Search

Background and Purpose: Early treatment is a critical determinant of successful intervention in acute stroke. The study was designed to find current patterns of stroke care by determining delays in time from onset of signs or symptoms to arrival at the emergency department and to initial evaluation by physicians and by identifying factors associated with these delays., Methods: Data were prospectively collected by nurses and physicians from patients, patients' family members, and medical records from 10 hospitals of the Robert Wood Johnson Health System in New Jersey., Results: A total of 553 patients who presented with signs or symptoms of acute stroke were studied. Thirty-two percent of patients arrived at the emergency department within 1.5 hours of stroke onset. Forty-six percent of patients arrived within 3 hours and 61% within 6 hours. Delays in arrival time were significantly associated with sex, race, transportation mode, and history of cardiovascular disease. Patients arriving by ambulance were more likely to present earlier (odds ratio [OR] 3.7 for arrival within 3 hours; OR 4.5 for arrival within 6 hours). Patients arriving by ambulance (OR 2.3 within 15 minutes; OR 1.7 within 30 minutes) and those requiring admission to intensive care units (OR 4.5 within 15 minutes and OR 5.2 within 30 minutes) were examined sooner by physicians., Conclusions: Despite national efforts to promote prompt stroke evaluation and treatment, significant delays still exist. The lack of improvement throughout the past decade underscores the need for implementation of effective public health programs designed to minimize the time to evaluation and treatment of stroke.

The purpose of this study is to measure the rate of genetic drug substitution by pharmacists, and factors influencing generic substitution, such as the extent of drugs listed on the formulary as well as physicians' and patients' acceptance rate of generic substitutes. A total of 9,328 prescription orders were retrospectively reviewed from 94 pharmacies which were selected at random. The substitution rate by pharmacists, which is the rate using the number of prescriptions eligible for substitution as the denominator, has risen from 47% in 1979 to 96% in 1997; double the rate over the past 20 years. The net substitution rate, which uses all prescriptions as the denominator, was 30% in 1997; over 4 times greater than the rate in 1979. Physicians wrote most prescriptions (86%) using the brand name of the drug, which has been the trend for the past 20 years. Of the prescriptions ordered by brand name, 47% were substitutable according to the New Jersey formulary. Of these prescriptions, prescribers allowed generic substitution 77% of the time. Out of these prescriptions, 97% of patients agreed to use a generic substitute if the physician approved of substitution. Generic substitution rates have increased, probably due to greater acceptance of generics by physicians and pharmacists as well as encouragement from external sources such as third party payers. Health care professionals, third parties, and patients all have an important role to play in order to increase the use of generics, and therefore reduce drug expenditures.