Game Analysis of Regulation for Online Prescription Drugs under Customer Feedback Mechanism

Objective To study the way to better regulate the online sales of prescription drugs,and to provide reference for the adjustment of relevant policies since the online sales of prescription drugs has become an inevitable trend.Methods A game model was constructed for the strategy choice of pharmaceutical e-commerce platform,customers and government departments based on differential game theory and Nash equilibrium game model to analyze the pure strategy Nash equilibrium,Nash equilibrium dominant strategy of each subject and the mixed strategy Nash equilibrium under different conditions.Besides,Matlab was used to carry out simulation analysis.Results and Conclusion The study shows that:(1)Improving the credibility of the government and reducing the cost of government regulation can not only make the pharmaceutical e-commerce platform operate with high quality,but also give greater play to government functions;(2)The greater the influence of social evaluation on pharmaceutical e-commerce platforms,the lower the cost of high-quality operation of pharmaceutical e-commerce platform,and the greater the probability of customer choosing real evaluation strategy;(3)The greater the customers’perception of potential risk,the greater the compensation,and the lower the cost of reporting.Then,the greater the probability that government departments will choose strict regulation.Finally,the model solution and simulation analysis are combined to provide countermeasures and suggestions for the safety regulation of online sales of prescription drugs.

Study on Anti-diarrhea Effect of the Prescription of 4 Tibetan Veterinary Drugs

This study was conducted to investigate the effects of extracts of 4 Tibetan veterinary drugs on bacterial diarrhea, and to guide the clinical treatment of the disease. The inhibitory effects of the extracts of the 4 Tibetan veterinary drugs, Veronica ciliate Fisch, Usnea diffracta Vain, Sophoraflavescens var. flavescens, Lamiophlomis rotata （ Benth. ） Kudo on 14 common diarrheagenic bacteria were detected by K-B diffusion method and micro-broth dilution method. Optimization was performed on prescriptions of the 4 Tibetan veterinary drugs using orthogonal design software, and a mouse bacterial diarrhea model was established with a clinical isolate, Salmonella blegdam. According to the LD50 value of the optimal prescription of the 4 Tibetan veterinary drugs, the established mouse bacterial diarrhea model was treated in 3 dose groups, i. e. , the high, middle and low dose groups （0. 060, 0. 030 and 0. 020 g/ml, respectively）. The results showed that the 4 Tibetan veterinary drugs had very good inhibitory effects on most of the tested diarrheagenic bacteria, and among them, U. diffracta had better inhibitory effects on all the tested bacteria. The optimal prescription of the d Tibetan veterinary drugs （high dose, 0.06 g/ml） exhibited very good inhibitory effect on mouse diarrhea, indicating that the prescription has very good anti-diarrhea effect, which is beneficial to the clinical treatment of such disease and the development of Tibetan veterinary drugs.

Survey of Shanghai Residents’ Perceptions of Buying Prescription Drugs Online

Objective To investigate the willingness of Shanghai residents to buy prescription drugs online.Methods By using e-questionnaire,Shanghai residents’perceptions of online prescription drugs were investigated,and 206 valid questionnaires were collected.Results and Conclusion 96.1%of the respondents knew the correct definition of prescription drugs.46.6%knew they could buy prescription drugs online.67.7%,through social media,knew they could buy prescription drugs online.72.3%knew a medical prescription should be required when buying prescription drugs online.And 83.5%refused to buy prescription drugs online because they were concerned about the quality and safety of drugs.The publicity of online-pharmacies and prescription drugs should be increased in China.Besides,the government supervision should be strengthened in the whole process of service to protect consumers’rights and benefits.Then,the channels of online purchase must be optimized for customers.Lastly,a medical insurance payment system should be set up for buying prescription drugs online.

