Seventeen years' experience of a voluntarily based drug rationalisation programme in hospital.

Abstract:

:A study was carried out analysing the operation of a drug rationalisation programme in a central London teaching district that had evolved from experience over 17 years. Creation of a limited list of about 700 drugs had been achieved by local consensus. Drug selection was based on appraisal of efficacy, safety, and cost and was undertaken by means of collaborative participation of most consultant specialists in the district. Educative and other non-restrictive strategies for reinforcing the rationalisation policy had achieved a consistently high rate of compliance in prescribing recommended drugs. The concept of selectivity in drug use and its continuous local reappraisal had a beneficial impact on the prescribing habits of doctors at all levels of seniority as well as on the training of medical undergraduates and nurses in the therapeutic use of medicines. Peer review and self audit were encouraged by use of an extensive monitoring system which incorporated continuous "facilitative" dialogue between ward pharmacists and prescribers. Two models of drug rationalisation programme were studied, the second of which together with other local initiatives had been associated with substantial and sustained reductions in drug spending each year over nine years since 1978. It is concluded that the second drug rationalisation programme model substantially improves the cost effective use of drugs in hospital and furthermore has the potential of being extended to general practice, especially in types of prescribing that are common to both forms of patient care.

journal_name

BMJ

authors

Baker JA,Lant AF,Sutters CA

doi

10.1136/bmj.297.6646.465

subject

Has Abstract

pub_date

1988-08-13 00:00:00

pages

465-9

issue

6646

eissn

0959-8138

issn

1756-1833

journal_volume

297

pub_type

杂志文章
  • Scottish attitudes to blood donation and AIDS.

    abstract:OBJECTIVE:To see whether the issue of AIDS has influenced the observed decline in blood donation in Scotland. DESIGN:Two methods: a quantitative survey using personal interviews based on a questionnaire and a qualitative survey based on group discussions. SETTING:Interviews based on the questionnaire were conducted i...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.298.6679.1012

    authors: MacAskill SG,Hastings GB,McNeill RE,Gillon J

    更新日期:1989-04-15 00:00:00

  • Outcome of breech delivery at term.

    abstract:OBJECTIVE:To compare neonatal mortality and morbidity in term infants presenting by the breech and delivered vaginally or by caesarean section. DESIGN:Population based comparison of outcomes. Data derived from the St Mary's maternity information system. SETTING:North West Thames Regional Health Authority, 1988-90. S...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.305.6856.746

    authors: Thorpe-Beeston JG,Banfield PJ,Saunders NJ

    更新日期:1992-09-26 00:00:00

  • Vitamin A supplementation and BCG vaccination at birth in low birthweight neonates: two by two factorial randomised controlled trial.

    abstract:OBJECTIVE:To investigate the effect of vitamin A supplementation and BCG vaccination at birth in low birthweight neonates. DESIGN:Randomised, placebo controlled, two by two factorial trial. SETTING:Bissau, Guinea-Bissau. PARTICIPANTS:1717 low birthweight neonates born at the national hospital. INTERVENTION:Neonates...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1136/bmj.c1101

    authors: Benn CS,Fisker AB,Napirna BM,Roth A,Diness BR,Lausch KR,Ravn H,Yazdanbakhsh M,Rodrigues A,Whittle H,Aaby P

    更新日期:2010-03-09 00:00:00

  • Effectiveness of rotavirus vaccination against childhood diarrhoea in El Salvador: case-control study.

    abstract:OBJECTIVE:To evaluate the effectiveness of a monovalent rotavirus vaccine against severe rotavirus disease and to assess its impact on diarrhoea in children aged less than 2 years after national introduction in El Salvador, a low-middle income country in Central America. DESIGN:Matched case-control study. SETTING:Sev...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究

    doi:10.1136/bmj.c2825

    authors: de Palma O,Cruz L,Ramos H,de Baires A,Villatoro N,Pastor D,de Oliveira LH,Kerin T,Bowen M,Gentsch J,Esposito DH,Parashar U,Tate J,Patel M

    更新日期:2010-06-15 00:00:00

  • Clinical and cost effectiveness of booklet based vestibular rehabilitation for chronic dizziness in primary care: single blind, parallel group, pragmatic, randomised controlled trial.

    abstract:OBJECTIVE:To determine the clinical and cost effectiveness of booklet based vestibular rehabilitation with and without telephone support for chronic dizziness, compared with routine care. DESIGN:Single blind, parallel group, pragmatic, randomised controlled trial. SETTING:35 general practices across southern England ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1136/bmj.e2237

    authors: Yardley L,Barker F,Muller I,Turner D,Kirby S,Mullee M,Morris A,Little P

    更新日期:2012-06-06 00:00:00

  • Neonatal screening for cystic fibrosis using immunoreactive trypsinogen and direct gene analysis: four years' experience.

