We demonstrated that voided orders effectively captured medication ordering errors. The mismatch between clinician-CPOE-selected and the chart review-based reasons for error emphasises the need for developing standardised operational descriptions for medication ordering errors. Such standardisation can help in accurately identifying, tracking, managing and sharing erroneous orders and their root contributors between healthcare institutions, and with patient safety organisations.

Background Drug name confusion is a common type of medication error and a persistent threat to patient safety. In the USA, roughly one per thousand prescriptions results in the wrong drug being filled, and most of these errors involve drug names that look or sound alike. Prior to approval, drug names undergo a variety of tests to assess their potential for confusability, but none of these preapproval tests has been shown to predict real-world error rates. Objectives We conducted a study to assess the association between error rates in laboratorybased tests of drug name memory and perception and real-world drug name confusion error rates. Methods Eighty participants, comprising doctors, nurses, pharmacists, technicians and lay people, completed a battery of laboratory tests assessing visual perception, auditory perception and short-term memory of look-alike and soundalike drug name pairs (eg, hydroxyzine/ hydralazine). Results Laboratory test error rates (and other metrics) significantly predicted real-world error rates obtained from a large, outpatient pharmacy chain, with the best-fitting model accounting for 37% of the variance in real-world error rates. Cross-validation analyses confirmed these results, showing that the laboratory tests also predicted errors from a second pharmacy chain, with 45% of the variance being explained by the laboratory test data. Conclusions Across two distinct pharmacy chains, there is a strong and significant

BACKGROUND: Encouraging generic drug use has reduced health care costs for payers and consumers, but the availability of therapeutically interchangeable medications or generic medications of choice is not equal across disease states. The extent to which systems of care are able to substitute with generics is not well understood. OBJECTIVES: To (a) define and measure the maximum generic rate (MGR) of currently prescribed drugs within an academic medical group in and (b) illustrate differences across drugs associated with selected underlying diseases. METHODS: Prescription claims data were examined from an academic medical group in Chicago, Illinois. Based on pharmacologic and therapeutic criteria, drugs were classified into 2 categories-potentially substitutable and not potentially substitutable-based on whether the drugs are branded forms of the same chemical entities that are available as generics or are therapeutically interchangeable with other medications that have different chemical compositions but the same mechanisms of action and potential efficacy. A medication was considered potentially substitutable if it (a) did not have a narrow therapeutic index as defined by the FDA; (b) did not belong to 1 of 6 protected classes of drugs in the Medicare D provisions; (c) was substitutable with a generic medication containing the same chemical entity; or (d) was therapeutically interchangeable with a therapeutically equivalent medication. MGR was defined as the percentage of prescriptions that could potentially be prescribed in generic form. This rate was examined overall and across drugs known to be associated with illustrative diseases including hypertension, diabetes mellitus, and obstructive lung diseases. RESULTS: The MGR ranged from 100% for drugs used in hypertension to 26.7% for drugs used in obstructive lung diseases. The MGR was 83.6%. CONCLUSIONS: Payers wishing to promote generic substitution should incorporate the potential for substitution of clinically appropriate generic medications as part of incentives for generic utilization to avoid unintended consequences of using a fixed target rate. A practical methodology for determining an MGR is offered.

Objectives: Medicine shortages are a global phenomenon. A growing number of reports indicate the problem is increasingly affecting the European pharmaceutical market. The present study aims to investigate the characteristics, determinants, legal aspects and management of medicine shortages in Belgium, France and from the perspective of the European Union. MethOds: A review of scientific and grey literature was performed. The legal framework on European and national level was reviewed. Primary qualitative data was collected through 22 semi-structured interviews with key representatives of health care systems' stakeholders on the national and European level. Results: France reported three times more shortages than Belgium. However, the main therapy area, the major cause and the dynamics of medicine shortages were analogous between the two countries. Determinants of medicine shortages were categorised in manufacturing problems, distribution and supply issues, and economic-related challenges. Manufacturing problems were most frequently reported as the primary cause of medicine shortages. Laws and regulations related to medicine shortages are more extensive in France than Belgium. Several preventive and responsive measures were identified to address such shortages. cOnclusiOns: Although medicine shortages are country-specific, the underlying mechanisms of medicine shortages appear to be similar in Belgium and France. Economic aspects seem to play a central role in the phenomenon of medicine shortages, as it influences stakeholders' business decisions. The impact of the legal framework around medicines on the occurrence of medicine shortages may be limited. Collaboration, communication and coordination are key to any effective approach to address medicine shortages.

tensive (HTN) patients. Methods: The study included adults (18 yrs. or older) HTN patients covered by commercial and Medicare Supplemental insurance in the Truven MarketScan database with an HTN diagnosis between October 2009 and December 2011. At least two filled prescriptions for Exforge HCT or two periods of minimum 15 days of concurrent use of amlodipine, valsartan and hydrochlorothiazide (FC cohort) were required. Patients were continuously enrolled at least 12 months before and 12 month after the index prescription and had valsartan initial dose of 160 or 320 mg/day. Adherence was measured with proportion of days covered (PDC) and medication possession ratio (MPR). Persistence was defined as no treatment gap greater than 30 days. Chi-Square tests and independent sample t-tests were used after adequate propensity score matching (PSM) (absolute standardized differences < 0.1) using demographics, comorbidities, pre-index health care utilization , pre-index costs and valsartan initial dose. Results: Exforge HCT patients (N= 9,221) had better unadjusted outcomes compared to FC patients (N= 1,884): higher MPR (81.6% vs 77.0%), PDC (70.0% vs 60.6%) and persistence (42.7% vs 23.6%) (all p< 0.0001). After risk-adjustment with PSM, Exforge HCT patients also exhibited better outcomes compared to FC patients: higher adherence (85.7% vs 77.0%), higher PDC (73.8% vs 60.6%) and persistence (46.8% vs 23.6%) (all p< 0.0001). More patients had MPR> 80% in the Exforge HCT cohort (72.9% vs 57.5%, p< 0.0001). ConClusions: Real-world data indicate that Exforge HCT is associated with improved adherence and persistence compared to amlodipine/ valsartan/hydrochlorothiazide FC. These data should be considered by stakeholders engaged with optimizing outcomes of HTN patients.objeCtives: Diet and exercise along with the pharmacological treatment are required for an adequate control of blood pressure among hypertensive patients. The aim of this study is to identify the drug treatments prescribed and attitudes and factors associated with the adherence to these indications. Methods: Sociodemographic and drug treatment information of hypertensive patients aged 20 years and older was obtained from an institutional health survey, Encoprevenimss 2010. Statistical relationships between socio-demographic variables and adherence to diet and exercise were tested. Two binary logistic regression models were constructed to measure the impact of personal attitudes and social and demographic variables on the decision of the patient whether to follow these recommendations. Results: Captopril was the leading prescribed drug (31.63%), followed by enalapril (22.45%) and metopropol (13.58%). The main combination of drugs recommended was captopril with metopropol. Additionally to the pharmacological treatment, 32.47% and 23.59% of the patients reported full adherence to the diet and exercise indications respectively, 24.04% and 15.78% partially complied and 11.03% and 16.63% did not comply. At 5% level of significance, statistically significant relationship...