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- W2046676300 abstract "To the Editor: —To evaluate drug prescribing by telephone, we studied prospectively 637 consecutive telephone contacts between physicians and nurses in two nursing homes.1 Nearly one half (43.3%) generated orders related to drugs, most of which started or renewed (82%) or changed (7%) medications. The two drug categories known to be most common in long-term care — systemic antibiotics and psychotropic drugs—were chosen for additional review by retrospective chart audit. There were 42 telephone prescriptions for psychotropic drugs: 21 for major tranquilizers, 14 for minor tranquilizers, three for sedatives/ hypnotics, and four for antidepressants. Of these, 27 began medications (ten as standing orders, eight as prn orders, and nine as short-term prescriptions), eight increased dosages, three switched medications, and only four discontinued or reduced drugs. Of these 42 cases, only four recorded a physician visit to the patient within 72 hours of the telephone prescription. Antibiotics showed a similar pattern: 24 prescriptions, all to start medications, and only three accompanied by a physician visit within 2 days before or after the drug order. Ten of these orders, however, were because of abnormal urine cultures, a situation which may not necessitate any physician visit. Because we observed a ratio of phone calls per patient day (1:16.8) that far exceeds the physician visit frequency mandated by Medicaid or Medicare, our observations suggest that telephone contacts may be the most common type of patient—physician interaction in nursing homes. Given the observed tendency of telephone contacts to lead to new prescriptions, we believe that telephone prescribing may be an important cause of polypharmacy in nursing homes today. We recognize that telephone decision-making is a valuable and necessary part of medical practice.2 In the nursing home, the availability of trained staff to monitor patients makes it feasible for physicians to assess problems without visiting the patient. On the other hand, this tendency of telephone contacts to lead to drug prescriptions must be countered by other measures, such as automatic stop orders, routine drug-regimen reviews, drug-monitoring protocols, educational programs, and on-site practitioners." @default.
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- W2046676300 date "1988-06-01" @default.
- W2046676300 modified "2023-09-27" @default.
- W2046676300 title "Drug Prescribing by Telephone: A Potential Cause of Polypharmacy in Nursing Homes" @default.
- W2046676300 cites W2075028024 @default.
- W2046676300 cites W2316537830 @default.
- W2046676300 doi "https://doi.org/10.1111/j.1532-5415.1988.tb04037.x" @default.
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