qual Saf Health Care. 2008;17:286–90.

    Article  PubMed  CAS  Google Scholar 

  15. Shojania KG. Safe medication prescribing and monitoring in the outpatient setting. CMAJ. 2006;174:1257–8.

    Article  PubMed  Google Scholar 

  16. Knudsen P, Herborg H, Mortensen AR, Knudsen M, Hellebek A. Preventing medication errors in community pharmacy: frequency and seriousness of medication errors. Qual Saf Health Care. 2007;16:291–6.

    Article  PubMed  CAS  Google Scholar 

  17. Chen YF, Neil KE, Avery AJ, Dewey ME, Johnson C. Prescribing errors and other problems reported by community pharmacists. Ther Clin Risk Manag. 2005;1:333–42.

    PubMed  Google Scholar 

  18. Rupp MT, DeYoung M, Schondelmeyer SW. Prescribing problems and pharmacist interventions in community practice. Med Care. 1992;30:926–40.

    Article  PubMed  CAS  Google Scholar 

  19. Hawksworth GM, Corlett AJ, Wright DJ, Chrystyn H. Clinical pharmacy interventions by community pharmacists during the dispensing process. Br J Clin Pharmacol. 1999;47:695–700.

    Article  PubMed  CAS  Google Scholar 

  20. Buurma H, de Smet PAGM, van den Hoff OP, Egberts ACG. Nature, frequency and determinants of prescription modifications in Dutch community pharmacies. Br J Clin Pharmacol. 2001;52:85–91.

    Article  PubMed  CAS  Google Scholar 

  21. Carroll NV. Do community pharmacists influence prescribing? J Am Pharm Assoc. 2003;43:612–21.

    Article  Google Scholar 

  22. Buurma H, De Smet PAGM, Leufkens HGM, Egberts ACG. Evaluation of the clinical value of pharmacists’ modifications of prescription errors. Br J Clin Pharmacol. 2004;58:503–11.

    Article  PubMed  Google Scholar 

  23. Hämmerlein A, Griese N, Schulz M. Survey of drug-related problems identified by community pharmacies. Ann Pharmacother. 2007;41:1825–32.

    Article  PubMed  Google Scholar 

  24. Braund R, Furlan HM, George K, Havell MMA, Murphy JL, West MK. Interventions performed by New Zealand community pharmacists while dispensing prescription medications. Pharm World Sci. 2010;32:22–5.

    Article  PubMed  Google Scholar 

  25. Lu RJF, Chiang TL. Evolution of Taiwan’s health care system. Health Econ Policy Law. 2011;6:85–107.

    Article  Google Scholar 

  26. Department of Health. The separation of dispensing practice from medical practice starting from Taipei and Kaoshiung by March 1, 1997 (in Chinese). DOH, Taipei, Taiwan, ROC. Document no. (DOH) 86007782; 1 Feb 1997; 1997.

  27. Tung C-Y, Wu F-L L, Lin C-C, Lin S-J, Ho Y-F. The public’s perception towards chronic-illness refill prescriptions: community versus hospital refill services. Formosan J Med. 2008;12:635–43. (in Chinese).

    Google Scholar 

  28. National Health Insurance Research Databases. 2010. Available from URL: http://www.nhri.org.tw/nhird/date_01.htm. Accessed 1 Dec 2010.

  29. Department of Health. Statistical information (in Chinese). DOH, Executive Yuan, Taipei, Taiwan, ROC. 2010. Available at: http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=10238&class_no=440&level_no=1. Accessed 15 Dec 2010.

  30. Department of Health. Health Statistics in Taiwan 2006. DOH, Executive Yuan, Taipei, Taiwan, ROC. 2010. Available at: http://www.doh.gov.tw/ufile/doc/HSIT.pdf. Accessed 15 Dec 2010.

  31. WHO. International classification of diseases, ninth revision, clinical modification (ICD-9-CM). ISBN:1-5706-6317-3.

  32. Taiwan Joint Commission on Hospital Accreditation. 2010. Available at: http://www.tjcha.org.tw/FrontStage/aboutus_en.html. Accessed 30 Dec 2010.

  33. Hynniman CE, Conrad WF, Urch WA, Rudnick BR, Parker PF. A comparison of medication errors under the University of Kentucky unit dose system and traditional drug distribution systems in four hospitals. Am J Hosp Pharm. 1970;27:802–14.

    PubMed  CAS  Google Scholar 

  34. Micromedex Computerized Clinical Information System. Thomson Reuters (Healthcare) Inc.; 2008.

  35. Drug facts and comparisons. Facts and comparisons. 61th ed. St. Louis (MO); 2007. ISBN:978-1-57439-256-2.

  36. Wang C-K, editor. Formosa drug references, vol I & II. Taipei: Ching-Kang Foundation for Pharmacy Promotion; 1996. ISBN:9-5799-1180-0.

  37. Chen C-F, Hsu K-Y, Tsai Y-C, editors. Taiwan drugs reference: ethical drugs. 2nd ed. Taipei: Taipei Pharmacists Association; 2000. ISBN:9-5799-8191-4.

  38. Chen C-A. Therapeutic handbook of common drugs. 37th ed. Taipei: Drug Year Book Magazine Ltd; 2007. ISBN:9-5728-6539-0.

  39. Bureau of National Health Insurance (BNHI). Pharmaceuticals reimbursed by the NHI. BNHI, Taipei, Taiwan, ROC. 2008. Available at: http://www.nhi.gov.tw/webdata/webdata.aspx?menu=21&menu_id=713&WD_ID=713&webdata_id=873. Accessed 01 July 2008.

