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Different groups of patients in a general practice have been under close observation by defined methods to assess the extent of their adherence to drug schedules. Patients taking antibiotics, admitted to a short drug trial and prescribed long-term treatments, proved in most cases to be compliant. Antenatal patients taking a once-daily dosage of prophylactic iron were more co-operative than those taking divided dosages. Socially isolated patients and those of low social class were particularly likely to neglect their drugs. It is suggested that the significance and extent of the problem have been largely ignored and that all drug trials undertaken on outpatients should incorporate methods of detecting defaulters.

municipal hospitals has grown. These considerations form the background of the research reported in the present paper. This report deals with inpatient utilization and costs of drugs in a group of metropolitan hospitals. It is one of several reports on research in drugs in medical care. It was felt that an exploration of drug utilization and costs in hospitals would provide information which would be useful to

An analysis of the general results of a drug monitor in a psychiatric unit have been reported previously (Gardiner and Hall, 1971). One of the principal findings of that analysis was that the propensity for ‘untoward events' increased as the number of drugs that a patient received increased. The definition of ‘untoward event’ was that given by Finney (1965)—a‘n event is a particular untoward happening experienced by a patient, undesirable either generally or in the context of his disease. The term is not to be limited either to recognised side-effects of a drug or to incidents that are in some sense unexpected’. This paper takes this particular aspect of the investigation further in an attempt to describe the prescribing practice and to discover any particular drug or combination of drugs that was associated with a high frequency of ‘untoward events'.

This paper examines the pharmaceutical market and prescription drug costs and consumption in the Federal Republic of Germany. Comparisons are made with the experience of other countries. It is argued that the pharmaceutical market in the Federal Republic is characterized by a relative abundance of pharmaceutical products and, as in other countries, is both limited by an inherently oligopolistic supply structure and modified by physician prescribing habits. The distribution system shows a tendency to supplier-administered prices owing to a noncompetitive retail structure, reinforced by the inclination of the statutory health insurance scheme toward price uniformity. Despite relatively higher promotional expenses than noted elsewhere, these factors are not conducive to the more meaningful price competition observed in some other countries with a more diversified distributive sector, such as the United States, or in other systems where tendencies toward oligopsony or near monopsony, e.g. Sweden and the United Kingdom, may provide some counterbalancing mechanisms aimed at the modification of retail prices. Recent per capita cost development is considered in the light of some cross-national comparisons. It is argued that in the countries studied, depending on the level of development, either a per prescription cost push or a cost increase pull due to increased utilization frequency is prevalent. This distinction would tend to refute the occasionally advocated view that cost increases are determined almost exclusively by increasing utilization, whether dynamically or as a function of time. In the Federal Republic, a relatively high level of utilization constitutes the main factor affecting the total per capita drug consumption cost. Nonetheless, owing to a comparatively lower per item cost, total costs are comparable to the outlay observed in some other countries. Both in the Federal Republic and in other countries with relatively stable utilization patterns, changes in the average per prescription cost may in the long run prove to be the dominant factor in the formation of total per capita costs for prescribed drugs.