Prescription patterns of antidiabetic and cardiovascular preventive medications in community-dwelling older adults with type 2 diabetes mellitus:a cross-sectional study

OBJECTIVE To describe trends in antidiabetics drug prescription patterns in community-dwelling older adults with type 2 dia-betes mellitus(T2DM)and to evaluate the use of cardiovascular preventive medications among those diagnosed with atheroscler-otic cardiovascular disease(ASCVD).METHODS This cross-sectional,face-to-face interview study that comprised community-dwelling older adults(≥65 years)dia-gnosed with T2DM.The study questionnaire included the patients’demographics,clinical data,and current medication use.Pati-ents with established ASCVD were further classified into low(i.e.,not receiving evidence-based therapy or only one)and high(i.e.,receiving at least two evidence-based therapies)composite score groups.Bivariate analysis followed by multivariable logistic re-gression analysis were performed to evaluate the demographic/clinical characteristics associated with the use of antidiabetic mo-notherapy/polytherapy and evidence-based pharmacotherapy.RESULTS A total of 500 older adults were enrolled.The mean age of included participants was 73±7 years,310 participants(62%)were males,and 385 participants(77.0%)had established ASCVD.Antidiabetic monotherapy was reported in 251 partici-pants(50.2%),with metformin followed by sulfonylureas being the most commonly prescribed drugs as monotherapy.The results of the multivariable analysis showed that age[odds ratio(OR)=0.89,95%CI:0.85-0.94,P<0.001],obesity(OR=4.18,95%CI:1.63-10.36,P=0.003),hypertension(OR=4.2,95%CI:1.22-7.66,P=0.04),and dyslipidemia(OR=4.1,95%CI:1.28-8.30,P=0.01),were significantly associated with the prescription of cardiovascular preventive medications.CONCLUSIONS Only one in twenty-one participant with T2DM and ASCVD collectively received three guideline-recommen-ded therapies,indicating a deficiency of utilization of cardiovascular preventive drugs.

A study on drug utilization and prescription habits of physicians in a government homeopathic hospital in West Bengal, India

Improper prescribing habits and inappropriate drug use lead to serious health and economic consequences. This study was undertaken to evaluate drug utilization services and prescription patterns of homeopathic doctors in a government homeopathic teaching hospital in India. METHODS： No standardized homeopathic drug use indicators are available. The researchers used indicators for health care setting （drug availability）-modified prescribing indicators and patient care indicators, based on World Health Organization＇s core drug use indicators. A cross- sectional, prospective, institutional, observational study of 2-month duration with record analysis was conducted on 600 patients visiting seven different outpatient departments （OPDs） for the first time at Mahesh Bhattacharyya Homeopathic Medical College ＆ Hospital, Howrah, West Bengal, India, using the developed indicators. RESULTS： Overall availability of prescribed drugs was quite satisfactory （92.28%）. Centesimal potencies accounted for the majority of prescriptions （74.76%）. There was a poor record of diagnosis （39.17%） except in the OPDs of Gynecology and Obstetrics （68.48%, P 〈 0.01） and Dermatology （64.58%, P 〈 0.01）. Records of investigational findings and ongoing therapies, if any, were also poor except OPDs of Gynecology and Obstetrics, and Pediatrics. Structure of prescriptions was maintained satisfactorily in all the OPDs. Though tendency of using ＇individualized homeopathy＇ predominated, there also existed the use of ＇polypharmacy＇. Mean consultation time was 5.9 min. Labeling was extremely poor and is an area needing improvement. The prescriptions were highly legible. CONCLUSION： This was a preliminary study, conducted for the first time in homeopathy using newly developed indicators that yield meaningful results. Further studies are necessary in order to evaluate the different factors involved and to plan future interventions to improve the quality of care in healthcare settings.

Irrational drug use-a pilot prescription study from Calicut,Kerala

Objective:To describe the prescribing behavior of the physician in Kerala,and to describe types and number of medicine prescribed by doctors so as to rationalize the prescription writing habits of physician.Methods: A six month study was done to define the pattern of drug use in Medical college hospital,Calicut. The data and the other important aspects of study were collected by personal interview,questionnaires meant for doctors and prescription monitoring Performa for the patients issued by WHO. The findings of survey were critically analyzed.Results: The results indicated that majority of doctors prescribed on the basis of patient's history,patient's feed back report,drug availability,brand cost,quality of drug and ADRs. All the interviewed doctors looked upon the side effects. It was found that individual drugs were prescribed more than fixed dose combinations (85.6%). Out of these 71.5% were prescribed as branded and 28.5% as generic. The demographic data,like name,age,sex,disease diagnosis were available on all the patient health care cards and these constituted an essential part of the prescription particularly age and sex being an important in deciding the dose preference for patients. Socio economically most patients were found to be in the grade ⅡI (Population below poverty line). During the study of drug related parameters,doses were mentioned only in 80% of the prescription. But duration of the drug therapy was found to be only 30%.These indicated the irrational use of prescription. Branded drugs prescribed were found to be 71.5%,which showed a trend towards a good prescription habit. The results indicated the rational use of drug.Conclusion: The survey reveales that most of the doctors in Medical college hospital,Calicut are maintaining rational use of drugs and their prescription writing habits was found to be good.

