E-drug: Canadian abstracts
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[This posting follows a request some time ago to summarize interesting
articles that are published nationally, and that might not easily be
found elsewhere, eg MEDLINE. If other E-druggers are interested to
summarize their national essential drug articles, please contact the
E-drug moderator at email 73377.3055@compuserve.com
Thanks Joel! WB E-drug mod]
Here are some recent articles that e druggers might find interesting.
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Pharmaceutical policies in Canadian family medicine training. Survey of
residency programs
S. Mahood, MD, CCFP C. Zagozeski, MD, CCFP T. Bradel, MD, CCFP K.
Lawrence, BSC, MD, CCFP
OBJECTIVE
To determine whether family medicine residency training programs have
formal policies regarding interactions between residents and the
pharmaceutical industry, to identify existing practices, and to find out
what issues in industry-physician interaction are addressed during the
2-year core curriculum training in Canada.
DESIGN
Mailed survey using a questionnaire.
SETTING
The 16 Canadian residency training programs in family medicine.
PARTICIPANTS
Program directors of all 16 Canadian family medicine residency training
programs replied.
MAIN OUTCOME MEASURES
Number of programs with formal pharmaceutical policies; number of programs
offering formal curriculum coverage of related topics in the field; program
practices regarding industry sampling, detailing, sponsorship, and access.
RESULTS
Only four of the 16 programs have formal policies or guidelines. Topics
generally covered in core curriculum included critical appraisal (13/16)
and cost trends (11/16). Few programs address determinants of prescribing
(5/16), marketing techniques (4/16), provincial drug access programs
(6/16), or the Canadian Medical Association guidelines on
physician-industry interaction (5/16). Industry presence and sponsorship in
family medicine training is notable, and screening is limited. Great
variation exists, and programs are interested in future initiatives.
CONCLUSIONS
Family medicine training in Canada is attempting to address pharmaceutical
issues. Interest is strong, but these issues need to be given more
emphasis.
Canadian Family Physician 1997;43:1947-1951.
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Intervention to reduce telephone prescription requests
Howard R. Cohen, MD, CCFP, DIP SPORT MED Heather Garwood, RN Carol Seaby,
RN
OBJECTIVE
To evaluate a systematic effort to reduce telephone orders for prescription
medications in a community family
practice.
DESIGN
Three-year intervention project.
SETTING
Solo family practice in Ottawa.
PARTICIPANTS
All patients requesting telephone orders for prescription medications.
INTERVENTIONS
A retrospective analysis of phone requests and orders was conducted on 1
continuous year's records. A new office policy was instituted on October 9,
1992, discouraging telephone orders for prescription medication.
Prescription telephone requests and orders were then monitored continuously
for the next 3 years.
MAIN OUTCOME MEASURES
Number of telephone prescription requests and orders per half-day 1 year
before the intervention compared with the number for the 3 years after the
intervention.
RESULTS
One year before the intervention, there were 4.96 telephone prescription
requests per half-day; 3 years after the intervention this number fell to
0.85. One year before the intervention, the number of telephone
prescription orders per half-day was 4.80; this number fell continuously to
0.67 during the 3 years following the intervention.
CONCLUSIONS
We observed a reduction in the number of telephone prescription requests
and orders following the introduction of an office policy that encouraged
prescribing and renewing medication in person.
Can Fam Physician 1997;43:1952-1957.
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Drug interactions among commonly used medications. Chart simplifies data
from critical literature review
N. Ren�e Crowther, MSC Anne M. Holbrook, MD, PHARMD, MSC, FRCPC Robert
Kenwright, BSC Margaret Kenwright, AOCA
OBJECTIVE
To simplify risk assessment, we have developed a way to present critically
appraised drug interaction information through a chart.
DATA SOURCES
Fifty drugs most frequently prescribed by Canadian family physicians and 16
drugs and substances that frequently interact with these drugs were the
basis for a literature review. Drug interaction textbooks and MEDLINE (from
1966 to 1994) were searched for documented interactions. Reports of
additive effects and animal or in vitro studies were excluded.
STUDY SELECTION
All reports of interactions were evaluated for clinical effect, clinical
significance, and quality of evidence.
SYNTHESIS
Of the 464 drug-drug or drug-substance pairs evaluated, 387 (83.4%)
demonstrated an interaction, 59 (12.7%) documented no effect, and 18 (3.9%)
pairs had conflicting evidence. Five percent of interactions were of major
clinical significance; only 1.3% were of major clinical significance and
supported by good-quality evidence. By using symbols, colours, and legends
in a "grid-map" format, a large amount of drug interaction information was
reduced to a single-page chart suitable for a desk reference or wall
mounting.
CONCLUSIONS
Our chart organizes a large amount of drug interaction information in a
format that allows for rapid appreciation of outcome, clinical
significance, and quality of evidence.
Canadian Family Physician 1997;43:1972-1981.
Copies of the chart can be obtained directly from:
Ren�e Crowther
Centre for Evaluation of Medicines
St. Joseph's Hospital
50 Charlton Ave. E.
Hamilton, Ontario
CANADA L8N 4A6
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Joel Lexchin MD
121 Walmer Rd.
Toronto, Ontario
CANADA M5R 2X8
Phone: (416)-964-7186
Fax: (416)-923-9515
e mail: joel.lexchin@utoronto.ca
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