  40. Taketomo CK, Hodding JH, Kraus DM. Pediatric dosage handbook with international trade names index. 15th ed. Hudson, OH: Lexi-Comp; 2008–2009. ISBN:978-1-59195-240-4.

  41. Department of Pediatrics. Growth charts. National Taiwan University Hospital, Taipei, Taiwan, ROC. 2008. Available at: http://www.ntuh.gov.tw/ped/default.aspx. Accessed 01 July 2008.

  42. Ho Y-F, Huang S-H, Lin H-N. Detecting drug–drug interactions in medication profiles of psychiatric inpatients: a two-stage approach. J Formos Med Assoc. 2002;101:294–7.

    PubMed  Google Scholar 

  43. Huang S-H, Lin H-N, Wu F-L L, Ho Y-F. Evaluation of pharmacist’s participation in the detection of drug–drug interactions. Formosan J Med. 2003;7:166–73 (Chinese).

    Google Scholar 

  44. Chen L-J, Lin W-C, Lee S-J, Hsieh L-L, Lu PY, Wang S-F, et al. An analysis on the formats and contents of ambulatory prescriptions. Formosan J Med. 2009;13:449–60 (Chinese).

    Google Scholar 

  45. Chou YJ, Yip WC, Lee CH, Huang N, Sun YP, Chang HJ. Impact of separating drug prescribing and dispensing on provider behaviour: Taiwan’s experience. Health Policy Plan. 2003;18:316–29.

    Article  PubMed  CAS  Google Scholar 

  46. Chen T-J, Chou L-F, Hwang S-J. Application of concentration ratios to analyze the phenomenon of “next-door” pharmacy in Taiwan. Clin Ther. 2006;28:1225–30.

    Article  PubMed  Google Scholar 

  47. Lesar TS, Briceland L, Stein DS. Factors related to errors in medication prescribing. J Am Med Assoc. 1997;277:312–7.

    Article  CAS  Google Scholar 

  48. Dean B, Schachter M, Vincent C, Barber N. Causes of prescribing errors in hospital inpatients: a prospective study. Lancet. 2002;359:1373–8.

    Article  PubMed  Google Scholar 

  49. Fijn R, Van den Bemt PM, Chow M, De Blaey CJ, Jong-Van De, den Berg LTW, Brouwers JRBJ. Hospital prescribing errors: epidemiological assessment of predictors. Br J Clin Pharmacol. 2002;53:326–31.

    Article  PubMed  CAS  Google Scholar 

  50. Dobrzanski S, Hammond I, Khan G, Holdsworth H. The nature of hospital prescribing errors. Br J Clin Gov. 2002;7:187–93.

    Article  Google Scholar 

  51. Bregnhøj L, Thirstrup S, Kristensen MB, Bjerrum L, Sonne J. Prevalence of inappropriate prescribing in primary care. Pharm World Sci. 2007;29:109–15.

    Article  PubMed  Google Scholar 

  52. Bregnhøj L, Thirstrup S, Kristensen MB, Bjerrum L, Sonne J. Combined intervention programme reduces inappropriate prescribing in elderly patients exposed to polypharmacy in primary care. Eur J Clin Pharmacol. 2009;65:199–207.

    Article  PubMed  Google Scholar 

  53. Condren M, Studebaker IJ, John BM. Prescribing errors in a pediatric clinic. Clin Pediatr (Phila). 2010;49:49–53.

    Article  Google Scholar 

  54. Wessell AM, Litvin C, Jenkins RG, Nietert PJ, Nemeth LS, Ornstein SM. Medication prescribing and monitoring errors in primary care: a report from the practice partner research network. Qual Saf Health Care. 2010;e19:e21. doi:10.1136/qshc.2009.034678.

    Google Scholar 

  55. Boockvar KS, Liu S, Goldstein N, Nebeker J, Siu A, Fried T. Prescribing discrepancies likely to cause adverse drug events after patient transfer. Qual Saf Health Care. 2009;18:32–6.

    Article  PubMed  CAS  Google Scholar 

  56. Trifirò G, Pariente A, Coloma PM, Kors JA, Polimeni G, Miremont-Salamé G, EU-ADR group, et al. Data mining on electronic health record databases for signal detection in pharmacovigilance: which events to monitor? Pharmacoepidemiol Drug Saf. 2009;18:1176–84.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to acknowledge Chia-Chi Cheng, MS and Chi-Ju Yang, BSPharm, MSCP for their helpful assistance in claims data processing.

Funding

This study was supported by a research grant (DOH 97-TD-D-113-97014) from the Department of Health, Executive Yuan, Taiwan, ROC.

Conflicts of Interest

None.

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Authors and Affiliations

  1. Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, No. 1, Sec. 1, Jen-Ai Road, Taipei, Taiwan, ROC

    Yunn-Fang Ho

  2. School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC

    Yunn-Fang Ho, Ling-Ling Hsieh, Shu-Jen Lee & Fang-Ju Lin

  3. Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan, ROC

    Yunn-Fang Ho & Ling-Ling Hsieh

  4. Mackay Memorial Hospital, Taipei, Taiwan, ROC

    Wan-Chen Lu

  5. Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan, ROC

    Fu-Chang Hu

  6. College of Pharmacy, Ohio State University, Columbus, OH, USA

    Kenneth M. Hale

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  1. Yunn-Fang Ho
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Correspondence to Yunn-Fang Ho.

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Ho, YF., Hsieh, LL., Lu, WC. et al. Appropriateness of ambulatory prescriptions in Taiwan: translating claims data into initiatives. Int J Clin Pharm 34, 72–80 (2012). https://doi.org/10.1007/s11096-011-9589-8

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  • DOI: https://doi.org/10.1007/s11096-011-9589-8

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