Share Videos, Not Pills: A Content Analysis of Prescription Drug Videos on YouTube for Presence of Behavior Change Theory

Objective: To identify the extent to which YouTube.com videos targeting prescription drug abuse include health behavior theory in their content and design. Methods: This study used a content analysis of 209 YouTube.com videos. Coders used an established theory-based instrument to rate each video’s inclusion of theoretical constructs from four prominent health behavior theories. Each YouTube.com video was coded for twenty-two theoretical items, which were summed to create a total theory score. Results: The mean theory score of videos was 3.26 out of a possible 22. Among the top 10% of videos with highest theory scores, social cognitive theory constructs were coded most often and transtheoretical constructs were coded least often. Conclusion: It is not unexpected that YouTube.com videos are largely void of theoretical content since these videos are made by a variety of organizations and sources that may not be trained in the application of health behavior theories. There is an opportunity for the organizations that create these videos to collaborate with health and behavior change experts in creating videos with more theoretical constructs, possibly resulting in better health outcomes.

Study of the Duration of Treatment in Drug Prescriptions Received in Pharmacies in Dakar

The prescription must include the name of the drugs or products prescribed, dosage form, dosage, directions for use and duration of treatment. However, sometimes errors can occur that can have consequences for the health of patients. Our study concerns the use of medical prescriptions received in pharmacies in the Dakar department. The survey was conducted in 90 pharmacies in these communes, which represent one third of the 270 pharmacies in the department of Dakar. This allowed us to study 2700 prescriptions. The study took place from 1 December 2016 to 30 June 2017, i.e. over a period of 7 months. Our results show that neurologists and urologists have a longer average treatment time than other specialists, with an average of 120 days and 90 days of treatment respectively. Then, the specialists who take a long time the drug represent more than 27%, and require renewal of the drug. In 63.90% of the cases, no notification on the duration of treatment was given by the prescriber. Only 5.39% were only given the mention “to be renewed”. At the end of our analysis, we can say that the prescription must be perfectly legible to avoid confusion by the patient or the pharmacist. The pharmacist then participates in the therapeutic education of the patient and thus helps him/her to live better with his/her disease. Therefore, socio-professional health associations and organisations must provide more continuous training on prescribing to ensure good compliance and above all avoid people buying medicines in the parallel circuit in order to better control health expenditure.

Does Direct-to-Consumer Prescription Drug Advertising Achieve a Mechanistic Fair Balance? A Critical Review of the Literature and Debate

The pharmaceutical industry is one of the most advertising-intensive industries.With the exponential growth of Direct-to-Consumer Prescription Drug Advertising(DTCA),there have been a large number of attempts to investigate the effectiveness of DTCA in various media,medications,and consumer groups.However,little attention has been paid to the history of the US Food and Drug Administration(FDA)regulations of DTCA and the status of DTCA practices in terms of regulatory compliance.Thus,this current study identifies a research gap in DTCA and highlights a new avenue that can be explored in future research.

Analysis on the Medication Law of Drug Pair Acorus Tatarinowii-Polygala Tenuifolia Based on the Dictionary of Traditional Chinese Medicine Prescriptions

