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Background: In Australia, brand substitution by pharmacists has been possible since 1994. There is no limit to the number of substitutions per prescription. Doctors have expressed concern that patients may receive a different product each time their prescription repeats are dispensed, which has the potential to confuse patients. It is unknown how often multiple substitutions per prescription occur. Objectives: We aimed to identify the number of switches per prescription for a range of medicines and to determine the number of different brand and generic products supplied on each prescription. Methods: Repatriation Pharmaceutical Benefits Scheme prescription claims between 1 January 2001 and 28 February 2006 were identified for atenolol, citalopram, enalapril, metformin, omeprazole, ramipril, and simvastatin. Original prescriptions with five repeats and all supplies dispensed were included. Switches were identified if a different product was supplied on consecutive repeat dispensings. Results: 533,279 original prescriptions were included. 488,735 (92%) had no switches on repeats and 37,513 (7%) had only one switch. Only 1% of all prescriptions had more than one switch identified on repeats, and in most cases only two different products were supplied. None of the prescriptions had a different product supplied on each dispensing. Conclusion and Implications: Multiple switches per prescription are uncommon and multiple different products are rarely supplied on repeats of the same prescription. The rules of the brand substitution policy appear to be adequate in allowing brand choice for patients, without leading to multiple switches per prescription. Key words: Generic substitution; generic drugs, pharmaceutical policy; pharmaco-epidemiology.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2005.05.042 Byline: Elizabeth D. Hotham (a), Andrew L. Gilbert (b), Elinor R. Atkinson (c) Keywords: Smoking; Smoking cessation; Pregnancy; Nicotine patches Abstract: Stopping smoking in pregnancy is a public health priority and a clinical imperative. However, many women who have not been able to 'quit' in early pregnancy find it very difficult to do so. This randomised-controlled pilot study examined feasibility issues in offering free nicotine patches with counselling to a group of 20 mid-trimester pregnant women at the Women's and Children's Hospital, Adelaide. A further 20 were offered counselling only. Smoking status at each visit was measured by self-report, carbon monoxide monitoring, and salivary cotinine. The most common pattern (eleven of the twenty women) was intermittent patch use. Only five women used patches continuously up to the 12 week maximum available. Three women in the patch group were abstinent at delivery compared with none in the control group. Notable features of the study were the low interest in participation and the high withdrawal rate. Nicotine patches may not be highly useful for pregnant women. Continuing tobacco control measures and customized support for women and their partners, often smokers, may prove more fruitful. Author Affiliation: (a) School of Pharmacy and Medical Sciences, University of South Australia, Adelaide SA 5000, Australia (b) Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Australia (c) Flinders Medical Centre, Adelaide, Australia Article Note: (footnote) [star] The work was undertaken within the Women's and Babies' Division of the Women's and Children's Hospital, Adelaide, South Australia.

Policy makers and health professionals charged with implementing policies to improve medication use require knowledge as to how to integrate and co-ordinate strategies and interventions which have been shown to be effective. Experimental methodologies are commonly used to assess the effectiveness of interventions to improve medication use and while valuable for determining the effectiveness of particular interventions, they do not add to our understanding of how to co-ordinate and integrate multiple initiatives to improve medication use. We argue that analyses of the overall system of events which are implemented to improve medication use are also needed. In this paper, we demonstrate how the case study analysed within the framework of the Transtheoretical Model of behaviour change can be used to provide an understanding of the relationship of events which result in changes in medication use. A case study of the sequence of events which led to changes in the utilisation of flucloxacillin in Australia is assessed. The analysis demonstrated that the effectiveness of individual interventions was dependent upon the initiatives which were implemented concurrently and those that had been implemented previously. Changes in the utilisation of flucloxacillin resulted from regulatory interventions and the promotion of appropriate alternative therapies. The effectiveness of this change was enhanced by previous interventions which had raised awareness amongst health professionals of the adverse hepatic reaction associated with the use of flucloxacillin. This methodology adds to those currently employed to study methods of improving use of medications. It provides an understanding of the role of each initiative in the overall system. This is valuable for policy makers, providing them with information on how to co-ordinate and orchestrate the myriad of activities which support quality use of medicines. Keywords: Medication; Drug; Improving; Quality; System; Adverse

Abstract Background Accurate and timely medication information at the point of discharge is essential for continuity of care. There are scarce data on the clinical significance if poor quality medicines information is passed to the next episode of care. This study aimed to compare the number and clinical significance of medication errors and omission in discharge medicines information, and the timeliness of delivery of this information to community-based health practitioners, between the existing Hospital Discharge Summary (HDS) and a pharmacist prepared Medicines Information Transfer Fax (MITF). Method The study used a sample of 80 hospital patients who were at high risk of medication misadventure, and who had a MITF completed in the study period June – October 2009 at a tertiary referral hospital. The medicines information in participating patients’ MITFs was validated against their Discharge Prescriptions (DP). Medicines information in each patient’s HDS was then compared with their validated MITF. An expert clinical panel reviewed identified medication errors and omissions to determine their clinical significance. The time between patient discharge and the dispatching of the MITF and the HDS to each patient’s community-based practitioners was calculated from hospital records. Results DPs for 77 of the 80 patients were available for comparison with their MITFs. Medicines information in 71 (92%) of the MITFs matched that of the DP. Comparison of the HDS against the MITF revealed that no HDS was prepared for 16 (21%) patients. Of the remaining 61 patients; 33 (54%), had required medications omitted and 38 (62%) had medication errors in their HDS. The Clinical Panel rated the significance of errors or omissions for 70 patients (16 with no HDS prepared and 54 who’s HDS was inconsistent with the validated MITF). In 17 patients the error or omission was rated as insignificant to minor; 23 minor to moderate; 24 moderate to major and 6 major to catastrophic. 28 (35%) patients had their HDS dispatched to their community-based practitioners within 48 hours post discharge compared to 80 (100%) of MITFs. Conclusion The MITF is an effective approach for the timely delivery of accurate discharge medicines information to community-based practitioners responsible for the patient’s ongoing care.