    abstract:OBJECTIVE:To assess the performance and impact of a two tier neonatal screening programme for cystic fibrosis based on an initial estimation of immunoreactive trypsinogen followed by direct gene analysis. DESIGN:Four year prospective study of two tier screening strategy. First tier: immunoreactive trypsinogen measured...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.308.6942.1469

    authors: Ranieri E,Lewis BD,Gerace RL,Ryall RG,Morris CP,Nelson PV,Carey WF,Robertson EF

    更新日期:1994-06-04 00:00:00

  • Using clinicopathological analysis of general practitioner skin surgery to determine educational requirements and guidelines.

    abstract:OBJECTIVE:To study the impact of skin surgery in general practice on the workload of a pathology laboratory and to identify what further training might be helpful. DESIGN:Analysis of skin biopsy specimens from general practitioners before and after their new contract to determine numbers of specimens, changes in diagn...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.304.6819.93

    authors: Cox NH,Wagstaff R,Popple AW

    更新日期:1992-01-11 00:00:00

  • Cardiovascular mortality in Dutch men during 1996 European football championship: longitudinal population study.

    abstract:OBJECTIVE:To investigate whether an important football match increases stress to such an extent that it triggers acute myocardial infarction and stroke. DESIGN:Longitudinal study of mortality around 22 June 1996 (the day the Dutch football team was eliminated from the European football championship). Mortality on 22 J...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.321.7276.1552

    authors: Witte DR,Bots ML,Hoes AW,Grobbee DE

    更新日期:2000-12-23 00:00:00

  • Abortion rates in England in 1995: comparative study of data from district health authorities.

    abstract::Lifetime fertility, abortion rates, and the proportion of pregnancies resulting in induced abortion were investigated in 105 district health authorities in England. In 1995, a total of 147,851 abortions occurred among women living in England, compared with 613,257 live births; a ratio of 1:4. This was equivalent to ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.316.7146.1711

    authors: Raleigh VS

    更新日期:1998-06-06 00:00:00

  • Personalia and the current health crisis.

    abstract::Recent changes in the Russian government introduced by Boris Yeltsin include the appointment of Eduard Nechaev as health minister at the beginning of this year. The appointment received little publicity in the West, although his predecessor was sacked after only one year for failing to make any effort to improve healt...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.306.6882.909

    authors: Ryan M

    更新日期:1993-04-03 00:00:00

  • Long term calcium intake and rates of all cause and cardiovascular mortality: community based prospective longitudinal cohort study.

    abstract:OBJECTIVE:To investigate the association between long term intake of dietary and supplemental calcium and death from all causes and cardiovascular disease. DESIGN:Prospective longitudinal cohort study. SETTING:Swedish mammography cohort, a population based cohort established in 1987-90. PARTICIPANTS:61 433 women (bo...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.f228

    authors: Michaëlsson K,Melhus H,Warensjö Lemming E,Wolk A,Byberg L

    更新日期:2013-02-12 00:00:00

  • Auditing audits: the method of Oxfordshire Medical Audit Advisory Group.

    abstract:OBJECTIVES:To develop a systematic method for both summative and formative audit of practice audits, and to use the method to review Oxfordshire practice audits and to plan improvement. DESIGN:Development of a coding system for the audit cycle subsequently used prospectively to assess audits reported to medical audit ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,meta分析

    doi:10.1136/bmj.303.6812.1247

    authors: Derry J,Lawrence M,Griew K,Anderson J,Humphreys J,Pandher KS

    更新日期:1991-11-16 00:00:00

  • Damage to DNA in cervical epithelium related to smoking tobacco.

    abstract:OBJECTIVE:To determine whether tobacco smoking causes increased DNA modification (adducts) in human cervical epithelium. DESIGN:Comparison of DNA adducts measured by the technique of postlabelling with phosphorus-32 in normal ectocervical epithelium of smokers and non-smokers. A questionnaire on smoking habit and a ur...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.306.6890.1444

    authors: Simons AM,Phillips DH,Coleman DV

    更新日期:1993-05-29 00:00:00

  • Population based study of prevalence of islet cell autoantibodies in monozygotic and dizygotic Danish twin pairs with insulin dependent diabetes mellitus.

    abstract:OBJECTIVE:To study the comparative importance of environment and genes in the development of islet cell autoimmunity associated with insulin dependent diabetes mellitus. DESIGN:Population based study of diabetic twins. SETTING:Danish population. SUBJECTS:18 monozygotic and 36 dizygotic twin pairs with one or both pa...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.314.7094.1575

    authors: Petersen JS,Kyvik KO,Bingley PJ,Gale EA,Green A,Dyrberg T,Beck-Nielsen H