Objective:Using data mining method to dig and sort out the prescriptions with Acorus tatarinowiiPolygala tenuifolia drug pair,and summarize the medication characteristics and compatibility of their prescriptions after preliminary screening.Methods:By searching the Dictionary of Traditional Chinese Medicine Prescriptions,a standardized database of prescriptions was established,and the properties,tastes and meridian tropism of prescriptions were classified,and the indications of prescriptions and core combinations of traditional Chinese medicines were analyzed.Results:178 prescriptions were collected,of which 210 were related.Most of the drugs were warm in nature and sweet in taste,and mainly return to the heart and kidney meridians.Under the same confidence and different support,the core drug combination for treating brain diseases was Acorus tatarinowiiPolygala tenuifolia-Ginseng,and the core drug combination for treating asthenia was Acorus tatarinowii-Poria cocos-Rehmannia glutinosa-Polygala tenuifolia.Conclusion:The compatibility characteristics of the prescriptions containing Acorus Tatarinowii and Polygala tenuifolia in the Dictionary of Traditional Chinese Medicine Prescriptions are remarkable,which provides reference for scientific guidance of clinical rational drug use and basic research of prescriptions containing Acorus tatarinowii and Polygala tenuifolia.

Prescription practice of antihistamines for acute upper respiratory tract infections in pediatric patients in a local emergency department in Hong Kong

BACKGROUND: Currently there is very limited data in the literature assessing the prevalence of antihistamine prescription, and there is no local prevalence data about the prescription of antihistamine agents among primary practitioner and emergency physicians. The objectives are 1) to report the prevalence of antihistamine prescription for children less than 6 years old with acute upper respiratory infection and 2) to explore the associated factors for the prescription practice.METHODS: This is a cross-sectional study. All consecutive cases of paediatric patients aged 6 or below who presented to the emergency department during a study period of one week from April 1 to July 4, 2009 with diagnosis of acute upper respiratory infection were included. Totally 162 patients were included.RESULTS: Among the 162 cases, 141(87%) patients were prescribed one antihistamine of any group. Sixty(37%) patients were prescribed two or more antihistamines. In multivariate logistic regression model, age was found to be signi? cantly(P<0.001) associated with multiple antihistamine prescription(OR=1.042, 95%CI=1.02 to 1.06). Years of graduation of attending physician for more than 5 years was also a strong predictor of multiple antihistamine prescription(OR=4.654, 95%CI=2.20 to 9.84, P<0.001).CONCLUSION: In the local emergency department, patients' age and the years of graduation from medical school of the attending physician were predictors of multiple antihistamine prescription for acute upper respiratory infections for children aged less than 6.

Potentially inappropriate prescribing of cardiovascular system and antiplatelet/anticoagulant drugs among elderly patients:a Korean population-based national study

OBJECTIVES To investigate the prevalence of potentially inappropriate prescribing(PIP)for cardiovascular system(CVS)and antiplatelet/anticoagulant(AP/AC)drugs among Korean elderly patients,using the Screening Tool of Older Persons’Prescriptions(STOPP)criteria version 2 and to identify the risk factors related to PIP.METHODS The 2016 National Aged Patient Sample data,comprising National Health Insurance claim records for a random sample of 20%of patients aged≥65 years,were used to calculate PIP prevalence of outpatient prescriptions.For criteria including drugdisease interactions,PIP prevalence per indication was estimated.RESULTS Among 1,274,148 elderly patients and 27,062,307 outpatient prescription claims,100,085 patients(7.85%)and 341,664 claims(1.27%)had one or more PIP.The most frequent PIP was“nonsteroidal antiinflammatory drug with concurrent antiplatelet agent(s)without protonpump inhibitor prophylaxis”in the claimlevel(0.97%)and patientlevel(6.33%)analyses.“Betablocker with bradycardia”(16.47%of claims)and“angiotensin receptor blockers in patients with hyperkalaemia”(23.89%of claims)showed the highest PIP prevalence per indication.Logistic regression analysis revealed that,among the patient and health care provider characteristics,female,older age,more severe comorbidities,polypharmacy,higher level of healthcare organization,and specialty of prescriber were significantly associated with a higher risk of PIP.CONCLUSIONS Our findings of a high prevalence of PIP for CVS and AP/AC drugs among the elderly suggest that an effective strategy is urgently needed to improve the prescription practices of these drugs.

