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BACKGROUND: Prescribing for older patients is a well-recognised problem, and inappropriate items are prescribed frequently. Several tools and criteria are available to promote rational prescribing in older patients. OBJECTIVE: To determine the prevalence of potentially inappropriate prescriptions (PIPs) in older South African patients. METHODS: A retrospective drug utilisation review was conducted using medicine claims data over a 1-year period. Patients aged ≥65 years with at least one paid claim for any medicine item during this period were included. The prevalence of PIPs was identified by applying the 2012-Beers criteria list. RESULTS: A total of 103 420 patients, mean age 74.0 years (standard deviation 6.7), 57.1% female, were included in the analysis. The number of PIPs identified was 562 852 in 71 206 patients (68.9%). The most common medicines inappropriately prescribed were oestrogen (oral and patch formulations only) (12.4%), meloxicam (7.3%), amitriptyline and combinations thereof (6.5%), diclofenac (6.4%), ibuprofen (6.1%), alprazolam (5.3%), meprobamate and combinations thereof (5.0%), sliding-scale insulin (3.3%), amiodarone (3.1%) and doxazosin (2.6%). Medicines were inappropriately prescribed to women statistically significantly more often than to men (1.9:1; p<0.001), although this difference was not of practical significance (Cramér's V=0.06). CONCLUSIONS: Medicine use in older patients must be appropriate and evaluated regularly. According to explicit criteria, PIPs were found to be common in older patients registered on the database. Monitoring of PIPs may increase the quality of prescribing, but explicit criteria cannot substitute for clinical judgement based on the individual patient.

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Primary health care services worldwide are currently experiencing many quality-related problems. Efforts to improve these services appear to be sporadic and unsatisfactory. Investigations have revealed (Sharma et Sharma 2007) that one of the main causes for this state of affairs can be identif ed as neglected or inadequate documentation of patient/case history. The health care provider (HCP) should be equipped to improve the quality of health care and to take the lead in assuaging the predicament. The present study was undertaken to assess the correlation between asthma control and patient-related case history notes as recorded via the HCP. The data were obtained retrospectively from the patient notes of all asthmatic patients (including children and pregnant women) who attended six selected clinics in the North West Province of South Africa (Dr Kenneth Kaunda Municipal District). The analysis of the data collected from the patient clinic books confirmed the suspicion of poor quality of documentation; although the documentation in certain categories rendered some positive results. When compared to the GINAr guidelines; none of the patients had been controlled properly and only a small number (18.4) had been controlled partly (GINA 2008). Asthma control may be enhanced when a standard template is developed for completion by the HCP. It is envisaged that this will ensure that vital information regarding asthma control is documented in order to contribute to satisfactory chronic disease control

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The priority of the National Health System in South Africa is primary health care (PHC). The approach involves a health system led by PHC services and includes personal and curative services for acute minor ailments delivered by PHC nurses. The nurses are also responsible for the treatment of these ailments with essential drugs according to protocols as proposed in the Essential Drugs List. A before-after experimental research design was used to evaluate the effect of a competency-based primary care drug therapy (PCDT) training programme for PHC nurses in the treatment of acute minor ailments. An experimental group (n = 35) and control group (n = 31) consisting of registered nurses undergoing training in PHC at Gold Fields Nursing College were randomly selected. The results showed a significant increase in prescribing outcomes and medicine utilisation.

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OBJECTIVES: The purpose of this study was to establish the proportion of pharmacies providing screening tests in the areas of Pretoria, Potchefstroom and Klerksdorp, the types of tests used and their cost to patients, the criteria employed to select high-prevalence groups, the attitudes of pharmacists towards screening, and their knowledge of test characteristics. SETTING: In Pretoria, 155 pharmacies were randomly selected and all 43 pharmacies in Potchefstroom and Klerksdorp were included. METHODS: The pharmacies included in the study sample were first contacted by telephone to identify those providing screening tests. Pharmacies that provided screening tests and agreed to participate in this study were then visited and a questionnaire was administered. RESULTS: 57% of the pharmacies provided at least one type of screening test. Blood pressure measurement, serum cholesterol, capillary glucose and pregnancy testing were the most common screening tests available. With the exception of blood pressure measurement, the screening tests were conducted less than 5 times per week. All respondents referred clients with abnormal results to general practitioners but only 35% of pharmacies kept records of the patients tested and the test results. The knowledge of pharmacists concerning the important features of screening tests, such as false-positive and false-negative rates, was poor. No quality control procedures for the screening tests were employed. CONCLUSIONS: Providing pharmacists with specific training in the application and interpretation of screening procedures, and implementing quality control measures will reduce the number of false referrals or non-referrals, and will improve the quality of the service. If pharmacies are to play a meaningful role in screening for disease, coverage of the population will need to be increased substantially.

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The objectives of this study were to improve the aqueous dissolution properties of the poorly soluble nonsteroidal anti-inflammatory drugs ibuprofen and ketoprofen and to explore the use of N-methylglucamine (meglumine) to enhance the dissolution properties of poorly water-soluble drug powders. Changes in both differential scanning calorimetry (DSC) and X-ray powder diffraction (XRD) results indicate that possibly complexes were produced between ibuprofen and N-methylglucamine. Similar changes were not observed for equivalent ketoprofen and N-methylglucamine mixtures. The results of solubility and dissolution studies in water at 25 degrees C and 37 degrees C showed that N-methylglucamine, in mixtures and coprecipitates, increased the solubility, intrinsic dissolution, and powder dissolution of ketoprofen and ibuprofen. N-Methylglucamine significantly improved the solubility and dissolution properties of both ibuprofen and ketoprofen even when DSC and XRD behavior did not indicate the formation of complexes.

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The orthorhombic form of paracetamol has been shown to exhibit greater compressibility and faster dissolution than the monoclinic form. The orthorhombic form is produced by melting of monoclinic crystals of paracetamol followed by cooling at specific rates. Cooling rate, although a very important factor, is not the only factor influencing the formation of either of the two morphs. To study the cooling rate required for production of form II, paracetamol samples were melted in a differential scanning calorimeter, cooled at three specific rates, and melted again. In all of the samples, cooling resulted in the glassy form followed by recrystallization and the melting of form II. On the hot-stage microscope both forms were produced in one sample. Standardizing conditions for prediction of the resulting form remains a problem. There seems to be a great deal of overlap of the two forms' transition phases, which would make it difficult to force the crystallization of one form by keeping the solution or melt at a specific temperature. The thermal behavior of paracetamol during the heating and cooling phases must be understood in order to manipulate the process. A video camera mounted on a hot-stage microscope was used to follow the changes during heating and cooling of both forms. Nucleation, crystal growth, habit transformation, sublimation, and the final melt are shown on snap shots taken from the video.

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