Factors associated with nonprescription of evolving modes of therapy--a model for drug use evaluation in hospitalized medical patients.
OBJECTIVE
To measure the rate of inappropriate underuse of drug therapy among hospitalized patients and to identify factors associated with nonprescription of two effective modes of therapy.


METHODS
A survey was conducted by retrospective chart extraction to measure the rates of nonprescription of two therapeutic modalities--aspirin and angiotensin converting enzyme inhibitors. Stepwise logistic regression was used to determine which factors were significantly associated with nonprescription of either drug.


METHODS
Two internal medicine departments in a major community and referral hospital in Israel.


METHODS
Those who were hospitalized through 1990 with a diagnosis on their discharge sheet of angina pectoris or congestive heart failure. A random sample selection was made to define the study population.


RESULTS
The rates of nonprescription among patients in whom there are no drug contraindications were 54% (95% CI 47-62) for aspirin and 34% (95% CI 27-41) for angiotensin converting enzyme inhibitors. Three variables correlated independently with nonprescription of both drugs: hospitalization in ward B, nonuse of the drug prior to hospitalization, and secondary priority of the diagnosis angina pectoris or congestive heart failure on discharge sheet.


CONCLUSIONS
Nonprescription of essential drugs is a common phenomenon that varies significantly among physicians. Inconsistency in application of knowledge to clinical practice, as well as a diversity of approaches toward interpretations of clinical study results, significantly influences the prescription rates of evolving modes of therapy.
Gertner Institute for Health Policy Research, Tel Aviv University, Tel Hashomer, Israel.
B
B
Mozes
Y
Y
Rosenblum
E
E
Shabtai
H
H
Halkin
D000787:Angina Pectoris / Q000188:drug therapy; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D003625:Data Collection; D017723:Drug Utilization Review / Q000379:methods*; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000188:drug therapy; D006746:Hospital Bed Capacity, 500 and over; D006760:Hospitalization; D006784:Hospitals, Teaching; D006801:Humans; D007557:Israel; D016015:Logistic Models; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data