Abstract Background Paracetamol (acetaminophen) is generally considered a safe medication, but is associated with hepatotoxicity at doses above doses of 4.0 g/day, and even below this daily dose in certain populations. Methods The Nova Scotia Prescription Monitoring Program (NSPMP) in the Canadian province of Nova Scotia is a legislated organization that collects dispensing information on all out-of-hospital prescription controlled drugs dispensed for all Nova Scotia residents. The NSPMP provided data to track all paracetamol/opioids redeemed by adults in Nova Scotia, from July 1, 2005 to June 30, 2010. Trends in the number of adults dispensed these prescriptions and the numbers of prescriptions and tablets dispensed over this period were determined. The numbers and proportions of adults who filled prescriptions exceeding 4.0 g/day and 3.25 g/day were determined for the one-year period July 1, 2009 to June 30, 2010. Data were stratified by sex and age (<65 versus 65+). Results Both the number of prescriptions filled and the number of tablets dispensed increased over the study period, although the proportion of the adult population who filled at least one paracetamol/opioid prescription was lower in each successive one-year period. From July 2009 to June 2010, one in 12 adults (n = 59,197) filled prescriptions for over 13 million paracetamol/opioid tablets. Six percent (n = 3,786) filled prescriptions that exceeded 4.0 g/day and 18.6% (n = 11,008) exceeded 3.25 g/day of paracetamol at least once. These findings exclude non-prescription paracetamol and paracetamol–only prescribed medications. Conclusions A substantial number of individuals who redeem prescriptions for paracetamol/opioid combinations may be at risk of paracetamol-related hepatotoxicity. Healthcare professionals must be vigilant when prescribing and dispensing these medications in order to reduce the associated risks.
ABSTRACTBackground: Antimicrobial resistance results in increased morbidity, mortality, and costs to the health care system. Evidence suggests an association between the use of antimicrobials in hospitals and the development of antimicrobial resistance. Fluoroquinolones constitute one group of antimicrobials that are effective against a variety of bacterial infections, yet they may be subject to misuse. Many hospitals in Nova Scotia have implemented policies to improve antimicrobial prescribing, but the impact of these policies on utilization is unknown.Objectives: To evaluate the use of fluoroquinolones in Nova Scotia hospitals using the World Health Organization's Anatomical Therapeutic Chemical classification system with defined daily doses (ATC/DDD) and to examine the influence of hospital policies for utilization of fluoroquinolones in community-acquired pneumonia.Methods: During the study period (April 1, 1997, to March 31, 2003), fluoroquinolones were administered at 31 of the 37 hospitals in Nova Scotia's 9 district health authorities. Hospital administrative data, hospital characteristics, and pharmaceutical purchasing data related to use of these drugs were aggregated using the ATC/DDD methodology for the fiscal years 1997/1998 to 2002/2003. District pharmacy directors were surveyed to obtain information about district and individual hospital antibiotic policies. Descriptive statistics were calculated, and univariable regression and multilevel analyses were performed.Results: Mean overall fluoroquinolone use increased over the study period, from 47.2 DDD/1000 bed-days per year in fiscal year 1997/1998 to 163.8 DDD/1000 bed-days per year in fiscal year 2002/2003 (p < 0.001). Multilevel analysis showed that utilization policies aimed at appropriate prescribing did not affect the use of fluoroquinolones.Conclusion: This study revealed that drug purchasing, hospital administrative, and diagnostic data could be combined to compare the utilization of fluoroquinolones among different hospitals and district health authorities. Utilization policies had little effect on the amount, type, or route of fluoroquinolone use. ; RÉSUMÉContexte : La résistance aux antimicrobiens se traduit par une hausse de la morbidité, de la mortalité et des coûts pour le système de santé. Des données suggèrent un lien entre l'utilisation des antimicrobiens dans les hôpitaux et l'apparition de résistance antimicrobienne. Les fluoroquinolones, qui sont un groupe d'antimicrobiens efficaces contre une variété d'infections bactériennes, peuvent pourtant être mal utilisées. De nombreux hôpitaux en Nouvelle-Écosse ont donc mis de l'avant des politiques visant à améliorer la prescription des antimicrobiens, mais on ignore quelle est leur incidence sur l'emploi