    更新日期:1997-05-31 00:00:00

  • Factors influencing recovery from headache after common whiplash.

    abstract:OBJECTIVE:To assess the relation between pretraumatic and trauma related headache in patients suffering from whiplash. DESIGN:Follow up study of patients examined a mean (SD) of 7.4 (4.2) days after trauma and again at three and six months. SETTING:Patients referred from primary care. SUBJECTS:117 patients (mean age...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.307.6905.652

    authors: Radanov BP,Sturzenegger M,Di Stefano G,Schnidrig A,Aljinovic M

    更新日期:1993-09-11 00:00:00

  • Progressive loss of bone in the femoral neck in elderly people: longitudinal findings from the Dubbo osteoporosis epidemiology study.

    abstract:OBJECTIVES:To determine prospectively the rates of change in bone mineral density in elderly people and to examine the relation between lifestyle and demographic factors and these rates of change. DESIGN:Longitudinal population based study. SETTING:Dubbo, New South Wales, Australia. SUBJECTS:Representative sample (n...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:

    authors: Jones G,Nguyen T,Sambrook P,Kelly PJ,Eisman JA

    更新日期:1994-09-17 00:00:00

  • Efficacy of PD-1 or PD-L1 inhibitors and PD-L1 expression status in cancer: meta-analysis.

    abstract:OBJECTIVE:To evaluate the relative efficacy of programmed cell death 1 (PD-1) or programmed cell death ligand 1 (PD-L1) inhibitors versus conventional drugs in patients with cancer that were PD-L1 positive and PD-L1 negative. DESIGN:Meta-analysis of randomised controlled trials. DATA SOURCES:PubMed, Embase, Cochrane ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,meta分析

    doi:10.1136/bmj.k3529

    authors: Shen X,Zhao B

    更新日期:2018-09-10 00:00:00

  • Large outbreak of food poisoning caused by Salmonella typhimurium definitive type 49 in mayonnaise.

    abstract::An investigation was conducted to determine the vehicle of infection of an outbreak of food poisoning in a large metropolitan building early in 1988. A questionnaire was distributed to 700 people who had eaten in the building during the week of the outbreak, and attack rates for specific food were calculated. Food and...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.298.6666.99

    authors: Mitchell E,O'Mahony M,Lynch D,Ward LR,Rowe B,Uttley A,Rogers T,Cunningham DG,Watson R

    更新日期:1989-01-14 00:00:00

  • Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit.

    abstract:OBJECTIVE:To identify the number of patients who were misdiagnosed as being in the vegetative state and their characteristics. DESIGN:Retrospective study of the clinical records of the medical, occupational therapy, and clinical psychology departments. SETTING:20 bed unit specialising in the rehabilitation of patient...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.313.7048.13

    authors: Andrews K,Murphy L,Munday R,Littlewood C

    更新日期:1996-07-06 00:00:00

  • Potential for cadaveric organ retrieval in New South Wales.

    abstract:OBJECTIVES:To measure the potential for cadaver organ retrieval in New South Wales and to determine the reasons for potential donors failing to become actual donors. DESIGN:Prospective audit of all patients dying in five hospitals in New South Wales between 1 December 1989 and 30 November 1990; quality assurance of th...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.304.6838.1339

    authors: Hibberd AD,Pearson IY,McCosker CJ,Chapman JR,Macdonald GJ,Thompson JF,O'Connell DL,Mohacsi PJ,McLoughlin MP,Spratt PM

    更新日期:1992-05-23 00:00:00

  • Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis.

    abstract:OBJECTIVES:To compare the efficacy and tolerability of butterbur (Petasites hybridus) with cetirizine in patients with seasonal allergic rhinitis (hay fever). DESIGN:Randomised, double blind, parallel group comparison. SETTING:Four outpatient general medicine and allergy clinics in Switzerland and Germany. PARTICIPA...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1136/bmj.324.7330.144

    authors: Schapowal A,Petasites Study Group.