Analysis on the Special Prescriptions from the Book of Chengfang Qieyong

The kinds of special prescriptions in the book of Chengfang Qieyong cover a wide range of subjects such as internal medicine,gynecology,pediatrics and surgery,etc.These prescriptions have gathered the original discussions of doctors of all ages,condensed the author's own in-depth insights,and displayed the profound connotation of traditional Chinese medicine prescriptions or clinical efficacy characteristics.Guided by the function and categories of the original monograph,26 prescriptions were integrated into seven categories,i.e.treating Qi and regulating Blood,nourishing and eliminating,exterior dispersing and dispelling cold,compromising and purging fire,drying dampness and expelling phlegm,fetal birth and baby,and carbuncle.Based on the characteristics of clinical efficacy,the connotation of legislative prescriptions,the modification of prescriptions and medicines,and the degree of decoction and prescription,etc,this paper analyzes the connotation of traditional Chinese medicine of these special prescriptions,and provides important reference for the research of modern prescriptions,the expansion of clinical application and the development of new drugs of traditional Chinese medicine.

2018年至2022年某中医院第二类精神药品使用情况分析

目的促进中医院第二类精神药品的合理使用。方法利用医院信息系统收集安徽省芜湖市中医医院2018年至2022年第二类精神药品的销售数据,分析用药频度(DDDs)、限定日费用(DDC)、排序比(B/A);按第二类精神药品门急诊处方150张/年和病历医嘱50份/年,根据药品说明书、相关指南及专家共识进行处方点评。结果2020年,第二类精神药品销售金额最大,占全院药品销售总金额的1.86%;地佐辛注射液、盐酸曲马多缓释片、咪达唑仑注射液销售金额排名前3;阿普唑仑片、艾司唑仑片、地佐辛注射液的DDDs排名前3;阿普唑仑片的DDC最低;地佐辛注射液的B/A在0.33~1.00之间。共收集1000张处方/医嘱,其中合理处方709张,合理医嘱228条,合理率为93.70%;不合理类型包括用药不规范、不适宜。结论该院2018年至2022年第二类精神药品的使用存在不合理现象,应继续加强对其的管理和监控,确保临床用药安全、合理。

基于循证证据的麻醉科处方前置审核规则精细化设置及效果评价

目的 优化麻醉科处方前置审核规则,提高审方质量和合理用药水平。方法 统计并分析2023年4月1日至30日青岛大学附属医院(以下简称“我院”)处方前置审核系统中麻醉科的住院医嘱,对不合理用药问题进行分类统计与循证查询,结合我院现执行的《麻醉科临床路径用药规范》,对审核规则进行精细化设置,并建立审核管理与沟通反馈流程。对规则精细化设置后(2023年5-12月)与设置前(2023年4月)的每月审核医嘱总数、预审弹窗医嘱数、系统拦截率、系统审核后医师修改率、药师审核率、医嘱合理率进行比较,对设置后与设置前(2022年5-12月)的麻醉科次均药费进行环比比较。结果 麻醉科不合理用药问题主要包括适应证不适宜、给药途径不适宜、用法用量不适宜、配伍不适宜、特殊人群用药问题、围手术期不合理用药问题。规则精细化设置后,麻醉科预审弹窗医嘱数随时间延长明显减少,经过不断完善后逐步达到平稳状态。与设置前比较,规则精细化设置后系统拦截率显著提高(P<0.001),系统审核后医师修改率显著提高(P<0.001),药师审核率显著下降(P<0.001);2023年5-12月医嘱合理率与月份存在线性趋势(P<0.001)。设置后与设置前相比,麻醉科次均药费由平均720.72元下降至平均528.21元,降幅为26.71%。结论 基于循证证据精细化设置麻醉科处方前置审核规则,可显著提高处方审核质量,促进合理用药,节约患者医疗费用。

基于中医辨证论治理论探索中成药处方审核方法

目的:依据国家卫生健康委员会等3部门联合发布的《医疗机构处方审核规范》,探索符合该院中医类别医师医疗活动的中成药处方审核方法。方法:参考药品说明书及相关资料,建立有代表性的31种中成药的“应用要点”;回顾历史处方,与梳理的中成药“应用要点”对比,分为“一致诊断”“不规范诊断”“待讨论诊断”和“不适宜诊断”。采用多学科中医专家论证的方式,探索符合中医师思维模式及医疗行为的处方审核要素及审核方法。结果:建立了该院31种中成药处方审核方法,包括处方用药与诊断是否相符,处方剂量、用法是否正确,疗程是否适宜,联合用药是否适宜,是否有用药禁忌等方面。结论:以“药证相符”为核心,建立符合该院中医师临床诊疗思维的中成药处方审核要素及审核方法,规范化中成药审核,对保障患者合理使用中成药、减少中成药使用风险具有重要意义。