de ces derniers.Objectifs : Évaluer l'utilisation des fluoroquinolones dans les hôpitaux de la Nouvelle-Écosse, à l'aide du système de classification anatomique, thérapeutique et chimique (ATC) et des doses journalières définies (DDD) de l'Organisation mondiale de la Santé, et analyser l'influence des politiques des hôpitaux sur l'utilisation des fluoroquinolones dans le traitement des pneumonies extrahospitalières.Méthodes : Au cours de la période de l'étude (du 1er avril 1997 au 31 mars 2003), des fluoroquinolones ont été administrées dans 31 des 37 hôpitaux des 9 régies régionales de la santé de la Nouvelle-Écosse. Des données sur les caractéristiques démographiques, les diagnostics et l'achat des médicaments concernant l'utilisation des fluoroquinolones dans ces hôpitaux ont été groupées à l'aide de la méthode ATC/DDD pour les exercices financiers de 1997–1998 à 2002–2003. Les directeurs de pharmacie des régies ont répondu à un sondage pour obtenir des renseignements sur les politiques d'utilisation des antibiotiques des régies et de chaque hôpital. Des statistiques descriptives ont été compilées, et des analyses de régression à variable simple et de modélisation hiérarchique ont été effectuées.Résultats : L'utilisation moyenne globale de fluoroquinolones a augmenté pendant la période de l'étude, passant de 47,2 DDD/1000 jours-lits par année pour l'exercice financier de 1997–1998 à 163,8 DDD/1000 jours-lits pour l'exercice financier de 2002–2003 (p < 0,001). L'analyse hiérarchique a montré que les politiques d'utilisation visant une meilleure prescription des fluoroquinolones n'ont pas eu d'effet sur leur utilisation.Conclusion : Cette étude a révélé que les données sur l'achat des médicaments, les caractéristiques démographiques et les diagnostics pouvaient être combinées pour comparer l'utilisation des fluoroquinolones dans divers hôpitaux et régies régionales de la santé. Les politiques sur l'utilisation des antimicrobiens ont eu très peu d'effet sur la quantité et le type de fluoroquinolones utilisées ou leur voie d'administration.
Abstract Background Keeping current with drug therapy information is challenging for health care practitioners. Technologies are often implemented to facilitate access to current and credible drug information sources. In the Canadian province of Nova Scotia, legislation was passed in 2002 to allow nurse practitioners (NPs) to practice collaboratively with physician partners. The purpose of this study was to determine the current utilization patterns of information technologies by these groups of practitioners. Methods Nurse practitioners and their collaborating physician partners in Nova Scotia were sent a survey in February 2005 to determine the frequency of use, usefulness, accessibility, credibility, and current/timeliness of personal digital assistant (PDA), computer, and print drug information resources. Two surveys were developed (one for PDA users and one for computer users) and revised based on a literature search, stakeholder consultation, and pilot-testing results. A second distribution to nonresponders occurred two weeks following the first. Data were entered and analysed with SPSS. Results Twenty-seven (14 NPs and 13 physicians) of 36 (75%) recipients responded. 22% (6) returned personal digital assistant (PDA) surveys. Respondents reported print, health professionals, and online/electronic resources as the most to least preferred means to access drug information, respectively. 37% and 35% of respondents reported using "both print and electronic but print more than electronic" and "print only", respectively, to search monograph-related drug information queries whereas 4% reported using "PDA only". Analysis of respondent ratings for all resources in the categories print, health professionals and other, and online/electronic resources, indicated that the Compendium of Pharmaceuticals and Specialties and pharmacists ranked highly for frequency of use, usefulness, accessibility, credibility, and current/timeliness by both groups of practitioners. Respondents' preferences and resource ratings were consistent with self-reported methods for conducting drug information queries. Few differences existed between NP and physician rankings of resources. Conclusion The use of computers and PDAs remains limited, which is also consistent with preferred and frequent use of print resources. Education for these practitioners regarding available electronic drug information resources may facilitate future computer and PDA use. Further research is needed to determine methods to increase computer and PDA use and whether these technologies affect prescribing and patient outcomes.
