title: Feedback and lessons from the prescription of rimonabant, a drug to be used under strict guidelines, in southeastern France, March 2007 through June 2008.
abstract: BACKGROUND
  To provide feedback on the initial market authorization of rimonabant, a drug to be used under strict guidelines, we conducted a study with information from the National health insurance reimbursements database for southeastern France. The aims of this study were to: (1) describe the characteristics of subjects who have had one rimonabant prescription reimbursed; (2) study the frequency of prescriptions that did not comply with reimbursement criteria; (3) study the frequency of prescriptions for patients simultaneously treated with antidepressants; and (4) analyse the factors associated with both types of prescription (patient and prescriber characteristics).
  
  
  METHODS
  Using the database of drug reimbursements maintained by the southeastern France general health insurance fund, we studied the characteristics of outpatients with at least one reimbursement for rimonabant, compared them to the rest of the population, and analysed compliance with the indications, contraindications, and regulations for rimonabant prescription with multivariate logistic regressions.
  
  
  RESULTS
  A total of 10,510 beneficiaries (0.28%) had at least one rimonabant reimbursement. Among them, 55.7% were treated for diabetes. For at least 62.4% of rimonabant beneficiaries, the reimbursement regulations were not respected: this was significantly more frequent among women less than 57 years old, subjects with no chronic diseases, and when the prescriber was not an endocrinologist; 11.4% of rimonabant beneficiaries also received an antidepressant treatment.
  
  
  CONCLUSIONS
  Despite the specific status of rimonabant regarding its reimbursement modalities, these results suggest that some prescribers get around reimbursement instructions and that a significant percentage of prescriptions did not respect an important contraindication. Tools to follow up the prescriptions of new drugs with strict guidelines for use should be developed and physicians should be better informed and trained regarding specific prescription regulations.
authors: Unité Inserm U912 (SE4S)-Sciences économiques et sociales, système et santé, sociétés, institut Paoli-Calmettes, Marseille, France.
authors: M
authors: M
authors: Jardin
authors: S
authors: S
authors: Cortaredona
authors: A
authors: A
authors: Bocquier
authors: S
authors: S
authors: Nauleau
authors: V
authors: V
authors: Sciortino
authors: J
authors: J
authors: Bouvenot
authors: L
authors: L
authors: Sauze
authors: G
authors: G
authors: Bouvenot
authors: P
authors: P
authors: Verger
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use*; D015992:Body Mass Index; D003866:Depressive Disorder / Q000188:drug therapy* / Q000209:etiology; D048909:Diabetes Complications / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data*; D005246:Feedback; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000188:drug therapy; D010880:Piperidines / Q000191:economics / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011720:Pyrazoles / Q000191:economics / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077285:Rimonabant
chemical_list: D000928:Antidepressive Agents; D010880:Piperidines; D011720:Pyrazoles; D000077285:Rimonabant