处方前置审核系统对产科门诊处方质量的影响

目的分析推行处方前置审核系统对济南市妇幼保健院(以下简称“本院”)产科处方质量的影响。方法选取2021年1月至4月及2023年1月至4月本院的产科门诊处方。采用处方前置审核系统之后,观察2021年1月至4月产科门诊不合理处方分布情况,并对不合理处方进行分析,针对“孕X周”的不合理处方采取相应的处理措施,以及观察2023年1月至4月本院产科门诊处方合格率的变化。结果2021年1月至4月产科门诊处方中,不合格处方数占比20.4%,适应证不适宜处方数占不合格处方数的91.62%,临床诊断为“孕X周”的不合格处方数占适应证不适宜处方数的93.52%。针对诊断为“孕X周”的不合理处方汇总用药规则并向产科医师反馈之后,2023年1月至4月本院产科门诊处方合格率为96.58%,与2021年1月至4月本院产科门诊处方合格率相比提高了16.98%。结论处方前置审核系统使本院产科门诊处方合格率有了很大的提升。

北京市某三级口腔专科医院门急诊处方不合理情况分析

目的 点评分析北京大学口腔医学院口腔医院门急诊处方,了解处方质量和临床用药存在的问题,为促进合理用药提供参考。方法 随机抽取2021年7—12月该院门急诊处方6 000张,利用美康合理用药软件进行用药合理性初步筛查,再由药师进行人工复审,采用Excel软件对不合理处方进行分类统计及分析。结果 6 000张处方中,软件初筛不合理处方798张(含药品不合理条目828条),不合理率为13.30%。药师人工复审后确认不合理处方214张(含药品不合理条目219条),不合理率为3.57%,不合理条目类型为用法用量不适宜(112条,51.14%)、诊断描述不全(59条,26.94%)、遴选药品不适宜(15条,6.85%)、书写不规范(14条,6.39%)。不合理条目分布最多的科室为口腔黏膜科,占比50.68%。不合理条目数最多的药品为他克莫司软膏,占比30.59%,主要问题为用药频次不合理(超过规定次数)。结论 医院门急诊处方基本合理,但需关注用法用量、诊断描述等问题。合理用药软件有助于处方点评初筛但无效提醒较多、需定期改进,点评结果需要药师结合医药进展及临床实际情况进行人工审核后最终判定。可通过软件初筛结合人工复审并及时反馈问题、加强超说明书用药管理等手段,加强临床合理用药。

某三甲医院2022年产科中成药不合理使用情况分析

目的:促进医院产科中成药的合理应用,保障孕产妇及婴儿用药安全。方法:利用临床用药决策支持软件对某三甲医院产科2022年度开具的中成药处方进行系统自动点评筛选,对筛选出的问题处方再次进行人工点评,对处方存在的问题类型进行归纳汇总,分析原因。结果:该院产科2022年开具中成药处方(含住院医嘱)共计14886张,系统智能筛选出问题处方3987张(26.78%),人工点评后确认存在用药不合理情况的处方199张(1.34%),其中不合理儿童药品处方19张(9.55%)。结论:该院产科2022年仍存在不合理使用中成药情况,医院需及时采取积极的干预措施,以保障产科用药规范合理,保障患者的安全。

抗肿瘤药审方规则的设置优化及实施效果评价

目的探讨抗肿瘤药审方规则设置及优化流程,提高处方合理率,降低不合理处方退费率。方法统计抗肿瘤药规则设置优化前(2021年12月~2022年3月)规则维护后(2022年4月~2022年7月)的门诊处方。比较规则设置优化前后处方合理率及退费率评价实施效果。结果设置了抗肿瘤药规则,建立了规则优化模式,形成了超说明书用药规则库。门诊处方合理率由96.53%提高到99.19%(P<0.001),处方退费率由1.11%降至0.23%(P<0.001),差异有统计学意义。结论我院维护的抗肿瘤药审方规则库提高了处方合理率,保障临床用药的同时提高了患者用药安全性及合理性。