    更新日期:2002-01-19 00:00:00

  • Integrated care for diabetes: clinical, psychosocial, and economic evaluation. Diabetes Integrated Care Evaluation Team.

    abstract:OBJECTIVES:To evaluate integrated care for diabetes in clinical, psychosocial, and economic terms. DESIGN:Pragmatic randomised trial. SETTING:Hospital diabetic clinic and three general practice groups in Grampian. PATIENTS:274 adult diabetic patients attending a hospital clinic and registered with one of three gener...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

    authors:

    更新日期:1994-05-07 00:00:00

  • Telephone or internet delivered talking therapy can alleviate irritable bowel symptoms.

    abstract::The studyEveritt H, Landau G, Little P. Therapist telephone-delivered CBT and web-based CBT compared with treatment as usual in refractory irritable bowel syndrome: the ACTIB three-arm RCT. Health Technol Assess 2019;23:1-154.This project was funded by the NIHR Health Technology Assessment Programme (project number 11...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 评论,杂志文章

    doi:10.1136/bmj.l4962

    authors: Cook R,Davidson P,Martin R,NIHR Dissemination Centre.

    更新日期:2019-11-04 00:00:00

  • Informed choice for users of health services: views on ultrasonography leaflets of women in early pregnancy, midwives, and ultrasonographers.

    abstract::With the aim of promoting the informed choice of pregnant women, staff and pregnant women at two urban hospitals were offered leaflets summarising the best available evidence about the effectiveness of routine ultrasonography in early pregnancy. Ultrasonographers doubted the credibility of the evidence and were concer...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.313.7067.1251a

    authors: Oliver S,Rajan L,Turner H,Oakley A,Entwistle V,Watt I,Sheldon TA,Rosser J

    更新日期:1996-11-16 00:00:00

  • AIDS and declining support for dependent elderly people in Africa: retrospective analysis using demographic and health surveys.

    abstract:OBJECTIVES:To determine the relation between the HIV/AIDS epidemic and support for dependent elderly people in Africa. DESIGN:Retrospective analysis using data from Demographic and Health Surveys. SETTING:22 African countries between 1991 and 2006. PARTICIPANTS:123,176 individuals over the age of 60. MAIN OUTCOME M...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.c2841

    authors: Kautz T,Bendavid E,Bhattacharya J,Miller G

    更新日期:2010-06-16 00:00:00

  • Weighting in the dark: resource allocation in the new NHS.

    abstract::National allocation of resources to regional health authorities and by them to districts is now determined by a weighted capitation formula. The national formula was derived from regression analysis, with hospital utilisation as an index of need for health care--a method which has fundamental limitations. This paper a...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.306.6881.835

    authors: Sheldon TA,Smith GD,Bevan G

    更新日期:1993-03-27 00:00:00

  • Neuroleptic sensitivity in patients with senile dementia of Lewy body type.

    abstract:OBJECTIVE:To determine the outcome of administration of neuroleptics to patients with senile dementia of Lewy body type confirmed at necropsy. DESIGN:Retrospective analysis of clinical notes blind to neuropathological diagnosis. SETTING:Specialist psychogeriatric assessment units referring cases for necropsy to a tea...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.305.6855.673

    authors: McKeith I,Fairbairn A,Perry R,Thompson P,Perry E

    更新日期:1992-09-19 00:00:00

  • Teenage pregnancy and social disadvantage: systematic review integrating controlled trials and qualitative studies.

    abstract:OBJECTIVES:To determine the impact on teenage pregnancy of interventions that address the social disadvantage associated with early parenthood and to assess the appropriateness of such interventions for young people in the United Kingdom. DESIGN:Systematic review, including a statistical meta-analysis of controlled tr...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,meta分析,评审

    doi:10.1136/bmj.b4254

    authors: Harden A,Brunton G,Fletcher A,Oakley A

    更新日期:2009-11-12 00:00:00

  • Incidence of and mortality from cancer in hypertensive patients.

    abstract:OBJECTIVES:To assess incidence of and mortality from cancer in hypertensive patients taking atenolol, comparing the findings with two control populations and with hypertensive patients taking other drugs. DESIGN:Retrospective analysis of patients first seen in the Glasgow Blood Pressure Clinic between 1972 and 1990. P...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.306.6878.609

    authors: Hole DJ,Hawthorne VM,Isles CG,McGhee SM,Robertson JW,Gillis CR,Wapshaw JA,Lever AF

    更新日期:1993-03-06 00:00:00

  • Neurotropic viruses and cerebral palsy: population based case-control study.

    abstract:OBJECTIVE:To investigate the association between cerebral palsy and direct evidence for perinatal exposure to neurotropic viruses. DESIGN:Population based case-control study. SETTING:Adelaide Women's and Children's Hospital Research Laboratory. PARTICIPANTS AND MAIN OUTCOME MEASURES:Newborn screening cards of 443 wh...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.38668.616806.3A

    authors: Gibson CS,MacLennan AH,Goldwater PN,Haan EA,Priest K,Dekker GA,South Australian Cerebral Palsy Research Group.

    更新日期:2006-01-14 00:00:00