التفاصيل البيبلوغرافية
| العنوان: |
Appropriate and inappropriate prescribing of narcotics for ambulatory HIV-positive patients. |
| المؤلفون: |
Morrison, Robert, Brint, J., Smith, Wally, Arheart, Kristopher, Wray, Debra, Palte, Stephen, Ackerman, Terrence, Morrison, R E, Brint, J M, Smith, W R, Arheart, K L, Wray, D, Palte, S B, Ackerman, T F |
| المصدر: |
JGIM: Journal of General Internal Medicine; Jun1994, Vol. 9 Issue 6, p301-305, 5p |
| مستخلص: |
Objective: To assess the appropriateness of narcotic-prescribing practices in an ambulatory clinic for patients infected with HIV.Design, Setting, and Patients: The medical records of 220 (190 HIV-positive) patients, seen in a clinic primarily designed for the long-term follow-up of ambulatory HIV-infected patients and located in an inner-city, public teaching hospital, were retrospectively reviewed to determine the prevalence and appropriateness of prescribing Drug Enforcement Administration schedule 2 narcotics. Appropriateness was based on published guidelines for the use of narcotics in the treatment of cancer patients.Measurements and Main Results: The prevalence of narcotic use among the HIV-positive patients was 15%. Narcotics were prescribed for 38% of the patients who died, 33% of those with AIDS [Centers for Disease Control and Prevention (CDC) clinical class C], 4% of those with AIDS-related complex (ARC) (CDC clinical class B), and 5% of asymptomatic HIV-positive patients (CDC clinical class A). None of the HIV-negative patients seen in the clinic received narcotics. Narcotics were more likely to be prescribed for patients with AIDS than for patients with ARC (p < 0.001) or for HIV-positive patients (p < 0.001). For the three CDC clinical classes, there was no significant difference among the proportions of patients receiving narcotics inappropriately (p = 0.108). Among the risk groups, intravenous drug abusers were more likely to be prescribed narcotics inappropriately than were men who were homosexual (p < 0.001) or individuals who were heterosexual (p = 0.013); transfusion recipients were also more likely to be prescribed narcotics inappropriately than were homosexual men (p = 0.026) or heterosexual men or women (p = 0.032). Narcotics were more likely to be prescribed for patients with disseminated histoplasmosis (p = 0.022), Pneumocystis carinii pneumonia (p = 0.001), candidal esophagitis (p = 0.020), Kaposi's sarcoma (p < 0.001), or wasted appearance (p = 0.043). Inappropriate prescriptions were more likely to be given to patients with dementia (p = 0.005) or wasted appearance (p = 0.019).Conclusions: Physicians tend to prescribe narcotics inappropriately to patients known to have previously abused drugs and to those who appear wasted or have dementia. Physicians have a duty to prescribe narcotics appropriately as guided by recognized medical indications and the patients' views concerning their current medical needs. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |